Reclaiming Power: Responding to Mental Health and Substance Use Coercion

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And I'm going to take a moment and switch to my other slideshow. We got a lot of people from a lot of different places. Welcome. Even somebody from Canada. Wonderful. Let's see. Right. Taking just a moment. All right. And feel free to keep introducing yourselves if you're still working on it.

And I'd like to now welcome you to our webinar series on mental health and substance use coercion in domestic violence services. Today's session is called Reclaiming Power: Understanding and Responding to Mental Health in Substance Use Coercion. My name is Amanda Lion and I'm the training and technical assistance manager for our center. The National Center on Domestic Violence, Trauma, and Mental Health offers training and technical assistance, research and evaluation, policy development and analysis, and public awareness. You can see the graphic on the right of the slide shows all of the things that contribute to our approach and the work that we do. So hopefully you'll see some of these themes reflected in the presentation today.

Our center is headquartered in Chicago, the unseated homelands of the Council of the Three Fires, the Odawa, Ojiway, and Padawadami nations. We invite each person to learn about the land you're connected to. And one resource to get started is the website native-land.ca.

During this presentation, we will be talking about mental health and substance use coercion, domestic violence, and trauma. And I really encourage you to take care of yourself, as these may be sensitive topics for many people. If at any point in time you need to take a break or wish to step away, know that we are here and we are hoping that you are doing what you need to care for yourself in the moment. So please feel free to rest or take a break as needed.

So, we think about all of these different areas: mental health, substance use, domestic violence, and sexual assault. We know they are interconnected and interrelated. And I'd like to start off by asking you to share in the chat, making sure I can see the chat well, if you could share how do you see some of these connections in your work. So what comes up for you in the work that you do with the connections between mental health, substance use, domestic violence and sexual assault. What do you see?

Um, we have somebody who shared child custody issues, just seeing they're generally connected, truly interconnected, intersection among all of the issues, using substances to perpetrate, mental health and substance use as both a consequence and risk factor for domestic violence and sexual assault, finding the connections to power and control, substance use to deal with abuse. Most of my clients have experienced all of these. Yes. Drug facilitated sexual assaults on campus. Yes. Using substances to cope. Adding another intersection with homelessness. Many of you are seeing these connections. Oh, and we say a lack of programming that addresses these intersections. Yes. All of the above. Using mental health as an excuse for abuse. Yes. Coping. Generational connections. ACEs. One could lead to more susceptibility to others. Struggle to find services. People are targeted for abuse based on their mental health diagnosis and substance use. Yes. Poverty and homelessness. All of the above. Wow. Fantastic answers.

And so as I go through today's presentation, I know there will be many things that are already familiar, that you're already seeing, that you already know. And the hope is that we're bringing this together in a way that helps you to say, what can I as an advocate do to offer support? Because we know we are supporting people who are navigating all of these different systems, different responsibilities, and we also know that we can't choose one thing to try to treat or support ahead of time. Nothing is happening in isolation. Everything is connected. And because of this, we say that really having a holistic and person-centered and trauma-informed approach is essential.

Thank you so much for sharing all of your responses. So we do know that domestic violence has significant effects on someone's mental health and substance use. People are three times more likely to have post-traumatic stress disorder, major depressive disorder or self-injury, four times more likely to have suicide attempts, and six times more likely to have a diagnosable substance use disorder. So that doesn't even include the many people who use substances who do not meet the criteria for a diagnosed substance use disorder or who have not sought a diagnosis. And of course, these are not the only effects on someone's mental health and substance use. There are many others, and people may experience multiple effects at the same time as a result of domestic violence. So we can see when we make these connections that this is absolutely important to our work.

And I see a question in the chat. Yes, the slides will be sent out to everyone who registered for this webinar. We are not offering CEUs, but you will receive a certificate of attendance. You're very welcome.

So we all are familiar with the idea that domestic violence happens when someone is enacting power and control over another. So although there are many tactics of abuse, we want to really focus on these coercive tactics that target someone's mental health or substance use because we know that an abusive partner will use whatever they can to maintain control. So mental health and substance use are common targets. We here have on this slide just some of the common ways that this happens. So you might have undermining someone's stability, like calling them crazy or blaming their abuse on their mental health or substance use. Someone might have controlling their access to care, which this could be blocking treatment by restricting money or transportation or childcare or stalking at appointments. Sabotaging recovery, like pressuring or forcing substance use, withholding sleep or food, or keeping substances in the home. Discrediting with others, so that could be lying to providers, friends, or family to damage credibility or support networks, making custody threats, or using mental health or substance use to manipulate decisions about children. Medication interference. This could be hiding, withholding, or misusing prescribed medications. This could also be exploitation for personal gain. That could be controlling finances, medications, or coercing caregiving or sex in exchange for substances. So, all of these examples show how abuse extends beyond some of the physical harm that we might initially think of and really affect someone's access to care, support, and recovery.

On our next slide, we're going to look at specific tactics of mental health coercion. And again, I'm sure these sound familiar, especially based on what everyone has shared. So, mental health coercion is using someone's mental health or the stigma around it as a tool of control. So again, we have undermining someone's well-being and stability, making them feel worse. Exploiting their health for personal or financial gain. Jeopardizing child-parent attachments. This is very common. That would be like calling someone crazy or lying about them to the child or in front of the child. Using mental health to justify abuse by saying it's their own fault. Discrediting them with sources of support. Again, oftentimes lying or making someone sound like they are feeling worse than they are or have more severe symptoms, and sabotaging access to mental health care or support. The more we recognize these patterns, the more we can understand the challenges people are facing with improving their well-being and accessing the care they want. It also highlights how abuse really can isolate people from the supports they're seeking.

So, next we'll look at some more specific tactics of substance use coercion. There's a lot. I don't need to go over every single one. Substance use coercion tactics often interfere with someone's recovery, their safety, and access to support. It's very common for an abusive partner to introduce someone to substance use. So that could be pressuring them to start, or it could be asking or forcing them to use more than they would want to, including being unsafe, or using substances to facilitate sexual violence. This could be also provoking setbacks in recovery, creating cravings, or provoking relapse. There could be threats related to withdrawal, actually causing withdrawal, just threatening, and that could be intimidating. They could coerce someone into doing things that are illegal. This could be threatening to disclose substance use, whether true or not, to law enforcement, courts, or child protective services. Sabotaging someone's treatment, including stalking or stealing medications. Again, blaming the abuse on substance use or finding ways to use stigma or oppression to continue to isolate or control this person. So again, this really emphasizes the importance of how we offer survivor-centered support and how we prioritize safety and well-being.

When we think about access to care and treatment, again, abusive partners can attempt to control or manipulate this access. So attempting to influence diagnosis or treatment. This could be trying to make a provider, again, give a worse diagnosis or trying to choose a diagnosis that the abusive partner wants, possibly to access medication or just to make them seem worse or unstable in some way, using threats of hospitalization or attempting to have that person involuntarily committed. Again, preventing access to care by withholding resources, preventing someone from taking their medications, forcing over medication, overdose, withdrawal, stealing medications, or insulting them for taking their medications, like calling them an addict. Again, this continues to isolate survivors from support. So again, as advocates, we can continue centering well-being and trying to support access.

So, we've looked at a lot of tactics of mental health and substance use coercion, and many of you have seen many different tactics. And I'd like to share a scenario. Riley and their abusive ex-partner Sam share custody of their daughter Mia. Riley has managed anxiety for several years with therapy and medication. When Riley has an anxiety attack, Sam tells Mia that Riley is losing their mind and that Riley can't properly care for her because Riley's unstable. After Mia goes to bed, Riley sometimes drinks to calm down. When Riley tries to explain their anxiety to Mia in an age-appropriate way, Sam accuses Riley of burdening Mia with adult issues and threatens to report Riley to Child Protective Services for using drugs and being an unfit parent.

So, right away, if you could share in the chat any signs that you see of mental health or substance use coercion. I know there's a lot, a lot in there. So, yeah, threats to call child protective services. That's definitely a big one. Undermining parenting, saying losing their mind, calling them unstable, gaslighting, interfering with the parent-child relationships, talking to the child about the parent's anxiety. Yeah. Kind of that, you know, even though Riley is trying to talk about it, Sam says, "Oh, no, you can't do that. It's not appropriate." But then says other things, right? The total gaslighting that's happening, the threats, name-calling. Yeah. Putting her down in front of her daughter. It's a lot of manipulation. You know, I want to also notice that there's not really evidence of actual drug use, right? So, again, it's common for an abusive partner to threaten that they're going to report drug use even if no drug use is present. Because even the alcohol use is not really described as problematic. And we do see, I feel like that we do see a couple of strengths for Riley. Does anybody could anybody want to identify any anything good for Riley? Any strengths that you see? Yeah, therapy and medication. So Riley is has been managing her anxiety through medication and therapy. Riley is attempting to explain, talk about her, their anxiety in an age-appropriate way. Yeah, trying to have that talk, trying to be developmentally appropriate. Yeah, Riley seeking treatment. Yeah, there's definitely some really nice strengths there. Something that I also want to mention of note is that even just the fact that, you know, Riley is aware and waits to drink until Mia goes to bed, which is one way of trying to be a little bit safer. Oh, I see somebody got that one. Very good. Yeah, finding ways to calm down, even if it's not the healthiest approach. Yeah, great. Oh my gosh, thank you all so much. And yes, Randy, getting out of the abusive relationship. And I know this is really hard when people still feel they have this shared custody and they still have to share space. Thank you all. Great thoughts.

So, I also want to emphasize that these tactics, especially mental health coercion, it's very common. And so these next few slides have some information from a survey of callers to the National Domestic Violence Hotline. So they found that 89% of people had experienced at least one type of mental health coercion. And again, they were, it was a survey, they were limited in asking more than a certain number of questions. So again, this isn't everything people were experiencing, but four out of five people said their partner was calling them crazy. Three out of four people said their partner did things to make them feel like they were losing their mind. And one out of every two said their partner threatened to report they were crazy to keep them from getting things they wanted or needed, like a protection order or child custody. And one out of every two did try to find help due to feeling depressed or upset. And half of those who sought help said their partner tried to discourage them from getting help or taking their medications. And we have a quote here that illustrates someone's experience from one of these survey participants. "He'd tell me I shouldn't get any help or take medications because he didn't want anyone to know about my depression. He'd say things really softly under his breath. And when I'd ask what he had said, he'd tell me I'm crazy and that he didn't say anything."

So similarly, substance use coercion is also common. In this survey, 43% of people had experienced at least one form of substance use coercion. So over one out of every four callers said that they were using substances to reduce the pain of domestic violence. They were being pressured or forced to use substances by their partner or were being made to use more substances than they wanted to. Again, we have another quote. "He threatened countless times to call the sheriff and the pastors and report my drinking. He discouraged me from getting help for my drinking. After I got help, if and when I drank again, he would say, 'See, you failed at this, too.' And he would leave bottles all around when I was in recovery."

We also know that substance use coercion really isolates people from sources of support. So 60% of callers said their partner tried to prevent or discourage them from getting help for their substance use. 24% were afraid to call the police for help because they said their partner would be, their partner said they would be arrested or no one would believe them. 38% said their partner threatened to report their substance use to authorities to prevent them from getting things they wanted or needed, again, like a protection order or child custody. And one more quote. "I'm very scared of calling the police because he lied and I got in trouble last time and I didn't even have any drug use." "He's lived here 12 years and knows everybody and they take care of him. They take care of their own, but not the new people. That's the way they are down here."

In a different survey of people who were pregnant at the time of the abuse, 88% reported that an abusive partner made false claims about them having challenges with mental health or substance use. And this is because mental health and substance use can be used against someone across so many different aspects of life. So, for example, to cause legal trouble with immigration, which again is very important right now, to make it harder to get or keep child custody, orders of protection, housing, or other public benefits, and to restrict access to mental health services, substance use services, or other healing activities.

So, we know experiencing a mental health or substance use disorder can increase the risk of being controlled by an abusive partner. The stigma related to both areas makes these abusive tactics more effective and can also create additional barriers when people try to access support. So some examples of this would be experiencing victim blaming, misunder misunderstanding, discrimination, or bias from potential sources of support, receiving lower quality of care, or being screened out of services because of mental health or substance use. And these challenges can reinforce someone's feelings of shame and guilt and contribute to isolation.

Now, these challenges are also compounded by structural violence. This is the way society's systems and institutions create harm for certain groups. This can include unfair laws, biased institutions, or policies that make it harder to access basic safety and well-being. Structural violence also can increase the likelihood that people become involved with systems like criminal justice or child welfare while at the same time limiting access to resources that support safety and healing. So, put together, stigma and structural violence interfere with someone's ability and willingness to seek help. So, there are additional barriers to recovery and support.

And I have a question for the slides to last a little bit longer. And I'll say that you will get a copy of these slides. So, you will have all of this information easy to access within I think the next week or so.

Domestic violence affects all people. However, certain groups may experience it at higher rates or face other unique barriers to support. The research has historically focused on women who are disproportionately impacted by domestic violence. However, people who are masculine identified and have a history of substance use often also have their own experiences of trauma, including domestic or sexual violence. Individuals who have marginalized social identities of any kind frequently face greater risks of harm. For example, trans and non-binary people are often erased in research and the limited data that does exist shows disproportionate rates of domestic violence and substance use related harms. The lack of trans-affirming services even further increases these risks. Similarly, people with disabilities or immigration experiences also experience higher rates of domestic violence. People who have marginalized identities and in underserved communities often face these compounded negative effects from stigma and structural violence that create additional barriers to safety and well-being.

So the more we learn about mental health and substance use coercion and these connections to domestic violence, we can start shifting our view. Which means we don't see what is happening underneath the surface and we only see just a tiny fraction of what is actually happening for someone in their life. So we must remember that people are doing the best they can to manage what they are experiencing. And people may have coping and survival responses that we don't understand or even necessarily agree with, but we don't really know the complexities of anyone else's struggles. And we need to know these responses are related to survival and how they create safety for themselves. So these coping strategies help even if we don't understand or agree.

We can counteract these effects of stigma and structural violence simply by building transparent and trustworthy relationships that are based on empathy, understanding, self-determination, and empowerment. So, when we want to talk about sensitive topics, we want to consider that a trauma-informed and anti-stigma approach starts even before we talk. We want our materials and spaces, both online and in person, to be welcoming, inclusive, and easy to access. You can provide community education on the intersections of these areas and partner and cross-train with local providers and other sources of support. Always make sure that you are sharing resources on mental health and substance use without requiring somebody to disclose what's happening for them. Work on building trust and safety instead of just collecting information, especially in our intake processes. When we are non-judgmental in all of our interactions, people will open up more because they feel safe. And of course, always explaining our confidentiality policies and any limits so people can choose what is safe for them to share.

It's also important to continuously ask for consent before proceeding with conversations about mental health and substance use. And if someone doesn't want to talk about it, we must respect their no. Many people have had their independence taken away because their unsafe partners ignored them when they said no. So when we want to give them back that empowerment by respecting their choice and stopping whenever they say no to give them that control over their decisions and support autonomy. We can ask if they want us to check in with them about this in the future. Let them know that we are still here and that they can also bring it up with us at any time.

These images are the front of the mental health and substance use coercion palm cards for advocates. These support trauma-informed conversations on these topics. And if you look along the left-hand side of each card, you can see the title there. We'll look at each section individually. And it's just taking a step-by-step approach to conversations. This card is available on our website for free to download in English, Spanish, and French.

The first section of the palm card we'll look at is the common forms of mental health and substance use coercion. Again, you might see overlap because someone is most likely experiencing several different tactics of power and control. We've already talked about several examples. So, I'll just highlight again provoking or threatening unnecessary commitment. Again, introducing someone to or escalating their substance use. Coercing someone to do illegal things like dealing drugs or stealing. Using someone's mental health or substance use to justify control, which could include controlling their finances or housing by saying they are helping or protecting them, and of course, gaslighting or creating confusion to make someone doubt their memory or judgment. And again, I will mention for the people in the chat that we will share these slides. You'll receive them by email shortly after this webinar within the next week or so.

The palm cards also have a way to start a conversation. So, both of them could be adapted to your use. So for mental health, we have people have shared that sometimes their partners say hurtful things or try to make them think that they're going crazy or losing their mind. Partners might do things to harm your mental health, interfere with mental health care, or make it difficult to do things for your own self-care. If you can relate to any of this, know that we're here to help. Now, both prompts do not require you to define mental health or substance use coercion or require someone to talk about their own mental health or substance use. Instead, we are opening a conversation to let someone know we can support or help them while building that safe and non-judgmental relationship so they feel that they can share more. This also opens up a space for someone to potentially talk about their partner's substance use and not talk about their own. It's never your fault when someone harms you. Regardless of what your partner or society tells you, you always deserve to be treated with dignity and respect.

The next section on the palm card is about validating and affirming. And so whatever someone tells us, we want to make sure that we are validating and affirming their experiences. So we want to avoid anything that's possibly victim-blaming because that will break trust, typically cause someone to shut down or share less right away. Do what we can to build trust and demonstrate that we believe them. So, we have a couple of other examples that are on the palm card. None of this is your fault. You're not alone. And I believe you. And I know as advocates, you have a lot of practice in affirming and validating people's experiences. And I would love to see you share some of your favorite phrases in the chat. I'll give you a moment to think about that. And while you're thinking about your responses, yes, you are not alone. It's like undermining your credibility with other people can strengthen control because it makes it difficult for you to get support, be believed, and trust what you know to be true. Let's see. We've also got this will not last forever. I see you. I'm sorry this has happened to you. I'd like to hear your perspective. You are not what happened to you. There is nothing you did to deserve abuse. You didn't deserve that. No one deserves to be treated this way. I'm sorry this happened to you. You are the one who knows what is best for you. Your feelings are absolutely valid. Would you like to talk about it? What do you want to see happen? You are loved and valuable. Thank you so much for sharing. Those are all beautiful. I'm here for you. Thank you. This experience does not define you. Thank you.

So both palm cards have this little pink arrow at the bottom that again give us that reminder to ask for permission before we continue these sensitive conversations. So we want to ask permission before we ask additional follow-up questions, share more information, or offer feedback. Oh, I like, I hear you and here for you. Very nice.

Now, the back of both cards have a brief intervention for collaborating around safety strategies, making active service connections, and some commonly used resources to help find connections to services. So we'll look at the back of the cards in more detail. Let's see. Mallerie says, "If you should not require clients to disclose their mental health or substance use, then should that information even be collected as part of intake forms?" No. That is correct. That is correct. Think about when we think about intake, the most important thing that we are trying to understand is is someone eligible for services and what services do they need? And in the immediate, you know, it's like you're, I know in the intake process, you're creating immediate safety rather than looking at, you know, these longer-term supports, unless someone brings it up themselves or, you know, you ask and they want to continue the conversation. But yeah, because this is not part of determining if someone is eligible for services.

So, we have some questions that you can ask to help you understand someone's experience and their strengths. So, you know, how is this person's behavior been affecting you? What's been helpful? How are other people supporting you? Who's supporting you? What are you already doing to keep yourself and your children safe? What else would be helpful? So, we ask open-ended questions to support their emotional safety. And concerns about mental health or substance use could come up without us needing to directly ask. And if it doesn't come up, we don't force it. You can check in before wrapping up by asking if there's any additional situations or safety strategies about mental health or substance use where they would like support. So again, people might need to see that we're not going to force the issue in order to feel safe sharing a little bit more.

So collaborative safety planning centers on what's realistic for someone and they choose how to lead. So with mental health and substance use coercion, we want to help someone counteract any sabotage around their own self-defined wellness, recovery, or treatment needs. So, we have some areas to consider how they can safely keep appointments and stay connected if they have stalking or are pressured to leave. Options for maintaining control of their medications. Any legal documents that give an abusive partner a role in their own, that person's care, and making a plan together to change that role to someone they trust. This could be something like a psychiatric advanced directive. Remember, we might not have an immediate solution for everything, but we can still discuss concerns and strategize. We want to support someone to stay safely connected to services because of how isolation is both a tactic of abuse and increases the risk of more harm.

Advocates can also actively support survivors with connections to services. We will be going into this topic in greater detail in our third session of this series. So you can be ready to make those referrals by setting up local partnerships. You can call together and help people reconnect with other people in their trusted support systems, like their family members, peers, or spiritual communities they define as safe. We want to remember these connections are always based on someone's self-defined needs and goals. And we can support empowerment by reminding them that it's okay to try out different resources to find what works for you. And this comes with a big reminder that we can't require or pressure people to participate in mental health or substance use services. And this is because the Violence Against Women Act voluntary services requirement makes all supportive services voluntary. Refusing services can't affect housing or program participation. OBVW guidance also reinforces that housing access cannot be conditioned on service use. So this voluntary services really supports survivor choice, trust, and empowerment. So again, we offer these connections based on their self-defined needs and goals. This approach really prioritizes choice and self-determination. So advocates are collaborative and we build trusting relationships, offering services that are flexible, accessible, and really tailored to meet people where they are today.

So the cards also include a few national helplines and directories to help find resources. You can always call 988 or your local crisis line for support. Even though you might be someone who answers a crisis line yourself, you can call another crisis line with the person if they would need some additional support or if you're needing additional support. So there are many listings for directories, including find support or find a health center. We have a couple of tip sheets with other resources. There are many free online support groups for mental health and substance use that people can access. So I encourage you to explore what's available in your area, as well as what other types of cultural or spiritual organizations might help to be responsive to the particular community you are supporting.

We have one more scenario here. Alex and Taylor. So, Alex lives with their partner Taylor and their young child and has nowhere else to go. When Alex tries to work, Taylor says Alex is too sick because of their mental health issues. After Alex tried to get counseling, Taylor accused them of cheating with a therapist. Taylor pressures Alex to use substances with them, threatening to call child protective services if Alex refuses. Often Taylor keeps them up arguing all night and Alex says, "I figure every couple goes through stuff like this."

So looking at this scenario, thinking about, you know, how could you support safety for Alex? So I know that's a pretty broad question. So maybe we start with what kinds of things might you explore as part of safety planning? Let's see. Oh, we've got Alex, you don't deserve to be treated like that. Would you like to safety plan with me? Great. Fantastic reminder that of course the first thing I didn't specify is to make sure that Alex wants to do safety planning. Thank you. So we will assume that Alex has shared this with you and Alex has said that they would like to learn more about support and safety planning. So, we've got some gathering resources. Good safety planning where they're at, if they're unsure about leaving the relationship. Safety planning in the home and for the event that needs to leave. Offering resources to help, asking if they have a safety plan already. What has kept them safe in the past or what have they already tried? Wonderful, Katherine. That's also very strength-based. What are they already doing? To make sure if jealousy is an issue, consider resources or providers that might be less triggering of abuse or coercion. Yeah, definitely. It's very helpful if advocates are referring somewhere that they have a trusted contact or there's a place that you know has some people have training in domestic violence and trauma specifically. Yeah. Asking how this behavior has affected them. Yeah, I love loving that. The what have they already been doing to stay safe is very empowering. You know, I might, yeah, it's really, it's tough because again, it's like that the pathological jealousy of being, you know, accusing someone of cheating with a therapist can be really challenging. Looking at what else might be helpful. So, exactly. We've got the suggestion of a DV support group. That might be another way that Alex could find support and so offering support resources, ask if they are safe. Great.

So, when Alex says, "I figure every couple goes through stuff like this" about Taylor keeping them up arguing all night, what might you say to that? And someone is normalizing an abusive behavior. Every relationship does have conflict, but the impact seems severe here. This isn't your fault, but it's not normal either. Education about power and control. Talking about emotional, psychological abuse. Yeah, I think sometimes bringing in that educational component and, you know, it's like that we can gently question and explore what's happening with someone to again be like, okay, so maybe if this isn't normal, what does that mean for safety? to get you to the next place on safety. Yeah. Every couple has disagreements, but your partner is keeping you up all night. Yeah. Very nice. Every relationship has fights, but fighting with your partner doesn't have to make you feel like this. Learning about what she grew up seeing. Yeah. Fantastic. Thank you all for thinking about this. And again, these scenarios are composites of stories that we've heard from people. So they're not a one real-life person, but I'm sure a lot of the situations that we describe sound very familiar. Green flag, red flag, what it looks like, green flag, red flags in relationships.

So, something I want to come back to as we come to a close is that as advocates, you don't have to be mental health or substance use specialists to offer support or to support those who have personal experiences of mental health or substance use. So all the things we've talked about today, I hope really show you how many tools you already have, how many skills you are already using that can be applied to these situations by focusing on the quality of your relationships. Really reducing stigma by having open opportunities for conversation and being non-judgmental. Focusing on someone's self-defined goals. Let someone define what positive change means for them, and we can offer support as they work towards that. Identifying and building on their strengths and successes and always starting from that place of empathy and releasing judgment. And I will say based on all of your wonderful responses in the chat today that I see all of your skills and I think it's amazing and I'm really excited for you to continue applying these skills to mental health and substance use because we understand that sometimes it can feel overwhelming until we remember, I have the skills. I can have these conversations. I can just approach someone from that same place of care that I approach anyone.

And I'll encourage you to register for our next two sessions in this series. In February, Kathy Cape will talk about creating emotional safety for survivors and staff. And then in March, Kathy will join me to talk more in depth about how we can support survivors in actually accessing services if that's what they want to do. So, thank you all so much. And we do have some other resources that will be in the slideshow so that you can easily link to some of the things I've talked about today. We do have a mini-training on these palm cards available if you want to share that with any of your co-workers. We have several resources for finding resources, collaborating, increasing access, working with survivors who use substances, supporting emotional support, helping people to determine if they want to see a therapist, looking at voluntary services. You can even download our infographics if you're interested in sharing them.

And I will take a moment to see if we have any questions. I appreciate all of your thank yous. I appreciate you being here. And let me just take a moment. I will stop sharing the slides and come back and see if you have any questions. Please share them in the chat. I'm very happy that you've been here today. I know we are at the end of our time. Let's see. Feel free to add any questions in the chat. And I will just start by saying thank you so much to everyone who was able to join me today, join all of us. Thank you so much to all of our interpreters and our wonderful team. Please click on the survey link provided in the chat and let us know what worked and how we did today. Within the next, excuse me, the next week or so, we will send a follow-up email with a link to the recording of today's webinar. You'll also receive a certificate of attendance for your time today and a link to the evaluation for the webinar. Thanks again and we hope you have a lovely afternoon.

Let's see. And I see somebody requesting my email address. I will put that in the chat right now. My email is a lion at ncdvmh.org and I'm happy to talk to you if you have any questions. Feel free to reach out. And I'm just looking at the chat to see if there's anything else that came up. Could I get your email address again a little slower? Sure. I'll put it in the chat again. It is my first initial A, my last name, L Y O N, A Lion at N C DVMH.org. Perfect. Thank you. And if there's somebody who has a hand raised, could you please put your question in the chat for me? Let's see. We cannot see the link for the survey. Christine, would you mind sharing that link again? And if it will also be sent out in the email with your certificate of attendance and the slides as well. And yes, all of the palm cards are linked in the slides and the resources are all linked in the slides. So you will have access to everything and all of our materials are free and available for anyone to download at any time. And then Christine, maybe you could try sharing the link for the survey again. I don't see it either. Thank you everybody. Yes, please stay safe and warm out there. Okay, I guess we don't have the link to the survey at the moment. I was wrong. So it will be sent out to you in an email. Thank you for your patience with us. Yeah, and stay safe, especially our Minnesota friends, everyone out there. Thank you everybody. All right, we'll sign off. Thank you so much and have a wonderful rest of your day. Take care.