Doctor’s Note: How can we help victims of abuse during lockdown?

“Stay home, stay safe, save lives.” This is the motto being used by the United Kingdom’s government to make us do our bit to get through the lockdown.

But what if staying at home wasn’t safe and was potentially a far worse outcome for you than contracting COVID-19?

For many, lockdown came as a relief. It was a necessary measure taken to protect us and to try and control the spread of this pandemic. For a significant number of people, however, the lockdown has brought more misery to their lives.

In the UK, calls to national domestic abuse helplines have risen by 49 percent in the last six weeks. This has been mirrored across Europe; France showed a 30 percent increase, and Spain saw an 18 percent increase in calls during the first two weeks of lockdown. In Wuhan, China a police station reported a 300 percent increase in calls during the height of the crisis there. This is alarming.

As a general practitioner (GP), I see many cases of domestic abuse. It is never stated as the reason a patient comes in to see me, of course, but rather something I tease out during a consultation.

Often patients will attend with a common ailment and it is only when I have gone to examine them that I find evidence suggestive of abuse.

Signs to look out for are bruises, being more withdrawn, having no financial freedom, not being able to leave the house without their abuser, or admitting to having all their technology monitored, such as calls, messages and social media.

Domestic abuse is not just physical – it includes coercive control and “gaslighting”, economic abuse, online abuse, verbal abuse, emotional abuse and sexual abuse.

Victims of domestic abuse are highly vulnerable and often rely on opportunistic recognition of the issue by somebody else, be it a friend, neighbour, colleague or doctor. Being able to read the verbal and non-verbal cues from victims is essential, as well as giving them space and support to make decisions about how they wish to proceed.

During lockdown, people have been forced into spending more time indoors with their families and have nowhere to go to for respite.

Stress levels are at an all-time high as people’s mental health progressively deteriorates as the weeks go by. In the context of domestic abuse, the perpetrators may no longer need to worry about their victims’ bruises being seen by others as they are in isolation.

The result of this is a spike in the number of cases of abuse.

In the UK, as school closures were announced, the first measure taken was to keep schools open for vulnerable children in order to keep them safe. The government identified these children as those on the child protection or social care registers, as well as those with special learning needs. We know, however, that not all children at risk of abuse during this time will be in these groups, and worryingly, only five percent of these eligible children have actually attended school.

Due to social distancing, our medical clinics have all turned to offering consultations predominantly via phone and videoconferencing. We are therefore missing those physical windows of opportunity in which to speak in confidence to our patients.

This means a caller who is a victim of abuse may not be able to open up because the consultation could be being monitored and controlled by the perpetrator of the abuse. We cannot examine them, which means we are likely missing all the cues we would normally pick up on in person.

Refuge, the UK’s largest domestic abuse charity, reported a phenomenal 700 percent increase in calls to its helpline in a single day following the start of the lockdown. The number of victims who have died from domestic abuse has also increased significantly in comparison to years before.

It is important to bear in mind that it is not just women and children who are at risk of domestic abuse. Male victims of abuse have also been calling for help in greater numbers, with the Men’s Advice Line in the UK seeing calls rise 35 percent in the first week of lockdown.

Some elderly people who are very vulnerable, or those with disabilities, may also be in lockdown with carers who are abusive.

A new development in recent weeks has been from teenagers lashing out at parents because they want to go out. Parents of children with disabilities and learning needs are also facing high levels of pressure and abuse at home as some children can become aggressive at times. 

The UK government is increasing funding to support helplines and online services and has also called for more “safe spaces” to be rolled out where victims can access help.

One of the UK’s largest pharmacies, Boots, has just opened these spaces up and offered a place where victims can contact specialist services for support and advice, no questions asked. This is a great intervention as pharmacies work closely with GP practices so this will help in keeping the channels of communication open between patients and their doctors.

This lockdown is a testing time for everyone, and frustration levels are high, but none of this can excuse causing harm to another person.

We must be able to feel safe in our personal spaces and it is the duty of all to help bring this to an end for the victims.

If you know anyone who is suffering, or if you are suffering yourself, please seek help by checking who your local support services are.

For information and support on domestic violence, consult:

• International directory of domestic violence agencies
• WAVE – Women Against Violence Europe
• Womens Crisis Care International – Middle East
• Refuge Against Domestic Violence – UK-wide 
• US National Domestic Violence Hotline
• US National Coalition Against Domestic Violence directory