August 2022
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Excerpt below from the August 2022 Kaleidoscope column in The British Journal of Psychiatry (BJPsych). You can read the full column for free here
Intimate partner violence (IPV) is underreported and underdocumented, but it is the most common form of violence worldwide and makes a significant contribution to subsequent mental health problems. The Lancet Psychiatry Commission on IPVReference Oram, Fisher, Minnis, Seedat, Walby and Hegarty1 sets out what we know and provides a road map for where we need to get to, particularly in secondary mental healthcare. Variation is notable by country (with national income level a significant factor), along with any minority status, but overall it's estimated that 27% of ever-partnered women will experience physical or sexual IPV in their lifetime, including almost a quarter of those aged 15–19 years. Exposure to IPV and suffering mental illness (particularly substance use) increase rates of perpetrating further violence, but the authors note the ethical and stigmatising complexities of this, including potentially pathologising women's responses to violence and oppression. A key message from the paper is that although IPV is endemic, it is not inevitable, and there are evidenced preventive and interventional opportunities at the level of the individual, the family, the community and society itself.
A primary preventive approach recognises how IPV lies alongside a spectrum of societal oppression of women. Opportunities for positive change include parenting- and schools-based teaching of non-violence norms, enhancing educational, employment and poverty-reducing programmes for women, and targeted substance use resources. Discrimination against women through extant laws and policies such as those surrounding divorce, property ownership and inheritance are rightly called out. Survivors of IPV have been inadequately involved in service development and assessment, although it is acknowledged that these services can be retraumatising to some, especially where care provision has been substandard. Inevitably, beyond capturing some headlines, we cannot do justice to the full report here. We can only commend the full piece to you and concur that reducing IPV will improve mental health outcomes and countless lives. This is everybody's business, and in mental health we need more co-produced gender-sensitive, trauma-informed approaches.