Emma Williamson

Background: General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA), and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID- 19 pandemic, there has been a reduction in DVA identifications and referrals to specialist services from general practice. Concurrently there has been the imposition of lockdown measures and a shift to remote care in general practices in the UK.Aim: To understand the patient perspective of seeking and receiving help for DVA in general practice during the COVID-19 pandemic. This was then compared with experiences of general practice healthcare professionals.Design and setting: A qualitative interview study in seven urban general practices in England and Wales, as part of a feasibility study of IRIS+, an integrated primary care DVA system-level training and support intervention.Method: Semi-structured interviews with 21 patients affected by DVA and 13 general practice healthcare professionals who had received IRIS+ training. Analysis involved a Framework approach.Results: Patients recounted positive experiences of seeking help for DVA in general practice during the pandemic. However, there have been perceived problems with the availability of general practice and a strong preference for face-to-face consultations, over remote consultations, for the opportunities of non- verbal communication. There were also concerns from healthcare professionals regarding the invisibility of children affected by DVA.Conclusion: Perspectives of patients and their families affected by DVA should be prioritised in general practice service planning, including during periods of transition and change.

Background: Domestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs.Methods: Qualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken.Results: Interviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action.Conclusion: GPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

Following lockdowns in countries around the world, reports emerged of a ‘surge’ or ‘spikes’ in the number of domestic violence and abuse cases. It is critical to contextualise this: more men are not starting to be abusive or violent; rather, the patterns of abuse are becoming more frequent. Spiking and surging make us think in terms of more one-off incidents but it is more likely that the pattern of abuse that is already there is increasing in terms of frequency and type because both parties remain together at all times. Amid such a crisis, it is imperative that we continue to see the dynamics of domestic violence and abuse as both a pattern of abusive behaviours and a product of gendered social and cultural norms, rather than a reaction to a specific factor or event, such as COVID-19.

Many women who experience domestic violence (DV) seek support from friends, relatives, colleagues, and neighbors. There are substantial knock-on effects for informal supporters, and they may seek help themselves. Tailored services for this group are rare, but DV helplines can provide listening and signposting support. The aim of this exploratory study was to understand which informal supporters contact DV helplines and what form these calls take. Three focus groups, following a topic guide, were conducted with staff and volunteers for DV helplines during autumn 2015. Discussions were digitally recorded, transcribed verbatim, and imported into NVivo10 software. Transcripts were coded line-by-line, and a thematic analysis carried out. All participants were female, aged between 22 and 54 years, with between 2 months’ and 8 years’ experience of taking helpline calls. Findings indicate that people with broad ranging connections to a survivor call a helpline. Calls can be triggered by disclosures, abuse escalation, witnessing incidents, feeling overwhelmed, and media highlighting of DV. Informal supporters respond to survivors, and experience impacts, in differing ways, often associated with their gender and their relationship with the survivor. Frequently, they feel a sense of responsibility and a desire to rescue the survivor, often calling a helpline to reduce feelings of helplessness and to seek a “magic” solution. Many people are concerned about the legitimacy of their involvement and seek reassurance about the validity of their own help-seeking. Helpline workers feel that informal supporters would benefit from opportunities to reduce isolation, have their predicament acknowledged, and learn from peers. DV helplines have an important role in helping informal supporters of survivors. The help requested is predominantly to equip and empower the informal supporter, so that they feel more adept at coping themselves and, are thus, better able to offer support to the survivor.

Objectives: To understand help-seeking by male victims of domestic violence and abuse (DVA) and their experiences of support services by systematically identifying qualitative and mixed-method studies and thematically synthesising their findings.Design: Systematic review and qualitative evidence synthesis. Searches were conducted in 12 databases and the grey literature with no language or date restrictions. Quality appraisal of the studies was carried out using the Critical Appraisal Skills Programme tool. Reviewers extracted first and second order constructs related to help-seeking, identified themes and combined them by interpretative thematic synthesis.Setting: DVA experienced by male victims and defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse among people aged 18 or over who are or have been intimate partners or family members, regardless of gender or sexuality.Participants: Male victims of DVA.Interventions: Any intervention which provides practical and/or psychological support to male victims of DVA including but not limited to DVA-specific services, primary healthcare and sexual health clinics.Primary and secondary outcome measures: Qualitative data describing help-seeking experiences and interactions with support services of male victims of domestic violenceResults: We included twelve studies which were published between 2006 and 2017. We grouped nine themes described over two phases (a)barriers to help-seeking: fear of disclosure, challenge to masculinity, commitment to relationship, diminished confidence/despondency and invisibility/perception of services; and (b)experiences of interventions and support: initial contact, confidentiality, appropriate professional approaches and inappropriate professional approaches.Conclusion: The recent publication of the primary studies suggests a new interest in the needs of male DVA victims. We have confirmed previously identified barriers to help-seeking by male victims of DVA and provide new insight into barriers and facilitators to service provision.PROSPERO registration number: CRD42016039999.

Domestic violence and abuse (DVA) can include physical, psychological, sexual, emotional or financial abuses, and is a globally widespread problem across all age groups, cultures and socioeconomic groups. Alongside the impacts of DVA experienced by survivors, there is a growing recognition that other people, who form the support network of survivors, may also be affected by the situation. Domestic violence organisations such as helplines are important third sector services supporting survivors. However, there has been little research into the impact on those providing the support. This qualitative study of domestic violence helpline workers explored their needs and well‐being. We used qualitative methodology, conducting interviews with staff recruited from a selection of different helplines who all undertook direct client‐focused work. The interviews used a semi‐structured format and followed a topic guide covering the training received before commencing work, self‐care strategies, the impact of work on their daily life and support offered by their employer. Ten helpline staff were interviewed, all female. Following analysis of the qualitative data, a number of themes emerged. Participants disclosed numerous ways in which their work challenged their well‐being, including burnout, impact on personal relationships, and lack of training and support at work. Participants used some self‐care strategies in order to “switch off” from work, but they also wanted clinical supervision to support them with the difficulties they experienced at work. This study suggests that helpline staff should receive more education about trauma triggers, and ongoing support to reduce the impact on their home and social life, thus improving mental well‐being and job satisfaction. This work begins the debate on the well‐being needs of frontline helpline workers, and whether better meeting these needs can facilitate the provision of better support.

This paper presents a narrative review of empirical evidence looking at connections between poverty and DVA. The findings presented includes social survey and qualitative evidence from the UK, and elsewhere where relevant, and is drawn from more than 80 research studies. The material was collated and supplemented by further secondary analysis of data collected as part of the 2012 UK Poverty and Social Exclusion Survey. Our review suggests that women experiencing poverty in the UK are more vulnerable to DVA, and this conclusion is consistent with wider international evidence. However, while associations clearly exist between poverty and DVA vulnerability, potential causal mechanisms are poorly understood and this reflects the limitations of existing data in this area. This paper highlights the need for further research exploring financial abuse within DVA relationships and post-separation financial abuse and poverty. Caution is needed in interpreting this relationship and drawing inferences for policy and practice. DVA is endemic throughout society in rich and poor countries, and interventions targeted at specific populations (including poverty) on their own are likely to be inadequate in the absence of a wider understanding of the social drivers of violence against women associated with patriarchal norms and practices in particular contexts.

This article discusses the book, The Handmaid’s Tale, by Margaret Atwood. Recently made into a televised series in the US and also aired in the UK, the book, which was written in 1985, presents a dystopic/futuristic vision of an American future Puritan society called Gilead where women have no rights and function in terms of the wider needs of the society. This book has received particular attention recently because of some of the parallels that can be drawn between the evangelical utterings of the current US Republican administration, and the fictional world which Atwood created over 30 years ago. The book also, however, raises a whole raft of questions which lie at the foundations of feminism: the relationships which exist between women, the role of reproduction and power, sexuality, repression, endemic violence against women and resistance. This article will look at the key themes in the book alongside recent discussions about the lessons which can be learnt from the text and the warnings we need to heed.