For women living in rural and remote areas of Australia, domestic violence is both more prevalent, and less frequently reported.

The reasons for this are varied and complex, according to Psychologist and Clinical Psychology Registrar, Dr Julia Hosie, also a member of domestic violence advocacy group, My Red Flags. 

“It is difficult to find accurate figures as many victims do not report abuse,” says Dr Hosie.

“In many cases, (this is due to) fear of increased aggression, economic concerns, fear for children being placed with the perpetrator, fear of rejection from family/community/church, and lack of support facilities.

“In rural communities there can also be more narrowly defined gender norms, more traditional stoic family values and strong family patriarchy, less anonymity within the community, and normalisation of violent behaviour in some communities.”

“The shame of the behaviour, small town gossip, isolation, lack of services (and knowledge of services when available),  as well as the likelihood that the authority figures or health professionals may be known to the perpetrator deter reporting.

“There is also a perception that the perpetrators of the violence may not be held accountable, particularly if they are held in high regard in the community.

“The issues extend further in immigrant and refugee communities with abuse and intimidation exacerbated due to uncertainty of immigration status, deportation threats, threats to take children overseas and language barriers that discourage help seeking.”

As a result, allied health professionals may be the first point of contact for those experiencing domestic abuse within these communities, which is why its so important for them to be able to spot the signs of DV.

“Domestic abuse is a sensitive topic and as such victims are reluctant to disclose due to shame and embarrassment as well as fear of repercussions due to the disclosure.

“Victims of domestic abuse may be more likely to have increased depressive disorders, anxiety disorders, and personality disorders.

“There is also increase suicidal behaviour, post-traumatic stress disorder, somatic disorders, drug and alcohol use disorders, and poor overall health.”

While mental health professionals may already have some understanding of the signs of domestic violence, other allied health practitioners may not.

“Often physical abuse is not the first sign of an abusive relationship.

“Abuse can include a partner that bullies, threatens or controls (psychologically or financially), being cut off from friends and family, or is physically or sexually abusive.

Dr Hosie says some of the more obvious signs to look for include your patient making excuses for injuries, hiding injuries, personality changes, preoccupation with upsetting a partner, or lack of autonomy.

“The client may appear nervous or ashamed, may describe a partner as angry, or seem anxious in the presence of their partner.”

If domestic violence is suspected, and you’re considering raising the issue, Dr Hosie says its’ important to work within the limitations of your patient’s readiness to process the abuse, while building trust and rapport to encourage a safe place for disclosure.

In opening dialogue with your patient, Dr Hosie recommends the following tips:

• Ask open questions using non-judgemental language.
• Do not rush into problem solving, but rather listen and acknowledge that the fear is important for clients that may have little autonomy, and are living in fear.
• Be clear that the behaviour experienced is abuse.
• Be aware of your own personal biases and values.
• Do not ask questions that may imply shared responsibility. Instead support a client’s autonomy by asking what support would be most helpful for them.
• Be respectful of the client at all times, trust them to make their own decisions. Support their understanding that the perpetrator’s violence is a choice, and that the client is in no way responsible for the violent behaviour of their partner.
• Support the client in finding safety and recovering from trauma with the knowledge of the complexities of domestic violence.
• A future safety plan should be discussed with the client and should include emergency contacts.

“Being aware of a victim’s sense of self and personal safety is important. Respectful, informed support will enable them to make sound decisions for themselves.

“It is also important for professionals to be aware of mandatory reporting in their state, in particular when children are involved. Safety should always be a priority.

“Health professionals should also keep appropriate, clear relevant records in relation to disclosures for risk management.

Dr Hosie recommends allied health professions seek professional development in the field, via organisations such as Relationships Australia and the Domestic Violence Resource Centre.

“Health workers should always seek supervision, practice within your area of expertise, and be aware of the vicarious trauma experienced when working in this very confronting field.

“Health professionals working in this field need to put good personal self-care strategies in place.”