Domestic Violence - Early Detection and Intervention (Date: 10/05/2003)

Domestic Violence – An Approach to Early Detection and Intervention

Domestic Violence is a very serious crime. Statistics show that 2,350 women have sought the services of SWDP since it was set up in 1994 and of Appogg (2001) – that means 300 women every year. The prevention of violence against women and children is a social and political issue and a priority for all levels of Government. It calls for an integrated and comprehensive strategy based on the three Ps:
• Active Prevention of crimes of violence against women and children
• Adequate Provision of support services
• Appropriate legal Protection for women and children who are victims of violence

It is right that the Police, the Criminal Justice System and Social Services, Probation and the voluntary sector should be given the focus on domestic violence, but we also know that the best way of ensuring that we tackle this crime, is through a multi-agency, multi-disciplinary approach and one that is rooted in early intervention. There is the need to build on this approach and to recognize that there are specific areas where a targeted and focused response is required and the Health Service is one of them.

Why the Health Service?
The Health Service has a particular contribution to make. Domestic violence effects health, both physical and mental health and so the Health Service may offer the best contact point with staff that can recognize domestic violence and help those affected by it. Women make use of the Health Service whether for illness injury, family planning, pregnancy and childbirth or in their role as a carer for children or older people. Those who suffer from domestic violence are more likely to suffer poor health; chronic pain, depression and suicide attempts and will be seen by health professionals in routine services. Domestic violence in pregnancy has been associated with foetal distress, poor pregnancy outcome, low birth weight, pre-term labour.

How can the Health Service help?
Health Service professionals should be able to recognize when abuse is occurring and to understand that often for good reasons the woman is reluctant to talk about it. She may be completely unable to talk about it. Even though they consult their GP they conceal their experience of domestic violence. There are very good reasons for this – shame, stigma, fear, fear that their partner might find out that they have told someone or fear that their children may be taken into care or the doctor, nurse, midwife, health professional may seem in a hurry, uninterested, unsympathetic and occasionally even hostile. They may feel embarrassed; the health professional may seem awkward, ill informed and out of their depth.

Training and Intervention
It is clear that if health professionals are to offer services which women who experience domestic violence need, and are entitled to expect, the staff must have two things: a greater understanding of the issues and the competence and the confidence to take appropriate action. If we do not identify domestic violence we are failing some of those who are most vulnerable in our community, women and children. The health professional that intervenes without understanding the complexity of the issues can in fact place the woman at greater risk. The focus is clearly on women, but we recognize that where there is domestic violence against women, abuse towards children and vulnerable adults in the family is also at risk.

Health professionals have responsibilities to do two things: first to ascertain whether domestic violence is a problem. Health professionals should be alerted to the possibility and prepared to ask questions moving from the general to the more specific. Certain injuries should trigger concern, for example, injuries on the face and hands, abdominal injuries and multiple and recurrent injuries.

Secondly, the health professional should be able to take the necessary action, believing the woman and responding to her immediate problems, assessing further risk to her and to her children, if she has children, keeping care records and providing information. In most cases, it is information that women need and not advice and to ensure continuing support and follow-up. Appropriate action can not only deal with the immediate problems which the woman is facing, but also help in the longer term, including provision of evidence for a criminal justice intervention, to prevent repeat abuse to the woman herself or her children.

Moving Forward
We need to create a culture which takes collective responsibility for tackling domestic violence rather than hoping that someone else, somewhere else will do what needs to be done. In Maternity Services and Primary Care we have opportunities to establish a relationship of trust with women. In other setting such as the Emergency Department, staff must be trained to respond to an immediate crisis. Protocols and referral processes should be in place and staff trained and supported in their use.

This is particularly important, as other initiatives which Government is taking, will make it more likely for women to seek help from health professionals. For the strategy to succeed, training is essential. It can be very damaging if, for example a midwife asks a question and does not understand why a woman answers in a particular manner rather than in another. Professional training also enhances the support that health professionals can give within their own community, social and family groups.

We also need to improve the data gathering systems to enable information on domestic violence to be analysed and shared. If we are to begin to plan local services better, we must be able to describe current services, detail how these services are being used and by whom and identify ways in which we need to improve them.

The Health Promotion Department
Health Promotion plays an important role as a mass media education campaign raises awareness of the extent and nature of crimes of violence against women and also looks at why these crimes happen. Campaign material should include pictures of positive images of women and children. A Health Promotion mass media campaign should promote health in its broadest sense that is by promoting the prevention of many health consequences of domestic violence: homicide, serious injuries, injuries during pregnancy, injuries to children, unwanted or early pregnancies, STD including HIV and AIDS. There are also the psychological consequences including suicide, mental health problems, and the effects on children of witnessing violence. Finally there are societal consequences, for example, added health care costs and the effects on productivity and employment.

It is not easy to introduce a social health care model into a hospital setting. This means a whole change of culture within the medical profession, especially within the hospital setting where a change from a medical model of health care to a social model is necessary.

I hope that this quotation from a resource manual will make us all realize the urgency with which we need to move forward.

"I wish I had been asked about what had happened, I was so ashamed, but I really wanted to tell them, they did not ask me though and I did not have the courage to tell them myself. Even though he was not there I lied for him just like I always did. They just gave me some pain killers and sent me home"