| Issue/Objective |
Mental health access for survivors of gender-based violence (GBV) is often framed within global health as a matter of awareness, stigma reduction, and service availability. However, for Black survivors, access is shaped by upstream determinants rooted in systemic racism, institutional distrust, and inequitable governance structures. This study examines how experiences across healthcare, legal, and social service systems influence mental health help-seeking among Black survivors of GBV in the Greater Toronto and Hamilton Area (GTHA), to reframe access as a function of institutional trust, cultural safety, and power, aligning with Sub-theme 1 on addressing upstream determinants of health equity.
This research draws on mixed-methods data from the Safe & Strong project conducted in the GTHA in 2021. Data sources include a survey (n=41), in-depth interviews (n=20), and focus groups (n=15) with Black survivors of GBV. A community-informed, trauma-aware approach was used to center lived experiences. Quantitative data assessed patterns of service hesitancy, while qualitative data examined how institutional encounters shaped perceptions of safety, trust, and care.
Findings reveal consistently high levels of hesitancy toward mental health services, with participants rating reluctance between 7 and 10 on a 10-point scale. This hesitancy was not due to lack of awareness, but rather to prior experiences of dismissal, stereotyping, disbelief, and retraumatization across systems. Participants were aware of available services but actively avoided engagement due to perceived cultural safety and institutional trust issues. These findings position institutional distrust as a key upstream determinant of inequitable mental health access.
The study challenges dominant global health approaches that prioritize awareness and service expansion, demonstrating that access cannot be achieved without trust and culturally safe systems. Addressing inequities requires anti-racist service design, accountability mechanisms, and community-informed care models. By situating mental health access within systems of power and governance, this research advances health equity through structural transformation. |
| Methodology/Approach |
This study draws on mixed-methods data from the Safe & Strong project conducted in the Greater Toronto and Hamilton Area (GTHA) in 2021. Data sources include a survey (n=41), in-depth interviews (n=20), and focus groups (n=15) with Black survivors of gender-based violence (GBV). A community-informed, trauma-aware approach guided the research, centring participants' lived experiences and perceptions of institutional systems. Quantitative data were used to assess patterns of hesitancy in mental health services, while qualitative data explored how interactions with healthcare, legal, and social service systems shaped trust, safety, and help-seeking decisions. This design enabled a comprehensive analysis of mental health access within broader governance structures and systemic inequality. |
| Results |
Findings reveal consistently high levels of hesitancy toward mental health services, with participants rating reluctance between 7 and 10 on a 10-point scale. This hesitancy was not associated with lack of awareness, but rather with prior experiences of dismissal, stereotyping, disbelief, and retraumatization across healthcare, legal, and social service systems.
Participants demonstrated awareness of available services but reported actively avoiding engagement due to perceived safety concerns, limited cultural understanding, and a lack of institutional trust. As one participant noted, "It's not that I don't know where to go. I just don't feel safe going there."
These findings identify institutional distrust as a central factor shaping mental health help-seeking and position it as a key upstream determinant of inequitable access.
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| Discussion/Conclusion |
These findings challenge dominant global health approaches that frame mental health access primarily in terms of awareness, stigma reduction, and service availability. For Black survivors of gender-based violence, access is shaped by upstream determinants, including systemic racism, institutional distrust, and inequitable governance structures. Expanding services without addressing these structural conditions risks reproducing inequities rather than reducing them. Reframing access as a function of safety, dignity, and trust shifts the focus from individual-level interventions to system-level accountability.
Policy implications include the need for anti-racist health system design, culturally safe and trauma-informed care, and mechanisms to address bias and discrimination across healthcare, legal, and social service systems. Scaling equitable access requires sustained investment in community-informed models of care, as well as accountability frameworks that center lived experience in service delivery and evaluation.
By situating mental health access within broader systems of power and governance, this study contributes to global health equity efforts focused on addressing upstream determinants (Sub-theme 1) and informs equity-driven approaches to health systems transformation. |
| Presenters and Affiliations |
Sheri Adekola University of Guelph |
