Perceptions of the mental health impact of intimate partner violence and health service responses in Malawi

Abstract

Background and objectivesThis study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these.DesignIn-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care providers; 18 FGDs and 1 small group with male and female, urban and rural community members; 7 IDIs with female survivors; and 26 key informant interviews and 1 small group with government ministry staff, donors, gender-based violence service providers, religious institutions, and police were conducted. A thematic framework analysis method was applied to emerging themes.ResultsThe significant mental health impact of IPV was mentioned by all participants and formal care seeking was thought to be impeded by social pressures to resolve conflict, and fear of judgemental attitudes. Providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV; this was complicated by staff shortages, a lack of clarity on the mandate of the health sector, as well as confusion over the definition and need for ‘counselling’. Referral options to other sectors for mental health support were perceived as limited but the restructuring of the Ministry of Health to cover violence prevention, mental health, and alcohol and drug misuse under a single unit provides an opportunity.ConclusionDespite widespread recognition of the burden of IPV-associated mental health problems in Malawi, there is limited capacity to support affected individuals at community or health sector level. Participants highlighted potential entry points to health services as well as local and national opportunities for interventions that are culturally appropriate and are built on local structures and resilience.

The implementation and effectiveness of the one stop centre model for intimate partner and sexual violence in low- and middle-income countries: a systematic review of barriers and enablers

“…Poor documentation and data management were seen across contexts (HC) 10 12 14 15 20 27–29 31 34 39 40 44 45. Reasons for this included lack of staff knowledge on how to document violence, outdated information systems, variable record keeping procedures and the ethical and logistical challenges of tracking survivors.…”

“…Reasons for this included lack of staff knowledge on how to document violence, outdated information systems, variable record keeping procedures and the ethical and logistical challenges of tracking survivors. A related barrier was lack of evaluation and research; many sites gathered data, but failed to analyse data (HC) 10 13–15 28–30 34 36 39 44 45…”

“…In 17 different countries, the cost to operate OSCs was a significant challenge, seen at both hospital-based and stand-alone OSCs, as well as government-run and NGO-run OSCs (MC) 10 11 13 15–17 28–30 33 35 36 45. Some OSCs were forced to weaken or forgo services due to cost, for example, through decreased operation hours,12 13 17 22 26 28 31 33 35–37 41 42 45 or heavy reliance on volunteers 33 35 36 45.…”

“…In over 14 countries, OSCs of all types were unable to provide adequate psychological support due to lack of trained staff (HC) 10 14 16 17 22 26 28–31 35 38–40 45 46. In some of these situations, untrained volunteers sometimes provided psychosocial support 31 33 45.…”

“…While multiple process evaluations of the OSC model have been performed, no studies have examined the effectiveness of the OSC model 18–51. Only one outcome evaluation has been published, which found that the OSC model led to short-term increased utilisation of primary health services 13.…”