Reports of family violence have increased worldwide since quarantine measures began in the wake of the COVID-19 pandemic. This should come as no surprise to clinicians as we know that factors like economic insecurity, social isolation, reduced options for support, exposure to exploitative relationships, and disaster-related instability are associated with this type of violence.
Unfortunately, family violence was a global problem even before the pandemic and service members have not been shielded from the issue. In 2019, the Family Advocacy Program (FAP) reported 15,473 formal complaints of spouse or intimate partner abuse in which one of the parties was an active duty service member. Regarding child abuse and neglect, the FAP reported 5,600 incidents of substantiated allegations among military families.
The known and hypothesized immediate and long-term consequences associated with family violence are significant and include:
- Physical injury, hospitalization and other short term and long term adverse health conditions
- Maladaptive coping mechanisms such as smoking, alcohol or substance abuse
- High prevalence of subsequent victimization
- Mental health concerns such as posttraumatic stress disorder (PTSD), depression, and anxiety
- Workplace disruption, causing further economic insecurity
- Poor social development, increased risk of learning and behavioral disorders, and obesity for children
On an even more somber note, research has also shown that exposure to family violence may lead to an increased risk for suicidal behavior. In a Veterans Health Administration study, female veterans who screened positive for psychological, physical, or sexual types of intimate partner violence were two times more likely to have reported suicidal ideation and/or self-directed violence compared to those who screened negative. Research has also shown a correlation between interpersonal violence and risk of suicide, regardless of whether an individual is the victim/survivor or the perpetrator.
While the pandemic has necessitated changes in the delivery of health care services, what should remain constant is clinicians’ attention to signs of family violence. Once family violence has been identified or suspected, what are your responsibilities as a clinician?
As indicated within Department of Defense Instruction (DoDI) 6490.08, there are nine circumstances for which disclosure of protected health information (PHI) is required. Consistent with DoDI 6400.06, disclosures concerning child abuse or domestic violence is one of them.
There are different ways to report family violence, however, and given that service members and their dependents may be hesitant to discuss family violence due to fears of career- and service-related consequences, it is important that clinicians be aware of the available options. Reports can be made in one of two ways: restricted or unrestricted. For a restricted report, military law enforcement and command will not be notified. To review the difference between restricted and unrestricted reports, visit the Military OneSource website.
For those worried about the potential consequences of reporting, speaking with a military chaplain may be an attractive option because communications with chaplains are protected and confidential.
Resources for Patients:
As the world grapples with the pandemic and our changing social landscape, family violence must remain an area of focus in terms of both prevention and support. Providing victims/survivors with options regarding reporting and resources for support may make the difference between them speaking up or staying silent.
- DoD Safe Helpline: safehelpline.org, 877-995-5247
- Military OneSource: militaryonesource.mil
- Family Advocacy Program: installations.militaryonesource.mil/
- Psychological Health Resource Center: pdhealth.mil/resources/call-centers/psychological-health-resource-center, 866-966-1020
- National Domestic Violence Hotline: thehotline.org, 800-799-7233
- National Child Abuse Hotline: childhelp.org, 800-4-A-CHILD
- National Sexual Assault Hotline: rainn.org, 800-656-4673
- National Suicide Prevention Lifeline: suicidepreventionlifeline.org, 800-273-8255
Ms. McDonnell is a contracted social work subject matter expert for clinical care at the Psychological Health Center of Excellence. She is a licensed clinical social worker with extensive experience in both direct service and administrative oversight of programs specializing in crisis intervention.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.