Shelter staff tell Mental Health Committee domestic and sexual violence drive lasting trauma and health harms

Carly Calera, agency therapist at Harmony House, told the Missouri Mental Health Committee that intimate partner violence and sexual violence cause both immediate injuries and long-term physical and mental-health problems for survivors.

Calera said the abuse she and her colleagues see ranges from “scratches, biting, grabbing” and strangulation to psychological tactics such as gaslighting and economic control that block a survivor’s ability to work or access money. She described reproductive coercion — including “hiding, withholding, or destroying a partner’s oral contraceptives” and removing condoms without consent — as another common tactic used to maintain power in relationships.

The presenters told the committee the health impacts are wide-ranging: from bruises and internal injuries to chronic conditions such as arthritis, digestive disorders and migraine, and elevated rates of post-traumatic stress disorder, depression and suicidality. They also warned that nonfatal strangulation is among the most dangerous forms of domestic violence, can cause traumatic brain injury and substantially raises a survivor’s risk of later homicide.

Why it matters: Committee members heard that domestic and sexual violence are not isolated personal conflicts but public-health issues that undermine survivors’ housing, employment and parenting and increase demand for medical, mental-health and social services.

Calera emphasized that abuse is tactical and intentional rather than merely impulsive: “It is a choice. It is not the victim’s fault,” she said. She described the “power and control wheel” framework — tactics such as denying, blaming, economic abuse and coercion — that staff use to explain patterns of abuse to clients and to other agencies.

Committee members asked about male survivors, youth exposure and social-media influences. Calera said Harmony House serves people of all genders and that national lifetime-prevalence figures she cited include “1 in 4 women and 1 in 7 men.” On youth, presenters told lawmakers that social media can normalize harmful behaviors and that providers are trying to teach healthy relationship skills in schools and to parents.

On strangulation, presenters said observers should treat any report of being “choked” or having hands placed on the neck as a serious medical risk because loss of consciousness can occur in seconds and brain injury may follow without obvious external bruising. Calera noted the odds of later homicide increase sharply after prior strangulation and urged clinicians and first responders to consider imaging and forensic evaluation when indicated.

Presenters also described the frequent co-occurrence of substance use disorders among survivors and said substance use is often a coping strategy rather than the cause of violence. They said many survivors use substances after incidents, while abusers more often use substances during incidents.

The presenters closed by describing clinical needs — trauma-informed therapy, safety planning, harm-reduction approaches and coordinated referrals — and urged lawmakers to support funding and cross-agency collaboration so survivors can access medical, mental-health and legal services without repeated transitions between offices.

The committee did not take action during the hearing; presenters provided materials and offered to follow up with staff and legislators.

Ending: Harmony House staff asked legislators to consider both funding and policy changes that would expand trauma-informed care, improve forensic and TBI evaluation access after strangulation, and reduce administrative barriers that prevent survivors from receiving services.