Paul McNamara is a GP and honorary clinical lecturer at the University of Glasgow
Anna de Natale is a 4th year medical student at the University of Glasgow
It’s dark outside, and I’m running late as I call my final patient of the day into my room. Mrs J* has been presenting more frequently recently with vague and non-specific symptoms. Usually accompanied with her husband, today is unusual in that she is here alone, and she has fresh bruising to her face, which it seems she has tried her best to cover with heavy-laden make-up. We have slowly built rapport over the preceding weeks, and now I just sit and listen as she weeps and releases a deluge of tears which fall from her beaten, broken eyes. Her story is heart wrenching but sadly not uncommon. As a deep end GP serving socio-economically deprived patients, stories like this are becoming more common.
As GPs we come face to face with domestic abuse (DA) victims and perpetrators regularly, with 1 in 4 women and 1 in 7 men experiencing domestic abuse in their lifetime.1,2
As GPs we come face to face with domestic abuse (DA) victims and perpetrators regularly, with 1 in 4 women and 1 in 7 men experiencing domestic abuse in their lifetime.
With the combination of a global pandemic, cost-of-living crisis and the Government’s austerity measures, over the last few years rates of DA are thought to have increased significantly. As GPs, we are critical players in identifying possible victims (and perpetrators) of DA and signposting them to support – a role that has been made much more difficult by COVID-19.
Between April and July 2020, the number of calls to National Domestic Abuse Helpline saw a 65% increase.3 As well as increased prevalence, people who were already victims of domestic abuse prior to the start of the pandemic reported that COVID-19 had worsened their experiences.4 Lockdown facilitated abusive behaviours; as a result of reduced contact with the outside world, perpetrators had less accountability and were able to carry out more controlling behaviours. Financial hardship and increased unemployment during COVID-19 and the cost-of-living crisis that has followed has given rise to more financial abuse. The barriers faced by victims of DA to access support have been exacerbated by COVID-19 and the cost-of-living crisis and are now harder than ever to overcome.
For many domestic abuse victims, financial hardship during COVID-19 and the current cost-of-living crisis, takes away the possibility of leaving their abusive setting as they do not feel that they are able to financially support themselves (and any dependents).
During lockdown, victims of domestic abuse had reduced access to face-to-face specialist domestic abuse services and for many, remote services were not safe for them to use. Since the end of lockdown and COVID-19 restrictions, specialist services have experienced increased numbers of referrals and increasingly complex cases, associated with more substance dependency and mental health issues, thought to be a direct result of the reduced availability of support during this time.3,4 Services are now struggling with insufficient resources to deal with increased and more complex demand. Furthermore, years of austerity have seen considerable cuts to service funding, and coupled with recent inflation of utility bills, services are struggling to continue.
COVID-19 and the cost-of-living crisis are having profound effects on prevalence of domestic abuse and access to services for victims.
Domestic abuse victims can present to general practice in a variety of ways, with different social and cultural contexts and help-seeking behaviours. Some domestic abuse victims may not feel it is possible for them to receive help at the time. Nevertheless, as a GP, it is critical that this appointment is used to sensitively respond to the patient’s situation and signpost/refer as and where appropriate, if that is the route the patient wants to go down. In order to get to this point, it is essential that GPs feel confident identifying signs of domestic abuse and navigating consultations with victims of domestic abuse.
With the expected increase in domestic violence cases, training on identification and management will be key going forward. Enquiring about domestic abuse into standard clinical practice by asking patients if they feel safe at home may be a quick and simple screening tool. GPs can use resources such as the Women Abuse Screening Tool as a starting point to help guide consultations.5 The SafeLives Dash Checklist6 can also be used by practitioners to identify high-risk victims of domestic abuse.
COVID-19 and the cost-of-living crisis are having profound effects on prevalence of domestic abuse and access to services for victims. As we move further into national financial hardship, it is crucial that primary care, and particularly GP services, are sufficiently equipped and supported to navigate the increased number of domestic abuse presentations. There are fundamental upstream changes needed too, so that GPs have time and resources to support patients. Funding is required for specialist services, and more work is needed to tackle basic and widespread inequalities that many marginalised groups and individuals face accessing and navigating health services.
Editor’s note: Mrs J is a hypothetical (fictional) patient with ‘typical’ presenting features and does not refer to any one individual person who has consulted with the author. See also:
- https://www.bristol.ac.uk/primaryhealthcare/researchthemes/pressure-study/ (accessed 17/11/23)
- https://www.kcl.ac.uk/mental-health-and-psychological-sciences/assets/lara-vp-online-resource.pdf (accessed 17/11/23)
- Women’s Aid. A Perfect Storm: The impact of the Covid-19 pandemic on domestic abuse survivors and the services that support them. Bristol: Women’s Aid; 2020.
- Shadow Pandemic. Shining a Light on Domestic Abuse During Covid. UK; 2021.
- Brown J. Woman Abuse Screening Tool. http://womanabuse.webcanvas.ca/documents/wast.pdf (Accessed 17/11/23)
- SafeLives Dash risk checklist for the identification of high risk cases of domestic abuse, stalking and ‘honour’-based violence. United Kingdom: SafeLives; 2014. Available from: https://safelives.org.uk/sites/default/files/resources/Dash%20for%20IDVAs%20FINAL_0.pdf (Accessed 17/11/23