The Domestic Violence as a Public Problem: the Importance of Health Care - Research Paper Example

 Domestic violence is an issue that will touch almost everyone's life as they, or someone they know, will be subjected to some form of physical, mental, economic, or sexual abuse sometime in their life. While it is one of the most prevalent crimes in the UK, it is also one of the most under reported. The issue is complex as it invades personal relationships, families, children, and is further complicated by the aspects of gender, religion, culture, and ethnicity. Victims may recant their stories out of fear, or law enforcement may minimize the crime and view it as a personal problem. The justice system may reluctantly return a victim to a home to face a repeat offender, yet be powerless to take the steps necessary to protect the parties involved. The UK has made significant changes in the ways that it handles cases of domestic violence in the recent decades. Have the changes in public policies that affect procedures, health care programs, and specialised courts adequate to handle this multifaceted problem? An evaluation of the current policies and processes will show that the UK is moving in the right direction, but at a pace too slow to appropriately address this growing concern. The statistics on domestic violence indicate it is the most pervasive violent crimes, yet is also one of the most under-reported. One in seven violent crimes in the UK is attributed to domestic violence, and about 100 women die from relationship abuse each year (Domestic Violence Mini-site 2008). About 1 out of every 8 women will suffer some form of domestic abuse this year, and 1 in 4 will experience it some time in their lifetime (Walby & Allen 2004, p.14). Overall, over one third of the population, male and female, will be the victim of inter-personal violence sometime in their lifetime (Walby & Allen 2004, p.v). However, the crime of domestic violence is only reported to the police in less than 1 in 4 cases, and "there has been little noticeable change in the rate of reporting over the last ten years for women, though this is somewhat higher than that more than 20 years ago" (Walby & Allen 2004, p.97). The crime is socially stigmatised, as women from households where the income exceeds £20,000 are only one third as likely to report domestic violence as women from households where the income is less than £20,000 (Walby & Allen 2004, p.98). Reasons for under-reporting vary from the belief that it is not important, that it was a personal matter, that they feared revenge, or that the police would not be effective (Walby & Allen 2004, p.102). In addition, only a minority number of the cases reported resulted in an arrest or a court date, and only one-third of the female victims were ever interviewed by an officer from the Domestic Violence Unit (Walby & Allen 2004, p.103). The statistics show a crime that is fomenting in society, while the progress towards effectively reducing it has stagnated. There are a number of different facets to the domestic violence problem that need to be considered. There will be cultural forces that may mediate the perception of the severity of the crime in the minds of law enforcement and the courts. These cultural forces will affect the way in which the victim responds and may shape the type of services that are offered. Children are a special concern, as they need to be protected from a situation where abuse occurs, yet there also needs to be some rights for the biological or adoptive parents. Health care workers are placed in a position to be a first responder to domestic violence, but may not be adequately prepared to address the issue. Law enforcement has been given new tools for the investigation and prosecution of domestic abuse, but may experience problems altering their traditional views of domestic abuse or responding without some level of cultural bias. The expansion of the specialised domestic court system has committed resources that should be able to focus on this crime more effectively, but may not be showing any positive results. The purpose of this paper is to explore the effectiveness of the UK's domestic violence policy as it impacts each of the five facets of culture, children, health care, law enforcement, and the courts. One of the most challenging aspects of the domestic violence policies is to craft a policy that is universally effective and acceptable across all cultures. Recently the issues of forced marriage and honour violence have made the headlines in the UK, and have received greater government focus. The UK has formed a dedicated Forced Marriage Unit (FMU) that handled 400 cases in 2007 (UK Home Office 2008, p.4). In an effort to confront the cultural problem of forced marriages, the policies have been aimed at education and awareness. "Raising awareness of the unit has been a key focus over the past year, and the unit has attended approximately 90 outreach events, ranging from national annual conferences for practitioners to local community led events" (UK Home Office 2008, p.17). The government has decided not to criminalize forced marriage, opting instead to keep it a civil matter, and is working with the Border Agency to protect those who are most at risk through Visa restrictions and sponsorship interviews (UK Home Office 2008, p.17). While these efforts have brought about greater awareness of the problem, they have done little to stem the rising numbers of forced marriages, or discourage a practice that is a long held cultural or religious tradition. Another increasing problem in the UK is the number of crimes which fall under the category of honour based violence. This crime has its roots in cultural or religious traditions and is almost always used as a form of punishment or revenge against a woman that is perceived as dishonouring their husband or family. The challenge for law enforcement is the early recognition of the potential for honour based violence, and the prevention of the crime. Once again, the focus of the UK's policy has been on education, outreach, and awareness. They have established an honour-based hotline that is staffed by violence survivors, and have embarked on a project to gather data on the prevalence and the most effective means to combat this crime (UK Home Office 2008, p.17, 30). The increased focus is a welcomed change in official policy, but cannot work independently of law enforcement. In these cases that involve minority women, the responding officers and the courts may exhibit cultural bias and discrimination against the victim. In 2000, Home Office Minister, Mike O’Brien recognised the need to view honour violence as a crime and not a cultural excuse. He advocated an "approach which demands that violence against women and other oppressive restrictions need to be understood as abuses and violations of women’s fundamental human rights, irrespective of the cultural or religious contexts in which they occur" (qtd. in Patel 2008, p.14). Still, as of 2009 law enforcement and the courts have few tools at their disposal that offers any effective protection for the potential victims of honour-based violence. Patel (2008, p.22) states that there is a "continuing police failure in domestic violence cases, with the result that, with a few individual exceptions, no progress is evident except at the policy level". This is certainly the case with culture based domestic violence where education and awareness have been substituted for investigation and prosecution. Culture and tradition also impact the government's response to violence and abuse when children are involved as either the victim or a witness to the crime. Since the early 1990s, the literature has increased the focus on the effect of domestic violence on children and many authors "argued that child protection systems should be extending into and encompassing domestic violence in order to adequately protect children" (Rivett & Kelly 2006, p.226). Indeed, children who live in a home where they witness domestic violence have an increased chance of having long-term developmental problems and an increased risk of becoming a victim of abuse (UK Home Office 2008, p.11). These issues are best recognised and raised by teachers, health care workers, and children's services. However, few resources have been devoted to creating effective assessment tools or expanding the services necessary to deal with this complex problem (Rivett & Kelly 2006, p.238). It is often assumed that the child from a violent home will have access to Child Protection Services, but because of the complex nature of the problem, and the under-reporting, many of these children have fallen outside the system (Rivett & Kelly 2006, p.237-8). The traditional rights of the mother and the lack of effective social safety nets often negatively impact children's rights to protection. The importance of children's rights cannot be overstated, but it should also be noted that he UK has made considerable progress in addressing this issue. The implementation of the Specialised Domestic Violence Courts have been instrumental in fostering an environment of training and cooperation among the various agencies that handle children's needs. Multi agency risk assessment conferences (MARAC) have brought agencies together to share information concerning the health and well-being of children that are exposed to violence. "By sharing information, agencies get a better picture of victims’ situations and so develop responses that are tailored to the needs and goals of individual victims and their children" (UK Home Office 2006, p.11). This has drastically increased the number of children who are referred to Social Services, or referred to services that may include "individual support, therapeutic play, advocacy, group work, parenting support for mothers, play sessions and childcare (UK Home Office 2006, pp.11, 26). These activities and policies have been a step in the right direction, but there is still a considerable risk if the crime is unreported. Once again, it is incumbent upon the people who are in contact with children to be able to recognise abuse and be willing to respond to it appropriately. One of the areas where the early recognition of domestic violence can be recognised, and help prevent an escalation of further abuse, is the health care system. In the US, there are mandatory reporting policies and laws when child abuse is evident that the British law has yet to implement. This places the judgement in the hands of the health care practitioner and the victim, who both may be reluctant to act out of anxiety over the consequences (Robinson & Spilsbury 2008, p.27). This has led to an environment where the health care system is almost totally disengaged from the issue of domestic violence. While domestic violence can increase during pregnancy, a recent report that studied pregnant women found that only "12% of all women had volunteered information to a health care professional about abuse during the pregnancy. None of these women were routinely questioned, and little or no help was offered" (D'Souza & Garcia 2004, p.601). The current policies regarding the importance of the health care system are currently under-utilizing the setting and the staff to gather information. The government needs to devote the necessary resources to the health care system to be able to adequately deal with this issue. Critics have contended that a mandatory reporting law could discourage victims from seeking help out of fear of losing their children (Robinson & Spilsbury 2008, p.27). In addition to overcoming these initial barriers, there are "difficulties in framing questions or seeing the patient alone, recording information, legal implications, confidentiality, child protection concerns, lack of awareness of support services, frustration at survivors' responses, raising expectations of the client, safety, time management, and issues relating to ethnicity and class" (Taket et al. 2003). The UK has made additional training material available to health care professionals and has made its number one objective to "increase the early identification of, and intervention with, victims of domestic violence by utilising all points of contact with front-line professionals" (UK Home Office 2008, p.10). However, there has been little action taken outside the formation of policy. However, Taket et al. argues that, "Although the government has advocated this approach, so far it has not provided any additional resources, targets, or time frames". Once again, there is the characteristic policy without any means or resources for the translation of the programme into any meaningful action. One of the most dramatic changes in recent years in the policies regarding domestic violence in the UK has been the formation of the Specialist Domestic Violence Court programme. These specialized courts focus on domestic violence and can bring together agencies, professionals, and services that can be of specific benefit to the victims of domestic violence. This is an important step as it has been recognised that inter-professional working produces more positive outcomes for the children involved (Devaney 2008, p.245). However, progress has been slow to materialize as only a small minority of cases, 10 percent, ever reaches the court once the police are called (Walby & Allen 2004, p.103). In addition, it has not been effective at reducing the repeat victimization of many women. It has been reported that "a third of female victims were subject to more than three incidents of domestic violence by the person who victims described as committing the worst incident they experienced" (UK Home Office 2008, p.i). This may be due to the recent procedural changes in regards to how an arrest is made. While police are charged with the gathering of evidence, charges and arrest must be brought by the prosecutor's office (Crown Prosecution Service 2005, p.6). This intermediary step may actually work as a buffer for the perpetrator as it gives them an additional layer of legal protection and easier access to plea-bargaining. This leads to a majority of the women being unaware if an arrest has even been made, and almost one third of the victims dissatisfied with the outcome (Walby & Allen, 2004, x-xi). While the main goal of the system should be to protect the victim, it has not discouraged repeat victimization or given the victims any emotional reassurance that the system works. Legislation has been passed in the recent years that has placed a greater legal responsibility on the perpetrators of domestic violence, and has given the justice system a few more tools to confront this problem on an individual basis. The Domestic Violence and Crime Act of 2004 was heralded as the first legislation to deal with domestic violence in 30 years. However, Women's Aid, the national domestic violence charity for England, cited the law as not going far enough and was simply a reiteration of existing law (Women’s Aid Briefing, 2005). The Protection from Harassment Act of 1997 facilitated the granting of protection orders and defined new criminal acts, but was a general law not specifically aimed at the challenges of a battered woman. The Zero Tolerance of Violence Towards Women and Children campaign has helped to keep the issue in the public spotlight, but requires significant cooperation between agencies such as housing authorities and women's forums to be effective (Bristol Women's Forum, 1999). According to the Women's Aid Federation, "agencies like health and the voluntary sector must also commit to local delivery, by working strategically to prioritise domestic violence, victim safety and offender accountability" (Women’s Aid Briefing, 2005). Legislation is left ineffective without the political will to devote the substantial resources necessary to bring about implementation through widespread inter-agency cooperation. In conclusion, the recent years have seen an increased focus on domestic violence as a public problem and have resulted in myriad government policies. However, many of them have not resulted in any meaningful improvement, as they have failed to go beyond the policy phase. Forced marriages and culture based honour violence continues to be a problem that has been recognized, but not effectively challenged. The importance of children has not been overlooked by policy, but resources have been slow to accompany the rhetoric. For example, the importance of health care as a primary point of recognition has only been utilized in a cursory fashion by making literature and training available. There have been no changes in the legal requirements or the physical resources necessary to exploit this important area. One of the bright spots, the ability of the Specialist Courts to bring together agencies and expertise, has not yielded any significant gains in reducing repeat offenders or improving the victims' perception of the system. Recent legislative acts have given the justice system the necessary tools to confront this issue as a criminal and civil problem, and the UK has made some important first steps regarding the recognition of domestic violence as a critical public issue. It is now time to devote the necessary resources and political will to implement the policies that have come as a result of this increased awareness. References Bristol Women's Forum. (1999). Zero tolerance of violence towards women and children. Bristol UK: Bristol City Council. Crown Prosecution Services 2005, Policy for prosecuting cases of domestic violence, Crown Copyright, London. Devaney, J. 2008, 'Inter-professional working in child protection with families with long-term and complex needs', Child Abuse Review, vol. 17, no. 4, pp.242-261 Domestic Violence Mini-site 2008, UK Home Office, London, viewed 9 February 2009, D'Souza, L., & Garcia, J. 2004, 'Improving services for disadvantaged childbearing women', Child Care, Health and Development, vol. 30, no. 6, pp.599-611. Patel, P., 2008, 'Faith in the state? Asian women's struggles for human rights in the UK, Feminist Legal Studies, vol. 16, no.1, pp.9-36. Rivett, M., & Kelly, S. 2006, 'From awareness to practice: children, domestic violence and child welfare', Child Abuse Review, vol. 15, no. 4, pp.224-242 Robinson, L., & Spilsbury, K. 2008, 'Systematic review of the perceptions and experiences of accessing health services by adult victims of domestic violence', Health and Social Care in the Community, vol.16, no.1, pp.16-30. Taket, A., Nurse, J., Smith, K., Watson, J., Shakespeare, J., Lavis, V., Cosgrove, K., Mulley, K., & Feder, G. 2003, 'Routinely asking women about domestic violence in health settings', British Medical Journal, vol. 327, no.7416, pp.673-676. UK Home Office 2006, Specialist domestic violence court programme resource manual, Home Office, London UK Home Office 2008, National domestic violence delivery plan: progress report 2007/2008, Crown Copyright, London. Walby, S., & Allen, J. 2004, Domestic violence, sexual assault and stalking: findings from the British Crime Survey, Home Office Research, Development and Statistics Directorate, London. Women’s Aid Briefing Domestic Violence, Crime and Victims Act 2004 (2005). Retrieved February 11, 2009, from http://www.womensaid.org.uk/page.asp?section=000100010009000500040002 Read More