IPV in the ED: A Resident’s View

Written by Khushmit Kaur, MD

Edited by Payal Modi, MD

The Covid-19 pandemic has resulted in a surge of intimate partner violence (IPV) as people find themselves quarantined with their abusers in the midst of broader financial strain, worsening mental health and drug abuse, and added childcare responsibilities.  Serving as the frontline provider to survivors of such violence in an urban emergency room, I can confidently say that these are amongst the most challenging cases. Often, the “treatment” is mere temporary physical bandaging with little to no psychological restoration. The ER has always been the front line and last resort for those who cannot look elsewhere, and it is no different for those facing domestic abuse. The current pandemic is often described as “unprecedented”; however, via the experiences of the most vulnerable, it has shed light on the ways our society failed to prepare and subsequently support individual groups, including survivors.

 

Beyond anecdotal evidence, numbers over the past year further validate system failures on a national level. As the news reported on economic struggles, increasing food insecurity, and worsening mental health concerns during  the peak of the pandemic in New York City, there was an underlying and less frequently discussed public health crisis - domestic violence. New York remains a representative and map of the social impact of covid by being among the first and hardest hit regions throughout the nation. According to the Office for the Prevention of Domestic Violence, the New York State Domestic and Sexual Violence Hotline received 45% more calls in April, May and June when compared to the same time period in 2019. This trend was unfortunately seen again in the fall when the pandemic worsened, with the hotline receiving 50% more calls in September, October, and November compared to the prior year. Evidently, this remained a blindspot for the government and local organizations in the fall despite the alarming statistics from the spring.¹

 

Historically, domestic violence is severely underreported by survivors, commonly due to fear of the abuser or burdens of sustaining family or economic security. Being isolated with one’s abuser only exacerbates those fears and decreases opportunities to seek help safely. Additionally, women are being disproportionately impacted during the coronavirus pandemic with rising unemployment rates nationwide. Women left or were removed from the workforce at four times the rate as men this past September (865,000 women vs. 216,000 men).² One reason for this includes that women are more likely to work in sectors more affected by the pandemic, including restaurants and retail, hospitality, and health care. Women also tend to bear a greater burden of childcare, and many left existing jobs to stay home with children due to schools and daycares closing. With decreased financial independence, survivors are more afraid to break ties with their abusers who may be financially supporting them, exacerbating the feedback loop.³

 

However, financial strain was certainly not the only reason for rising concerns and abuse, as social isolation remains prevalent. An often overlooked component of domestic violence during the covid pandemic is the reduced availability of external help and support, whether that be family members or legal representatives. With social distancing from family members, friends, and/or children, victims have less access to external support and perpetrators are subsequently less accountable. Their actions are unseen and unheard, facilitating continued emotional and physical abuse.

 

Furthermore, existing IPV organizations and community advocates are overwhelmed with rising cases and decreased funding. Shelters, domestic violence or otherwise, have exhausted their limits. They have faced increasing expenditures in the form of hotel rooms for survivors to maintain social distancing, and trials by jury are taking longer to begin and/or come to fruition, compelling survivors to remain in this indefinite limbo of fear, and in fact deterring them even further from reporting in the first place.⁴

 

While recent statistics and surges in violence, which most urban ER physicians can anecdotally confirm, are on the rise, there are several ways to support those in danger during this unprecedented time. For starters, it is more critical than ever before to check up on loved ones. They may no longer be routinely seeing co-workers every morning, or relatives and friends on the weekends, and may be suffering in silence with nobody to notice. Local and national domestic violence hotlines are available 24/7 to help. While support systems may look very different during a pandemic, they are still available and advocacy will help with visibility of said organizations. Furthermore, with rising fears to seek medical attention due to covid exposure, it remains paramount that one go to their local emergency room in the context of injury, physical or psychological. Emergency medical attention can be obtained safely, while wearing PPE. Hospitals are often overlooked as a first line of support in the absence of physical injury; however, they can certainly serve as liaisons to appropriate social and psychological services for those in need, including information about domestic violence shelters, mental health professionals, rehabilitation, and at times even legal or financial resources.⁵

  

References:

 

  1. Roth, Amy Neff. “COVID Pandemic Leads to More Domestic Violence Hotline Calls in New York State, Oneida County.” Utica Observer Dispatch, Observer-Dispatch, 23 Nov. 2020, www.uticaod.com/story/news/2020/11/23/domestic-violence-hotlines-report-more-calls-during-covid-pandemic/6357572002/.

  2. “COVID-19 Recession Is Tougher on Women : Monthly Labor Review.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 1 Sept. 2020, www.bls.gov/opub/mlr/2020/beyond-bls/covid-19-recession-is-tougher-on-women.htm.

  3. Julie Kashen, Sarah Jane Glynn. “How COVID-19 Sent Women's Workforce Progress Backward.” Center for American Progress, www.americanprogress.org/issues/women/reports/2020/10/30/492582/covid-19-sent-womens-workforce-progress-backward/.

  4. Will, K. Sophie. “Justice Slow to Come for Domestic Violence Survivors during COVID-19 Pandemic.” The Spectrum, St. George Spectrum & Daily News, 18 Jan. 2021, www.thespectrum.com/story/news/2021/01/18/justice-slow-come-domestic-violence-survivors-during-covid-19/6472508002/.

  5. Eve Valera, PhD. “When Lockdown Is Not Actually Safer: Intimate Partner Violence during COVID-19.” Harvard Health Blog, 29 June 2020, www.health.harvard.edu/blog/when-lockdown-is-not-actually-safer-intimate-partner-violence-during-covid-19-2020070720529.

 

John Purakal