“The pressure on general practice to be alert for signs of domestic abuse in patients has never been greater”. IRISi interviewed leading researchers and key specialists to talk about the impact of the pandemic on Domestic Violence and Abuse in the UK – and here are 3 responses to our Look Beyond campaign questions from Dr. Eszter Szilassy, Research Fellow at the Centre for Academic Primary Care (University of Bristol).
As we continue with our “Look Beyond the Pandemic” campaign, IRISi interviewed leading researchers and key specialists to talk about the impact of the pandemic on Domestic Violence and Abuse in the UK. Here is what Dr. Eszter Szilassy, Research Fellow at the Centre for Academic Primary Care, Bristol Medical School at the University of Bristol, and a member of the Domestic Violence and Health Research Group, told us.
1) How did the pandemic change the health care response to domestic violence and abuse? What were the main difficulties that clinicians had to face once the lockdown was put in place?
The pandemic is having a detrimental impact on the health and wellbeing of people affected by domestic violence and abuse. As usual routes to support and safety are shut down or limited, general practices play a vital role in responding to patients and families at risk and to suspected cases or self-disclosure.
The pressure on general practice to be alert for signs of domestic abuse in patients has never been greater, and the potential consequences for unsafe or no response never more stark. Yet a drop in consultations during the pandemic has reduced the opportunity for detection. Domestic violence and abuse also remained easily hidden by the many varied presentations around general anxiety linked to the pandemic.
A consultation in a safe space is the key for disclosure of abuse of violence. Yet there has been a shift from face-to-face to phone and video consultations, making it more difficult and potentially dangerous for clinicians to ask about abuse and patients to disclose. In the context of an already heavy general practice workload, the requirement for additional skills and competencies for the management of telemedicine have also emerged.
2) How has the new guidance provided by Royal College of General Practitioners (RCGP) and IRISi has benefited primary care clinicians – and why is that important?
The necessary transition to remote clinical consultations has uncovered a knowledge gap about how GPs can safely ask about abuse, respond appropriately and provide ongoing support. RCGP and IRISi were quick to develop step-by-step guidance for clinicians, raising awareness about the heightened risks and providing advice on overcoming barriers to identification and referral to specialist services. They also recommended that surgeries display information on their patient-facing websites about GP and specialist support available for survivors. These quick interventions, together with the roll-out of COVID-19 GP webinars, helped survivors connect safely with specialist support from very early on in the pandemic.
3) What has the pandemic taught us about the primary care response to DVA? Are there any new insights that have emerged due to the pandemic?
Although early feedback from clinicians indicates that GPs were quick to respond to the new challenges, there is uncertainty about how they adapted their engagement more generally with patients affected by domestic abuse. We also want to understand more about the extent to which clinicians were able to implement national guidance and online training on safe remote consultations. PRECODE, our new study on the GP response to domestic violence and abuse during the pandemic, is exploring the impact of COVID-19 on domestic abuse referrals and patient support. Using practice-level referral data, online clinician training observations and interviews with GPs, practice managers and IRIS Advocate Educators, we are assessing the utility, feasibility and safety of GP responses to violence and abuse during the pandemic and its aftermath. Our findings, we believe, will remain relevant even in more ordinary times as GPs will, no doubt, continue to use remote consultations beyond national lockdowns.
Finally, it is important to add that whilst we are keen to understand the scale and impact of violence and abuse during the pandemic, researchers have been also reminded of the possibility of harm caused by scientific inquiry. The World Health Organization, for example, specifically warned researchers worldwide against measuring abuse in large population-based surveys during the lockdown due to heightened risks to research participants. Others raised awareness about the hidden impact of researching sensitive subjects on researchers during the lockdown and beyond. These recommendations contributed to a more nuanced understanding of the mechanisms and complex impact of domestic abuse and health research. They also led to more innovative research capturing the experiences of survivors, perpetrators, and their children. COVID-19 findings emerging from these studies during the next few months will inform national policy on the general practice response to domestic violence and abuse in the post-pandemic world.
Dr Eszter Szilassy is a Research Fellow at the Centre for Academic Primary Care, Bristol Medical School at the University of Bristol, and a member of the Domestic Violence and Health Research Group. Her research is focused on the primary health care response to domestic violence and abuse.