The Picture of Texas

Domestic violence programs reported seeing an increase of clients with mental health issues with 88% of Executive Directors and 76% of staff reporting their programs serve survivors with mental health diagnoses “very often.” In 2019, 78% of Texas’ 254 counties were designated as mental health professional shortage areas (HPSA) by the United States Health Resources & Services Administration. Even when a supportive system recognizes that a survivor needs mental health or psychiatric services, there are very limited places for survivors to receive those services. Staff and survivors explained experiences of long wait times, not meeting eligibility requirements for certain diagnoses, and having to be in a state of psychological crisis before receiving services from local mental health agencies. This reality creates a dysfunctional mental health system that can only be accessed when an individual has deteriorated to the point of needing hospitalization or criminal justice intervention in order to have basic mental health needs met. When interventions are available, they can have lifelong economic consequences, including high medical bills and criminal records. 

During State Plan interviews, survivors recounted many ways that abusers target their mental health to assert power and control. The majority of survivors accessing programs interviewed (69%) met PTSD diagnosis criteria. Having trauma symptoms was significantly correlated with decreased social support, more lifetime experiences of homelessness, higher economic abuse, higher rates of disabilities, and reproductive coercion. It is important to note that survivors’ mental health needs related to abuse are intertwined with their needs related to other experiences, stresses, historical trauma in their lives, and being from a minority population. White women and young people with higher socioeconomic statuses and health insurance are more likely to seek mental health care on their own, which creates huge gaps for the most vulnerable populations (El-Khoury et al., 2004; Cheng & Lo, 2015; Alegria, Lin, Chen, Duan, Cook, & Meng, 2012; Cho and Kim 2012).

¹Smith, S.G., Chen, J.., Basile, K.C., Gilbert, M., Merrick, M.T., Patel, N., Walling, M., & Jain, A.
(2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

While 80% of surveyed domestic violence agencies have on-site counseling where staff can help survivors process trauma and life experiences, 57% of those same agencies say they could use 50-100% more counseling staff to meet the actual service demands. This shortage of staff who are able to provide clinical mental health services compounds the issue, leading to short session limits or a lack of ongoing care over time. While a majority of programs do have some level of adult mental health services, there is a severe lack of services for children’s mental health, with many programs unable to address the specific needs of children. Greater attention and funding should be focused on building collaborations between behavioral health and domestic violence services. Some agencies have created unique and creative partnerships with local behavioral health providers to fill gaps in services, including psychiatric care and medication management. These include on-site clinics, utilizing mobile crisis units, and training community partners about the symptoms of trauma and mental health.