The Identification and Response of Psychiatric Services to Domestic Violence

Abstract

Despite a high prevalence of domestic violence among service users, most cases remain undetected by psychiatric services. Moreover, little is known about the attitudes and opinions of service users and clinicians, regarding psychiatric services response to domestic violence. This research comprises three studies that aimed to: (1) systematically review the prevalence of domestic violence among psychiatric service users; (2) systematically review the effectiveness of interventions for psychiatric service users disclosing domestic violence, and (3) qualitatively explore the experiences and expectations of psychiatric service users and clinicians in relation to domestic violence. Study One: 42 studies were reviewed. Among high-quality studies measuring lifetime partner violence, the pooled prevalence in female inpatients was 37.6% (95% CI 24.3-51) and 31.6% in the one study of males across mixed psychiatric settings. Study Two: Three studies were reviewed. Insufficient evidence was found to establish the effectiveness of cognitive behavioural therapy or domestic violence advocacy. Study Three: Semi-structured interviews were conducted with 24 service users and 25 clinicians. Interviews focused on attitudes towards routine enquiry, experiences of being asked/asking about domestic violence, and views on what interventions had been or would be helpful. Overlapping themes among clinicians and service users included the dominance of the medical diagnostic and treatment model and the establishment of specialist services for abused service users. Service user specific themes included unanimous agreement towards routine enquiry, barriers to disclosure (e.g. blaming attitudes, fear of consequences) and clinicians’ assistance with their complex needs.
Clinician specific themes included mixed views about the implementation of routine enquiry, barriers to enquiry (e.g. role boundaries, competencies and confidence to address abuse) and the need for improved referral pathways and support at an organisational-level.The development and implementation of system-level interventions and evidence-based treatments are crucial to improving psychiatric services identification and response to domestic violence.

Date of Award	2013
Original language	English
Awarding Institution	King's College London
Supervisor	Louise Howard (Supervisor) & Craig Morgan (Supervisor)