title: Perceptions of the mental health impact of intimate partner violence and health service responses in Malawi.
abstract: OBJECTIVE
  This study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these.
  
  
  METHODS
  In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care providers; 18 FGDs and 1 small group with male and female, urban and rural community members; 7 IDIs with female survivors; and 26 key informant interviews and 1 small group with government ministry staff, donors, gender-based violence service providers, religious institutions, and police were conducted. A thematic framework analysis method was applied to emerging themes.
  
  
  RESULTS
  The significant mental health impact of IPV was mentioned by all participants and formal care seeking was thought to be impeded by social pressures to resolve conflict, and fear of judgemental attitudes. Providers felt inadequately prepared to handle the psychosocial and mental health consequences of IPV; this was complicated by staff shortages, a lack of clarity on the mandate of the health sector, as well as confusion over the definition and need for 'counselling'. Referral options to other sectors for mental health support were perceived as limited but the restructuring of the Ministry of Health to cover violence prevention, mental health, and alcohol and drug misuse under a single unit provides an opportunity.
  
  
  CONCLUSIONS
  Despite widespread recognition of the burden of IPV-associated mental health problems in Malawi, there is limited capacity to support affected individuals at community or health sector level. Participants highlighted potential entry points to health services as well as local and national opportunities for interventions that are culturally appropriate and are built on local structures and resilience.
authors.affiliation: Medical and Surgical Nursing department, Kamuzu College of Nursing, Blantyre, Malawi; chepukal@yahoo.co.uk.
authors.forename: Lignet
authors.initials: L
authors.lastname: Chepuka
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
authors.affiliation: Medical and Surgical Nursing department, Kamuzu College of Nursing, Blantyre, Malawi.
authors.forename: Genesis
authors.initials: G
authors.lastname: Chorwe-Sungani
authors.affiliation: Medical and Surgical Nursing department, Kamuzu College of Nursing, Blantyre, Malawi.
authors.forename: Janet
authors.initials: J
authors.lastname: Mambulasa
authors.affiliation: Medical and Surgical Nursing department, Kamuzu College of Nursing, Blantyre, Malawi.
authors.forename: Ellen
authors.initials: E
authors.lastname: Chirwa
authors.affiliation: Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Tolhurst
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008297:Male; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care; D010465:Perception; D012017:Referral and Consultation; D012111:Residence Characteristics; D013179:Spouse Abuse / Q000523:psychology* / Q000628:therapy*
keywords: GBV services; Malawi; counselling; health care providers; intimate partner violence; mental health