- On May 6, 2020
- May / June 2020
Are you alone now?
As medical professionals embrace telehealth during COVID-19, many are looking at how they can better support patients who may be affected by domestic violence at this time.
SHUTDOWN MEASURES, financial pressures, and an inability to reach out to normal supports is creating a perfect storm for families who may be affected by domestic violence, experts warn.
“Social distancing and isolation throughout COVID-19 mean vulnerable women in our community face greater barriers to accessing help,” says Louise McCann, President of the Hornsby-Ku-ring-gai Women’s Shelter.
“It’s critical that at this time health professionals and domestic violence service providers work together to ensure women have access to the vital support services they need.”
The Hornsby-Ku-ring-gai Women’s Shelter (HKWS) launched an awareness campaign to educate medical professionals about the resources that are available to women during the pandemic.
“Women turn to doctors and nurses in emergency, often suffering critical injuries. However, health professionals often don’t know where to refer their patients after they have been treated,” Ms McCann says.
“HKWS has dedicated shelter professionals on hand, delivering comprehensive case management programs to women in need, assisting them to get their lives back on track.
Ms McCann adds, “The key message to health practitioners is that women’s shelters are open and have capacity to take women.”
In a bid to reduce transmission of COVID-19, shelters have put policies and procedures in place should there be a confirmed case of the virus at the shelter.
“The environment is safe for women and families. There is a perception that they’ll be locked in a hotel room, but that is not the case,” she says.
HKWS aims to provide temporary supported accommodation for women in times of crisis such as homelessness and/or domestic violence.
Women stay at the shelter for up to three months and are allocated specialist caseworkers who support them to assist necessary legal, health, employment and financial services. Women who cannot be housed can access outreach programs.
HKWS is part of a network of women’s refuges across Sydney.
HKWS, as part of the Women’s Community Shelters network, is preparing for a potential 30% increase in demand for support services because of COVID-19.
“Fear of uncertainty, job loss and financial stress are key risks that could lead to an increase in domestic violence,” she said.
According to the World Health Organisation, violence against women tends to increase during emergencies, such as bushfires, earthquakes and hurricanes. Reports from China demonstrate family violence incidents tripled in February 2020, as compared to the same time period the year before. There have been similar increases reported from the UK and the US during the COVID-19 outbreak.
The World Health Organisation also suggests perpetrators of abuse may use the COVID-19 restrictions to exercise power and control over partners to further reduce access to services, help, and psychosocial support from both formal and informal networks. They may also restrict access to soap and hand sanitiser or exert control by spreading misinformation about the disease and stigmatise partners.
The WHO also indicates that access to vital sexual and reproductive health services, including for women subjected to violence, will likely become more limited.
Medical professionals working in hospitals are encouraged to identify information about services available locally (e.g. hotlines, shelters, rape crisis centres, counselling) for survivors, including opening hours, contact details and whether these can be offered remotely, and establish referral linkages.
Over 1 in 5 women make their first disclosure of domestic violence to their GP. It is estimated that every week, a general practitioner sees up to five women who have been abused by their partners, of which the GP may not be aware.
Consequently, GPs need to be aware of the warning signs of domestic violence. These could physical signs – bruising, bite marks, injuries to bone or soft tissue. There could also be unexplained physical signs such as ulcers, dizziness, or chronic pain conditions such as headaches, pain in the joints and back, and more.
In addition, there could be psychological signs such as anxiety, panic, PTSD, self-harm, drug abuse, sleeping and eating disorders.
Other indicators to look for are controlling behaviours from the patient’s partner – a partner that wants to get the test results, is overly attentive, or wants to attend the appointment.
While GPs and other medical specialists are trained to look for these warning signs, the rise of telehealth has created a new challenge for both practitioners and patients who may be seeking assistance.
Video and phone consults are changing the way patients and doctors interact with each other. In some respects, telehealth may make it easier for women disclosing experiences of domestic violence, says Professor Kelsey Hegarty, co-director of Safer Families.
Experiences by general practitioners overseas suggest some patients find it easier if it’s not face to face, there is less judgement, or they feel less guarded about displaying their emotions.
Doctors are still able to assist patients who disclose via telehealth by offering first-line support and relevant medical treatment. First line support includes listening empathetically and without judgment, inquiring about needs and concerns, validating the patients’ experiences and feelings, enhancing safety, and connecting the patient to relevant resources and support.
However, there are some unique challenges with telehealth and things medical professionals can do to assist patients who may be affected by domestic violence.
One of the key methods, according to Prof Hegarty, is to ask the patient during the teleconsult yes/no questions, such as ‘are you alone?’ or ‘could anyone be listening in?’
She says you can sometimes pick up on other cues that might suggest the patient isn’t able to speak privately. For example, she may change the subject abruptly, provide short answers, or be on speakerphone. If you are able to establish that the patient is alone, Prof Hegarty suggests the doctor and patient decide on safe word or phrase that they can use should someone else come in the room, or if the patient fears they are in danger. This should be something common and innocuous, such as ‘I’m feeling cold.
If the patient is not alone, the health professional could try to arrange a follow-up telehealth consult when the patient knows the perpetrator will be occupied or out of the house.
For patients who may be being monitored by the perpetrator, WESNET, a national peak body for specialist women’s domestic and family violence services, offers safe phones to women.
For more information on their services here.