Public Health Alert: Domestic Violence

It was another “first” for Massachusetts. Governor Patrick signed a violence intervention bill in June, making Massachusetts the first state requiring health care providers to link victims of violence to educational, legal, counseling, housing, and other social services. The bill requires the state Department of Public Health (DPH) to draft voluntary guidelines to help hospitals and community centers provide such services.

Simultaneously, DPH issued a landmark public health advisory on domestic violence. That, too, was a first. It was the first time such an advisory was released to the public and the health care community for a non-disease related cause. 

“The statistics on the impact of domestic violence are sobering,” said DPH, “and point clearly to the extent of this serious public health problem.” The numbers from Jane Doe Inc., the Massachusetts Coalition Against Sexual Assault and Domestic Violence, are emphatic in describing its severity.

Fatalities from domestic violence in Massachusetts over a three-year period have risen dramatically, and were nearly three times higher in 2007 than in 2005. There were 15 murders in 2005, 28 in 2006, and 42 in 2007, and 20 domestic violence-related suicides during this three-year span. And through the third week of September of 2008, 30 more people have died, with 23 murders and 7 suicides. Children are also among the victims: in 2007, 5 were killed and 13 orphaned.

The problem is widespread. SAFELINK (1-877-785-2020), the statewide domestic violence hotline, records some 22,000 calls annually, and in 2005, more than 33,000 women, men, and children were served by domestic violence programs in the state. 

And those are just the numbers for partner violence. Child and elder abuse, teen dating violence, and shaken baby syndrome add thousands more to the total number of victims and at-risk individuals across the state. Reports of elder abuse in 2005, for example, surpassed 11,500, with 3,700 newly confirmed cases. Both numbers represent a 16 percent jump from the previous year.

Incredibly, the real numbers may be even higher. Because much abuse and violence remain hidden and silent, it’s hard to know how much really occurs. Victims may feel ashamed and fearful of coming forward, and friends and family, believing it a personal matter, shun involvement. Domestic violence also goes beyond the physical; mental, emotional, sexual, and even economic abuse claim their casualties as well. All of that makes screening and accurate recording difficult.

The DPH advisory acknowledged that violence is a serious, underlying cause of poor health and that health care providers can play an important role in identifying and responding to victims of domestic violence. It recommended “routine screening for domestic violence victimization in all health care settings.”

And that’s the critical message for patients: physicians and health care providers can help. They are often the first and sometimes the only professionals that victims of violence will encounter, and thus are in a unique position to help break the cycle of violence.

This message is not new for the health care community. For more than a decade, the Massachusetts Medical Society and Alliance, through its Campaign Against Violence™, has been educating health care professionals in recognizing and treating victims of abuse and urging them to ask their patients about it. At the same time, it has been encouraging patients to speak honestly with their providers. 

The state’s action has given the health care community a significant opportunity to revive its efforts against domestic violence. And it’s given victims and those at-risk the chance to think about a new way to look for help.

We shouldn’t let those opportunities pass. Physicians and providers, by recognizing that their public health role is just as important as their mission of caring for individual patients, can play a vital role in ending such violence by early detection and referral to resources. 

As we acknowledge the 21st anniversary of Domestic Violence Awareness Month this October, I encourage all health care professionals to join the campaign against domestic violence. And I urge victims and those at-risk to look to their health providers as a source of assistance. Domestic violence is no longer just a personal matter; it affects a community’s sense of safety, and thus affects us all. To learn more about domestic violence and what you can do about it, visit www.massmed.org/violence or www.janedoe.org.

Elliot M. Pittel, M.D., M.P.H., is Co-Vice-Chair of the Massachusetts Medical Society’s Committee on Violence Intervention and Prevention and a child and adolescent  psychiatrist with the Children’s Community Support Collaborative of The Home for Little Wanderers in Brighton. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org