563848 research-article2014
APY0010.1177/1039856214563848Australasian PsychiatryO’Connor et al.
Australasian
Psychiatry
Domestic violence
What can psychiatrists do to better support victims of family violence?
Australasian Psychiatry 2015, Vol 23(1) 59–62 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214563848 apy.sagepub.com
Manjula O’Connor Psychiatrist and Hon Senior Fellow, The University of Melbourne, VIC, Australia
Joanne Cox Policy Officer, Victorian Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia
David J Castle Chair of Psychiatry, St Vincent’s Mental Health, The University of Melbourne, Fitzroy, VIC, Australia
Abstract Objective: This article aims to draw psychiatrists’ attention to the problem of family violence and offer pragmatic guidance to detect and manage family violence in the psychiatric context. Methods: Selective narrative review. Results: Family violence involves complex interactions between societal, cultural, family and individual factors. Awareness and understanding of family violence is important for psychiatrists as engagement can result in enhanced opportunities for early intervention and harm reduction. Conclusions: There are barriers facing psychiatrists regarding successful family violence intervention outcomes. Concerted action is required to improve services and support to victims and perpetrators. Keywords: family violence, barriers, psychiatry, women
‘The community has been traumatized by the brutal death of 11-year-old Luke Batty at the hands of his mentally ill father, Greg Anderson, who was then fatally shot by police as he advanced on them with a knife.’1 ‘Where do you turn when members of your own family turn on you?’2 Family violence is defined in the Family Violence Protection Act, Victoria 20083 as: (a) behaviour by a person towards a family member of that person if that behaviour—(i) is physically or sexually abusive; or (ii) is emotionally or psychologically abusive; or (iii) is economically abusive; or (iv) is threatening; or v) is coercive; or vi) in any other way controls or dominates the family member and causes that family member to feel fear for the safety or wellbeing of that family member or another person; or (b) behaviour by a person that causes a child to hear or witness, or otherwise be exposed to the above effects. A recent Australian survey found 19% of women had been subjected to sexual violence and 34% had experienced
physical violence after the age of 15.4 Although Australian population studies reported a downward trend in family violence in the decade from the mid 1990s to 2005, subsequent surveys reveal a disappointing lack of reduction in family violence from 2005 to 2012.4,5 Indeed, in the state of Victoria, family violence episodes increased from 50,000 in 2012 to 61,000 in 2013; of the 29 reported homicides in Victoria during 2013, half were attributable to family violence.6 New Zealand has also reported high rates of family violence. A survey published in 20117 reported that over half of ever-partnered women had been exposed to family violence, with 33% experiencing more than one type of family violence (for example sexual/physical violence plus emotional violence). Family violence is a complex issue. The ecological model of Heise and colleagues8,9 illustrates the interactions
Corresponding author: David J Castle, Chair of Psychiatry, St Vincent’s Hospital, The University of Melbourne, PO Box 2900, Fitzroy, VIC 3065, Australia. Email: [email protected]
59 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
Australasian Psychiatry 23(1)
between societal, cultural, family and individual factors that give men the position of power, dominance and control over women and children. Family violence is experienced by one in three women globally and is a leading cause of mental disorders, physical ill health, non-fatal and fatal injuries to women aged 15–45 worldwide.10,11 Of course it is not always men perpetrating family violence against women, and the opposite can occur, albeit women are more commonly the victims.12 Irrespective, attention needs to be paid to the perpetrator as well as the victim and (where relevant) children in terms of fully addressing family violence.13 Family violence has profound consequences in many aspects of health and wellbeing. Around 75% of family violence cases result in physical injury or adverse mental health consequences for the victim.10,11 This often extends beyond the primary victim to other family members, especially children.14 The health profession has long been aware of the range of medical, gynaecological, psychiatric and orthopaedic complications suffered by victims of family violence.15 Recurrent physical illnesses, including urinary problems and sexually transmitted infections, often lead to unnecessary investigations and treatments. The relationship between mental health issues and violence against women is complex. On the one hand, family violence is a major risk factor for depression, deliberate self-harm and post-traumatic stress disorder (PTSD).14 On the other hand, women with diagnosed mental illnesses have increased vulnerability to physical and sexual violence.16,17 Awareness and understanding of family violence amongst psychiatrists is thus vital. A lack of a satisfactory nosology for family violence in psychiatric classifications is a barrier to teaching students and clinicians about family violence issues.18 DSM-519 has included family violence for the first time, under ‘Other conditions that may be a focus of clinical attention’ in the chapter ‘Relational problems’ (p.720). Furthermore ‘Adult abuse by non-spouse or non-parent’ now earns a label of its own.19 This is particularly relevant for Aboriginal and Torres Strait Islander (ATSI) people as well as some other racial and cultural minorities where extended family systems are the norm, hence family violence can be perpetrated by multiple individuals.20,21 ATSI people are much more likely than non-Indigenous Australians to experience family violence and to be hospitalized for injuries arising therefrom.22 In 2002, 23% of Aboriginal women aged over 15 years reported physical violence or threatened violence in the previous 12 months.10
Family violence in clinical practice Family violence presents to health practitioners in varied clinical situations. Surveys of women attending general practice in Australia reveal partner abuse rates of
between 8% and 28%. Hegarty et al.23 lament that family violence is a ‘mental health blind spot with health professionals’. Research has identified barriers in patients as well as clinicians regarding disclosure of family violence.18 Fear of authorities taking away children, immigration authorities cancelling visas, fear of the perpetrator, shame, embarrassment and self blame are some of the chief barriers among the patient-victim group. Having said this, a New Zealand study reported that 75% of women who had been the victim of family violence had told someone about the violence, but 40% went on to say that no one had offered them appropriate help and support.24 Psychiatrists thus require a high index of suspicion and need sensitively to enquire if family violence is suspected; routine screening is not recommended.25 Useful questions to ask can be found in an overview by Warburton and Abel.14 It is important to make sure the patient feels safe and that they understand fully issues of confidentiality. There has been emerging recognition that doctors require specific training to identify cases of family violence.25 Clinicians tend to be reticent about asking about family violence directly. However, people experiencing abuse often have frequent contact with healthcare professionals. Studies indicate that victims want healthcare professionals to ask about family violence in a sensitive and non-judgmental manner, with many considering it appropriate that doctors and nurses ask direct questions.25,26 However, the individual’s perception of appropriate or inappropriate responses can depend on their readiness to address the issue, the consultation setting, and the patient/clinician relationship; cultural issues are also important.27,28 Perpetrators are often vilified and their mental health not adequately addressed.8 Perpetrator treatment must be based on the firm understanding that family violence is unacceptable, but there is some dissonance in the literature as to whether a (‘value neutral’) cognitive behavioural approach or a more direct ‘pro-feminist’ approach is most appropriate and effective.13 There are no risk factors among perpetrators that can predict family violence accurately. Some factors, however, can accelerate or exaggerate violent behaviours. These include psychotic illness, obsessive sexual jealousy, alcoholism, gambling, substance abuse and psychopathic personality disorder.29 Again psychiatrists need to be aware and respond to defined risk in this regard.
Treatment pathways Evidence for interventions to support identified victims of family violence is encouraging.30 Management guidelines have been published by many jurisdictions including the UK Royal College of General Practice31 and the Western Australian Department of Health.32
60 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
O’Connor et al.
A rapid, coordinated response and follow-up can enhance the identification, reduce the impact of victimization, prevent the problem from progressing and prevent predictable, long-term harmful consequences and revictimization. Much needs to be done to refine and further develop clinical pathways to enhance secondary and tertiary prevention measures. Early identification, effective and empathic communication, followed by exploration of the needs of the victims and the perpetrators alike are the first steps. Specific issues such as safety, and legal, financial and housing support require appropriate referrals. Mental health needs of both victim and perpetrator are central to early intervention and rehabilitation but often receive limited attention. Evaluation of suicide and homicide risk is essential. Specific treatments for victims include supportive therapy, self-esteem building, self-empowerment techniques and trauma therapy. Addiction programmes and antidepressant medications should be employed as clinically indicated. Specific psychological interventions have a limited database, with most studies being limited by small sample sizes and other methodological constraints. The best studied interventions are those nested in cognitive-behavioural principles with specific adjuncts such as assertiveness training: these seem to enhance self-esteem and improve depressive and post-traumatic symptoms.33 Clearly more research is required in this area.
5. Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. ABS Cat No 4704.0. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare. Commonwealth of Australia, 2005. 6. Victoria Police. Victoria Police statistics. Melbourne, Australia, 2013, http://www. police.vic.gov.au (accessed 1 April 2014). 7. Fanslow JL and Robinson EM. Sticks, stones or words? Counting the prevalence of different types of intimate partner violence reported by New Zealand women. J Aggress Maltreat Trauma 2011; 20: 741–759. 8. Heise L, Ellsberg M and Gottemoeller M. Ending violence against women, Population Reports, Series L, No. 11. Baltimore: Johns Hopkins University School of Public Health, 1999. 9. Heise LL. Violence against women: an integrated, ecological framework. Violence Against Women 1998; 4: 262–290. 10. World Health Organization. WHO multi-country study on women’s health and domestic violence against women: initial results on prevalence, health outcomes and women’s responses. Geneva: World Health Organization, 2005. 11. World Health Organization. Intimate partner violence and women’s physical and mental health in the multi-country study on women’s health and domestic violence: an observational study. Lancet 2008; 371: 1165–1172. 12. Trevillion K, Hughes B, Feder G, et al. Disclosure of domestic violence in mental health settings: a qualitative meta-synthesis. Int Rev Psychiatry 2014; 26: 430–444. 13. Romans SE, Poore MR and Martin JL. The perpetrators of domestic violence. Med J Aust 2000; 173: 484–488. 14. Warburton AL and Abel KA. Domestic violence and its impact on mood disorder in women. In: Castle DJ, Kulkarni J and Abel KA (eds) Mood and anxiety disorders in women. Cambridge: Cambridge University Press, 2006, pp.92–115. 15. Ramsay J, Rutterford C, Gregory A, et al. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. Br J Gen Pract 2012; 62: 647–655. 16. Shidhaye R and Patel V. Association of socio-economic, gender and health factors with common mental disorders in women: a population-based study of 5703 married rural women in India. Int J Epidemiol 2010; 39: 1510–1521.
Conclusions Given the rising rate of family violence and the pivotal role of mental health in this complex web, psychiatry can play a key role. It is encouraging that the Australian Commonwealth Government has launched an enquiry into the issue of family violence: psychiatry needs to participate actively in that dialogue. At a systems level, we require a review of ways of improving the whole service delivery system for family violence victims and better coordinated programmes for perpetrators. We also need to enhance teaching and professional development regarding these matters. Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
17. Godman L, Rosenberg S, Mueser K, et al. Physical and sexual assault history in women with serious mental illness. Prevalence, correlates, treatment and future research directions. Schizophr Bull 1997; 23: 685–696. 18. Rose D, Trevillion K, Woodall A, et al. Barriers and facilitators of disclosures of domestic violence by mental health service users: qualitative study. Br J Psychiatry 2010; 198: 189–194. 19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: APA, 2013. 20. Colucci E, O’Connor M, Field K, et al. Nature of domestic/family violence and barriers to services among Indian immigrant women. Int J Intercult Res 2013; 3: 9–26. 21. O’Connor M and Colluci E. Exploring domestic violence and social distress in AustralianIndian migrants through community participatory theater. J Transcultural Psychiatry 2014 (in press). 22. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander health performance framework report. Canberra, Australia: Australian Health Ministers’ Advisory Council, 2006.
References
23. Hegarty K, Hindmarsh E and Gilles MT. Domestic violence in Australia: definition, prevalence and nature of presentation in clinical practice. Med J Aust 2000; 173: 363–367.
1. Holden A. The growing problem of family violence in Victoria. Editorial Opinion. The Age 2 February 2014, http://www.theage.com.au/comment/the-age-editorial/a-bereftmothers-insightful-message (2014, accessed 12 April 2014).
24. De Bounville M. Department of Human and Health Services. AHPE. Policy Brief. Screening for domestic violence in health care settings, http://aspe.hhs.gov/hsp/13/dv/pb_ screeningdomestic.cfm (2013, accessed 22 January 2014).
2. Kleiman R. The growing problem of domestic violence in Victoria. The Age 27 March 2014, http://www.theage.com.au/national/the-growing-problem-of-family-violence-invictoria (2014, accessed 12 April 2014).
25. Hegarty K. Domestic violence: the hidden epidemic associated with mental illness. Br J Psychiatry 2011; 198: 169–170.
3. Family Violence Protection Act (2008). http://www.legislation.vic.gov.au/Domino/ Web_Notes/LDMS/PubStatbook.nsf (2008, accessed 12 April 2014). Melbourne: The Parliament of Victoria. 4. Australian Bureau of Statistics. Australian Bureau of Statistics personal safety survey. Canberra: Australian Bureau of Statistics, 2012.
26. Fanslow JL and Robinson EM. Help-seeking behaviours and reasons for help seeking reported by a representative sample of women victims of intimate partner violence in New Zealand. J Interpers Violence 2010; 5: 929–951. 27. Feder GS, Hutson M, Ramsay J, et al. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a metaanalysis of qualitative studies. Arch Intern Med 2006; 166: 22–37.
61 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
Australasian Psychiatry 23(1) 28. Ben Natan M, Ben Ari G, Bader T, et al. A universal screening for domestic violence in department of obstetrics and gynaecology: a patient and carer perspective. Int Nurs Rev 2012; 59: 108–114.
31. Royal College of General Practitioners. IRIS and CADA. Responding to domestic abuse. Guidance for general practices, http://www.rcgp.org.uk/clinical-and-research/clinicalresources (2013, accessed 12 April 2014).
29. Lang L. Risk assessment in domestic violence. Australian Domestic Violence Clearing House, http://www.adfvc.unsw.edu.au/PDF%20files/risk_assessment.pdf (2013, accessed 2 May 2014).
32. Department of Health, Government of Western Australia. Responding to domestic violence. A guide for health care practitioners in Western Australia, http://www.health. wa.gov.au/Publications/respondingtoFFV.pdf (2003, accessed 1 April 2014).
30. Taft A J, Small R, Hegarty KL, et al. Mothers’ Advocates in the Community (MOSAIC) – nonprofessional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomized trial in primary care. BMC Public Health 2011: 11: 178.
33. Trevillion K and Agnew-Davies R. Interventions for mental health users who experience domestic violence. In: Howard LM, Feder G and Agnew-Davies R (eds) Domestic violence and mental health. London: Royal College of Psychiatrists, 2013.
62 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
APY0010.1177/1039856214563848Australasian PsychiatryO’Connor et al.
Australasian
Psychiatry
Domestic violence
What can psychiatrists do to better support victims of family violence?
Australasian Psychiatry 2015, Vol 23(1) 59–62 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214563848 apy.sagepub.com
Manjula O’Connor Psychiatrist and Hon Senior Fellow, The University of Melbourne, VIC, Australia
Joanne Cox Policy Officer, Victorian Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia
David J Castle Chair of Psychiatry, St Vincent’s Mental Health, The University of Melbourne, Fitzroy, VIC, Australia
Abstract Objective: This article aims to draw psychiatrists’ attention to the problem of family violence and offer pragmatic guidance to detect and manage family violence in the psychiatric context. Methods: Selective narrative review. Results: Family violence involves complex interactions between societal, cultural, family and individual factors. Awareness and understanding of family violence is important for psychiatrists as engagement can result in enhanced opportunities for early intervention and harm reduction. Conclusions: There are barriers facing psychiatrists regarding successful family violence intervention outcomes. Concerted action is required to improve services and support to victims and perpetrators. Keywords: family violence, barriers, psychiatry, women
‘The community has been traumatized by the brutal death of 11-year-old Luke Batty at the hands of his mentally ill father, Greg Anderson, who was then fatally shot by police as he advanced on them with a knife.’1 ‘Where do you turn when members of your own family turn on you?’2 Family violence is defined in the Family Violence Protection Act, Victoria 20083 as: (a) behaviour by a person towards a family member of that person if that behaviour—(i) is physically or sexually abusive; or (ii) is emotionally or psychologically abusive; or (iii) is economically abusive; or (iv) is threatening; or v) is coercive; or vi) in any other way controls or dominates the family member and causes that family member to feel fear for the safety or wellbeing of that family member or another person; or (b) behaviour by a person that causes a child to hear or witness, or otherwise be exposed to the above effects. A recent Australian survey found 19% of women had been subjected to sexual violence and 34% had experienced
physical violence after the age of 15.4 Although Australian population studies reported a downward trend in family violence in the decade from the mid 1990s to 2005, subsequent surveys reveal a disappointing lack of reduction in family violence from 2005 to 2012.4,5 Indeed, in the state of Victoria, family violence episodes increased from 50,000 in 2012 to 61,000 in 2013; of the 29 reported homicides in Victoria during 2013, half were attributable to family violence.6 New Zealand has also reported high rates of family violence. A survey published in 20117 reported that over half of ever-partnered women had been exposed to family violence, with 33% experiencing more than one type of family violence (for example sexual/physical violence plus emotional violence). Family violence is a complex issue. The ecological model of Heise and colleagues8,9 illustrates the interactions
Corresponding author: David J Castle, Chair of Psychiatry, St Vincent’s Hospital, The University of Melbourne, PO Box 2900, Fitzroy, VIC 3065, Australia. Email: [email protected]
59 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
Australasian Psychiatry 23(1)
between societal, cultural, family and individual factors that give men the position of power, dominance and control over women and children. Family violence is experienced by one in three women globally and is a leading cause of mental disorders, physical ill health, non-fatal and fatal injuries to women aged 15–45 worldwide.10,11 Of course it is not always men perpetrating family violence against women, and the opposite can occur, albeit women are more commonly the victims.12 Irrespective, attention needs to be paid to the perpetrator as well as the victim and (where relevant) children in terms of fully addressing family violence.13 Family violence has profound consequences in many aspects of health and wellbeing. Around 75% of family violence cases result in physical injury or adverse mental health consequences for the victim.10,11 This often extends beyond the primary victim to other family members, especially children.14 The health profession has long been aware of the range of medical, gynaecological, psychiatric and orthopaedic complications suffered by victims of family violence.15 Recurrent physical illnesses, including urinary problems and sexually transmitted infections, often lead to unnecessary investigations and treatments. The relationship between mental health issues and violence against women is complex. On the one hand, family violence is a major risk factor for depression, deliberate self-harm and post-traumatic stress disorder (PTSD).14 On the other hand, women with diagnosed mental illnesses have increased vulnerability to physical and sexual violence.16,17 Awareness and understanding of family violence amongst psychiatrists is thus vital. A lack of a satisfactory nosology for family violence in psychiatric classifications is a barrier to teaching students and clinicians about family violence issues.18 DSM-519 has included family violence for the first time, under ‘Other conditions that may be a focus of clinical attention’ in the chapter ‘Relational problems’ (p.720). Furthermore ‘Adult abuse by non-spouse or non-parent’ now earns a label of its own.19 This is particularly relevant for Aboriginal and Torres Strait Islander (ATSI) people as well as some other racial and cultural minorities where extended family systems are the norm, hence family violence can be perpetrated by multiple individuals.20,21 ATSI people are much more likely than non-Indigenous Australians to experience family violence and to be hospitalized for injuries arising therefrom.22 In 2002, 23% of Aboriginal women aged over 15 years reported physical violence or threatened violence in the previous 12 months.10
Family violence in clinical practice Family violence presents to health practitioners in varied clinical situations. Surveys of women attending general practice in Australia reveal partner abuse rates of
between 8% and 28%. Hegarty et al.23 lament that family violence is a ‘mental health blind spot with health professionals’. Research has identified barriers in patients as well as clinicians regarding disclosure of family violence.18 Fear of authorities taking away children, immigration authorities cancelling visas, fear of the perpetrator, shame, embarrassment and self blame are some of the chief barriers among the patient-victim group. Having said this, a New Zealand study reported that 75% of women who had been the victim of family violence had told someone about the violence, but 40% went on to say that no one had offered them appropriate help and support.24 Psychiatrists thus require a high index of suspicion and need sensitively to enquire if family violence is suspected; routine screening is not recommended.25 Useful questions to ask can be found in an overview by Warburton and Abel.14 It is important to make sure the patient feels safe and that they understand fully issues of confidentiality. There has been emerging recognition that doctors require specific training to identify cases of family violence.25 Clinicians tend to be reticent about asking about family violence directly. However, people experiencing abuse often have frequent contact with healthcare professionals. Studies indicate that victims want healthcare professionals to ask about family violence in a sensitive and non-judgmental manner, with many considering it appropriate that doctors and nurses ask direct questions.25,26 However, the individual’s perception of appropriate or inappropriate responses can depend on their readiness to address the issue, the consultation setting, and the patient/clinician relationship; cultural issues are also important.27,28 Perpetrators are often vilified and their mental health not adequately addressed.8 Perpetrator treatment must be based on the firm understanding that family violence is unacceptable, but there is some dissonance in the literature as to whether a (‘value neutral’) cognitive behavioural approach or a more direct ‘pro-feminist’ approach is most appropriate and effective.13 There are no risk factors among perpetrators that can predict family violence accurately. Some factors, however, can accelerate or exaggerate violent behaviours. These include psychotic illness, obsessive sexual jealousy, alcoholism, gambling, substance abuse and psychopathic personality disorder.29 Again psychiatrists need to be aware and respond to defined risk in this regard.
Treatment pathways Evidence for interventions to support identified victims of family violence is encouraging.30 Management guidelines have been published by many jurisdictions including the UK Royal College of General Practice31 and the Western Australian Department of Health.32
60 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
O’Connor et al.
A rapid, coordinated response and follow-up can enhance the identification, reduce the impact of victimization, prevent the problem from progressing and prevent predictable, long-term harmful consequences and revictimization. Much needs to be done to refine and further develop clinical pathways to enhance secondary and tertiary prevention measures. Early identification, effective and empathic communication, followed by exploration of the needs of the victims and the perpetrators alike are the first steps. Specific issues such as safety, and legal, financial and housing support require appropriate referrals. Mental health needs of both victim and perpetrator are central to early intervention and rehabilitation but often receive limited attention. Evaluation of suicide and homicide risk is essential. Specific treatments for victims include supportive therapy, self-esteem building, self-empowerment techniques and trauma therapy. Addiction programmes and antidepressant medications should be employed as clinically indicated. Specific psychological interventions have a limited database, with most studies being limited by small sample sizes and other methodological constraints. The best studied interventions are those nested in cognitive-behavioural principles with specific adjuncts such as assertiveness training: these seem to enhance self-esteem and improve depressive and post-traumatic symptoms.33 Clearly more research is required in this area.
5. Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. ABS Cat No 4704.0. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare. Commonwealth of Australia, 2005. 6. Victoria Police. Victoria Police statistics. Melbourne, Australia, 2013, http://www. police.vic.gov.au (accessed 1 April 2014). 7. Fanslow JL and Robinson EM. Sticks, stones or words? Counting the prevalence of different types of intimate partner violence reported by New Zealand women. J Aggress Maltreat Trauma 2011; 20: 741–759. 8. Heise L, Ellsberg M and Gottemoeller M. Ending violence against women, Population Reports, Series L, No. 11. Baltimore: Johns Hopkins University School of Public Health, 1999. 9. Heise LL. Violence against women: an integrated, ecological framework. Violence Against Women 1998; 4: 262–290. 10. World Health Organization. WHO multi-country study on women’s health and domestic violence against women: initial results on prevalence, health outcomes and women’s responses. Geneva: World Health Organization, 2005. 11. World Health Organization. Intimate partner violence and women’s physical and mental health in the multi-country study on women’s health and domestic violence: an observational study. Lancet 2008; 371: 1165–1172. 12. Trevillion K, Hughes B, Feder G, et al. Disclosure of domestic violence in mental health settings: a qualitative meta-synthesis. Int Rev Psychiatry 2014; 26: 430–444. 13. Romans SE, Poore MR and Martin JL. The perpetrators of domestic violence. Med J Aust 2000; 173: 484–488. 14. Warburton AL and Abel KA. Domestic violence and its impact on mood disorder in women. In: Castle DJ, Kulkarni J and Abel KA (eds) Mood and anxiety disorders in women. Cambridge: Cambridge University Press, 2006, pp.92–115. 15. Ramsay J, Rutterford C, Gregory A, et al. Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. Br J Gen Pract 2012; 62: 647–655. 16. Shidhaye R and Patel V. Association of socio-economic, gender and health factors with common mental disorders in women: a population-based study of 5703 married rural women in India. Int J Epidemiol 2010; 39: 1510–1521.
Conclusions Given the rising rate of family violence and the pivotal role of mental health in this complex web, psychiatry can play a key role. It is encouraging that the Australian Commonwealth Government has launched an enquiry into the issue of family violence: psychiatry needs to participate actively in that dialogue. At a systems level, we require a review of ways of improving the whole service delivery system for family violence victims and better coordinated programmes for perpetrators. We also need to enhance teaching and professional development regarding these matters. Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
17. Godman L, Rosenberg S, Mueser K, et al. Physical and sexual assault history in women with serious mental illness. Prevalence, correlates, treatment and future research directions. Schizophr Bull 1997; 23: 685–696. 18. Rose D, Trevillion K, Woodall A, et al. Barriers and facilitators of disclosures of domestic violence by mental health service users: qualitative study. Br J Psychiatry 2010; 198: 189–194. 19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Washington, DC: APA, 2013. 20. Colucci E, O’Connor M, Field K, et al. Nature of domestic/family violence and barriers to services among Indian immigrant women. Int J Intercult Res 2013; 3: 9–26. 21. O’Connor M and Colluci E. Exploring domestic violence and social distress in AustralianIndian migrants through community participatory theater. J Transcultural Psychiatry 2014 (in press). 22. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander health performance framework report. Canberra, Australia: Australian Health Ministers’ Advisory Council, 2006.
References
23. Hegarty K, Hindmarsh E and Gilles MT. Domestic violence in Australia: definition, prevalence and nature of presentation in clinical practice. Med J Aust 2000; 173: 363–367.
1. Holden A. The growing problem of family violence in Victoria. Editorial Opinion. The Age 2 February 2014, http://www.theage.com.au/comment/the-age-editorial/a-bereftmothers-insightful-message (2014, accessed 12 April 2014).
24. De Bounville M. Department of Human and Health Services. AHPE. Policy Brief. Screening for domestic violence in health care settings, http://aspe.hhs.gov/hsp/13/dv/pb_ screeningdomestic.cfm (2013, accessed 22 January 2014).
2. Kleiman R. The growing problem of domestic violence in Victoria. The Age 27 March 2014, http://www.theage.com.au/national/the-growing-problem-of-family-violence-invictoria (2014, accessed 12 April 2014).
25. Hegarty K. Domestic violence: the hidden epidemic associated with mental illness. Br J Psychiatry 2011; 198: 169–170.
3. Family Violence Protection Act (2008). http://www.legislation.vic.gov.au/Domino/ Web_Notes/LDMS/PubStatbook.nsf (2008, accessed 12 April 2014). Melbourne: The Parliament of Victoria. 4. Australian Bureau of Statistics. Australian Bureau of Statistics personal safety survey. Canberra: Australian Bureau of Statistics, 2012.
26. Fanslow JL and Robinson EM. Help-seeking behaviours and reasons for help seeking reported by a representative sample of women victims of intimate partner violence in New Zealand. J Interpers Violence 2010; 5: 929–951. 27. Feder GS, Hutson M, Ramsay J, et al. Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals: a metaanalysis of qualitative studies. Arch Intern Med 2006; 166: 22–37.
61 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
Australasian Psychiatry 23(1) 28. Ben Natan M, Ben Ari G, Bader T, et al. A universal screening for domestic violence in department of obstetrics and gynaecology: a patient and carer perspective. Int Nurs Rev 2012; 59: 108–114.
31. Royal College of General Practitioners. IRIS and CADA. Responding to domestic abuse. Guidance for general practices, http://www.rcgp.org.uk/clinical-and-research/clinicalresources (2013, accessed 12 April 2014).
29. Lang L. Risk assessment in domestic violence. Australian Domestic Violence Clearing House, http://www.adfvc.unsw.edu.au/PDF%20files/risk_assessment.pdf (2013, accessed 2 May 2014).
32. Department of Health, Government of Western Australia. Responding to domestic violence. A guide for health care practitioners in Western Australia, http://www.health. wa.gov.au/Publications/respondingtoFFV.pdf (2003, accessed 1 April 2014).
30. Taft A J, Small R, Hegarty KL, et al. Mothers’ Advocates in the Community (MOSAIC) – nonprofessional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomized trial in primary care. BMC Public Health 2011: 11: 178.
33. Trevillion K and Agnew-Davies R. Interventions for mental health users who experience domestic violence. In: Howard LM, Feder G and Agnew-Davies R (eds) Domestic violence and mental health. London: Royal College of Psychiatrists, 2013.
62 Downloaded from apy.sagepub.com at The University of Iowa Libraries on June 6, 2015
