Assessing the Acceptability, Feasibility and Sustainability of an Intervention to Increase Detection of Domestic Violence and Abuse in Patients Suffering From Severe Mental Illness: A Qualitative Study.

Roos E Ruijne,Louise M Howard,Astrid M Kamperman,Cornelis L Mulder,Milan Zarchev,Mark Van Der Gaag,Stefan Bogaerts,Carlo Garofalo,Kylee Trevillion

doi:10.3389/fpsyt.2020.581031

Abstract

Rationale: Despite interventions to improve detection rates, domestic violence, and abuse (DVA) remains largely undetected by healthcare services. We therefore aimed to examine the acceptability, feasibility, and sustainability of an intervention aiming to improve DVA detection rates, which included a clear referral pathway (i.e., the BRAVE intervention) and to explore the acceptability and feasibility of DVA management and referrals in general, in the context of low detection rates.Methods: Qualitative study design with four focus groups of 16 community mental health (CMH) clinicians from both control and intervention arms. The focus groups discussed managing DVA in clinical practice and staff experiences with the BRAVE intervention in particular. Focus groups continued until saturation of the subject was reached. Interviews were analyzed using a thematic analysis approach.Results: DVA was seen to be highly relevant to mental healthcare but is also a very sensitive subject. Barriers in CMH professionals, institutions, and society meant CMH professionals often refrained from asking about DVA in patients. Barriers included communication difficulties between CMH professionals and DVA professionals, a fear of disrupting the therapeutic alliance with the patient, and a lack of appropriate services to help victims of DVA.Conclusion: The BRAVE intervention was acceptable but not feasible or sustainable. Personal, institutional, and public barriers make it not feasible for CMH professionals to detect DVA in mental healthcare. To increase the detection of DVA, professional standards should be combined with training, feedback sessions with peers and DVA counselors, and routine enquiry about DVA.Clinical Trial Registration: ISRCTN, trial registration number: ISRCTN14115257.

Highlights

Domestic violence and abuse (DVA) are important societal problems with negative consequences for individuals and for society
The BRAVE training comprised of three elements: training for mental health care professionals on Domestic Violence and Abuse (DVA); training on mental health for DVA professionals, and the provision and establishment of a referral pathway between community mental health (CMH) services and DVA services for SMI patients who were victims of DVA
16 mental healthcare professionals participated in the focus groups, which comprised between three and five participants, of whom 63.5 % (10/16) were female and 37.5% (6/16) of whom had received the BRAVE intervention

Summary

Introduction

Domestic violence and abuse (DVA) are important societal problems with negative consequences for individuals and for society. The results of the RCT showed that the intervention was followed by a significant improvement in DVA knowledge and management skills, and by a change in attitudes toward DVA among mental healthcare professionals, the number of DVA cases detected did not increase (Ruijne et al, in review, Journal of Interpersonal Violence) The purpose of this parallel qualitative study was to [1] explore the acceptability, feasibility and long-term sustainability of the BRAVE intervention and [2] to explore the acceptability and feasibility of DVA management and referrals in general, with a focus on: knowledge about DVA, assessment of DVA, safety, and treatment/follow-up. To gain more variety in the gained information from interviews, we decided to interview members from control teams as well as intervention teams

Methods

Results

Discussion

Conclusion