The horrors of domestic violence are in everybody’s mind at the moment. Recent media coverage has made ignoring or overlooking the issue no longer a possibility for anyone.
Health Professional Responsibility
For many health professionals the dilemma is around where our responsibility lies. We may think it is not our responsibility to intervene or that it’s not something we see, but the health and social consequences of domestic violence are so broad that we can be sure there are people hiding in plain sight in our waiting rooms and our consulting rooms who have experienced domestic violence in the past, or who are currently experiencing frightening situations at home who are perhaps too afraid or ashamed to talk about it.
Professor Kelsey Heggarty is a GP and academic with a special interest in domestic and family violence. She is Chair of Family Violence Prevention in the Department of General Practice and Primary Care at the University of Melbourne and Chair of Family Violence Prevention at Royal Women’s Hospital, Melbourne. Prof Heggarty firmly believes that health professionals, especially GPs, need to be doing more to help in domestic violence situations and doing it better.
Physical and Mental Health Consequences
Professor Heggarty agrees that a lot of domestic and family violence is hidden. As GPs we need to be very aware that physical injury, although important and important for us to recognize as a consequence of domestic and family violence, is just the tip of the iceberg. Chronic stress can lead to physical conditions as well, such as hypertension and cardiovascular disease, irritable bowel syndrome and chronic unexplained pain.
Perhaps more importantly, because it is not always apparent, is the need to recognize the mental health consequences of psychological trauma and coercive control. Issues such as intractable anxiety, and treatment resistant depression, may have their roots in lack of physical and psychological safety in the home. Substance abuse issues may be a way to protect yourself from the psychological pain of an abusive situation. The long-term consequences for people exposed to family violence in childhood, whether directly or indirectly, are immense. It may be too easy to overlook the role of domestic and family violence in people’s lives if we don’t have it in our minds and we fail to ask and act.
Coercive Control – how do we know it’s happening?
In situations of coercive control there may be many clues but we may not see them if we are not looking. What’s more, coercive control can take many forms including financial and reproductive control.
We need to pay close attention to people who cannot pay their bills themselves because they may not be allowed access to family funds, to people whose partners insist on being present in the consultations (sometimes as interpreters if English is not their first language), and to parents who will not let their children speak with you alone.
Reproductive control is a difficult issue and may be a clue about coercion in other areas. Women presenting reluctantly for termination of pregnancy and women with unwanted pregnancies who are “not allowed” to terminate, provide clear opportunities for further enquiry.
Other control tactics that we may have an opportunity to see include isolation from family and friends, monitoring movements with apps and constant phone calls and deprivation of necessities.
Safety at Home
Probably the most important clue to domestic violence is feeling unsafe at home. Safety in their own home is something everybody deserves. Asking someone where they feel safest may be the best way to initiate a conversation with someone you are concerned about.
These conversations need to be taken very gently. We need to balance a person’s safety with their readiness to talk and act. We need to constantly reassure them that we are there to support them and will help in any way we can. And while we need to express our concerns we also need to progress at a pace they feel comfortable with. It is not going to be helpful if they are afraid of us as well.
Learning More
In 2024 Professor Heggarty joined me for two brief conversational webinars for health professionals about aspects of family and domestic violence which provide excellent insights into how health professionals can help.
You can find these webinars here:
Resources
Resources for victims/survivors:
- Daisy app from 1800RESPECT
- Ask Izzy
- Men’s Referral Service
- Each state has a crisis service
- Primary Health Network – HeathPathways
Resources for health practitioners:
About the author
