Many may have enjoyed the peace and quiet in life that came with Alert Level 4 lockdown but many experienced the opposite. Bubbles of people confined to their houses may have provided the perfect conditions for interpersonal and sexual violence. Like a natural disaster (e.g. Christchurch earthquake), often there is a ripple effect with violence rates increasing for some time after the event.
Inadequate or overcrowded housing, poverty, stress of having to teach/supervise their own children, job uncertainty and lack of the normal safety netting that surrounds a child (e.g. school) can all contribute to increased rates of violence, and decreased rates of detection of that violence.
When it comes to violence detection, as demonstrated in the most recent Crime and Victim Survey 2018 -2019, the majority of interpersonal violence goes unreported. Staggeringly 94 percent of those who suffer sexual violence do not report this to Police.
As GPs, we are in the privileged position of hearing and being able to ask about ‘domestic’ violence. When we hear about physical violence, we need to ask about sexual violence, and we need to specifically ask about strangulation.
To add to that list it is useful to have discussions with younger people about healthy sexuality. Most young people in Aotearoa get their sex education from porn sites. The effect of pornography on sexual norms cannot be underrated. It is unfortunate that porn sites promoting strangulation do not explain the deleterious effect on the brain. The excellent website https://thelightproject.co.nz/ has plenty of information about pornography and there is also a section for health professionals to help negotiate these conversations. There are some alarming statistics there, including that one in four children have looked at porn by the age of 12.
As you may know, strangulation is now a separate offence under our law. In the context of intimate partner violence, previous strangulation increases risk of a completed homicide by 700 percent. The Police and justice system have now recognised the significance of this.
We may be congratulating ourselves on ‘flattening the curve’ with respect to COVID-19, but wouldn’t it be great if we could do the same with interpersonal and sexual violence in Aotearoa?
What we can do in community medicine
- Ask about whānau/family safety e.g. “How are things going at the moment? How are things with your partner? There has been a real range of experiences during level 4 - how was level 4 lockdown for you?”
- If violence is disclosed, discuss where you might go from here – how safe are they to come in for an in-person consult, offer resources and referral, e.g. to Sexual Abuse Assessment Treatment Service (SAATS) or local crisis support (e.g. Women’s Refuge).
A note about sexual violence
Please remind people that the Police do not have to be involved if you refer them to a local SAATS. There are SAATS all throughout the motu and their services are free. People can choose to have:
- A health and safety check (medical and psychological care).
- A ‘Just in Case’ examination. This is a forensic exam where samples are taken and stored anonymously. The patient has six months within which to make up their mind about involving the Police. If they do not want to use the samples, the forensic kits get destroyed.
- A full forensic exam with Police involvement.
Medical Sexual Assault Clinicians Aotearoa (MEDSAC) is the training, CME, mentorship and accreditation body for clinicians who work in sexual assault services. MEDSAC runs an annual conference at Te Papa. New trainees are fully supported by a mentor, and the Expert Advisor Forum on www.saats-link.nz. MEDSAC also offers a medical expert review group that will review doctors’ statements prior to court.