New work is being done in Ohio to help free people who are caught in the complex web of domestic violence, addiction and mental health.

Cheryl Stahl, who is heading the Ohio Domestic Violence Network's new Substance Use Mental Health Project, said most survivors who seek services are facing multiple traumas and concerns.

"You're working with women who - say, from childhood - have had sexual-abuse experiences and then date people who are abusive," she said "Those people perhaps are using drugs. They get introduced to drugs; they may have mental-health concerns that are being masked by the trauma."

Research indicates that between 47% and 90% of women who seek substance-use disorder treatment say they've experienced domestic violence. Stahl said the project is teaching advocates at shelters about addiction and mental health, and how they can better assist people who struggle with these challenges.

Stahl said domestic-violence survivors can be reluctant to leave because of mental-health and substance-use coercion, when an abuser uses tactics to undermine their sanity and sobriety.

"The abusers will often use substance use particularly as a way of threatening to take custody of children," she said. "You may have the abuser as the person who is providing the drugs and sort of in control of when they get them and when they don't."

Stahl said the training will teach shelter staff how to talk about addiction in ways that encourage change and can connect survivors with peer-support services, and provide help for people who are actively using but not ready to enter treatment.

"Survivors aren't going to shelter necessarily to get off of drugs, that's not what they're seeking that service for," she said. "So, introducing some harm-reduction strategies - safety planning with people on how to hopefully prevent overdose."

Stahl said some of the work will focus on identifying brain injury as it pertains to substance use and mental health. The three-year project is starting in seven counties and Stahl said she hopes to expand it to 30 shelters.

Ohio's domestic violence shelters provided emergency housing to nearly 10,000 people last year, and advocates are calling for a funding boost.

Providers said they are unable to meet demand, especially for the nearly 73,000 residents seeking counseling, court advocacy and other non-shelter services.

Mary O'Doherty, executive director of the Ohio Domestic Violence Network, said the volume of calls and the severity of cases has worsened since the pandemic.

"They are seeing survivors with more severe injuries, survivors describing more lethal situations," O'Doherty observed. "I hear regularly that the calls to our crisis lines are more complicated, are scarier for the advocates who are receiving the calls."

Ohio Gov. Mike DeWine has allocated $20 million for domestic violence services in his proposed budget, but the funding still needs approval from the state legislature. Dozens of advocates gather in Columbus today for the Ohio Domestic Violence Network's Advocacy Day to meet with lawmakers on the issue.

Last year in Ohio there were more than 80 domestic-violence related homicides, including the deaths of children.

Even with the funding increase, Ohio continues to spend less per capita for domestic violence services than its neighbors, including Pennsylvania, West Virginia, Kentucky, and Indiana. O'Doherty pointed out investments in services ultimately save taxpayer dollars.

"Those are costs associated with medical care, property damage, law enforcement, emergency response, child protective services, legal fees, and the loss of life of survivors, including end-of-life expenses," O'Doherty outlined.

According to the Centers for Disease Control and Prevention, nationwide the lifetime economic cost associated with medical services, criminal justice, and other costs related to intimate partner violence totals more than $3 trillion.

Gov. Mike DeWine recently announced he's providing $30 million to boost rape crisis services statewide, after years of federal funding cuts.

Jennifer Seifert, executive director of the Ohio Survivor Advocacy Outreach Program, said the trauma associated with sexual violence demands a tailored response that crisis centers are staffed and trained to address.

"And that can be all the way from a civil protection order to perhaps filing a Title IX complaint, if they're a college student," she said, "or all the way to maybe mobilizing some housing resources or reporting to law enforcement, getting the evidence collection done at a medical facility."

Since the start of the pandemic, crisis centers have had to cut staff and reduce service areas, as centers saw a 55% jump in monthly hotline calls, along with a rise in survivors seeking emergency shelter, legal advocacy and mental-health services.

Emily Gemar, director of public policy at the Ohio Alliance to End Sexual Violence, explained that the services people need throughout their lifetime to recover from sexual violence, and that the response from law enforcement and prosecutors offices can be costly. She said for every act of sexual violence prevented, more than $122,000 in lifetime costs are averted.

"We know that by investing money into prevention, which was one of the primary reasons for the state funding for sexual assault services, that we are actually saving our state money and improving the quality of life for for all Ohioans," she said.

Rose Beltre, the alliance's executive director, said centers are grappling with how to expand coverage across the state, retain existing services and reach into new areas, and asked, "How can the centers maintain adequate staff to be able to provide services for survivors, holistic and comprehensive services?"

According to the National Intimate Partner and Sexual Violence Victimization Survey, nearly one in five women and one in 67 men have experienced some form of sexual violence in their lives.

Ohio community groups seeking ways to increase support for sexual assault survivors living with disabilities. A January 23rd training session hosted by the Ohio Alliance to End Sexual Violence will focus on how law enforcement, hospitals, and other institutions can provide equitable services.

Natasha Larson, director of training and member engagement with the Alliance explained it is common for perpetrators to be closely linked to their victims, and can often include family members or staff at a caregiving facility. She said people with disabilities are at higher risk for assault because their abuser can interfere with attempts to report it.

"They may tamper with things," Larson said, "like withholding any assistive technology that they have - mobility aids, communication devices - things that allow them to perform daily tasks."

A 2012 nationwide survey, the first of it's kind published by the Spectrum Institute, found more than one-third of respondents were victims of repeated sexual abuse. More information on the training is online at 'oaesv.org.'

Nicole Kass Colvin, manager of coordinated community responses with the Alliance, added society often views those with disabilities as asexual, and points out that people born with disabilities are less likely to be taught the proper names of body parts, or the definitions of sexual assault and consent.

"This leads to a lack of comprehensive sex education and consent education, which increases risk," she said.

Kass Colvin said Ohioans can help protect their loved ones with disabilities by advocating for increased accessibility in their communities and workplaces.

"When we are able to know ahead of time how to access or activate a trauma-informed qualified interpreter, or services that have accessible spaces, then we're better able to respond to those situations," she said.

Children with disabilities are nearly three times more likely to experience sexual violence, according to the World Health Organization.