Thread by @coopesdetat

Our first keynote at #RANZCP2021 today will be from Carole Warshaw, director of the US National Center on Domestic Violence, Trauma & Mental Health

Warshaw talking emergence of trauma theory and how powerful it was for survivors - DV not a psychiatric condition but has many MH and substance use related effects. Reframing #RANZCP2021

Coercive control at the heart of DV, physical violence may be a threat to enforce but not always most prominent aspect, says Warshaw. Like being in a hostage situation, aided and abetted by systems - legal, migration and medical #RANZCP2021

How are MH, trauma and DV interconnected? Warshaw says psychiatrists may not always join the dots, particularly political and structural forms of trauma. Importance of a social justice approach #RANZCP2021

DV has many downstream effects for MH #RANZCP2021

Risk factors for suicidality for those experiencing DV #RANZCP2021

What are the narrated experiences of DV among survivors? #RANZCP2021

Often we make the mistake about underlying psychology making people prone to being in abusive relationships, but this is not borne out by the data Warshaw says. These figures are Australian #RANZCP2021

IPV has associations with psychotic symptoms too - esp threats and sexual violence #RANZCP2021

The #SDOH also exacerbates risk profile - poverty, unsafe living, says Warshaw. Lack of gender/trauma specific treatment creates even greater barriers #RANZCP2021

Warshaw also stressing the importance of historical, intergenerational trauma and structural violence in this space. Notes an epidemic of murdered and missing Indigenous women in the US, and these patterns mirrored in Australia #RANZCP2021

Warshaw presenting data on MH and coercion. Gaslighting and weaponising distress #RANZCP2021

Some of the ways this plays out for survivors in the psychiatric/therapeutic space #RANZCP2021

Data on DV, coercion & substance use #RANZCP2021

Abusive partners introducing victims to substances, using them to control. Experiences of survivors #RANZCP2021

Amid an opioid epidemic in the US, Warshaw says it is a powerful form of coercive control #RANZCP2021

More on opioids & women experiencing IPV #RANZCP2021

Amplificatory effects of #COVID19 for DV #RANZCP2021

Warshaw highlighting how #COVID19 and telehealth has been a risk for survivors - how do you treat people isolated at home with their abuser? #RANZCP2021

Important lessons for clinical practice #RANZCP2021

Always think about safety. There are multiple risks, some of which may not immediately come to mind when treating survivors. Are you in danger from another person? #RANZCP2021

Telehealth safety. So important in this era #RANZCP2021

Warshaw says one of the most things to important to remember is survivors are very attuned to power imbalances. Do not assume or demand responses #RANZCP2021

Opening conversations around coercion and substance use #RANZCP2021

Acknowledge and affirm disclosures. Engage in safety planning. Talk about coping strategies, never convince someone to leave an abuser as it may increase their risk of harm #RANZCP2021

Lots of evidence and treatment gaps in this space #RANZCP2021

Focus on strengths & cultural strengths critical. Abuse and coercion strips away - treatment should rebuild. Even the 'what happened to you' paradigm diminishes survivors. Remember to document carefully and sensitively given potential litigious dimension of this space #RANZCP2021

Psychiatrists have a responsibility to challenge the conditions that perpetuate violence in our society, not just a clinical duty to survivors. Strong words to close from Warshaw #RANZCP2021

Does our preoccupation with diagnosis cloud our ability to consider social, cultural and political drivers asks @DrVinayLakra. Warshaw says we must always come back to the context #RANZCP2021