Feature

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Identifying the underlying signs of family violence

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‘Family violence presents in a huge number of guises,’ Dr Elizabeth Hindmarsh, GP and Chair of the RACGP’s Specific Interests Abuse and Violence network, told newsGP. ‘The most common way it presents in general practice is depression. It also presents as anxiety, not sleeping, drug and alcohol [issues], eating disorders and as non-explained pain.’
 
Recognising and deciphering these symptoms often requires an understanding of what Dr Hindmarsh refers to as the ‘underneath’ story – the underlying factors in family violence.
 
On the eve of White Ribbon Day, which is dedicated to stopping violence against women, Australia exhibits alarming statistics: one in six women has experienced partner violence since the age of 15, and women are eight times more likely to experience sexual violence from a partner than men.
 
These numbers mean all GPs will likely be seeing women who are experiencing family violence – it has been found that up to five women experiencing family violence attend an unsuspecting GP per week.
 
‘Prof Kelsey Hegarty [joint Chair in Family Violence Prevention at the University of Melbourne] did a study in which she interviewed women in the waiting room [about their experiences of violence] and mapped it against what we thought,’ Prof Jan Coles, Professor of General Practice at Monash University and leading family violence educator, told newsGP.
 
‘I was disappointed that even being trained and knowing how to ask I still missed a lot of these patients. But if you don’t have that training, you miss even more.’
 
Prof Coles has found that indicators of violence can also be behavioural.
 
‘Women presenting alone or with their children, with no good reason to come in, was another flag,’ she said. ‘I often ask, “Sometimes when people come in like you have today they are afraid of something that’s happening at home. Could this be happening to you?”’
 
Although practitioners may worry about asking this type of question, Dr Hindmarsh and Prof Coles believe it is the most important action GPs can take when they suspect a patient is experiencing family violence.
 
‘The first aid of family violence ... is to ask and to check safety,’ Dr Hindmarsh said.

Prof Coles has found that, for the most part, patients are happy to have been asked the question.

‘Nearly everyone I’ve spoken to has just looked relieved; almost, “Thank goodness she’s asked. Now I can tell her what’s going on”,’ Prof Coles said
 
The next step is to provide access to support resources.
 
‘Even if you’re not sure of your local services, you can always look them up with the patient or ring 1800-RESPECT and find out what they are while she’s in the room,’ Prof Coles said.
 
Once a woman has disclosed a situation of family violence, it is also important for practitioners to understand the huge step a patient has taken in speaking out.
 
‘It takes a lot of courage for them to talk to you, and I think it means a lot to acknowledge that to women,’ Prof Coles said.
 
Resources for GP
The RACGP recently developed Professional development program on family abuse and violence, a QI&CPD-accredited program that provides effective resources to support GPs assisting families who are experiencing violence. The program helps GPs learn at their own pace and covers:

• prevalence and impact of family violence in our communities
• skills needed to identify and respond to family violence
• effective collaboration with the broader family violence sector
• self-care in the context of family violence practice.

The RACGP also offers Abuse and violence: Working with our patients in general practice (the White Book). Developed for GPs by GPs, this resource contains evidence-based information, tools and resources (including webinars and videos) for dealing with family violence in general practice.

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