To the editor,
Intimate partner violence (IPV) against women is a global public health concern that adversely affects women’s physical and mental health, leading to increased use of health services. 1 Healthcare providers will likely be the first point of contact for women experiencing IPV, to provide services in health settings. 2 However, numerous barriers to disclosure and inquiry may be responsible for low detection rates in healthcare settings. 3 The most common reasons for non-disclosure of violence are cultural acceptance of violence, stigma, embarrassment, shame, fear of further violence, and lack of privacy. 4 Healthcare providers may also be reluctant to screen for IPV. The most common barriers identified include lack of training, negative attitude, lack of time, personal discomfort, and fear of re-traumatizing the victim. 5
Women availing psychiatric treatment are more vulnerable to IPV, and prolonged exposure to IPV was associated with the onset of psychiatric illness. 6 Despite these findings, IPV remains mostly undetected by Mental Health Professionals (MHPs), where clinicians rarely ask for IPV and fail to address the abuse within the treatment plans. 7 The current research aimed to explore MHPs’ knowledge, attitude, and preparedness and their need to respond to IPV in a clinical setting.
A cross-sectional study was conducted at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, a tertiary mental health hospital. A total of 51 full-time practicing MHPs (including psychiatrists, psychiatric social workers, psychologists, and psychiatric nurses) working in adult psychiatry units were recruited for the study using purposive sampling. Written informed consent was obtained from all the participants at the time of recruitment. The study was approved by the Institute Ethics Committee, Behavioral Division.
The data was collected using Mental Health Professionals’ Attitude & Opinion, Knowledge, Preparedness to Manage Intimate Partner Violence (MAP-IPV) prepared by the research team. 8 It consists of 49 items in three domains: attitude and opinion (15 items), knowledge (17 items), and preparedness (17 items). The scale’s content validity was established through ten subject experts in the area of gender and mental health. The responses for each item are “strongly disagree”, “disagree”, “somewhat agree”, “agree”, and “strongly agree” on a five-point Likert scale. Total scores obtainable on the MAP-IPV scale range from 49 to 245. A higher score indicates a higher or greater level of preparedness to handle IPV cases among professionals.
The participants’ age ranged from 24 to 52 years with a mean ± SD of 33.8 ± 6.87 years. Of the 51 MHPs, 43.1% were psychiatric social workers, 19.6% were clinical psychologists, 17.8% were psychiatrists, and 19.5% were psychiatric nurses. The majority (52.9%) were females.
Regarding the rates of IPV identification, 38% of the professionals routinely asked all the women about their IPV experiences. The weekly number of IPV cases seen by MHPs in inpatient and outpatient services ranged from 1 to 20 with a mean of 3.53 ± 4.27 and from 1 to 10 with a mean of 2.74 ± 2.65, respectively. Almost 65% of MHPs had not received any formal training in screening and providing care to women exposed to IPV.
The mean scores on the MAP-IPV revealed that MHPs had a higher level of preparedness (mean = 64.4 ± 13.1) to handle IPV cases and knowledge (mean = 63.5 ± 5.8) about various forms of violence against women in society. In the domain of attitude and opinion towards violence against women, MHPs showed an unfavorable/negative attitude and opinion (mean = 59.2 ± 5.9) towards women victims of IPV, where victim-blaming was perceived or attributed as the cause for the IPV.
The scores obtained by the professionals from different disciplines on MAP-IPV indicated that psychiatric social workers had a better attitude and opinion against IPV against women. However, MAP-IPV scores showed no significant difference between the groups. Clinical psychologists had better preparedness and readiness to deal with IPV cases, although the difference was non-significant. On the knowledge aspect, psychiatric social workers had better knowledge regarding the nature, impact, and risk factors of IPV against women. However, the differences among the groups were non-significant. Overall, psychiatric social workers had better attitudes, opinions, knowledge, and preparedness to respond to IPV cases than other groups. However, the group difference was non-significant (Table 1).
Table 1.
Scores of MHPs on MAP-IPV Scale.
| Domains | Discipline | Mean (SD)/Median (Q3-Q1) | F/H test | df | p-value |
| Attitude and opinion* | Psychiatric social workers | 61 (63–56) | 1.89 | 3 | 0.596 |
| Clinical psychologists | 61 (64.25–57.75) | ||||
| Psychiatrists | 58 (65–53.5) | ||||
| Psychiatric nurses | 55 (65–52) | ||||
| Preparedness* | Psychiatric social workers | 66 (73–53) | 3.32 | 3 | 0.354 |
| Clinical psychologists | 75 (76.25–61.25) | ||||
| Psychiatrists | 57.50(68.25–50.20) | ||||
| Psychiatric nurses | 65 (70.25–56.75) | ||||
| Knowledge** | Psychiatric social workers | 65.4 (6.17) | 1.50 | 3 | 0.230 |
| Clinical psychologists | 64.7 (6.16) | ||||
| Psychiatrists | 61.6 (5.31) | ||||
| Psychiatric nurses | 63.5 (5.83) | ||||
| Total score** | Psychiatric social workers | 189.8 (15.37) | 0.15 | 3 | 0.929 |
| Clinical psychologists | 186.5 (16.18) | ||||
| Psychiatrists | 185.8 (14.66) | ||||
| Psychiatric nurses | 187.2 (6.41) |
*Kruskal-Wallis Test, **One-way analysis of variance (ANOVA).
MHPs: mental health professionals, MAP-IPV: Mental Health Professionals’ Attitude, Knowledge, Preparedness to Manage Intimate Partner Violence
Regarding the resources available at the workplace to address the IPV cases, three-fourth (78.4%) of the MHPs felt that their workplace did not have a standard protocol, institutional policy, or resource materials to deal with IPV-related issues. Regarding professional needs to handle IPV cases, 48% of MHPs wanted to have resource material to handle IPV cases and 44% wanted training on various therapeutic models and specific hands-on training on couple therapy. They also expressed the need to have information materials that can be displayed at the workplace for the patients’ benefit (Figure 1).
Figure 1. Needs of MHPs to Handle IPV Cases at the Workplace.
MHPs: mental health professionals, IPV: intimate partner violence.
Our findings strengthen previous studies that examined clinician attitudes and practices specific to IPV identification and intervention.
MHPs have an important role in protecting women’s rights to be free from gender-based violence. It involves identification, risk assessment, providing emotional first aid, and safety planning.
Footnotes
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: Funded by the National Institute of Mental Health and Neuro Sciences (NIMHANS) − Extramural Fund, Bengaluru, Karnataka, India.
References
- 1.Bonomi AE, Thompson RS, Anderson M, et al. Intimate partner violence and women’s physical, mental, and social functioning. Am J Prev Med 2006; 30(6):458−466. [DOI] [PubMed] [Google Scholar]
- 2.McGrath ME, Bettacchi A, Duffy SJ, et al. Violence against women: provider barriers to intervention in emergency departments. Acad Emerg Med 1997; 4(4): 297−300. [DOI] [PubMed] [Google Scholar]
- 3.Goff HW, Byrd TL, Shelton AJ, et al. Health care professionals’ skills, beliefs, and expectations about screening for domestic violence in a border community. Fam Community Health 2001; 24(1): 39−54. [DOI] [PubMed] [Google Scholar]
- 4.Chamberlain L and Perham-Hester KA. The impact of perceived barriers on primary care physicians’ screening practices for female partner abuse. Women Health 2002; 35: 55–69. [DOI] [PubMed] [Google Scholar]
- 5.Kirst M, Zhang YJ, Young A, et al. Referral to health and social services for intimate partner violence in health care settings: a realist scoping review. Trauma Violence Abuse 2012; 13: 198–208. [DOI] [PubMed] [Google Scholar]
- 6.Dutton MN, James L, Langhorne A, et al. Coordinated public health initiatives to address violence against women and adolescents. J Women’s Health (Larrchmt) 2015; 24(1): 80–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Dunham K and Senn CY. Minimizing negative experiences: Women’s disclosure of partner abuse. J Interpers Violence 2000; 15: 251–261. [Google Scholar]
- 8.Vranda MN, Channaveerachari NK, D M, et al. Psychosocial correlates of domestic violence among women with mental illness, mental health professionals’ knowledge, attitude and preparedness to respond to domestic violence. Annual Report. NIMHANS Publication, 2019. [Google Scholar]