Domestic violence has huge impacts on our lives. It not only affects the victim, it also has an impact on our community and has an impact on a global level. The impact of domestic violence on an individual depends on the type of violence experienced. For example, victims of physical violence have physical injuries. Victims of sexual violence may have physical injuries depending on the severity of violence. These victims also experience emotional and psychological trauma. Children witnessing domestic violence in households also suffer psychologically. Irrespective of the type of domestic violence, most individuals witnessing an assault or experiencing it suffer from mental health issues. The common mental health issues these individuals suffer from are anxiety and depression.

Domestic violence also has huge direct and indirect effects on our community. It impacts our community health and crime rates. This is because children exposed to domestic violence have trouble learning at school and have reduced social skills due to the emotional trauma they are suffering from (1). As they grow, they are more likely to use violence to solve their problems. This places a threat on the safety and security of our community. Pregnant women suffering from domestic violence are more likely to give birth to low birth weight babies (2). Recent research has shown that underweight babies are more likely to develop insulin resistance, glucose tolerance and high blood pressure as they age, increasing their risk of developing heart problems. This shows the indirect effects of domestic violence on an individual’s health.

Moreover, domestic violence has a global impact. Statistics from World Health Organisation shows 35% of women worldwide have experienced intimate partner violence or non-partner sexual violence in their lifetime (3). Many pregnant women, particularly those aged 15-49 have experienced a certain form of domestic violence (physical, emotional or sexual assault) in different countries (4). Research shows that a third of women experience domestic violence in low income countries compared to one in four women in developed countries. The rate of domestic violence in Australia is not much lower than the rates in developing countries. This places an economical burden on our economy as $13.6 billion is spent yearly on domestic violence in Australia (5).

Thus domestic violence is a prevalent and silent issue. It is important for us to be aware of it and promote it for the better wellbeing of individuals suffering from it, and for the better wellbeing of our community and globally.

References:

(1) Community.nsw.gov.au. 2014. effects of domestic violence. [online] Available at: https://www.community.nsw.gov.au/docs_menu/parents_carers_and_families/domestic_and_family_violence/effects_of_domestic_violence_.html [Accessed: 4 Apr 2014].

(2) Community Impact of Domestic Violence. 2014. [e-book] https://pathssk.org/wp-content/uploads/2011/04/Community-Impact-of-Domestic-Violence2.pdf [Accessed: 4 Apr 2014].

(3) Who.int. 2014. WHO | Violence against women. [online] Available at: https://www.who.int/mediacentre/factsheets/fs239/en/ [Accessed: 4 Apr 2014].

(4) Profiling Domestic Violence- A Multi-Country Study. 2014. [e-book] https://dhsprogram.com/pubs/pdf/OD31/OD31.pdf [Accessed: 4 Apr 2014].

(5) Browne, R. 2013. Domestic violence becoming 'greatest social epidemic of our time'. [online] Available at: https://www.smh.com.au/national/domestic-violence-becoming-greatest-social-epidemic-of-our-time-20130622-2op6c.html [Accessed: 4 Apr 2014].

Anybody can experience domestic violence throughout their lifetime. That said, factors such as gender, age, socioeconomic status (SES), and previous exposure to abuse can increase the risk of experiencing domestic violence. It is recognised that younger and middle aged women in particular, who are in the lowest SES bracket are at increased risk of experiencing domestic violence (1). Lack of appropriate services and resources, and difficulty accessing existing services are also factors that can exacerbate the issue, particularly for women living in rural or remote communities (2). Some (rural) communities, for example, lack healthcare, transportation and access to resources (3). In Australia, Indigenous women are also more likely to have been exposed to domestic violence in their community (1). The aforementioned factors are often 'upstream' issues that reflect systemic social and structural inequities.

Gender inequality is still a global issue, and even in developed countries such as Australia, women have not yet achieved equal status to men despite ongoing reform (for example, a woman's salary remains lower than a man's for performing an identical role, across all vocations). Also, women who attempt escape from the cycle of abuse with their children are at risk of homelessness and disruption of a children’s routine (4). The severe financial strain is likely to create a cycle of poverty for a single mother, as children may grow up in an impoverished environment with diminished opportunity for upward mobility.

From the perpetrator's perspective, factors that are more likely to lead to acts of violence include substance abuse (particularly alcohol) (4), low SES and education level (1), and exposure to domestic violence as a child (6).

The factors underpinning domestic violence – for both the abused and the abuser – are complex and multifaceted, and require a concerted effort from government, society, and community to break the vicious cycle.

(1) Mouzos J, Makkai T. Women’s experiences of male violence: Findings from the Australian component of the International Violence Against Women Survey (IVAWS) [Internet]. Canberra: Australian Institute of Criminology, Research and Public Policy Series; 2004 [cited 2014 April 5]. Report No.: 56. Available from: https://www.aic.gov.au/publications/rpp/56/

(2) The Women's Services Network (WESNET) 2000. Domestic vioolence in regional Ausralia: A literary review. Canberra: Australian Government [Internet]. 2000 [cited 2014 April 12]. Available from: https://www.wesnet.org.au/publications/reports/0006RuralandRemote_report.pdf

(3) Asay S. Awareness of domestic violence within the evangelical community: Romania and Moldova. Journal of family violence. [Internet]. 2011 [cited 2014 Apr 8]; 26(2): 131-138. Available from: SpringerLink

(4) Marcus G, Braaf R. Domestic and family violence studies, surveys and statistics: Pointers to policy and practice. Sydney: Australian Domestic and Family Violence Clearinghouse [Internet]; 2007 [cited 2014 April 5]. Available from: www.adfvc.unsw.edu.au/rtf%20files/stakeholderpaper_1.rtf

 (6) Tomison A. Exploring family violence: Links between child maltreatment and domestic violence. Sydney: Australian Domestic & Family Violence Clearing House [Internet]. 2000 [cited 2014 April 8]  Report No.: 13. Available from: https://www.aifs.gov.au/nch/pubs/issues/issues13/issues13.pdf

The Governments in Australia have implemented a number of programs and policies on a Commonwealth, State and Territory level (1).  Each jurisdiction across the country fully support, both social and economically, the current programs which focus on the key strategies of primary precention, support and law enforcement (2)

National hotlines for victims such as '1800 RESPECT', 'Respectful Relationships' programs and increased efforts into research exploring abuser behaviour are examples of Government implemented initiatives through 'The National Council's Plan of Action". Police now have more power to arrest domestic offenders, on reasonable grounds, thanks to the Governments increased emphasise on law enforcement as a method of primary prevention (2). 

Primary prevention is now the MAIN FOCUS of Governments to really tackle the issue of Domestic Violence in Australia (4).

But is this enough?

These prevention methods are currently focussed on women and children. Women and children are not the only ones who experience domestic violence. Men experience is too. Although men are less likely to be victims, the violence they experience is no less severe than their female counterparts. Despite this, there is a lack of support for men as victims (5). 

What about sentecing of offenders?
Those that are most often convicted of common assault are given an unsupervised good behaviour bond (7).  Is this enough to protect victims and prevent re-offending? Recommendation has been made that there be a national standad for sentencing offenders as currently each State and Territory government has there own laws on sentencing. A standard would ensure sentences given match the seriousness of the offence (6). 

How about resources for health practioners?
Inefficiant analysis of current tools is preventing clinical research and practice in the area of domestic violence. Valuable knowledge from practioners based on their experiences of domestic violence proves to be an excellent resource for other practioners, however, these resources are not easily accesible. If the problem is to be dealt with at an individual level then there needs to be an appropriate platform for practioners to access this information to directly make a positive impact on those affected by domestic violence. (8)

So, do you think enough is being done to tackle the issue?  Have Your say

Resources: 

1.         AGS. Domestic Violence Laws in Australia. In: SocialServices, editor. The Australian Department of Social Services website2009. p. 1-258.

2.         Mitchell L. Domestic violence in Australia - an overview of the issues. In: ParliamentaryServices, editor. Parliament of Australia website: Parliamentary Library 2011. p. 29-37.

3.         NCRVWC. Time for Action: the National Council's plan for Australia to reduce violence against women and their children 2009-2021: FaHSCIA; 2009 [cited 2014 5 April 2014]. Available from: https://www.fahcsia.gov.au/sa/women/pubs/violence/np_time_for_action/national_plan/Pages/default.aspx.

4.         VicHealth. Preventing violence before it occurs: A framework and background paper to guide primary prevention of violence against women in Victoria In: Health, editor. VicHealth website: Victorian Health Promotion Foundation Melbourne 2007. p. 14.

5.         NSW, Parliament. Domestic violence trends and issue in NSW/Standing committee on Social Issues. In: LegistlativeCouncil, editor. Parliamentary Website2012. p. 32.

6.         ALRC. Family Violence - A National Legal Response. In: Attorney-General, editor. Sydney: NSWLRC; 2010. p. 509-43.

7.         Ringland C, Fitzgerald J. Factor which influence the sentencing of domestic violence offenders In: Bureauofcrimestatisticsandresearch, editor.: NSW Bureau of Crime; 2010. p. 1-12.

8.         Robinson E, Moloney L. Family Violence: Towards a holistic approach to sceening and risk assessment in family support services. Austrailian Family Relationships Clearinghouse, 2010. Report No 17

Domestic violence can happen to anyone.
If you think it’s happening to you or someone you know it’s important to know that there is help and support available.   

The first step to getting help is recognising the abuse.
If you are fearful of your partner, feel controlled and have feelings of desperation and helplessness, you may be in an unhealthy and abusive relationship. People often associate domestic violence with physical abuse, however, it is multifaceted. For instance, you can still be emotionally or psychologically abused without being battered and bruised. The psychological consequences of domestic violence and abuse are just as severe as the physical injuries you may or may not sustain(1).
For more information on how you can get help with recognition of domestic violence and other excellent resources including hotlines and specific information for women, men, teens, immigrants and for people in same sex relationships head to https://www.helpguide.org/mental/domestic_violence_abuse_types_signs_causes_effects.htm

Why do people stay in abusive relationships? With regards to women, if they are in an abusive relationship and are asked why they stay, they may be made to feel as though they are responsible for the abuse they experience. Reasons why women stay in abusive relationships are complex. Some women fear for their children or other family members if they were to leave, others feel responsible for their partner’s wellbeing despite the abuse they experience and some also have a deep sense of reliance on their partner. Women may even stay in these relationships based on their cultural experiences or upbringing, which has moulded their views towards abusive relationships (2).  Some people genuinely believe that staying in the relationship would be better for them than not having one at all (3).

If this sounds like you or someone you know then it’s time to act.

It may seem difficult to remove yourself from an abusive relationship, especially if you identify with some of the aforementioned reasons why women stay in relationships but its important to know that something can be done about it. You don’t have to experience the abuse any longer. There is a way out and there are many excellent resources to guide you through the process including https://www.leavingabuse.com/domestic_abuse/poa.html which offers step by step action on how to leave an abusive relationship as well as https://www.helpguide.org/mental/domestic_violence_abuse_help_treatment_prevention.htm which offers other ways youcan remove yourself from danger. 

If you are in IMMEDIATE DANGER call 000

Here is a list of national hotlines you can call if you feel you are unsafe or would like more information:
1800 RESPECT (1800 737 732): 24 hour, National Sexual Assault, Family & Domestic Violence Counselling Line
Lifeline  (24 hours) 131 114
Mensline Australia 1300 78 99 78
Kids Help Line Freecall: 1800 551 800. E-mail and web counselling www.kidshelp.org

If you believe someone is in an abusive relationship, it may be difficult to approach the person about your suspicion. Visit
https://www.bethehero.com.au/index.php?id=13
for excellent tips on how to deal with a someone you feel is being abused including signs to look out for and a list of “Do’s” and “Don’ts”. 

1.         Melinda S, Jeanne S. Domestic Violence and Abuse - Signs of Abuse and Abusive Relationships Internet2014 [updated February 2014; cited 2014 24 March 2014]. Available from: https://www.helpguide.org/mental/domestic_violence_abuse_types_signs_causes_effects.htm.

2.         Compelling Reasons Women Stay 2014 [cited 2014 24 March 2014]. Available from: https://www.domesticabuseproject.com/get-educated/compelling-reasons-women-stay/.

3.         Pamela C, Leanne, L. Stay/leave decision-making processes in abusice dating relatinships. Personal Relationships. 1999;6:351-67.

We all know that domestic violence has an adverse impact on the health and wellbeing of victims and theirfamilies. We also know that it is illegal to commit such acts of violence. However, in most states (Northern Territory being the exception (1), it is not mandatory for health professionals to report suspected or known adult abuse resulting from domestic violence.

Mandatory reporting, as enacted by the NT, is highly contentious and questions whether this further depletes a woman’s autonomy to decide on the best course of action with regards to her (and her family’s) safety and wellbeing. It also introduces potential for further danger in the home where police following up a report of domestic violence can exacerbate retaliation by the perpetrator against their partner, as well as introducing fear of having children removed from home or the process resulting in homelessness (2). In addition, health professionals and others are also concerned that women will avoid seeking treatment or legal advice based on mandatory reporting measures, preferring to keep their affairs private.

Across all states, it is also mandatory for health professionals to report suspected child abuse. Depending on the state in which you are practicing, however, the definition of child abuse may include exposure to domestic violence (3). Given that domestic often occurs in a family setting where children are present, is important to consider how a child’s health is impacted on with exposure to domestic violence (regardless of whether the child is directly exposed to acts of violence or is witness to them). The Royal Australasian College of General Practitioners (RACGP) has published an excellent resource for General Practitioners on how to address, manage and assist patients who experience acts of violence, including children, the elderly, and Indigenous persons. The Department of Health website provides a response guide for health practitioners specifically dealing with women who are pregnant and experiencing intimate partner violence.

So at what point should a health practitioner step in and break patient confidentiality? There is no clear answer to this question, and the decision that a health professional makes with respect to mandatory reporting of domestic violence is fraught with ethical, as well as legal, consequences. It is also important to remember that if you are working for an organisation or institution, such as a hospital, you are obligated to follow the employee guidelines. The Department of Health WA has a resource manual for managing patients in hospital who may be experiencing domestic violence. The manual mentions that in the context of upholding patient safety, patient confidentiality must be weighed against duty of care (4). Again, immediate threat to life appears to be the driving factor in making the decision to report the incident to police where a patient does not consent to the disclosure of information.

The bottom line is that a patient’s health and safety is the health professional’s priority, and that the more equipped we are to deal with such incidents, the more confident we will be in supporting the patient experiencing domestic violence to seek out options unique to their situation.

Would you like to know more?

DV-alert is a Domestic Violence Response Training government funded course for health professionals (and students in relevant disciplines). It is run by Lifeline and teaches health professionals how to recognise, respond to and refer patients to the appropriate services. They also have an online E-Learning module that covers the topic in greater detail.

There are many victims of domestic violence. Victims of domestic violence are often women (from violence amongst partners) and children (from child abuse or witnessing violence at home). Did you know, victims of domestic violence not only suffer from the actual violence, but also suffer from mental health problems? This is mainly due to lack of support and loneliness. There are two types of loneliness, emotional loneliness and social loneliness. Emotional loneliness is at an individual level of loneliness, in which victims lack sufficient attachment relationships. Social loneliness is a community level of loneliness where the victim may not have a strong support network or peer groups for support. Studies have shown that both types of loneliness have an impact on the mental health of domestic violence victims.¹ The most common mental health issues experienced by these victims are anxiety and depression. Anxiety is an important part of human behavior. We usually have low levels of anxiety as it encourages us to engage with others. However, at high levels, anxiety may affect our functioning in daily life. Depression is related to disruptions in our interpersonal relations, causing sadness and demotivation to engage in everyday activities. A study on physical violence experienced by women in dating relationships showed a correlation between the amount of violence suffered by the victim with the severity of anxiety and depression they experienced. Victims suffer from anxiety and depression as domestic violence affects their self confidence and their ability to function as normal individuals. It takes away their security of feeling protected and results in them feeling helpless, ultimately leading to anxiety and depression.² Women experience greater domestic violence than men, hence are more vulnerable to mental health disorders. This may accumulate over time, ultimately leading to suicide. Women are more vulnerable mainly as male dominance is present in some cultures. Whilst we are unable to change their cultures, it is important to be aware of such issues women are facing worldwide so that we are able to take small steps to ultimately make a difference. On the other hand, children exposed to interparental violence show short-term and long-term mental health issues. Greater severity and duration of violence may lead to the development of posttraumatic stress disorder in both children and adults. This causes victims to re-experience the trauma, persistently avoid stimuli associated with trauma and experience persisting hyper arousal (hence have issues with concentration and sleeping). This may continue in adulthood even after victims are no longer witnessing domestic violence.³ Imagine living a life with high level of vigilance and no sense of calm, would you want to live it? If your answer is no, then help us make a difference.

1. Kunst, M., Bogaerts, S. and Winkel, F. W. (2010) ‘Domestic violence and mental health in a Dutch community sample: The adverse role of loneliness’, Journal of Community & Applied Social Psychology, vol. 20, pp. 419–425 [Online]. Available at: https://onlinelibrary.wiley.com.ezproxy.library.uwa.edu.au/doi/10.1002/casp.1040/full (Accessed: 17th March 2014).
2. Yalch, Matthew M ; Lannert, Brittany K ; Hopwood, Christopher J ; Levendosky, Alytia A (2013) ' Interpersonal Style Moderates the Effect of Dating Violence on Symptoms of Anxiety and Depression', Journal of Interpersonal Violence, vol. 28(16), pp. 3171-3185 [Online]. Available at: https://jiv.sagepub.com.ezproxy.library.uwa.edu.au/content/28/16/3171.full.pdf+html (Accessed: 17th March 2014).
3. Mathilde M Overbeek, J Clasien de Schipper, Francien Lamers-Winkelman andCarlo Schuengel (2012) The effectiveness of a trauma-focused psycho-educational secondary prevention program for children exposed to interparental violence: study protocol for a randomized controlled trial’, Trials Journal, vol. 13(12), [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369208/ (Accessed: 17th March 2014).