Table 2

Recommendations for services and interventions for female survivors of violence, abuse and mental health problems

Adopting trauma informed IPV tailored approaches
  • Tailoring services and interventions to meet the individual circumstances and needs of survivors.

  • Adopting trauma-informed approaches and IPV tailored psychological treatments in care settings to meet women’s complex needs.18 24–26

  • Including strategies which enable survivors to manage their trauma symptoms within interventions.18 24 27 28

Prioritising privacy and confidentiality (in service provision settings and through service provision engagements)
  • Ensuring interactions between service providers and survivors prioritise privacy and confidentiality by conducting interventions in private and secure settings.19–21

  • Ensuring service providers actively assure confidentiality to survivors to support disclosures by:

    • Explaining to survivors why disclosures are beneficial.

    • Respectfully and non-judgementally discussing IPV without asking potentially stigmatising questions.

    • Making use of open-ended and behaviourally anchored questions using a broad understanding of abuse (including physical, sexual and emotional forms).

    • Ensuring multiple opportunities for disclosure are provided over time.

    • Using active listening and empathetic approaches to build trust and rapport.19 25 26 29–31

Developing targeted training for service providers
  • Implementing context-specific and specialised training programmes for service providers and clinical staff around responding to domestic violence and mental health problems. In settings such as Afghanistan where interventions for violence are forbidden, the focus can be placed on improving the emotional challenges the woman is facing as a gateway to opening up the discussion around violence.

  • Addressing stigmas and negative stereotypes around domestic violence and mental health in service provider training resources.32

Including social support, mother and child, and mind-body interventions
  • Implementing interventions in which women’s informal social support structures are strengthened to enhance their ability to cope, access resources and improve their psychological well-being.18 33

  • Supporting mother and child interventions to improve the mental health of female survivors of violence through strengthening the bond between mother and child. This provides women with a distraction from the stressors of their situation through engaging in play, and providing women with motivation, purpose, joy and love.25 34 35

  • Implementing interventions which engage the body in healing from trauma (eg, yoga, meditation, somatic experiencing) which can support survivors in their ability to manage symptoms and triggers,36 increase their quality of life and improve psychological outcomes.18 37 38

Including family-focused interventions
  • Being attentive within interventions and services to the varied identities of perpetrators of violence, who are not only comprised of intimate partners but can also be other members of the family, including mother in-laws.

  • Incorporating approaches which address mother-in-law violence through understanding the mother-in-law as a ‘victim’ of gender-based violence and aiming to resolve the trauma she has experienced herself as a first step to addressing her use of violence against others.

  • Implementing interventions within services which strengthen positive trauma-informed relationships between women and mother-in-laws to break the cycle of violence within households. This will prevent future violence, strengthen social support systems for women and allow for the possibility of reconciliation and/or therapeutic processes to take place within households where violence has occurred.39

Increasing awareness raising and engagement activities on violence against women and mental health
  • Raising awareness about the psychosocial impact of VAW and associated mental health challenges in Afghanistan to reduce stigma, improve access to services, and cultivate supportive community environments.

  • Community mobilisation and awareness through culturally relevant adaptations of advocacy interventions, such as social media and outreach campaigns which target harmful stereotypes and the stigma associated with gender-based violence and mental health20 28 40 41 driven by grass roots, NGO and governmental sources.

Considering alternative delivery formats such as mHealth or Telehealth
  • Implementing trauma-informed Telehealth, e-Health or mHealth approaches to mental health services to reduce stigma and increase service access to remote, urban or displaced communities in Afghanistan.

  • Ensuring the delivery of alternative formats Telehealth, e-Health or mHealth account for the risks of disclosure to survivors such as further violence or stigmatisation in the community.

  • Connecting primary care workers in rural and remote areas with specialists to provide better access to care.15

  • IPV, intimate partner violence; NGO, non-government organisation; VAW, violence against women.