Domestic violence during COVID-19: the GP role

WITHIN THEIR HOMES MANY WOMEN FACE AN ENEMY MORE TERRIFYING THAN COVID-19

Threatened by COVID-19, the world has been on lockdown. Danger and death lay without; safety is to be found alone in the isolation of the home. The UK government’s message was ‘Stay at home … Do not meet others, even friends and family.’ But within the walls of their own homes many women face an enemy more terrifying than COVID-19.

The domestic abuse charity Refuge reported a 700% increase in calls in a single day.¹ The most recent findings are that ‘... demand has spiked again significantly — calls and contacts to the Helpline have risen to a weekly average increase of 66% and visits to our website ... have seen a phenomenal 950% rise compared to pre Covid-19.’ ²

In response to this surge in domestic abuse, the Home Office announced an additional 2 million pounds of funding to support helplines and online support. But this is insufficient to mitigate the long-term consequences (for many years) of increased domestic abuse during the UK’s lockdown.

Even under normal circumstances, worldwide, about 30% of women report intimate partner violence (physical, sexual, or both) in their lifetime.³ It is estimated that 1.3 million women suffered from domestic abuse in England and Wales during the year ending March 2018.⁴ These women are at increased risk of experiencing difficulties with activities of daily living, gastrointestinal symptoms, chronic pain, memory loss, dizziness, headaches, vaginal discharge and sexually transmitted infections, emotional distress, depression, post-traumatic stress disorder, and suicidal thoughts and attempts.^5–8 As they grow into adulthood, their children are more likely to have problems with drug and alcohol use, violence, sexual risk taking, mental ill health, smoking, cancer, and cardiac and respiratory disease.⁹

The dynamics of domestic abuse are not straightforward.¹⁰ In some relationships situational couple violence predominates, where both partners are equally aggressive towards each other. In others, one individual makes a concerted and sustained attempt to utterly control their partner. These abusers may be motivated by obsession and jealousy or simply driven by a determination to get their own way, no matter what. This is intimate terrorism. When an abused partner, who has been worn down by weeks, months, or even years of abuse, finally hits back (violent resistance), the consequences can be deadly. Many simply want to leave but are afraid to do so. Their intimate terrorist has often convinced them they are useless and unable to fend for themselves. What happens if they are stalked and harassed, lose their job, their home, or even their children? There is always the possibility they will be murdered.

STAYING ALERT FOR INDICATORS

The lockdown will have seen a rise in every kind of domestic abuse. More violent acts will have been committed within the home. More women enduring the overwhelming fear of being trapped and abused in the very place where they should feel safe. More children will have witnessed domestic abuse and it will have been harder than ever for women to escape from such abusive relationships.

As we emerge from the current pandemic, more women and children (throughout the world) will have suffered from and be experiencing the consequences of domestic abuse than ever before. As the lockdown is eased we need to stay alert for indicators of domestic abuse in our patients, use appropriate questions to detect coercive and controlling behaviour, and be ready to assess the risk of domestic homicide (using, for example, the SafeLives DASH risk assessment).¹¹ We should remain sensitive to their medical and mental health needs and support them as best we can.

This may include signposting them to charitable organisations, and referring children to social care and women to the Independent Domestic Violence Advocacy (IDVA) service or even the police, if we feel their life is under threat.