Family violence and COVID‐19: Increased vulnerability and reduced options for support

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Abstract

Introduction Family violence refers to threatening or other violent behaviours within families that may be physical, sexual, psychological, or economic, and can include child abuse and intimate partner violence (Peterman et al. 2020, van Gelder et al. 2020). Family violence during pandemics is associated with a range of factors including economic stress, disaster‐related instability, increased exposure to exploitative relationships, and reduced options for support (Peterman et al. 2020). Due to the social isolation measures implemented across the globe to help reduce the spread of COVID‐19, people living in volatile situations of family violence are restricted to their homes. Social isolation exacerbates personal and collective vulnerabilities while limiting accessible and familiar support options (van Gelder et al. 2020). In many countries, including Australia, we have already seen an increase in demand for domestic violence services and reports of increased risk for children not attending schools (Duncan, 2020), a pattern similar to previous episodes of social isolation associated with epidemics and pandemics (Boddy, Young & O’Leary 2020). In Australia, as stay‐at‐home orders came into force, the police in some parts of the country reported a 40% drop in crime overall, but a 5% increase in domestic abuse call‐outs (Kagi 2020). At the same time in Australia, Google reported a 75% increase in Internet searches relating to support for domestic abuse (Poate 2020). This pattern is repeated internationally. Reports of domestic abuse and family violence have increased around the world since social isolation and quarantine measures came into force. Recently, anecdotal evidence from the United States, China, Brazil, and Australia indicates increases in intimate partner, women, and children violence due to isolation and quarantine (Campbell 2020; Peterman et al. 2020; van Gelder et al. 2020). China, the first country to impose mass quarantine in the Wuhan province, saw reported domestic abuse incidents rise threefold in February 2020 compared to the previous year (Allen‐Ebrahimian 2020). As Europe imposed quarantine measures in an effort to slow the tide of infection, the Italian government began commissioning hotels to provide shelter to the increasing number of people fleeing abusive situations (Davies & Batha 2020). Similarly, France reported a 32% ‐ 36% increase in domestic abuse complaints following the implementation of self‐isolation and quarantine measures (Reuters News Agency 2020). France also began commissioning hotels as shelters for those fleeing abuse. As quarantine measures extended to the United States, individual states reported similar increases in domestic abuse incidents ranging from 21% to 35% (Wagers 2020). Back in Europe, the UK has also seen concerns about increase in family violence (Bradbury‐Jones & Isham 2020). There have been reports of homicide associated with family violence in several countries (Bradbury‐Jones & Isham 2020; Reuters News Agency 2020). The National Domestic Abuse Hotline in the UK saw a 25% increase in calls since stay‐at‐home measures were implemented (Kelly & Morgan 2020), recording at least eight family violence‐related deaths (Knowles 2020). Isolation and family violence As the novel coronavirus outbreak has intensified globally, countries are adopting dedicated measures to slow the spread of the virus through mitigation and containment (van Gelder et al. 2020; Campbell 2020). Social distancing and isolation are central to the public health strategy adopted by many countries, and in many settings, penalties are in place for any person who breaches these imposed restrictions. Social isolation requires families to remain in their homes resulting in intense and unrelieved contact as well as the depletion of existing support networks, such as through extended family as well as through social or community‐based support networks for families at risk. Additionally, isolation places children at greater risk of neglect as well as physical, emotional, sexual, and domestic abuse (National Society for the Prevention of Cruelty to Children [NSPCC] 2020). Due to (necessary) imposed social distancing and isolation strategies, and the resulting shortages of essential resources and economic consequences of these measures, people globally are living under stressful conditions. While social isolation is an effective measure of infection control, it can lead to significant social, economic, and psychological consequences, which can be the catalyst for stress that can lead to violence. A perfect storm Isolation paired with psychological and economic stressors accompanying the pandemic as well as potential increases in negative coping mechanisms (e.g. excessive alcohol consumption) can come together in a perfect storm to trigger an unprecedented wave of family violence (van Gelder et al. 2020). In Australia, as social distancing measures came into place, alcohol good sales rose more than 36% (Commonwealth Bank Group 2020), and as restaurants, bars, and pubs closed, people are now drinking more within the confines of their homes. Unemployment figures around the world have rapidly risen into the double digits, with millions signing up for welfare payments and a worldwide recession predicted in the near future (Kennedy 2020). Substance misuse, financial strain, and isolation are all well‐known domestic abuse risk factors (Richards 2009). During isolation, there are also fewer opportunities for people living with family violence to call for help. Isolation also helps to keep the abuse hidden with physical or emotional signs of family violence and abuse less visible to others (Stark 2009). COVID‐19 and coercive control Reports show that COVID‐19 is used as a coercive control mechanism whereby perpetrators exert further control in an abusive relationship, specifically in the use of containment, fear, and threat of contagion as a mechanism of abuse. In Australia, charities providing support to people experiencing domestic abuse have highlighted concerns specifically related to reports from people whose intimate partners are using COVID‐19 as a form of abuse. There have been reports of misinformation used by intimate partners related to the extent of quarantine measures (Gearin & Knight 2020) and other forms of COVID‐19‐related abuse (Fielding 2020). Further, there are reports that those experiencing domestic abuse may be afraid to go to hospital for fear of contracting COVID‐19 (Fielding 2020). Reimagining support networks for people living with family violence during these challenging times We recognize that these are challenging times for all of us, but especially for the most vulnerable families and children. The United Nations Secretary‐General Antonio Guterres recently called for countries to prioritize support and set up emergency warning systems for people living with family violence (News Wires 2020). Pharmacies and grocery stores in France are now providing emergency warning systems to help enable people to indicate that they are in danger and need support (Guenfound 2020), through the introduction of code words to alert staff they need help (Davies & Batha 2020). Domestic abuse support agencies in some areas have published specific guidance on domestic abuse in COVID‐19 focussing on what friends and family can do to support people who are isolated (Domestic Violence Resource Centre Australia [DVRCA] 2020). Charities are also recognizing the role that neighbours can play in supporting people living with family violence, providing advice on what to listen for and look for while they themselves are home, and encouraging conversation with neighbours (Gerster 2020). Conclusion The fear and uncertainty associated with pandemics provide an enabling environment that may exacerbate or spark diverse forms of violence. Actions such as social distancing, sheltering in place, restricted travel, and closures of key community resources are likely to dramatically increase the risk of family violence (Campbell, 2020). Governments and policymakers must create awareness about an increased risk of violence during pandemics and highlight the need for people to keep in touch with each other (while observing precautionary measures) and the great importance of reporting any concerns of abuse. It is important to remember that maintaining social connectedness is an important strategy during times of isolation (Usher et al. 2020), even more so with family or friends you suspect may be at risk of family violence. In addition, information about services available locally (e.g. hotlines, tele‐health, respite services, shelters, rape crisis centres, and counselling) must be made known to the general public through a range of sources, including social media, the mainstream media, and health facilities. Mental health professionals can support people by providing first‐line psychological support, including listening empathetically and without judgment, enquiring about needs and concerns, validating peoples’ experiences and feelings, enhancing safety, and connecting people to relevant support services (WHO 2020).

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The pandemic paradox: The consequences of COVID‐19 on domestic violence

Caroline Bradbury-Jones, Louise Isham (2020)

COVID‐19 (the new strain of coronavirus) has been declared a global pandemic. Measures announced over recent weeks to tackle it have seen people's day‐to‐day life drastically altered. These changes are essential to beat coronavirus and protect health systems (UK Home Office, 2020). However, there are unintended, negative consequences. As the virus continues to spread across the world, it brings with it multiple new stresses, including physical and psychological health risks, isolation and loneliness, the closure of many schools and businesses, economic vulnerability and job losses. Through all of that, children and their mothers are particularly vulnerable (End Violence against Children, 2020) to the risk of domestic violence. Domestic violence refers to a range of violations that happen within a domestic space. It is a broad term that encompasses intimate partner violence (IPV), a form of abuse that is perpetrated by a current or ex‐partner. In this editorial, we talk about “domestic violence” because this is the term used most often in the media. It is important to clarify though that we are mainly referring to IPV and its impact on children who live with or are exposed to IPV between adults. We also focus mainly on women, because they are disproportionately affected by domestic violence; however, we recognise that domestic abuse happens to men and occurs within same‐sex relationships. It is a matter of just about a week ago where one of us (Bradbury‐Jones) was writing another editorial about COVID‐19 for the Journal of Clinical Nursing, reflecting on life in the pandemic (Jackson et al., 2020). Within that editorial, we raised the emerging concern as to whether domestic violence rates would rise as a result of the “lockdown” that is being imposed by many countries across the globe. Although these measures vary, to some degree, in their timing and severity, they generally require that people stay at home and only leave for an essential reason such as buying food, collecting medication or carrying out a key worker role. At the time of writing this first editorial, the concern was expressed as speculation, a questioning as to whether it might happen. Within such a short time span, there is clear evidence that we need to speculate no more. Domestic violence rates are rising, and they are rising fast. Experience in New Zealand and internationally has shown that family violence (including IPV, child abuse and elder abuse) and sexual violence can escalate during and after large‐scale disasters or crises (NZFVC, 2020). Around the world, as communities have gone into lockdown to stop the spread of coronavirus, the mass efforts to save lives have put women in abusive relationships more at risk. A very recent article published in The Guardian (2020) reported on how the surge of domestic violence cases is a pattern being repeated globally. Reporting from several different countries, the article highlighted alarming figures, for example a rise of 40% or 50% in Brazil. In one region of Spain, the government claimed that calls to its helpline had risen by 20% in the first few days of the confinement period and in Cyprus, calls to a similar hotline rose 30% in the week after the country confirmed its first case of coronavirus. In the UK, Refuge, one of the leading domestic abuse organisations reported that calls to the UK Domestic Violence Helpline increased by 25% in the seven days following the announcement of tighter social distancing and lockdown measures by the government. During the same period, there was a 150% increase in visits to the Refuge website (BBC, 2020). Governments across the globe are imposing necessary draconian measures to try to level the curve of the virus and to delay its peak. In the UK where we both live and work, we have listened to what has become a well‐rehearsed mantra: Stay Home; Protect the National Health Service (NHS); Save Lives. We use this editorial to propose the pandemic paradox, to unravel and problematise these measures in terms of what they mean for those who are living and surviving abusive relationships. Let us start with staying at home. Home is not always a safe place to live; in fact, for adults and children living in situations of domestic and familial violence, home is often the space where physical, psychological and sexual abuse occurs. This is because home can be a place where dynamics of power can be distorted and subverted by those who abuse, often without scrutiny from anyone “outside” the couple, or the family unit. In the COVID‐19 crisis, the exhortation to “stay at home” therefore has major implications for those adults and children already living with someone who is abusive or controlling. Stringent restrictions on movement shut off avenues of escape, help‐seeking and ways of coping for victim–survivors. Restrictive measures are also likely to play into the hands of people who abuse through tactics of control, surveillance and coercion. This is partly because what goes in within people's homes—and, critically, within their family and intimate relationships—take place “behind closed doors” and out of the view, in a literal sense, of other people. Unintentionally, lockdown measures may therefore grant people who abuse greater freedom to act without scrutiny or consequence. Social norms and attitudes that suggest there is a “sanctity” to family life—to home, in a social rather than physical sense—can also make it difficult for people to speak out about, let alone leave, abusive situations as a result of feelings of shame and embarrassment. During the COVID‐19 crisis, it is therefore important to think critically about idealised representations of home and family and to make it possible for people to talk about, and where possible take action to counter abusive and controlling family life. Asking people directly, on repeated occasions, about whether they consistently feel safe at home is one way of doing this; however, it is also important that people asking this question have the time and emotional resources to listen and respond to the often‐subtle ways that people indicate they are scared and unsafe. As regards protecting health, social and therapeutic services, of course there has been considerable focus on front‐line staff, directly relevant to dealing with the novel coronavirus. Nurses and health professionals are clearly at the forefront of the response to COVID‐19 and we stand with those underlining the need to meet, as a basic requirement, health professionals’ physical, practical and emotional needs during and after the immediate impact of the pandemic. It is vital that health services are protected and resourced. It is also vital, however, that we continue and where necessary increase support to the services who work alongside health and avoid tendencies to pit services against one another in practical or moral terms. Services working alongside health include the advocates, therapists and helpline practitioners working in specialist domestic and sexual violence services in the voluntary sector. These organisations provide an array of services, including but not limited to refuge accommodation, independent advocacy and peer support and mentoring services. Their independence is often highly valued by victim–survivors, many of whom may have had difficult experiences with institutions such as the police or social services. During the COVID‐19 crisis, these services are more crucial than ever. They provide support and care to victim–survivors experiencing immediate danger and distress. Thus, it is critical that governments across the world enable these services to remain open. This means ensuring that voluntary sector practitioners can access personal protective equipment, be paid in full and be supported to care for their own families whilst working. It also means finding new solutions, including increasing capacity for helpline services and running targeted campaigns, alongside specialist services, about discrete ways that victim–survivors can contact the emergency services without alerting their abuser (Independent Office for Police Conduct, 2019). For people already accessing crisis and therapeutics services, the use of phone support and online technologies to provide advice and counselling is welcomed. However, it is also important to recognise that victim–survivors may not have access to these mechanisms because of control tactics used by an abusive partner, or more simply, because they cannot afford them. This underlines the need to provide different types of support and to recognise that many people will simply not be able to access help or care whilst social restrictions are in place and this will have an impact on their safety, health and well‐being now and in the longer term. In terms of saving lives, one of the most serious manifestations of intimate partner and familial abuse is domestic homicide. In the UK, approximately two women are killed every week by their current or ex‐partner. During the COVID‐19 pandemic, reports have emerged of an apparent increase in domestic homicides in a number of affected countries. In March 2020, Spain (a country that has been particularly hard hit by the pandemic) saw its first domestic violence fatality just 5 days following lockdown; a woman was murdered by her husband in front of their children in Valencia. There is also emerging evidence of an increased number of domestic homicides in the UK since the lockdown restrictions were enacted (Ingala Smith, 2020). At this early stage of the pandemic, it is too early to verify whether the increased reporting of these deaths represents an actual rise in domestic homicide rates or increased media attention. However, it is important to highlight that reported cases are of violence are known to be a small percentage of actual incidents. Moreover, the emerging homicide numbers underline the serious and potentially devastating unintended consequences of the pandemic for victim–survivors of abuse. At the time of writing, we are grappling, like everyone else, with the myriad, often deeply worrying effects of this novel coronavirus. Seeking to stem its spread, safeguard our health systems and, critically, best protect those with health vulnerabilities that put them at risk of life‐limiting or life‐ending illness, it has been necessary to alter social behaviours like never before and for governments to alter radically, the extent to which they intervene into our private lives and behaviours. We raise concerns about the needs and experiences of victim–survivors of domestic violence as a way of drawing attention to some of the unfortunate and troubling paradoxes of social distancing and isolation measures, not in opposition to them. We do so because the voices and needs of victim–survivors are too often over‐looked and under‐represented in some parts of the media and within policy and political spheres. We also raise these issues because there are actions that may help to mitigate the additional risks that COVID‐19, and its attendant social and economic effects, may have on victim–survivors. National and local governments can, for example, take action now in terms of protecting and supporting services that provide crisis and therapeutic support to victim‐survivors. However, it is also by being aware of and, where possible, reaching out to those who may be affected by domestic violence that we can support one another, whether in our personal or professional lives. This pandemic creates a paradox as regards staying safe at home and it is one to which we should all pay attention. Governments across the globe have called upon us all to play our individual part in tackling COVID‐19 by staying at home, but a critical mindfulness of what this means for many women and children is also important.

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An increasing risk of family violence during the Covid-19 pandemic: Strengthening community collaborations to save lives

Andrew Campbell (2020)

Though necessary to slow the spread of the novel Coronavirus (Covid-19), actions such as social-distancing, sheltering in-place, restricted travel, and closures of key community foundations are likely to dramatically increase the risk for family violence around the globe. In fact many countries are already indicating a dramatic increase in reported cases of domestic violence. While no clear precedent for the current crisis exists in academic literature, exploring the impact of natural disasters on family violence reports may provide important insight for family violence victim-serving professionals. Improving collaborations between human welfare and animal welfare agencies, expanding community partnerships, and informing the public of the great importance of reporting any concerns of abuse are all critical at this time.

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The COVID‐19 pandemic and mental health impacts

Kim Usher, Joanne W. Durkin, Navjot Bhullar (2020)

The newly identified novel coronavirus, COVID‐19, was first reported in Wuhan, China, in late 2019. The COVID‐19 virus is now known to belong to the same family as SARS and Middle East respiratory syndrome coronavirus (MERS‐CoV), which are zoonotic infections thought to have originated from snakes, bats, and pangolins at the Wuhan wet markets (Ji et al. 2020). The virus has rapidly spread across the globe leading to many infected people and multiple deaths (Wang et al. 2020); especially of the elderly and vulnerable (Centers for Disease Control and Prevention 2020). While efforts to control and limit the spread of the pandemic in the community are quite straight forward to follow, it seems that prejudice and fear have jeopardized the response efforts (Ren et al. 2020). In fact, the COVID‐19 pandemic has already unleashed panic, as evidenced by the empty toilet paper shelves in stores, resulted in accusations against people of Asian races (Malta et al. 2020), and impacted people’s decisions to seek help when early symptoms arise (Ren et al. 2020). In this editorial, we discuss the issues related to the occurrence of fear, panic, and discrimination, analyse the causes of these phenomena, and identify practical solutions for addressing mental health issues related to this pandemic for both public and healthcare professionals. People tend to feel anxious and unsafe when the environment changes. In the case of infectious disease outbreaks, when the cause or progression of the disease and outcomes are unclear, rumours grow and close‐minded attitudes eventuate (Ren et al. 2020). We know that the level of anxiety rose significantly when the SARS outbreak occurred. For example, in Hong Kong, about 70% of people expressed anxiety about getting SARS and people reported they believed they were more likely to contract SARS than the common cold (Cheng & Cheung 2005). Anxiety and fear related to infection can lead to acts of discrimination. People from Wuhan were targeted and blamed for the COVID‐19 outbreak by other Chinese people and Chinese people have since been stigmatized internationally, for example, use of the term ‘China virus’ and the use of terms such as ‘Wuhan virus’ and the ‘New Yellow Peril’ by the media (Ren et al. 2020). Fear is a known (for centuries and in response to previous infectious outbreaks such as the plague), yet common response to infectious outbreaks and people react in many and individualized ways towards the perceived threat. Hypervigilance, for example, can arise because of fear and anxiety and, in severe cases, result in post‐traumatic stress disorder (PTSD) and/or depression (Perrin et al. 2009). Fear of the unknown, in this case, the spread of the disease and the impact on people, health, hospitals, and economies, for example, raises anxiety in healthy individuals as well as those with pre‐existing mental health conditions (Rubin & Wessely 2020). Individuals, families, and communities experience feelings of hopelessness, despair, grief, bereavement, and a profound loss of purpose because of pandemics (Levin 2019). Feelings of loss of control drive fear and uncertainty as the trajectory of the pandemics is constantly evolving; so is the advice on the action to take to stop the spread of a pandemic. Perceived mixed messaging from government or health officials can also lead to public confusion, uncertainty, and fear (Han, Zikmund‐Fisher et al. 2018). People’s responses to fear and intolerance of uncertainty lead to negative societal behaviours (Rubin & Wessely 2020). Uncertainty increases feelings of alarm resulting in behaviours targeted at reducing uncontrollable situations which people fear. For example, we have seen people clearing shelves of supermarkets resulting in global shortages of food and essentials such as toilet paper (El‐Terk 2020). This behaviour is purported to occur for two reasons: one because the threat of COVID‐19 is perceived as a ‘real’ threat and expected to last for some time and second as a means to regain control (El‐Terk 2020). While outright panic as a result of this pandemic is unlikely, it can occur as a consequence of mass quarantine (Rubin & Wessely 2020). The current state of the COVID‐19 illness already paints a picture of inevitable and large‐scale quarantine – some of which are already occurring. In the case of mass quarantine, experiencing social isolation and an inability to tolerate distress escalate anxiety and fear of being trapped and loss of control, and the spread of rumours (Rubin & Wessely 2020). Rumours fuel feelings of uncertainty and are extricably linked to issues such as panic buying and hoarding behaviour. Anxiety related to this pandemic is also compounded by people being reminded of their own mortality that can lead to an ‘urge to splurge’, that is an increase in spending as a means to curb fear and regain control (Arndt et al. 2004). Throughout history, people have sought to allocate blame to someone in order to calm their fear of disease outbreaks (McCauley et al. 2013). This fear and othering is often present with pandemics. For example, the 2014 Ebola outbreak was considered an African problem resulting in discrimination against those of African descent (Monson 2013), while the 2009 H1N1 flu outbreak in the USA saw Mexican and migrant workers targeted for discrimination (McCauley et al. 2013). In the past century, a number of serious outbreaks of influenza have developed in Southeast Asia, for example Avian H7N9 Influenza, 2013; H2N2 Pandemic, 1957‐1958; H1N1 Pandemic, 1918 (Sugalski & Ullo 2018). The ‘blame’ for avian influenza has centred on Asian countries, and we see some world leaders dubbing COVID‐19 the ‘Chinese virus’ (Chui 2020). Since January 2020, The UK and the USA have reported increased reports of violence and hate crimes towards people of Asian descent (Russell 2020) and an overall rise in Anti‐Chinese sentiment (Rich 2020) as a result of the spread of COVID‐19. Misinformation, public anxiety, and rumours must be addressed by Government and Health officials (Madhav et al. 2017), that help mitigate the adverse effects of stigmatization and help provide protection of vulnerable populations (DeBruin et al. 2012). Ultimately, to apportion blame in any circumstance can damage everyone involved and can reduce individual and community resilience both in the short and long term (Murden et al. 2018). Fear and guilt can also occur as a result of being infected by the virus. Infected people, while also the target of discrimination, also experience self‐blame or guilt. Unfortunately, this feeling culminated in the suicide death of a health worker recently who feared she had contaminated seriously ill people she cared for while infected by COVID‐19 (Giuffrida & Tondo 2020). Recovery from the negative impacts of this pandemic must include plans for addressing mental health issues for both public and healthcare professionals. Public health surveillance during and after this pandemic must include plans for mental health surveillance to allow for an adequate response to the anticipated mental health issues (Levin 2019). Fear and isolation of those who are sick or quarantined, breakdown of social support structures, disruption of everyday life that we take for granted, and mental health impacts on health workers are real and anticipated outcomes of this pandemic. Following the SARS outbreak in 2003, Chong et al. (2004) found that 77.4% of health workers caring for patients during the outbreak had mental health issues ranging from anxiety, worry, depression, somatic symptoms, and sleep problems. Despite the potential seriousness and impact on the mental health related to the pandemic in the infected patients and the community at large, most healthcare professionals have received relatively little training in the delivery of mental health care in the face of such pandemics (Xiang et al. 2020). Timely mental health care and mental healthcare training need to be developed and implemented as part of professional development activities (Xiang et al. 2020). As with any infectious disease outbreak, it is necessary for the Governments to take steps to quell the epidemic of fear that eventuates (Malta et al. 2020). Rapid communication about disease control and prevention is essential. Education campaigns should be launched to promote public health messages that prevent the spread of the disease and encourage the public to take proactive actions, such as reporting signs of illness to health professionals (Wang et al. 2020). Practical steps to manage our mental health during these difficult times include managing media consumption and accessing information which allows us to take practical steps to protect ourselves and our loved ones (World Health Organization 2020). Accessing non‐official information can foster further, and often unnecessary, anxiety and panic (Johal 2009). Increasingly populations are being asked to stay in our homes for personal safety and the safety of others. Ensuring daily exercise activities, albeit for some of us in the confines of our home, have a positive impact on our mental health (Deslandes et al. 2009). As the physical distance from each other increases, finding ways to maintain our social connectedness is critical. Lack of interpersonal attachments is linked to poor physical, emotional, and mental health (Baumeister & Leary 1995). Setting up regular phone calls or video conferences with family, friends, and colleagues can bridge the gaps brought on by social distancing. As social beings, we need each other. As we are being asked to act in an increasingly unsocial way in order to overcome the challenges of this pandemic, we must remember that we are all in this together and act accordingly.