Introduction by Croakey: Over the weekend, the UK became the latest jurisdiction to report a surge of domestic domestic and family violence during the COVID-19 crisis, with massive increases in approaches to helplines for both victims and perpetrators after the start of the UK’s lockdown.
This is consistent with international experience.
Here in Australia where we already have high rates of domestic and family violence, emergency department staff are often the conduit to assessment and referral, when women present with injuries or other related problems.
But what happens when presentations are a little different, work practices and interactions with patients change, priorities shift, workload blows out and referral pathways become uncertain as a result of an infectious disease crisis?
Global health lawyer Dr Janani Shanthosh spoke to some front line health workers in a public hospital, to gauge their concerns.
Janani Shanthosh writes:
As emergency departments come under unprecedented stress from the COVID-19 crisis, more must be done to support staff on several fronts, including maintaining their ability to identify and assist women facing domestic and family violence (DFV).
Women are known to disclose abuse in Emergency Departments (EDs) where a multidisciplinary team can organise a risk assessment, and referral to services that will support the woman’s health and safety.
However diverse sectors of the health workforce have expressed concerns that during the current COVID-19 pandemic, when victims of DFV present within frontline health services, including hospitals, women’s health centres and shelters, these services may not have the capacity to provide adequate care.
The rapid increase in unemployment, 30% increase in bottle shop sales, and lax restrictions on the amount of alcohol Australians can buy by major bottle shops, have also led peak bodies to express their concern that rates or severity of DFV will increase.
With many women’s shelters having already reached capacity, DFV experts are also concerned that as child protection concerns arise, there may be limited referral options.
The National Cabinet has identified the potential for increased family violence as a problem in this emergency, and has approved an initial $150 million for two national telephone counselling services.
But people working on the frontlines of gender-based violence point out that at this time when people are confined to their homes, it will be harder than ever to safely use a hotline service.
The hospital workers I spoke to need to remain anonymous, but they gave their permission for their comments and concerns to be shared.
Social isolation will increase the vulnerability of women and children in family violence situations
One clinical psychologist confirmed to me that this would indeed be a critical time for emergency department staff to be able to identify family violence, saying:
With the increased financial stress, social isolation and time spent working at home due to COVID- 19 already pressurised family dynamics are going to be challenged even further.”
A lack of protocols for women and children who need emergency accommodation during this pandemic
A social worker with experience caring for acute presentations in ED expressed growing concerns among their colleagues, saying:
I would hope that the surge in COVID patients would not mean that staff neglect to still ask the appropriate questions and assessments, however, nobody knows how bad it will get and if it’s too much for somewhere like ED to handle.
I am sure these people will fall through the cracks or maybe even feel they aren’t worthy enough to ask for help given what society is dealing with.”
A lack of resourcing of the community sector as a whole to deal with the crisis
Another social worker with experience in ED said they were concerned about the potential lack of referral options, such as emergency accommodation, and the ability of those services to provide safe services now.
It scares the crap out of me that we simply will not have any space, time or resources to even have the capacity for these women and homeless people to walk through our doors because we will be inundated with critically unwell patients. I don’t think the community sector is set up to support these people,” this person said.
Also, there will be nothing left in our government budgets for anything for these people – they will throw all their money into the health system for now.”
With added pressures on the medical system, staff may forget to assess for DFV
When staff are so stretched, there’s a risk that assessment for family violence may be overlooked. As one social worker told me:
We can’t just push aside the everyday problems we see just because there is a larger scale problem at hand. There would need to be an increase in staff (nurse or doctors) and education from us social workers as well to remind them to refer to us in those situations.”
Frontline services need support to fill the gaps
The coronavirus pandemic has the ability to overwhelm Australia’s health system and exacerbate barriers to accessing help for DFV. Governments must work with peak DFV bodies and professional organisations responsible for training and educating the health workforce now to develop plans that will help staff respond to every patient’s needs.
This means preparing for the lack of availability of treatment settings and overflow facilities, to ensure services have the capacity to consistently follow DFV screening protocols and that throughout the pandemic, victims can be sure privacy and confidentiality are maintained.
Given the right support, DFV frontline services can find innovative ways of coordinating to identify and fill gaps in service provision as well as evaluating management plans on a regular basis to ensure they are fit for purpose.
The widespread social impacts of this pandemic are unprecedented – but we can ensure that, even in this resource-constrained environment, victims of DFV have every possible opportunity to be heard and receive care.
Dr Janani Shanthosh is a global health lawyer and Research Fellow at The George Institute for Global Health, and Academic Lead of the Health and Human Rights Program at the Australian Human Rights Institute. Twitter: @janshanthosh