We all have specific images that come to mind when we hear the term intimate partner violence or the more widely used term domestic violence. Common pictures include women suffering under the control and abuse of their husbands, men who are subjected to verbal and physical abuse by their partners and the emotional trauma suffered by children who witness these acts in the home.
The National Institute of Justice and Centers for Disease Control estimates that between 20 percent and 30 percent of women and 7.5 percent of men will be the victim of IPV at some point in their lives. Up to 10 million violent home-based episodes per year are witnessed by children. These shocking statistics, along with the long-term effect in the community easily add up to IPV being a public health crisis.
We all know IPV occurs — most of the time behind closed doors where the violence can go on for years, harming all involved and very often continuing an insidious cycle that the children in the household may unconsciously carry into their own adult relationships. Very often outside family members and friends are either in denial of the abuse, somehow accept it as “normal,” simply do not “see it,” or are intimidated into not intervening. Those who do step up and offer assistance to the victim can get frustrated when things don’t change right away.
This is why a public health movement needs to occur. Victims of this abuse present a multitude of health problems. This includes not only direct injuries from the violent acts they have sustained but neck/back pain, chronic ulcers, headaches/migraines, gynecological problems, arthritis/joint problems, pregnancy complications, irritable bowel syndrome and digestion issues. In addition, victims have higher rates of HIV and sexually transmitted diseases than the rest of the population. Psychologically, rates of depression, anxiety, post traumatic stress disorder, homicide, suicide and substance abuse are higher in victims of IPV abuse. Consequences can continue for years following the end of the abuse. These problems can result in ongoing issues that cost our island millions of dollars per year in emergency and on-going medical care as well as the “hidden” costs passed on to our children. Our health care and social service systems has the ability to play an important role in helping to stop this violent cycle.
Sooner or later most individuals will seek out medical or social service care in some form, be it a school physical, hospital visit (whether injuries form abuse are present or not), dentist appointments, or counseling sessions. While some health care/social service organizations have taken the initiative to offer tips to their employees and volunteers for identifying IPV and strategies for referring those clients, few have created formal guidelines and protocols to screen and intervene in these situations.
Additionally, facilities that should be prepared to identify and respond to IPV victims include all of those in public health settings, substance abuse centers, schools, rehab/occupational settings, and social service non-profits (after school programs, foster care agencies, parenting programs etc).
Standardized confidential screening of everyone for IPV at all health care/social service facilities on our island could go a long way in addressing IPV issues. Research indicates that routine face-to-face inquiry by skilled service providers can identify victims much more efficiently than a question on a form. Providers also need to be given the tools to assist in assessing the victim’s specific situation including appropriate referrals for intervention and care to take place. Even when a patient does not disclose abuse the first time they are asked, repeated screening allows for future opportunities to disclose and creates a supportive environment where an eventual disclosure will feel “safe.”
There is no question that domestic violence/intimate partner violence is a profound public health issue. We have the opportunity as a community to share resources between organizations and offer a continuity of care. It is up to each of us who works or volunteers for a health related organization to raise these issues and request any help needed to put these important steps in place.