Why is it necessary to address?
Pandemics like COVID have a significant impact on individuals, families, and countries. Persons not only have to deal with consequences of infection but also have to deal with measures taken to contain the infection like quarantines, social distancing, and lockdowns. Individuals face issues related to health, finances, and security concerns and these can impact their mental health and their relationships. Since there are curbs on the movement of the individuals, persons who are in abusive relationships face challenges as they are likely to be in close confined spaces with the perpetrators and may have difficulties in getting timely help.
UN WOMEN have reported rates of increased violence against women and children more so girls in COVID-19 times. Hence it is important to address this issue as it can lead to further crisis and probably secondary trauma.
What happens to violence during pandemics /social isolation/lockdowns and why conflicts increase?
Violence is likely to increase as the persons are likely to be in close confined spaces during the lockdowns
Financial crisis due to lockdowns may lead to increased conflicts
Substance-related issues in the perpetrators
Reduced opportunities to go out and seek help for violence
Non-availability of services for violence during the pandemic such as shelters or one-stop centers
and difficulty reaching them due to lockdowns
How can violence manifest?
Violence manifests in different forms like physical, emotional, sexual and often only physical violence gets highlighted.
Simple Tips for families
Encourage members to have separate times and together times
Be aware when conflict is escalating so that they give each other emotional space
Don't dwell on the small stuff
Lower your expectations from each other so that quarrels are reduced
Plan your day – Restart hobbies, exercises, work to reduce times for conflicts
Make available in health settings/public domain about violence and avenues to seek help – public information makes people more aware of their conflicts
What can health professionals do?
Suspect violence when they see persons with injuries (maybe unexplained), unexplained physical symptoms or mental health consequences like anxiety, psychological distress, deliberate self-harm attempts.
Screening questions
Questions need to be framed and asked in a sensitive manner. Please conduct the interview in a safe place. Ensure confidentiality
Begin with the following statement-
1. We generally ask about family life and relationships as they affect an individual's health
2. Have you been having to face any trouble in your close relationships?
3. Do you have any arguments/conflicts at home?
4. How are they generally resolved?
5. Have you been subjected by anyone in your close relationships to any form of ridicule,
the humiliation that has made you feel upset?
6. Have you been subjected by anyone in your close relationships to any form of threats of harm,
hitting, slapping, or kicking that has made you feel upset?
If the answer is Yes, to questions 5 & 6 you can then ask
Can you talk more about it? Allow the person to express their feelings, Do not interrupt when they are expressing their concerns, Validate their feelings, Be non –judgmental.
LIVES is a psychosocial approach that has been formulated by the World Health Organization (WHO) that can be used as First aid for women who are facing intimate partner violence or any other forms of domestic violence. This has been adopted in this chapter to address the immediate needs of any person who is exposed to domestic/intimate partner violence.
LISTEN - Listen to the person closely, with empathy, and without judging.
INQUIRE ABOUT NEEDS AND CONCERNS
Assess and respond to various needs and concerns—emotional, physical, social and practical (e.g. childcare)
VALIDATE
Show that you understand and believe the person. Assure the person that he/she is not to blame.
ENHANCE SAFETY
Discuss a plan to protect the person from further harm if violence occurs again.
SUPPORT
Support the person by providing access to information, services, and social support.
Issues in Discussing IPV in tele sessions with women
With the lockdown and restriction, accessing health services is a challenge during COVID times. Telemedicine and teleconsulting have been considered as an option of providing services to the client. There are some concerns related to discussing violence during tele session
Ensuring privacy is a challenge
The perpetrator might to in the same space and there is the possibility of escalation of violence
The client might not be able to discuss the details of violence
Health professionals may not be able to examine for injuries
So what can be done? Before asking, check with the person if someone is nearby, ask to respond only in yes or no. If the person says no one is around, give a code word that can be used when the person feels unsafe during the conversation or when someone is nearby- like the name of a fruit or vegetable. If there is an imminent threat of violence or continued violence, ask if the person has any support or can move to a neighbor/friend.
If there is an imminent danger of violence to the client, please direct them to contact the nearest police station (Police helpline Phone 1091 ) or Government of India (National commission for women-domestic violence help-line) (Phone No.181 ) or Central Helpline (181).
Conclusion
People in abusive relationships face challenges during lock-downs and restrictions in movements (as in COVID-19 as they are likely to be in close confined spaces with the perpetrators and may have difficulties in accessing help. Frontline personnel needs to be aware and if required explore sensitively and offer timely support to the victims.
References
https://www.mohfw.gov.in/pdf/COVID19Final2020ForOnline9July2020.pdf