We begin this week by commemorating women’s fight for equality and equity, as well as their resistance against gender-based violence. Regarding this last point, the figures in our country are alarming and have worsened over the past year due to the pandemic. In 2020, more than 114,000 cases of violence were reported, 83% of them against women. Thirty-one percent of reports corresponded to violence against children and adolescents, including 9,582 cases of sexual violence. Likewise, more than 5,500 women went missing in 2020, and in January 2021 alone, more than 400 women, girls, and adolescents were reported missing.

What is the impact of these concerning figures on mental health? We spoke with Vanessa Herrera López, a member of the technical team of the Ministry of Health’s Directorate of Mental Health, who answered our questions about this important topic.

• Considering the perspective of community mental health, how does violence affect individuals and communities? Are only the victims affected?

The impact occurs in the short, medium, and long term. The presence of violence in our communities represents a violation of human rights and constitutes a public health problem that affects the life projects and development of those affected, their families, and their communities.

During the pandemic, many women have been more exposed to living with their aggressors and experiencing situations of violence, in addition to the burden of domestic work, the loss of loved ones, and socioeconomic difficulties. The impact of these factors on individual mental health may appear in the form of insomnia, anxiety, depression, different manifestations of stress, alcohol or other drug use, eating disorders, suicide attempts, and completed suicide. This is also accompanied by other health problems associated with violence, such as unwanted pregnancies, induced abortions, gynecological problems, and sexually transmitted infections, including HIV infection. Likewise, children and adolescents may experience behavioral changes, poor academic performance, depression, anxiety, and, in general, a greater risk of perpetuating and remaining within the cycle of violence.

It is important to highlight that not only survivors of violence are affected, but also their family and community environments. Therefore, we must commit ourselves to eliminating and not tolerating any form of violence in our communities.

• We often hear people referring to men who sexually abuse girls and women as “mentally ill.” Why is it important to break this association?

People who commit violence fundamentally have irrational beliefs linked to machismo and beliefs that justify violence, such as “she provoked me,” “I have needs,” or “she wanted it.” It is important not to fall into stigma by associating people living with mental health conditions with being violent. We must recognize that many sexual aggressors are people within our own families, without any apparent mental health problems, and this is why many members of the community refuse to accept that they may be the aggressors.

• Do Community Mental Health Centers (CSMC) work with survivors of gender-based violence and their support networks?

The 198 Community Mental Health Centers provide specialized mental health care to women survivors of violence and their family members. This includes comprehensive assessment of the consequences and problems associated with violence, psychotherapeutic treatment, comprehensive treatment for depression, anxiety, PTSD, substance use problems, multiple psychosocial interventions according to each user’s needs, social support, and long-term continuity of care. This also takes place through coordination and collaboration with the local health service network, as well as with Women’s Emergency Centers, police stations, the Public Prosecutor’s Office, the Attorney General’s Office, among other institutions.

• How do women’s community support networks contribute to the mental health of survivors of violence?

The presence of community support networks for women is essential. These can take the form of virtual mutual support groups, women’s networks available in their districts, and listening circles, which through spaces of mutual support, active listening, solidarity, and unconditional support can help women consider ways to leave the cycle of violence, maintain hope, and ensure their own safety and that of their children. It is necessary to strengthen and rebuild these support networks for women, especially during the pandemic and post-pandemic period.

• What warning signs should we look out for to identify whether someone is experiencing violence?

During the pandemic, we should identify the following as signs of violence:

• • Insulting, harassing, controlling, or forcing someone to engage in sexual relations.
  • Restricting communication through phone calls, social media, or messages.
  • Withholding essential resources needed to meet basic needs.
  • Preventing someone from leaving the home during emergencies or justified situations.
  • Forcing someone to perform domestic tasks.
  • Any action that causes psychological, physical, or sexual harm, suffering, or even death.

• How can we help someone who is experiencing a situation of violence? If they have not told us directly, how can we approach them in order to provide support?

It is essential to listen to them and actively offer support, without judging or criticizing them. They should not feel alone. It is important to connect them as soon as possible with Line 100 from the Ministry of Women and Vulnerable Populations, which will provide guidance on socio-legal support and protection measures. They can also be connected with Line 113, option 5, from the Ministry of Health, where they will be listened to and receive support for emotional distress and/or mental health problems that may have been triggered by the situation of violence. They will also receive guidance on which specialized mental health service they can access according to their place of residence.

Es muy importante que permanezcamos presentes durante todo el proceso, en disposición de escucha activa. El soporte en la red comunitaria contribuye a que las personas podamos salir del ciclo de violencia y continuar el plan terapéutico a largo plazo.

#EveryoneForMentalHealth

We thank the Ministry of Health’s Directorate of Mental Health for their collaboration on this article.