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Domestic Abuse Is a Public Health Concern

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Domestic abuse has become an entrenched public health issue. NICE statistics show the alarming impact upon society, with 1 in 3 women and 1 in 6 men being affected by domestic abuse. 

Tavistock Relationships explains the importance of halting the abuse before it escalates, as fear and control is instilled into the victim as the cycle of abuse continues. Many victims do not report their abuse due to fear of their safety or others. The common questions for victims are ‘why did you stay? Why did you not leave?’. However, leaving is not an option; it is a change in mindset, a process that is ultimately required. A process which can take months or years for the victim to build the courage needed to escape and report.

Domestic abuse is gender and sexuality neutral, resulting in any potential relationship dynamics to develop an uncontrollable unbalanced level of power. The UK has reviewed policies on several occasions, increasing sentencing, improving support, and training to assist in identifying potential victims of abuse. However, policies such as ‘End Violence Against Women and Girls 2010 to 2015’ may discourage male victims from seeking support, as the policy title emphasises the misconception that domestic abuse is only a female concern. In 2018 a review of policy had begun, ‘No Defence for Abuse: Domestic Abuse Strategy 2018–2023’, focusing on prevention, intervention and partnering strategies to ensure awareness of domestic abuse is raised across the UK. This is in accordance with domestic abuse existing as a hidden disease of society, happening behind closed doors.

Various campaigns have been launched to tackle this public health concern, with the latest report of ‘A Cry for Health’ being published in 2017. More specifically, SafeLives found the importance of locating specialist trained domestic abuse support workers at accident and emergency (A&E) and maternity units to empower people to report their abuse. However, not all victims will attend A&E. Domestic abuse is an umbrella term that can include a variety of abuse; psychological/emotional abuse, coercive control, physical, financial, harassment/stalking, and online abuse.

Further education within various healthcare settings such as hospitals, GP’s, dentists, therapists, and pharmacies could improve the potential of identifying a domestic abuse victim. Primarily, domestic abuse training has often focused on physical signs of abuse (bruises, cuts, wounds). However, additional training is needed to understand the psychological abuse victims suffer, reviewing the victim’s behaviour. While training focusing on noticeable marks and behaviours could prompt the staff to provide a leaflet or discuss in private their concerns. Even though on initial contact, the victim may not disclose due to lack of confidence or disbelief of their abuse, it is a conversation starter. Some victims do not receive life-threatening injuries or require medical attention; however, they may attend a pharmacy for pain relief medication or see their dentist on several occasions for broken or chipped teeth. Repetitive visits to these settings could ‘red flag’ the situation and prompt the staff to delicately and sensitively enquire.

Currently, systems are in place, with healthcare professionals being trained on safeguarding and domestic abuse awareness. However, these training sessions need to be more intense to emphasise that not every victim will demonstrate the same ailments. Additionally, more training for professionals is needed, to encourage them to ask the questions such as: ‘Is everything OK at home?’. Victims may not disclose the first time or the second, but it will begin to break down the stigma and may encourage the victim to seek support when they are ready. This is notably because often victims are unaware that they are in an abusive relationship, especially if no physical abuse is involved.

To assist in tackling this public health concern, the development of a gender-inclusive approach needs to be adopted. Consequently, the re-development of policies could empower more male victims to report their abuse. Significantly, the Office for National Statistics ₃ reveals that in 2014/15 that there were 1.3 million female victims of domestic abuse and 600,000 male victims, calculating for every three victims there were two females and one male. As an extension, Trust for London explains figures are equating to an alarming £5.5 billion per annum being spent on physical and mental health services (£1.6bn), criminal justice (£1.2bn) and housing and refuge costs (£185.7m). With the current overstretching of budgets for the provision of adequate care within the NHS and public health service, tackling this ongoing problem could save millions and save lives. Alarmingly, Trust for London explains with an economic output loss of £1.8 billion per annum, which is an increasing yearly and ongoing problem, could result in irreversible damage to the economy, in particular assisting in another potential recession.

In consideration of Maslow’s hierarchy of needs, clearly without meeting the basic needs of life: safety and physiological needs, which is often stripped from a victim, they are then trapped in the circle of ongoing abuse. This, in turn, stunts their ability to realise their true capabilities. Everyone should have the opportunity to meet their potential. Tackling domestic abuse at the root causes can assist in the prevention of long-term economic issues and potential physical and psychological damage to the victims.

Due to economic issues which may be faced by the families such as loss of work, unemployment, the struggle for provisions of a balanced diet, the World Health Organization₇ research suggests these can increase the risk of family conflicts, resulting in domestic abuse. Thus, increasingly emphasis is placed towards Public Health England to tackle this evergrowing problem.

Domestic abuse causes ripples throughout the healthcare system, housing, and employment. It does not only affect the victim, but it also affects the families and friends of the perpetrator and victim, which is a hidden cost of the burdens of the abuse. Families and friends may require therapy, in particular children. Until domestic abuse is tackled as a gender-neutral approach, the statistics will never demonstrate the actual cost of domestic abuse – life or financial cost. Ultimately, domestic abuse is not an in-house issue; although it happens behind closed doors, the impact affects everyone.

Natalie Quinn-Walker is a PhD researcher focusing on male domestic abuse victims and family structures. You can connect with Natalie on Twitter @QUINNWA91648884.

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