Intimate partner violence is a broad problem. An estimated one in four women (24%) and one in seven men (14%) aged 18 and older in the United States have been the victim of severe physical violence by an intimate partner. Current stay-at-home restrictions preventing the spread of COVID-19 may drastically increase these incidents. Some agencies in the United States are already reporting an increase in such reports. And on March 30, a Pennsylvania man, upset about losing his job during the pandemic, shot his girlfriend and killed himself. His girlfriend was hospitalized with non-life-threatening injuries.
Also called domestic violence, intimate partner violence (IPV) is a global health problem that primarily — though not exclusively — affects women in every country. Here in the United States, the Centers for Disease Control and Prevention noted that one in four women will experience domestic violence during her lifetime.
IPV can happen to anyone, affecting people across socioeconomic groups. Partner abuse or aggression can begin in subtle or insidious ways, starting with calling the woman rude names, making negative and sarcastic remarks, and escalating to intense verbal abuse on a daily basis. It can further accelerate into increasingly dangerous and damaging forms of violence, life-threatening trauma, and even death. This pattern of harmful behaviors tends to continue over time as the perpetrator uses the abuse, or threat of violence, to maintain power and control over the woman.
The perpetrator’s abusive behavior can be obvious or subtle. In many cases, that person uses both approaches to induce fear and self-doubt, leading to the woman’s capitulation to the will of the perpetrator. The abused woman’s sense of self diminishes over time as the abuse erodes her self-confidence, ability to function, and decision-making. Although there are many forms of IPV, the most universally known are physical, psychological, emotional, sexual, and financial, along with intimidation, isolation, and abuse of male privilege.
My research has focused on disabled and nondisabled women who have experienced IPV, and those women who have extricated themselves from these situations. More recently, I studied verbal abuse that precedes more serious and life-threatening forms of abuse, as well as the destruction of the woman’s personal property. My work, looking at both nonmilitary and military wives’ experiences, has found that verbal abuse tends to accentuate one’s vulnerability and becomes a precursor for the person developing other health problems, especially mental health issues.
Now, given the need to maintain social distance and shelter-in-place, one local outpatient community behavioral mental health center has received fewer than usual calls from women for mental health services. Although services are available, and the center has embraced telehealth through digital communication to provide care, some women that use weekly services have declined to use telehealth.
When counselors have reached out to check in with clients via phone, it’s been women who are known victims of IPV, or those most at risk for abuse, who either do not answer their phones or say they “are too busy to talk.” Only a few women have indicated the presence of a partner or spouse nearby, with remarks such as: “I’m needed by my husband” or “I’m busy with someone right now.” These brief interactions between the counselor and client are limited to a few words. Questions asking the woman when a good time would be to call back go unanswered with phrases like: “I don’t know” or “You don’t have to call back.”
These comments suggest to the counselor that these women cannot speak freely, and they sound different, as if something is amiss. Although one may say that this is only an assumption on the counselor’s part, I believe it is typically an educated and intuitive supposition based on the counselor’s knowledge and clinical experience from working with that specific client.
If the services usually in-place — such as hotlines, phone resources, and agencies serving women experiencing abuse — are not accessible, then these women will go unserved. One of the limitations of telehealth is privacy in the home setting, where other people can hear or even purposely listen to an individual or group counseling session. Perpetrators of abuse who maintain control of a woman and secrecy surrounding their lives together are the last people who would accept a woman participating in group therapy or a support group session via telehealth. It could be even more dangerous for a woman experiencing IPV to reach out for help at this time.
Nurses, including those in advanced practice, will continue to use established standards of practice to assess and effectively intervene with victims of IPV. Nurses are well prepared to identify and educate women on types of abuse and help formulate plans for safety, family care, and treatment interventions for the victim.
Hotlines, crisis centers, and shelters have remained open during the pandemic. Additionally, two places women can still frequent during this pandemic are grocery stores and pharmacies, which could be used to provide information about domestic violence services in local areas. This crisis isn’t going away, and nor should our support.