Domestic violence & mental health: what lies ahead

This piece was written to mark “No More” - Domestic Violence Awareness Week 2021

I am regularly asked for my perspective about what trends I am seeing in my work as an Adult Psychiatrist during the course of the pandemic. I usually reflect on how the pandemic has affected people in all walks of life and of all age groups.

One specific group of people that I remain concerned about because I have seen less of them, are victims of domestic violence. 

This is of great concern to me.

For much of the past eight to nine months, we have been bombarded with the narrative of an impending tsunami of mental health problems and I certainly see significant levels of anxiety, grief, distress and trauma across society.

However, it feels particularly disconcerting that I have not seen high numbers of patients reporting domestic violence, which itself seems to be a reflection of the invisible nature of domestic violence within mental health settings.

It is well established in the psychiatric literature that there are high rates of lifetime violence and abuse amongst women presenting to mental health services.

The figures are startling.

Nearly two decades ago it was established by the Department of Health that more than 50% of women in contact with mental health services have a history of domestic violence.1

A systematic review in the past decade by colleagues at UCL identified an increased rate of historical domestic violence amongst women with high levels of depressive, anxiety and PTSD symptoms in the antenatal and postnatal periods; the risk was threefold for depressive symptoms.2

People with mental health conditions are more likely than the general population to have experienced various forms of abuse, including physical abuse, sexual abuse, jealous and controlling behaviour, harassment and stalking.

Victims with mental health needs were also more likely to have problems associated with drug and alcohol use and to be in financial difficulty. Of the people that have attempted to leave the perpetrator of abuse, those with mental health needs have attempted to leave more times than average than those without mental health needs. 2

The perpetrators of this violence are usually men who are known to the victim and often motivated by power and control.

In trying to understand why domestic violence remains invisible at this time, it is important to consider what mechanisms for support victims of domestic violence have.

We know that victims are more likely to visit their GPs and to access health care services. They may also seek support from charities, religious organisations and shelters.

There are significant demand pressures on shelters, places of worship have been closed at various points during the past years and there appears to be some reluctance to access support from health care services or a perceived lack of access to these services.

Another important mechanism for women who are victims is to gain a sense of agency over their finances by securing work. For some, this has become very challenging at this time and therefore they are under high levels of financial control as they are stuck at home, trapped with the perpetrator and silenced by them.

Therefore a combination of difficulty coming up with a plausible reason to leave the house whilst restrictions are in place and financial pressures make it even more challenging for victims to reach out for help.

All this comes despite the fact that recognition of domestic violence has been strongly promoted throughout the healthcare service.

My prediction is that whilst there is a lot of interest in the well-being of children and adolescents, rightly so, in recent months, we should brace ourselves for a flood of referrals and the fallout associated with prolonged and hidden domestic violence.

Health care professionals can support women by a variety of means.

Offering face-to-face appointments (with safety precautions at this time) may offer victims a vital opportunity to speak freely and disclose violence. During remote consultations, coded safety words can be used to communicate whether a violent partner is in the vicinity and if the patient is at risk. 

Providers should also be aware of relevant support services and resources they can signpost victims towards and be creative in how this information is shared if, for example, the victim and perpetrator share an email address. One example would be passing on details of local support services under the guise of other healthcare-related correspondence. 

If you need help for any of the issues in this blog, please contact us today. There is also this domestic violence helpline.

References

1. Department of Health (2002) Secure Futures for Women: making a difference. London: Department of Health

2.Howard et al (2013). Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis https://doi.org/10.1371/journal.pmed.1001452

3.Spotlight Report  #SafeAndWell. https://safelives.org.uk/sites/default/files/resources/Spotlight%207%20-%20Mental%20health%20and%20domestic%20abuse.pdf (accessed 23 February 2021)