Talk - Domestic violence still covered by silence

In Australia, one in three women experience violence from the age of 15 and, on average, a woman dies every week at the hands of a partner or former partner.

A 2012 study revealed that one in five Australian women make their first disclosure of domestic violence to their GP.  As the frontline service for identifying and providing management for these women, GP’s are typically the first to uncover the realities of how domestic violence affects mental health as well as physical.

We took a moment to speak with Club Melbourne Ambassador, Professor Jayashri Kulkarni, Director of Monash Alfred Psychiatry Research Centre (MAPrc) – Australia’s largest and most innovative centre for clinical mental health research on the prevalence of mental illness in domestic violence victims, and what initiatives her research centre are creating to support GPs and the wider profession in treating these patients.

Are domestic violence numbers in Australia comparable to global statistics?

Australia does have high incidence rates of domestic violence; however they are also comparable to other western society domestic violence statistics. Women in other countries such as India, are thought to experience even higher violence, but obtaining data has been difficult in many parts of the world. Almost any number would be too high, so I hope Australia can lead the way in reducing the numbers as much as possible.

In your opinion how does mental illness play a role in domestic violence cases?  

Mental illness is a common consequence of violence and unfortunately can be a major ‘downstream’ effect for many years after violence has occurred. Conditions such as depression, anxiety and a form of post-traumatic stress disorder are common results of violence.

In 2014, you ran a one day conference dedicated to domestic violence. What was your motivation for creating that event?

The conference was a joint initiative between MAPrc and Eastern Heath General Practitioners in response to a common observation that GPs found it difficult to broach the subject of violence against women with their female patients. Our one day conference was dedicated to identification, management and prevention of domestic violence. It was designed for primary health and other clinicians to learn how to take a history from their female patients that included sensitive questioning and identification of violent acts against her – and most importantly, what the practitioner can do to better manage the situation.

Was there an increased need for process improvements?

Identification and management of women with violence related mental and physical health issues needs a cross disciplinary approach as still today there is considerable need for greater resourcing in this sector. We also understand that many cases of violence were being missed and doctors felt they were not equipped to do anything meaningful for their patients if they detected violence.  This must be addressed by improving the whole of community approach to prevention and early intervention.

What initiatives and developments came from the conference?

During the conference, we launched a ‘toolkit’ for GPs that sets out how to take an appropriate patient history and detail available resources for patient management in this area of care. We continue to use this educational toolkit for other conference presentations and have recently begun working on a similar toolkit for mental health clinicians as well.

What initiatives are MAPrc creating around family violence?

We currently have several studies underway to better understand health practitioners’ current practices and barriers to identifying and responding to family violence suffered by their patients. We are additionally looking into the extent to which mental health clinicians elicit a history of previous trauma in female psychiatric patients.

Could more be done to support the identification and management of domestic violence victims?

I believe we need a ‘New’ thinking and integration of environmental issues within the existing frameworks for considering treatment for mental ill health in women, particularly where violence is a key factor. We also need to have better facilities in our psychiatric inpatients unit wards. Currently, patients of both genders are managed alongside each other in the same location, and further emotional and or physical violence to women can actually occur whilst they are in care.

If the ‘whole of community’ approach is maintained with the education, Police, judiciary, housing and health sectors working together then the future looks much brighter. Continued universal condemnation of violence against women in both attitudes and by law enforcement is a really significant step for us all to keep taking. Although our conference, subsequent studies and educational workshops provide great impact for patients and clinicians, this work needs to be expanded and continued to be supported.