This report is based on a Chief Executive Officer with unlimited budget to improve mental health services in London Borough of Ealing. The following neighbourhood study will focus on a proposal for change to improve services. It will focus on the changes necessary in the services provided for Asian Women experiencing domestic violence with mental health issues. An understanding of social and cultural diversity will be discussed and their impact on healthcare. In addition, these issues will be compared to the London borough of Hammersmith and Fulham.
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Domestic violence has come to the forefront as an important issue that affect many people in our society. DH, (2005) define domestic violence as any violence, abuse or threatening behaviour between current or former partners. It stipulate that any attempt to exercise control over an intimate partner or family members regardless of gender, sexuality constitutes domestic violence; the violence can include physical, psychological, sexual, financial and emotional abuse. Domestic violence can also include honour base violence, female genital mutilation and force marriages.
According to Home Office, (2004), women are more likely to become victim of domestic violence than men; children are also affected and can be traumatised by the incidences they have seen. Research has shown that one in four women experience domestic violence over their lifetime and one in ten women experience it annually and 32% of children (Walby and Allen, 2004).
Williamson, (2000) outlined that ethnic minority women are well known to be victims of domestic violence particularly Asians. However (DH, 2005) highlighted that the affects of domestic violence can result in women experiencing isolation, loss of job and income, low self esteem and self worth; It can lead to mental health issues in women causing the victims to suffer from mental health problems including, anxiety disorder, eating disorder, depression and self harm which could lead to suicide. Experience of domestic violence can also exacerbate an existing mental health condition.
Womensaid, (2009) highlighted that a large number of women accessing mental health services have experienced domestic violence, and at least 20% of service users are still experiencing the abuse. It further suggests that 50% of Asian women who have attempted suicide or self harm are survivors of domestic violence.
The London Borough of Ealing consists of 23 wards. It is the third largest borough in London with a population of 300,948 of which 151,200 of the residents are females and 22,200 are of Asian background (Neighbourhood statistics, 2006). When compared to Hammersmith and Fulham borough, they have a population of 165,242 Nationally Domestic Violent rate for Asian women. However, 58% of these women view themselves to be white British and only 25% declares to be Asians (Ealing Council, 2009) (appendix 1).
The motivation for this proposed change is necessary as services for ethnic minority women experiencing domestic violence in various areas in the country are under-funded or non-existence (Williamson, 2000). Mainstreaming Gender and Women’s Mental Health (DH, 2002) identify experiences of violence and abuse as a core theme in women’s mental health difficulties. Today’s mental health system manages diagnosis and accepts long-term disability consequently offering a label as an explanation for suffering instead of permitting service users to share their stories, experiences and their feelings.
The level of domestic violence amongst women has increased significantly in Ealing Borough. Recent figures revealed that Ealing is the ninth highest borough for reporting domestic violence between April 2007 to January 2008 Ealing Council (2009). It was highlighted that 41% of reported cases were of white European whereas the second highest reported cases were from Asian background (see appendix 3). It was also suggested that domestic violence is the highest crime reported nationally to the police, and 89% of domestic violence victims are women (Ealing Council, 2009). The cost of domestic violence on the UK economy is enormous; recent figures reported to be £23 billion annually for the UK and £280 million for London Borough of Ealing respectively (Ealing Council, 2009).
Furthermore, it is estimated that on average women are assaulted 35 times before they report to the police however; most women do not report and suffer in silence. This may be due to the psychological state known as battered women syndrome identified by (Walker, 2000) in which the victim feels powerless to change the situation.
Baggot (2004) argued that ethnic minority groups are faced with poorer health conditions than the rest of the population; people from certain ethnic background may be denied timely access to healthcare or offered lower standards of care than the rest of the population. 55% of Ealing’s population is predominately ethnic minority groups. The total South Asian population in Ealing is 41% compared to 24.7% in the borough of Hammersmith and Fulham. This significant difference in ethnic profile has a key impact on the overall health of the community.
According to Kandola & Fullerton (1998), diversity is the difference in ethnic origin, religion and other factors which cause people to have different perspectives on the same set of facts or issues. The culture amongst Asian communities makes it difficult for married women to disclose that they are victims of domestic violence; breakdown of marriages is often seen as the women’s fault hence they are likely to be rejected by family members and their community. It is culturally accepted that women should be abuse consequently becoming victims of domestic violence.
Additionally, Some Asian women may be subject to immigration control. This can influence their decision to take action against their husbands because of deportation from the UK. Moreover, most of these women do not speak English and finds it difficult to communicate. Women’s National Commission, (2009) report outlined that many of the victims are of insecure immigration status, having limited leave or no leave to remain within the country and are therefore subject to no recourse to public funds therefore are unable to obtain state benefits, hence limiting their access to services, social housing, legal advice and support.
Ealing Council, (2009) report, emphasised that currently Ealing has only two organizations offering emergency accommodation services. These services are limited as there are only eighteen adult bed places, the places available for counselling and advocacy services do not have adequate staff to provide support to accommodate the number of victims identified by the Council.
(WHO, (1997) cited in DH, (2006) states that violence against women is a public health issue which could be prevented. The Department of Health published a manual aimed at healthcare professionals in 2000 who contacted victims of domestic violence; the purpose was to focus on the need to treat vulnerable women with compassionate and holistic approach. These opinions were echoed by the participants of two surveys who identified the flaws in their treatment as being lack of advocacy and follow up interventions.
An individual’s ethnicity and cultural group remain useful points for understanding the motives behind domestic violence and the impact it has on their mental health. It can be argued that attending to the specific needs and conditions of Asian women by providing integrated culturally and gender-sensitive services highlights good practice. Hence, it becomes important that the individual’s perceptions of self care are identified in the context of their culture. Addressing issues of domestic violence in relation to mental health, health inequalities and other social problems which lead most women to social disadvantages would be easily addressed.
The table below gives an indication of the different offences in the borough of Ealing and the UK National Average. Of the offences committed violence against the person is the highest in the borough.
Violence against the person
Burglary dwelling offences
Theft of a motor vehicle offences
Theft from a vehicle offences
Source: Ealing Council, (2009).
The diagram below gives an analytical breakdown of ethnicity for domestic violence victims in the Borough Ealing. It shows that 41% were of white European origin. The highest of all the ethnic groups as defined by police were those of Asian backgrounds at 28% and thirdly Afro-Caribbean groups with 22%.
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