The Link Between Mental Health and Intimate Partner Violence

• A recent study by Ms. Phiona Koyiet in low socioeconomic communities near Nairobi, Kenya suggests intimate partner violence is preceded by lack of employment leading to alcohol and substance abuse and mental health problems.
• Cultural beliefs that intimate partner violence is "normal" amplify the problem.
• Male victims can also be reluctant to speak out due to perceptions of the traditional male role.

In many cultures, mental health is an issue that is so often neglected and not addressed. However, its prevalence leads to greater issues, sometimes in the form of intimate partner violence. In this interview, Phiona Koyiet discusses her research in Kenya on the subject and how to seek sustainable and culturally-appropriate solutions to mental health and intimate partner violence.

Source: Phiona Koyiet, used with permission

Phiona Koyiet is the Senior Technical Advisor Mental Health and Psychosocial Support (MHPSS), at World Vision International. Phiona holds a Bachelor of Arts degree with a double major in Psychology and Community Development from Daystar University Nairobi, a Masters of Arts in Gender and Development from the University of Nairobi. Ongoing Master of Science in Psychology and Neuroscience of Mental Health, Kings College London.

She is a mental health and gender expert with over 15 years of experience in development, fragile and crisis context. Phiona provides technical leadership for Mental Health and Psychosocial Support programs in fragile and crisis contexts. This includes leading organizational MHPSS strategies and approaches, technical research, supporting programs and interventions to be consistent with international MHPSS standards and guidelines.

This is Part 1 of a two-part interview with Ms. Phiona Koyiet; you can find Part 2 of this series, along with all other Hope + Resilience posts, here.

Jamie Aten: How did you first get interested in this topic?

Phiona Koyiet: Similar to many countries, mental health is a neglected health problem in Kenya, which is rarely discussed due to its social stigma. On the other hand, intimate partner violence is a common yet normalized problem, where in most instances, women are the victims and their intimate partners the perpetrators. I grew up in a local community where this scenario — stigma about mental health issues and intimate partner violence — was the norm. As an adult, I see this to be the case in many places. So my personal background, experience in various contexts and countries has motivated my keen interest in gender equity and mental health and wellbeing.

Particularly for this project, our curiosity led us to think about the link between alcohol and substance use, mental health and intimate partner violence, and the need to explore for evidence on the same. We hope it will be key to informing interventions to address the dual problem of mental health, including alcohol abuse, and intimate partner violence. We were motivated to engage men and key stakeholders as part of the initial stages in the intervention with a particular interest to generate sustainable and culturally acceptable solutions to these problems.

JA: What was the focus of your study?

PK: Our study was a rapid ethnographic assessment focused on understanding the link between mental health challenges, alcohol and substance abuse, and intimate partner violence to inform adaptations needed for the World Health Organization psychological intervention known as Problem Management Plus (PM+; WHO, 2016).

We adapted PM+ for men’s groups, and with an emphasis on reducing harmful alcohol use and intimate partner violence. We examined the common problems men face, the presentation of men with mental health challenges, local perspectives on intimate partner violence, local beliefs on alcohol and substance use, and the broader array of mental health issues. We conducted the study in a metropolitan low socio-economic status area of Waithaka and Muitini in Nairobi County, Kenya.

The study involved local men, women, and key local stakeholders in the community. Key informant interviews, focus group discussions, and a survey (administered to both men and female) were conducted. The rapid ethnographic approach we used was different [from] well-known ethnographic approaches, which usually sees researchers embedding themselves in the community and drawing their conclusions over a long period of time. However, considering the limited time available and the urgency to provide sustainable solutions to the problem, the rapid approach was preferred. Such an approach is not new and has been used previously in health and social sciences research in similar circumstances (Ackerman, Gleason, & Gonzales, 2015; Saleem et al., 2015). The approach has also been recommended for psychological and mental health needs assessment (WHO, 2012).

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JA: What did you discover in your study?

PK: The main problems faced by men in the study area were unemployment, lack of income and financial challenges, alcohol and substance use, and family problems, which were believed to be linked to increased stress and mental health problems.

Men's mental health problems were expressed through social withdrawal, change in behavior, alcohol and substance abuse, lack of responsibility, and mood changes. The positive coping approaches communities saw men implementing as a means to address mental health challenges were talking to friends and family members and seeking divine [church/religious] intervention. Negative coping strategies were also commonly adopted and included greater alcohol and/or drug use, violence, and keeping quiet about their problems.

Our study suggested a circular link between drug and substance abuse, mental health problems, and intimate partner violence. For instance, lack of employment led to alcohol and substance abuse, which led to or exacerbated mental health problems and marital conflicts. Jointly, mental health problems, alcohol and substance abuse, and marital conflicts commonly resulted in intimate partner violence. Cultural beliefs amplified gender-based violence, where intimate partner violence is viewed as ‘normal’. Traditional male role-perception also limited men's ability to speak out if they were victims of violence from their female partners.

Check back tomorrow for Part 2 of this series, along with all other Hope + Resilience posts, here.