At a time when many people are more vulnerable to domestic abuse, healthcare professionals should be extra vigilant of the signs, say Manás Dave and Neil Patel
The World Health Organization (WHO) estimates that one in three women experience physical or sexual violence in their lifetime, with the majority of abusers being partners or former partners. The UK media has reported an increase in cases of domestic violence since the covid-19 lockdown began, with similar patterns being seen across the world.
In China, a charity estimated that 90% of all causes of violence during the lockdown were related to the pandemic. Increases have been reported in several other countries too, with data collated from sources such as the number of calls to helplines and the queries entered into search engines from people looking for help from domestic violence. It has amounted to what the UN chief António Guterres called a “horrifying global surge in domestic violence.”
The covid-19 pandemic has resulted in a global restructuring of public services, which will have disrupted sources of support for people experiencing domestic violence. Quarantines and lockdowns have meant that people at risk of abuse are left alone with abusive partners for prolonged and continuous periods. With fewer barriers, abuse may be more frequent and of a higher severity. The stress generated from health concerns; sudden financial challenges; and the quarantine itself, which has been shown to increase psychological distress, can all negatively affect mental health, wellbeing, and intensify the risk of domestic violence taking place. Other risk factors for domestic abuse include but are not limited to pregnancy, ending of a relationship and someone who is dependent on a carer or disabled.
People experiencing domestic violence may seek medical attention for their injuries and clinicians should be alert to non-accidental injuries as a potential cause and initiate further enquiry, as per local protocols, if they deem it appropriate. A complication of the covid-19 pandemic is that many people are avoiding healthcare facilities or having medical appointments deferred to a later date. Consultations are also being undertaken digitally. This can stop people from disclosing their situation to healthcare professionals if their abusers are in close vicinity in their homes. It also means that visible signs of physical abuse will be missed with telephone consultations.
If healthcare professionals have concerns about a patient, guidance from domestic abuse charities emphasises the importance of checking that a patient is alone before making any enquiries. It also recommends that if patients cannot speak English, an official interpreter service should be used and not a friend or family member, as this can form barriers to the disclosure of abuse and a healthcare professional’s understanding of the situation. For patients who are known to have experienced domestic abuse, code words can be devised, which patients can use to inform healthcare staff that their abuser is listening or if they do not feel safe and need help.
Public health authorities need to ensure that all vulnerable adults are protected by including designated refuges or “safe accommodation” sites in their covid-19 contingency plans, and ensuring they remain staffed and open during this lockdown.
Limited awareness of resources and knowledge about domestic violence have been identified as barriers for health professionals enquiring about abuse with patients. Further information is available from the WHO Global Plan of Action, United Nations Women, and specific advice in the context of covid-19 is accessible from charities such as Women’s Aid.
At a time when many people are more vulnerable to domestic abuse and feel trapped by their circumstances, healthcare professionals should be hypervigilant of signs of abuse that can affect any adult or child. This can safeguard some of the most vulnerable people in society and, potentially, help save their lives.
Manás Dave is an NIHR academic clinical fellow in oral and maxillofacial pathology at the University of Manchester, UK.
Competing interests: None declared.
Neil Patel is a senior lecturer in oral surgery at the University of Manchester, UK.
Competing interests: None declared.