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Domestic violence victims slipping through the health care net

Helen Adams and Dawn Brazell | MUSC News Center | October 31, 2014

Domestic violence
Dawn Brazell

Dr. Jane Liebschutz and attorney Pamela Jacobs speak on an MUSC panel about solutions to domestic violence. 

Pamela Jacobs put it plainly: “I’m just fortunate to be here.”

Apart from her voice, the room was silent at the Thomas A. Pitts Memorial Lectureship in Medical Ethics at the Medical University of South Carolina.

Jacobs told the audience that her mother was an immigrant who “became addicted to alcohol and drugs and found a man who was very willing to indulge all of those addictions and eventually became an additional barrier in her life.

“She was pregnant many times before me, and he would always either beat the child out of her or force her to have it aborted,” Jacobs said. This time, her father wanted the baby, hoping for a son. Jacobs was born, then later sent to what was supposed to be a safer environment.

“I went to live with my grandmother and her husband and was sexually abused by my step-grandfather my entire childhood.”

Jacobs said all of this in a matter-of-fact tone, standing before the audience of mostly health care professionals. She spoke from the perspective of an abuse survivor who has become an advocate and lawyer fighting to end domestic violence.

Her personal story added weight to the larger message she was there to deliver: It’s important for communities to take an integrated approach to ending domestic violence. Police, lawyers, judges, advocates and health care professionals who deal with domestic violence cases need to know about each other so they can get victims the resources they need, she said. And people who don’t fall into those categories need to be willing to step forward as well when they see someone who needs help.

“Perhaps if someone had intervened with my mother at a different stage, if perhaps when she was eight months pregnant and drinking in the bar with bruises covering her face. If someone had said, are you okay and can I do anything for you instead of judging, then perhaps things may have gone differently.”

Jacobs’s lecture was one of several presentations at MUSC focusing on the complex nature of domestic violence. Other speakers discussed how it can turn deadly, how health care professionals should respond when they see possible evidence of abuse and the impact domestic violence has on everything from children to our national health care costs.

Jacquelyn Campbell, Ph.D., R.N., Professor and Anna D. Wolf Chair of Community-Public Health at Johns Hopkins University

domestic violence 
Participants ask the panelists questions at the 21st annual Thomas A. Pitts Memorial Lectureship in Medical Ethics at MUSC. 

In her lecture at MUSC, Jacquelyn Campbell, chairwoman of the board of directors of the national organization “Futures Without Violence,” focused on domestic abuse that turns deadly.

It’s a serious problem in South Carolina, which has led the nation in the murder rate of women at the hands of men.

Campbell told a story about two women she came across in her research.

“One in Baltimore and one in Seattle, Washington who were both shot in the back by their husbands. Unfortunately, both of them ended up paralyzed.”

When the women were ready to go home, “both of them were discharged to their husbands.” The men were out of jail after serving just a few months because they weren’t considered a “risk to society.”

“Both women told us that they had decided carefully that he was really sorry and he was promising to take care of her for the rest of her life,” Campbell said. “And after all, somebody needed to. It was a way to keep the family together.”

She said neither woman was offered domestic violence counseling in the hospital or rehabilitation center, despite the fact that they were there because their husbands had shot them.

“Both said they wished they had been able to talk to somebody knowledgeable about domestic violence,” Campbell said.

This danger assessment tool created by Dr. Jacquelyn Campbell is used by health professionals. 

Nationally, she said, 40 to 47 percent of the women who were killed by their abusers were seen in the health care system in the year before their deaths.

“Some of them were seen in the emergency department but also in primary care, in prenatal care, in mental health services. Only 4 percent of those women had actually sought help from a domestic violence agency. We apparently didn’t do a very good job of allowing them to disclose abuse and getting them the help that they needed. “

She told the audience about a tool she created that’s available online called danger It’s a free scoring system designed to calculate the likelihood that an abused woman will die at the hands of her intimate partner.

Jane Liebschutz, M.D., associate professor of medicine and social and behavioral sciences at the Boston University schools of Medicine and Public Health

Speaker Jane Liebschutz focused on how people in the health professions can help domestic abuse victims as safely and effectively as possible.

First, she advised being careful when dealing with possible abuse victims. For example, she said, “You have to make you’re not putting a patient in a compromised situation by asking” if they’ve been hurt by a loved one.

If there is any chance that someone might overhear, she advised against asking to avoid the risk of making the patient’s situation worse.

Second, she explained why doctors should be careful about giving sedatives to patients they suspect were abused. “If you give somebody a sedating medication, you may be decreasing their ability to be vigilant and care for themselves.”

Third, she said it’s important to let domestic violence patients make their own decisions. “We don’t want to recreate the power and control relationship that the patient is already in or has experienced.”

“It’s really their decision whether they want to stay or go. It’s complex,” Liebschutz said. “It’s important that patients get a choice related to their violence situations but also related to health care.”

The stakes are high, not only for the victims but also for everyone else. The reason: Domestic violence accounts for more than $8 billion in medical and mental health costs and lost productivity in this country, Liebschutz said.

Alyssa Rheingold, Ph.D., associated professor of psychiatry and behavioral sciences at MUSC

domestic violence 
Alyssa Rheingold discusses the psychological impact of domestic abuse. 

Alyssa Rheingold, who serves as clinical director of the National Crime Victims and Research Center at MUSC in addition to her work as a professor, focused on the psychological impact of abuse during her speech.

“Roughly 1 in 4 women at some point in their life will be a victim of domestic violence,” she said. “That means either you are a woman in this room who has been impacted by domestic violence yourself or you know somebody who has.”

She used more numbers to demonstrate how powerful the impact can be. Between one third and one half of abuse victims develop post-traumatic stress disorder, she said, and the risk of alcohol abuse is increased by a factor of four.
So why do some people have those problems while others don’t?

Rheingold said three key factors affect a person’s resilience: genetics, environmental stress (such as other life problems or legal issues), and whether the victims have good social support.

In a separate interview, Rheingold said she was pleased that MUSC addressed the issue of domestic violence “within a forum that provides not only information about this underserved population but also thoughtful discussion about how to approach the complexities of violence in the home.”

She said MUSC is already taking steps to deal with domestic violence in the Tri-county area. Its National Crime Victims Research and Treatment Center has a division within the Department of Psychiatry and Behavioral Sciences at MUSC. It includes an outpatient clinic and an outreach center that offers intensive case management and therapy.

“Our faculty and staff are actively collaborating in a number of community-based prevention and intervention initiatives to best address the issue of domestic  violence,” Rheingold said.

This marks the 21st year that MUSC has hosted the Pitts Lectureship in Medical Ethics. The series is named after Thomas Pitts, who served on the MUSC board of trustees and left a bequest to endow lectures on medical ethics.



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