{"id":47450,"date":"2020-05-07T18:20:10","date_gmt":"2020-05-07T17:20:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47450"},"modified":"2020-05-07T18:20:10","modified_gmt":"2020-05-07T17:20:10","slug":"domestic-violence-during-the-covid-19-pandemic","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/07\/domestic-violence-during-the-covid-19-pandemic\/","title":{"rendered":"Domestic violence during the covid-19 pandemic"},"content":{"rendered":"<p class=\"standfirst\">At a time when many people are more vulnerable to domestic abuse, healthcare professionals should be extra vigilant of the signs, say Man\u00e1s Dave and Neil Patel<\/p>\n<p><!--more--><span style=\"font-weight: 400\">The World Health Organization (WHO) estimates that <\/span><a href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/violence-against-women\"><span style=\"font-weight: 400\">one in three women<\/span><\/a> experience physical or sexual violence in their lifetime, with the majority of abusers being partners or former partners. The UK media has reported an <a href=\"https:\/\/www.theguardian.com\/society\/2020\/apr\/12\/domestic-violence-surges-seven-hundred-per-cent-uk-coronavirus\"><span style=\"font-weight: 400\">increase in cases of domestic violence<\/span><\/a><span style=\"font-weight: 400\"> since the covid-19 lockdown began, with similar patterns being seen across the world. <\/span><\/p>\n<p><span style=\"font-weight: 400\">In China, a charity estimated that <\/span><a href=\"https:\/\/www.theguardian.com\/society\/2020\/mar\/28\/lockdowns-world-rise-domestic-violence\"><span style=\"font-weight: 400\">90% of all causes of violence<\/span><\/a><span style=\"font-weight: 400\"> 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 <\/span><a href=\"https:\/\/news.un.org\/en\/story\/2020\/04\/1061052\"><span style=\"font-weight: 400\">search engines<\/span><\/a><span style=\"font-weight: 400\"> from people looking for help from domestic violence. It has amounted to what the UN chief Ant\u00f3nio Guterres called a \u201c<a href=\"https:\/\/news.un.org\/en\/story\/2020\/04\/1061052\">horrifying global surge in domestic violence<\/a>.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">The covid-19 pandemic has resulted in a global restructuring of public services, which will have disrupted <\/span><a href=\"https:\/\/www.womensaid.org.uk\/covid-19-coronavirus-safety-advice-for-survivors\/\"><span style=\"font-weight: 400\">sources of support for people experiencing domestic violence<\/span><\/a><span style=\"font-weight: 400\">.<\/span><span style=\"font-weight: 400\"> 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 <\/span><a href=\"http:\/\/www.standingtogether.org.uk\/sites\/default\/files\/docs\/COVID-19%20National%20Health%20Guidance.pdf\"><span style=\"font-weight: 400\">more frequent and of a higher severity<\/span><\/a><span style=\"font-weight: 400\">. The stress generated from health concerns; sudden financial challenges; and the quarantine itself, which <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15324539\"><span style=\"font-weight: 400\">has been shown to increase psychological distress<\/span><\/a><span style=\"font-weight: 400\">, can all negatively affect mental health, wellbeing, and intensify the risk of domestic violence taking place. Other risk factors for domestic abuse <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4768593\/\"><span style=\"font-weight: 400\">include but are not limited to<\/span><\/a><span style=\"font-weight: 400\"> pregnancy, ending of a relationship and someone who is dependent on a carer or disabled.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">If healthcare professionals have concerns about a patient, <a href=\"http:\/\/www.standingtogether.org.uk\/sites\/default\/files\/docs\/COVID-19%20National%20Health%20Guidance.pdf\">guidance from domestic abuse charities<\/a> emphasises <a href=\"https:\/\/pdfhost.io\/v\/EaI78LLgC_IRISi_COVID19_Doc_and_info_sheets.pdf\">the importance of checking that a patient is alone<\/a> 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\u2019s understanding of the situation. For patients who are known to have experienced domestic abuse, <\/span><a href=\"http:\/\/www.standingtogether.org.uk\/sites\/default\/files\/docs\/COVID-19%20National%20Health%20Guidance.pdf\"><span style=\"font-weight: 400\">code words<\/span><\/a><span style=\"font-weight: 400\"> 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Public health authorities need to ensure that all vulnerable adults are protected by including designated refuges or \u201csafe accommodation\u201d sites in their covid-19 contingency plans, and ensuring they remain staffed and open during this lockdown.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Limited awareness of resources and knowledge about domestic violence <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3426604\/\"><span style=\"font-weight: 400\">have been identified as barriers<\/span><\/a><span style=\"font-weight: 400\"> for health professionals enquiring about abuse with patients. Further information is available from the <\/span><a href=\"https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/252276\/9789241511537-eng.pdf;jsessionid=6CB67E0EF5884277D43AD1DA1265CCA3?sequence=1\"><span style=\"font-weight: 400\">WHO Global Plan of Action<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/www.unwomen.org\/en\/what-we-do\/ending-violence-against-women\/facts-and-figures\"><span style=\"font-weight: 400\">United Nations Women<\/span><\/a><span style=\"font-weight: 400\">, and specific advice in the context of covid-19 is accessible from charities such as <\/span><a href=\"https:\/\/www.womensaid.org.uk\/covid-19-coronavirus-safety-advice-for-survivors\/\"><span style=\"font-weight: 400\">Women\u2019s Aid<\/span><\/a><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.\u00a0<\/span><\/p>\n<p><b><i>Man\u00e1s<\/i><\/b><b><i> Dave<\/i><\/b><i><span style=\"font-weight: 400\"> is an NIHR academic clinical fellow in oral and maxillofacial pathology at the <\/span><\/i><i><span style=\"font-weight: 400\">University of Manchester, UK.\u00a0<\/span><\/i><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n<p><b><i>Neil Patel<\/i><\/b> <i><span style=\"font-weight: 400\">is a senior lecturer in oral surgery at the University of Manchester, UK.<\/span><\/i><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>At a time when many people are more vulnerable to domestic abuse, healthcare professionals should be extra vigilant of the signs, say Man\u00e1s Dave and Neil Patel [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/07\/domestic-violence-during-the-covid-19-pandemic\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":47451,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-47450","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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