Domestic Violence During COVID-19
It had all the tell-tale signs. A woman in her 30s presented to the Emergency Department (ED) with a “black eye”. Triage notes said she fell down her stairs.
We have all heard the oft-repeated line “COVID-19 has changed the way we live forever”. Indeed, it has. For some it is the inconvenience of working from home with your distracted and screaming kids that need home schooling, but for others it is being locked down with an intimate partner that literally threatens your life every day.
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According to data collected by the United Nations, 243 million women and girls between the ages of 15 and 49 worldwide were subjected to sexual or physical violence by an intimate partner in the last twelve months. Put a different way, one in three women has experienced physical or sexual violence at some point in her life. On average, one woman every week is killed by her current or ex-partner in Australia. One in every four Australian women has experienced emotional abuse from a current or former partner.
Back to my patient. I saw her in a cubicle with curtain drawn and no other patients nearby. I took one look at her and my heart sank. She had bruises over her knuckles and a few haematomas on her scalp, and the “black eye”. I sat her down. I asked her about her past medical history and drug history. Then I looked her in the eye and said, “From my experience working in ED for many years, a fall down the stairs usually does not give you a black eye or bruises on your knuckles and head. Tell me, what really happened?” At this point she broke into tears and admitted to me that her partner had assaulted her with a baseball bat.
In Australia, reports have shown that instances of Domestic Violence (DV) have increased during the last few months of the lockdown due to COVID-19. The national sexual assault, domestic and family violence counselling service 1800 RESPECT said between March and April, the use of its online chat tool had increased by 38 per cent. The organisation said the increase represented close to 1,000 people, with more than 4,000 people overall seeking help through its webchats in March and April. The organisation said for online chats, March and April in 2020 had been one of the busiest periods in the organisation's history. The Australian Institute of Criminology just published data on DV during the COVID-19 pandemic where they surveyed 15,000 women online in May 2020. Two thirds of the women reported that the DV had started or escalated during the three months prior to the survey. Worryingly, both studies highlighted women who experienced DV for the first time. That was my patient. He had never hit her before. And she was distraught and perplexed all at the same time.
The Perfect Storm
COVID-19 has created a perfect storm for DV to thrive. Many of the drivers and reinforcing factors for domestic violence have been accentuated or exacerbated by the pandemic conditions.
The lockdown has caused increased stress in households, having to balance working at home with home-schooling kids. Elevations in stress hormones have long been associated with increased aggression. Similarly, alcohol is also widely considered to be a key predictor of DV, primarily due to its disinhibitory effect on aggression - alcohol consumption has increased during the pandemic (ANU study). Concerningly in some settings there has been a trend towards purchasing or hoarding guns as an emergency measure.
The pandemic has highlighted growing disparities in wealth and widened existing social fragmentation and inequity. Financial insecurity, coupled with uncertainty of employment, have added to the cauldron of stress at home. We know that DV is more likely (and more severe) in households that are economically distressed. For example, studies from the 2008 recession found that increases in unemployment claims correlated with a greater number of reported cases of DV. Economic anxiety and joblessnesscan cause a perceived threat to the masculine identity of the abusers, as “bread-winners”. The loss of identity coupled with a sense of hopelessness and loss of control can result in them taking out their frustrations on their partner.
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The lockdown measures that many nations have taken have socially isolated abused women and made it difficult for these women to have any support system. By isolating victims from friends, family, and any outside contact, abusers are able to assert control over the victim’s entire environment. Social isolation can lead to the normalization of abuse and allow abusers to more easily engage in gaslighting techniques.
Estimates from the UN Population Fund suggest that 3 months of quarantine will result in a 20% rise in DV throughout the world – that is at least 15 million additional cases. These are astounding figures, which demand a swift response from authorities and healthcare providers.
Shifting Our Focus
I think to really address the “DV Pandemic” during this viral pandemic, we need to not only focus on the women who are disproportionately the victims, but also on the perpetrators. We need to study why perpetrators do what they do, and how they convince themselves that what they are doing is acceptable.
One prominent clinical intervention for perpetrators employs a feminist psychoeducational approach and is widely known as the Duluth Model. Originating in 1981 from the Duluth Domestic Abuse Intervention Project in Duluth, Minnesota, this intervention proposes that the principal cause of domestic violence is a social and cultural, patriarchal ideology that historically has allowed men to control women through power and violence. Violence perpetrated on women and children originates from their relative positions of weakness and vulnerability socially, politically, economically, and culturally. As such, the model does not assume that domestic violence is caused by mental or behavioural health problems, substance use, anger, stress, or dysfunctional relationships. The program concentrates on providing group-facilitated exercises that challenge a male’s perception of entitlement to control and dominate his partner. This treatment technique focuses on providing an improved and broadened understanding of the causes and effects of the underlying problems experienced by the offender.
The Duluth Model makes use of the “Power and Control Wheel” as a tool to understand patterns of abusive behaviour, including acts and threats of physical and sexual violence.
The wheel includes the following eight items:
1) intimidation
2) emotional abuse
3) isolation
4) economic abuse
5) male privilege
6) coercion and threats
7) using children
8) minimizing, denying, and blaming.
The wheel is designed to enable abusers to recognize the patterns of domestic violence rather than as isolated or cyclical acts. The goal of the intervention is to convince men to use nonviolent strategies outlined in the “Equality Wheel”, which are the foundations of a strong and egalitarian relationship The eight items making up this wheel are:
1) negotiation and fairness
2) economic partnership
3) shared responsibility
4) responsible parenting
5) honesty and accountability
6) trust and support
7) respect
8) non-threatening behaviour
The Duluth model is not without critics, and success in the model has been variable in different contexts, but it is a start. It must also be used in conjunction with support for those who have drug and alcohol problems, and support must always be offered to victims of DV.
Making Change
I advocate for focusing more on the perpetrator in our fight against DV. But that should not be done at the expense of support services for victims. When I did my research project while I was a trainee in the Northern Territory, I found a point prevalence of DV of more than 30% in patients aged above 16 presenting to the ED. This data was used to advocate successfully for a social worker to be based in the ED 24/7 who could link victims to support services.
We have to learn how to identify DV, how to screen for it and how to refer to support services. If patients present with physical injury, especially strangulation, we need to be highly vigilant and proactive in referral - in NSW, it is a mandatory notification to the Police DV unit. This is because strangulation is highly correlated with subsequent killing of the victim by the perpetrator. GP consultations can include asking a series of structured questions about things like stress and anxiety, which could help to assess the risk of DV or child maltreatment, and whether more questions are needed.
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Active surveillance methods could be repurposed. For example, existing tools for monitoring people with COVID-19 infections in home-isolation could be adapted to include questions to screen for violence in the home. Linking data between Police, health and social care to identify and effectively monitor and support individuals at risk should be encouraged. We need to advocate for more funding for support services including shelters, legal services and financial and employment assistance, as well as programs to assist perpetrators in reducing violence.
We have to shift the unequal power relations and gender inequality in relationships, earning power and childcare responsibilities. We have to shift community perception that this is a private matter between partners; that we cannot and should not interfere. We need to engender a culture of equality and respect in our children – especially our boys.
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The pandemic has further shone the light on increased vulnerabilities borne by marginalised and poor communities, including victims of DV. Let us use this opportunity to support the patients that we see, who are victims of DV, to remove themselves from a precarious situation and to ensure a better life for them and their children. We should not be a bystander in their suffering. We should support them in whatever ways they require to ensure their safety, and do so in a non-judgmental way, which offers them space and freedom to heal.
If you are experiencing domestic and family violence, or have experienced sexual assault, seek support, call 1800 RESPECT (1800 737 732). www.1800respect.org.au
If you’re aged between 5 and 25 years and violence is occurring in your home or relationships, contact Kids Helpline on 1800 55 1800. kidshelpline.com.au
Mensline is a dedicated service for men with relationship and family concerns. Contact Mensline Australia on 1300 78 99 78.
No to Violence COVID-19 update (Men’s Referral Service ph. 1300 766 491)
www.mensline.org.au
If you are scared now or in immediate danger, call 000.
References
Dr Lai Heng Foong, “Domestic violence in patients presenting to an Emergency Department in the Top End of the Northern Territory”, presentation at the Annual Scientific Meeting of ACEM, 2008.
https://www.cfr.org/in-brief/double-pandemic-domestic-violence-age-covid-19
https://www.anu.edu.au/news/all-news/alcohol-consumption-increases-during-covid-19-crisis
Anderson, K. L., & Umberson, D. (2001). Gendering violence: Masculinity and power in men’s accounts of domestic violence. Gender and Society, 15, 358–380.
Babcock, Julia C., Charles E. Green, and Chet Robie. 2004. “Does Batterers’ Treatment Work? A Meta-Analytic Review of Domestic Violence Treatment.” Clinical Psychology Review 23: 1023–1053.
Dutton, D. G., & Browning, J. J. (1988). Concern for power, fear of intimacy, and aversive stimuli for wife assault. In G. Hotaling, D. Finkelhor, J. T. Kirkpatrick, & M. A. Straus (Eds.), Family abuse and its consequences: New directions in research (pp. 163-175). Newbury Park, CA: Sage., A. H. (1987). Sex differences in social behavioural: A social role interpretation. Hillside, NJ: Lawrence Erlbaum.
Perpetrators
http://driveproject.org.uk/wp-content/uploads/2020/01/Executive-Summary_Final2020.pdf