Damian Sendler, M.D. – Victims of domestic violence face a wide range of mental health issues as a result of COVID-19, which may have significant human and economic ramifications. In the context of COVID-19, there is a dearth of mental health interventions that are specifically designed for victims of domestic violence. To close a knowledge gap, we set out to find interventions that can improve the mental health of victims of domestic violence in the midst of the COVID-19 pandemic.
Damian Jacob Sendler: All demographics are affected by domestic violence, which can lead to significant morbidity and mortality. Although domestic violence victims face a variety of psychological problems, multidisciplinary approaches to helping them cope with these issues have been identified. These include everything from individualized shelter home strategies to education programs and escape plans to legislation and regulations to more technologically based mental health solutions. Multifaceted and multidisciplinary approaches to combating domestic violence are urgently required, especially in light of the widespread availability and low cost of technology-based solutions.
Dr. Sendler: Some statistics show that one in every three people in the world will experience some form of domestic violence, which is a global health crisis [1]. Domestic violence is defined as a behavior that focuses on the oppression of another individual, resulting in significant pain and trauma through physical, sexual, and mental harm [3]. Domestic violence is on the rise around the world as a result of the COVID-19 pandemic [5–7]. Despite the fact that lockdown has reduced crime by 40% in Australia, the number of domestic violence cases has increased by 5% [8–10]. In addition, Google Trends data shows a 75% increase in online searches for domestic violence victims’ support [9].
Domestic violence is on the rise in many countries, including China [11]. According to police in Hubei Province’s Jianli city, cases of violence against women have increased threefold, with 90% of those cases being affected by isolation and lockdown as a result of COVID-19 [12]. Furthermore, alarming statistics show that the number of women murdered by their intimate partners has doubled in the United Kingdom (U.K.) between March 23rd and April 12th, 2020 compared to the average annual rates for the past decade [13]. Prior studies have shown that men and women behave differently when it comes to violence [14], but more recent studies on domestic violence show an increase in the frequency of both types of violence [15]. As an example, let’s consider acts of violence perpetrated solely against men. An alarming trend in the prevalence of violence against men has prompted a call for more research to untangle cultural and societal perceptions of victimization [17, 18], as well as the challenges associated with help-seeking behavior among victim demographics [19, 20].
Systematic research suggests that cases of domestic violence against women are frequently unreported or underreported [21–23], making the situation even worse. It has been found that only 5% of current domestic violence victims in Bosnia and Herzegovina are reporting their crimes to the police [24]. Amidst a nationwide epidemic of domestic violence, these sombering figures highlight how critical it is for policymakers to develop timely strategies and practical solutions to address the new problems that victims are confronted with. Research on women’s violence has been a major focus of COVID-19, so this paper’s narrative is consistent with this. Although the findings are primarily focused on the COVID-19 pandemic, the majority of them should be viewed as addressing domestic violence as a whole and highlighting the long-term health consequences of domestic violence against women, particularly in the area of mental health.
Victimization of women can have long-term and short-term health consequences, which often manifest in both physical and mental health issues. Mental health issues may not be as visible or tangible to victims and society as physical health issues. There are a variety of symptoms and ‘asymptomatic’ individuals who appear to be mentally healthy who may be dealing with serious and significant mental health challenges that may go unnoticed and therefore left untreated [27]. [28,29] Delaying seeking help for mental health issues can have a negative impact on the individual’s well-being and welfare [28]. A growing body of research demonstrates that victims of domestic violence frequently experience significant mental health issues [29–31].
In order to be mentally healthy, one must be able to “realize one’s own potential, cope with everyday stresses, work productively and fruitfully, and make a contribution to one’s community” [32]. Some studies have found that 75% of people who seek help from domestic violence support services report clinical posttraumatic stress symptoms, with depression and anxiety cases even more common [30]. Domestic violence victims in China, like their Western counterparts, frequently suffer from a wide range of mental health issues, including substance abuse, stress, anxiety, depression, and suicide [33–35]. Depression was found to affect 65.8 to 75.8 percent of the 2987 Chinese victims of domestic violence studied [36].
Researchers generally agree that mental health plays an essential role in determining a person’s overall health and well-being. Health problems resulting from a decline in mental well-being can affect the mind and body [37–40]. Mental health experts have long warned that society is facing an epidemic of mental illness because of its prevalence and severity [41]. Mental health issues faced by victims of domestic violence must be addressed more effectively in the face of a pandemic [42–45], which has already had significant human and economic consequences for public health [46–48].
For example, health interventions could be defined by a targeted strategy or program that aims to provide timely and cost-effective health solutions to a specific population. According to the literature [51–55], tailored interventions are necessary and beneficial. Mental health interventions have been shown to reduce the negative effects of mental health issues and protect the overall health and well-being of domestic violence victims [46–48]. In spite of the enormous promise of health interventions, there is a critical shortage of mental health interventions specifically designed for survivors of domestic violence, especially in the COVID-19 context [8–10]. Many mental health services and domestic violence support systems have had to postpone or cancel their services because of lockdown and social distancing measures [8–10], which has exacerbated the lack of mental health solutions for many domestic violence victims [56]. For this reason, this paper aims to identify existing interventions that can be adapted to the COVID-19 context for domestic violence victims’ mental health and well-being to address the research gap.
COVID-19 pandemic showed that three direct and modifiable factors influenced women’s domestic violence and mental health issues: (1) increased exposure to the abuser, (2) decreased financial security, and (3) diminished mental health services. Figure 1 shows how these factors interact with domestic violence and mental health issues faced by women. To help domestic violence victims cope with their mental health issues in the midst of COVID-19, we used these approaches as a framework.
Even during the most intense lockdowns, essential businesses like supermarkets and pharmacies were often available to meet people’s basic physiological needs [77]. Health organizations and government agencies should take advantage of these shifts in social norms to put in place support systems to help people flee abusive situations during and after the pandemic [78–80]. Coded messaging systems have been used by supermarket and pharmacy staff to raise the alarm about suspicious activity.
Europe’s most vulnerable women are encouraged to seek help by using a code known as “Mask 19,” which has been adopted by France, Germany, Italy, Norway, the Netherlands and Spain [78–80]. ANI stands for “Action Needed” in the United Kingdom, where domestic abuse victims can seek immediate help at participating pharmacies using this codename. [81] By using a code word (either spoken or written), women can ask for help without drawing the attention of their abusers, even if they are within a few feet of them. Staff at the participating company can then contact the police or social services on behalf of the woman.
Damian Sendler
Pharmacies and supermarket chains could use coded systems to help domestic violence victims in countries where these services are not available. Many international fast-food chains like McDonald’s and Pizza Hut provide their managers and employees with extensive training based on international standards [82–84]. Police and social workers are able to respond to domestic violence incidents at restaurants because both victims and their abusers are in a known location and in the same room for a predetermined amount of time (dining-in time). Domestic violence victims living outside of China can benefit from using Chinese food restaurant chains as possible points of support, given that many of these chains operate in China and often have an international presence.
The good news is that many countries have a telephone or virtual help-seeking service. Accessibility, affordability, and the ability to maintain one’s anonymity, privacy, and security are just a few of the benefits of seeking help virtually [85–87]. Additionally, online services have the added benefit of being referred to as “silent services,” where victims can tell their stories and seek help without fear of their abusers listening in. During the first three weeks of the pandemic, calls to the domestic violence charity ‘Respect’ increased by 97%, emails by 185%, and website visits by 581% in the United Kingdom [56].
Damian Jacob Markiewicz Sendler: Online help-seeking platforms, such as those found in Norway, Germany, France, Spain, Italy and Argentina, are one of the most empowering online service formats [88]. Domestic violence victims can get access to vetted and comprehensive resources without having to search for another website to address their health and safety concerns or considerations through ad-hoc platforms [88]. Domestic violence victims need an ad-hoc online help-seeking platform because an all-encompassing system reduces the time and effort required to find online assistance. Because of this ease of access, people who are in need of assistance face fewer obstacles [89] and are less vulnerable to interruptions from those who are abusing them [87].
A national telephone or ad-hoc online system for domestic violence victims is still lacking in some countries, such as China [2]. Developing an ad hoc online help-seeking system that connects China’s abused women with timely and comprehensive resources is clearly needed by health organizations and government agencies [5, 12, 90]. Access to information and resources in various formats is required when designing and developing online help systems for victims of domestic violence. Depending on the format, high-speed bandwidth may be required or low-tech devices may be used to access it [80]. In order to access domestic violence resources using these devices, women will need to clear their browsing history or use a device that the abuser can’t get their hands on.
It is critical to have a system in place that provides for the physiological and safety needs of victims of domestic violence, such as food, shelter, safety, and medical care [91]. Domestic violence shelters in countries like Canada and France have remained open in the face of a pandemic by implementing emergency shelter provisions that allow the government to repurpose hotels as safe houses [79]. The French example may be more relevant for countries that did not have adequate infrastructure or resources prior to the onset of the pandemic [2]. Hospitals or housing facilities that are unused due to COVID-19, for example, could be repurposed as emergency shelters for people in need by Chinese health organizations and government agencies.
COVID-19’s negative effects on international and domestic tourism have made the use of hotels during the pandemic a cost-effective approach for society at large to organize a collaborative response to domestic violence. In addition, because hotels frequently have unused rooms, the government can investigate the feasibility of repurposing them as shelter homes in the long term. The use of these facilities could be compensated in some way in collaboration with local support services. In order to implement this idea, hotel staff will need extensive training in dealing with difficult situations, such as a spouse or partner looking for the whereabouts of an individual who is a victim of domestic violence.
As a result of failing social systems and the need for support from others, domestic violence often occurs [3]. As a result, it is critical to recognize the importance of taking the first step to seek help [94–96]. Integrated campaign interventions are a low-cost way to boost the demand for services. Campaigns that use communication and marketing resources to deliver persuasive messages to domestic violence victims, aimed at influencing their attitudes and behaviors toward seeking help, are known as integrated campaign interventions in this study.
Several countries and non-governmental organizations (NGOs) have launched public health campaigns to address the prevalence and severity of domestic violence [80, 97–99]. Domestic violence is a widespread problem, and many of these campaigns, including those sponsored by individual countries like the Netherlands and Kosovo, aim to educate abused women about the importance of seeking help and to raise public awareness about the pervasiveness of domestic violence and the importance of reporting it to “Save Lives” Consider expanding your campaign’s scope to include abusers in addition to these two types of campaigns. Informing domestic violence offenders about the laws and regulations in place as well as the social repercussions of domestic violence abuse can often help reduce their likelihood of committing abuse or of committing it further.
Domestic violence intervention programs for specific gender abusers have been examined by a growing body of research [100–102]. Other members of the abusers’ social network are frequently included in these dyad-centered programs. More comprehensive domestic violence care community members (e.g., health experts, social workers, and so on) are often included in dyad-based programs, which can have a positive impact on intervention outcomes. For a practical solution, campaigns to educate and inform those who perpetrate domestic violence of the consequences could be developed. This would take into account the frequency, prevalence, and severity of domestic violence. It is critical to educate members of the community about the dangers of domestic violence and how to intervene to help protect women.
Damien Sendler: If an individual decides to leave their abuser(s) during a lockdown, there is a need for more training on how to create an escape plan. It may be nearly impossible for women to leave their abusers as more women work from home, stay at home to care for their children, or are in lockdown as a result of the pandemic [8–10]. A well-developed escape plan can help victims of abuse because they may not be able to leave if the abuser is still in the house. While fleeing an abusive partner can be risky, it is especially so when children are involved, because “strategies that don’t match risks and circumstances may not improve safety and may even increase risks” [104]
Damian Jacob Sendler
One strategy is to have organizations and businesses provide resources, tips, and supplies that can be picked up discreetly and used to plan for an escape or to help women put together an escape bag. Accessing extra cash or opening a new bank account in their name, getting sets of keys, clothes, a prepaid phone to avoid being tracked, or copies of important documents or necessities for children are all examples of emergency escape plans [104, 105]. Alternative modes of transportation should be considered because an abuser can track a family car [104, 105]. They should have a designated place to go, whether it be a shelter, new rental property (such as an apartment or hotel), friends’ houses, or even a family member’s house at a location unknown to the abuser [104–105].
The lack of a detailed plan puts the victim and their children at an unanticipated danger. It is possible to alter a plan in the event of a postponement until it is safe to do so, if an abuser is identified [104, 105]. It’s critical to know how to properly dispose of smart devices, such as phones and watches, because they can connect to a home computer and be used as a tracking device. Victims of domestic violence in Western countries, such as the United States, are often protected by specialized programs [106]. Domestic violence victims could benefit from programs tailored to their specific needs based on these examples.
A national domestic violence registration system is one way to address the problem of domestic violence in countries. For example, the National Sex Offender Registry in the United States, where concerned parents and educators have access to a searchable public record, is a model for this type of registry in countries like China [107]. National domestic violence registration could allow individuals to check if their potential partners have violent or abusive pasts before they enter into a relationship with them.
An innovative concept has already been put into action in the Chinese city of Yiwu [108] in the context of this approach. An online database enacted by the Yiwu government lets anyone search for convicted, issued with a restraining order or sentenced to detention for domestic abuse since 2017 [108]. [108]. In order to inquire or begin this process, a few documents are required: (1) the I.D. of both individuals, (2) their official marriage application, and (3) a signed confidentiality agreement.
Since July 2020, this database has been available, but data on how this system has prevented domestic violence has not yet been released. People in Yiwu will have access to critical information about their fiancée before they embark on any further relationships with them, which is clear. As a model for domestic violence prevention and control, the Yiwu model will also serve as a valuable resource for other municipal governments and the central government. People with disabilities, such as blindness or illiteracy, may find it difficult to complete the application process on their own. The government should provide assistance in these cases, in order to remove any unnecessary hurdles.
Lockdowns and social distancing mandates will likely continue to be used when there are future outbreaks or infections until COVID-19 vaccination becomes a universal fact [109–111]. Technology-based interventions for domestic violence victims’ mental health issues can be facilitated by this barrier to physical contact [112, 113]. These health promotion strategies may benefit from the use of technology-based interventions if they can be made more “accessible and affordable to the target audience” [114].
Many studies show that technology-based interventions can help victims of violence against women reduce their symptoms of depression and anxiety, as well as their vulnerability to violence in intimate relationships [115–117]. There is some evidence to suggest that technology-based interventions (such as in-person interventions) can produce better results than more traditional methods [118]. Women are more likely to share their experiences with technology-based interventions than they are with more traditional methods of intervention, according to research [119]. Due to the power disparity between abusers and victims [120], people are often reluctant to seek out the kind of help that can help keep them safe and free from their abusive environments.
Interventions delivered via technology have a unique set of benefits that make them an ideal delivery method for COVID-19: Cost-effectively tailored to the specific needs and preferences of the target audience, (2) adopted to deliver health solutions remotely via transcending physical barriers such as time and money needed for transportation, (3) can be developed, delivered, and accessed cost-effectively, and (4) can be engineered to protect the target audience’s privacy and emotional concerns as they facilitate user anonymity in the health solution delivery process [121–123].
In some countries, waiting lists for mental health services are growing and there are disproportionate numbers of support workers. Face-to-face consultations may be delayed due to a lack of psychiatrists or other mental health professionals in China [124–126]. In light of the scarcity of mental health professionals in the United States, health care providers and government agencies should consider including international assistance in their online mental health services, such as assistance from countries that have ratified the Istanbul Convention, a legally flawed but urgently necessary framework for protecting women from violence across Europe [127–130]. Domestic violence victims now have access to a global network of multilingual mental health professionals thanks to technological advancements and globalization. Health organizations and government agencies should consider establishing a system that can connect all available international mental health experts across the globe with domestic violence victims and their families [132].
There is a public health crisis in the United States as a result of domestic violence. For generations, it has the potential to disrupt people’s hopes, dreams, and plans for a life free of violence. As a result of the devastating human and economic consequences that the pandemic has sparked, COVID-19 has exacerbated and introduced new mental health issues for victims of domestic violence. However, there are no COVID-19-specific mental health interventions for victims of domestic violence. While the pandemic of domestic violence continues, we identified practical and multidisciplinary interventions that can be used to address the mental health challenges faced by victims. Efforts to alleviate the many health burdens of domestic violence victims could be explored in future research. Victims of domestic violence require more support and assistance if the current and future pandemics are to be ended without them having to suffer in silence, pain, or fear.