Domestic violence as a women’s health issue— panel discussion

Abstract

in the evolution of domestic violence. Third, mental health providers and systems have let us know that they could be an important intermediary in this work. Physicians may be more familiar and more comfortable referring to colleagues whom they know and understand, and the new focus on depression screening in primary care certainly has fueled that familiarity with mental health professionals. However, although it may lead to or coexist with a mental health diagnosis, domestic violence is not a mental health diagnosis. We need new ways of identifying and diverting domestic violence and sexual assault survivors who present in the context of community mental health care. Anticipating my next point, I suspect that when we do that very well, we will realize some of the important cost savings that our managed care partners need to care about. Fourth, managed care companies told us that they need to see the evidence. Could we show them that health care intervention for early domestic violence screening and referral would save dollars and result in improved outcomes? To close, I want to leave you with a couple of reminders. We’ve talked about smoking and pregnancy. Domestic violence may be involved. We’ve talked about addiction. We’ve talked about child abuse. Domestic violence may be involved there as well. Sexually transmitted diseases have been an important focus of this conference, as well as contraceptive failures and abortion. Here too, the inability to negotiate the use of condoms in a sexual relationship may be linked to coercive control by an intimate partner. All of these may be linked with domestic violence. We’ve discussed medical noncompliance. At the Partnership, we have seen situations where a woman’s partner tells her “You don’t need to take that. You don’t need to fill that prescription,” and those meds are going down the toilet—not because the woman herself is flushing them, but because her partner is. Finally, there’s the link between depression and domestic violence. With so many of the women’s health concerns that we’ve talked about, domestic violence is something that should always be at the forefront of our thinking.