Case 9- domestic abuse and empathy Flashcards
Domestic abuse
Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality
Types of domestic abuse
Psychological, emotional, physical, sexual, honour based violence, female genital mutilation and financial
Define controlling behaviour
A range of acts designed to make the person subordinate and/or dependent by
- isolating them from sources of support
- depriving them of means needed for independence, resistance and escape
- exploiting their resources/capacities for personal gain
- regulating their every day behaviour
Define coercive behaviour
An act or pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish or frighten the victim
Risk factors for domestic abuse
Females, young age, learning disability, mental health issues, power imbalance, controlling behaviour, pregnancy, sexuality
Why is domestic abuse hard to spot
1) Evolves- not immediate
2) Manipulation
3) Shame/embarrassment
4) Fear of getting it wrong
5) Charm offensive (cycle of abuse)
The cycle of abuse
Calm - incident is forgotten, no abuse taking place, honeymoon period
Tension building - breakdown of communication, victim becomes fearful and tries to placate the abuser
Incident - verbal, emotional or physical abuse, anger, blaming, arguing, threats
Reconciliation - abuser apologises and gives excuses, blames victim or denies abuse
Biological impact of domestic abuse
- cuts, scars, wounds, bruises, fractures
- STIs and unwanted pregnancy
- non specific symptoms - headaches, fainting, churning pain
- self neglect
- homicide
Psychological impact of domestic abuse
- emotional distress
- depression, anxiety, suicidility, self harm, PTSD
- alcohol/substance abuse
- eating disorders
- sleep disorders
Social impact of domestic abuse
- financial dependence on partner
- impact on work
- homelessness
- drink/drug behaviours
- isolation from friends and family
What medical help do survivors of abuse need
More visits to doctors
More operative surgery
More hospital stays
More mental health consultations
What to do if a patient discloses domestic abuse
Believing not blaming Treating health consequences Supporting Documenting Following up Identifying and managing risks Safeguarding role Signposting Safety planning - exit plans Share concerns - safeguarding, social services DON'T IGNORE IT
When should domestic abuse be referred to safeguarding
Children involved
Risk of serious crime
Vulnerable person
Why is it hard for the victim to leave
Fear of criminal action Fear of loss of children Family breakdown Financially trapped Homelessness Stigma Embarrassed Still love the perpetrator
Emotional and financial abuse
Emotional- name calling, undermining, ignoring, belittling them
Financial- small allowance, no money of their own, aren’t allowed to get a job
Sexual abuse
Rape, forced to watch pornography, taking inappropriate photos and then sharing them.
Empathy
The capacity to understand the patients situation, perspective and feelings and to communicate that understanding back to the patient
Difference between sympathy and empathy
Empathy is understanding why another person is suffering and being able to put yourself in their shoes. Sympathy is natural response to someone else suffering, feeling of pity or concern seen from an external perspective
Benefits of empathy
Enhances the doctor-patient relationship
Increases patient and doctor satisfaction
Improves diagnostic accuracy
Reduces anxiety and depression in cancer patients
Linked with quality of life and well being measures
Increases concordance with treatment plans
Consequences of lack of empathy
Patient feels unacknowledged and unheard
Doctor feels unappreciated
Ineffective consultation
Inaccurate diagnoses
Components of empathy
Emotive - emotional intelligence to recognise the patients emotions (seeing an emotion)
Cognitive - accurately appreciate and understand the patients feelings
Moral - altruism, choosing to respond
Behavioural - sensitively and effectively communicating that understanding back to the patient, verbally and non verbally
What facilitates empathy
1) Listening and empathy - non verbal communication and responding to cues
2) Continual human connection - successful opening of interview, open questions and giving patients time. Mirroring, professional appearance and appropriate physical contact
3) Information flow from the patient - show interest in the patient and use of silence. Don’t interrupt, be dismissive or make assumptions
How can you display empathy?
Verbal Facial expression Eye contact Body posture Gesture Tone of voice Use of silence Immersion and interest Use of touch
Types of touch in empathy
Procedural touch - physical contact that occurs during a task (eg greeting, examination or helping on/off couch)
Expressive touch - spontaneous contact which is not required as part of task or examination
What factors influences the use of touch in a consultation
Age of patient, gender of doctor and patient, level of distress, clinical context and personality. Generally touch on the hand or forearm is accepted
Skills for developing rapport with patient
- Acceptance- accepts legitimacy of patients views and feelings, is non-judgemental.
- Empathy- uses empathy to communicate understanding and appreciation of the patients feelings. Overtly acknowledge patients views and feelings
- Support- express concern, understanding, willingness to help. Acknowledge coping effort and appropriate self care
- Sensitivity- deal sensitively with embarrassing and disturbing topics and physical pain.
How to respond to a patients emotion
First you recognise the emotions or feelings from their cues. You then respond to the emotion in some way, you acknowledge the emotion, invite further exploration as appropriate and using a non-verbal and verbal empathic response.
Newsreader effect
Changing your posture, expression and tone of voice to suit the mood of the session
Mental health
A state of wellbeing in which an individual realises their ability, can cope with the normal stresses of life, can work productively and is able to contribute to their community.
Attitudes of society to those with mental health issues
- Public is more accepting of a person with depression than they are with schizophrenia
- Public less willing to interact with someone with a mental illness in a personal setting (marrying into family or providing child care)
- Majority think an employee with depression is less likely to be promoted
- Negative stigma with mental illness, stereotyped views so people may be subject to discrimination
- Stereotype that someone with a mental illness is dangerous/violent and unable to live a normal life
Vulnerability factors affecting mental health
Psychological- genetic, resilience Personality- low self esteem Social adversity- housing, poverty Family- parental loss, child abuse Social reasons- few social contacts
Protective factors concerning mental health
Good parenting
Happy relationship
High self esteem
Diagnosing a mental illness
Largely based on history taking
Symptoms very subjective and individual - they vary depending on situation
Limited investigations to diagnose
Requires clinical judgement - interpret symptoms in the context of that individual
Comprehensive biopsychosocial assessment
Biological vulnerability to mental health issues
Biogenetic risk factors= genetic factors, temperamental predisposition, gender
Psychological risk factors= early and recurrent trauma, poor coping styles
Psychological vulnerability to mental health issues
Somatic risk factors= somatic disease, substance misuse,
Social and cultural risk factors= instability, environmental factors
The cycle of stigma
1) Stigma
2) Negative perception of mental illness
3) Fear of discrimination
4) Avoidance of help and recourses
5) Untreated mental illness, perpetuating misconceptions
Trigger for mental health issues
People may have a disproportionate response to a life event, like a break up. Can be not having a big enough response ie to death.
Most common mental health disorder in the UK
Mixed anxiety and depression
How mental health issues may present to the doctor
Women are more likely to present than men, can be direct or indirect. May present with low mood, insomnia, weight loss and irritability. Can be hand on door.
Physical manifestations of depression
Lethargy, poor sleep, loss of appetite, poor libido
Physical manifestations of anxiety
Palpitations, chest pain, breathlessness, sweating, dizziness and diarrhoea
Somatic symptoms
An illness where emotional factors produce physical symptoms. For example, abdomen pain, headache and dizziness. Underlying anxiety and mood drives exacerbations. It is challenging to explain and treat.
What other specialities does mental health overlap with
Neurology (epilepsy), chronic pain clinics and obstetrics (post-natal depression)
Self help recourses for mental health
Online forums
Mood gym
Self guided CBT online
Self referred for counsellor by GP
Cognitive behavioural therapy
Talking therapy which helps you manage your problems by changing the way which you think and behave Breaks problems into smaller parts Stop negative thought cycle Often used alongside SSRIs Key non pharmacological intervention
Other psychological therapies
RELATE - relationship therapy Family therapy DBT and MBT Anger management Art therapy Music therapy Bereavement counselling EMDR (eye movement desensitisation and reprocessing)
Social support to help mental health
Financial services Employment services Housing services Social care and social workers Safeguarding team
Stepped-care model; Step 1
Assessment, support, psychoeducation, referral
Stepped-care model: Step 2 (Persistent symptoms; mild-moderate)
Low intensity psychosocial, psychological interventions, medication, referral
Stepped care model: Step 3 (moderate to severe)
Medication, high intensity psychology, combined treatment, referral
Stepped care model: Step 4 (severe and complex, risk to life)
Medication, high intensity psychology, combined, ECT, crisis, MDT, inpatient care
Patient self care
Reducing caffeine, weekly Pilates, listening to music to de-stress, meeting up with friends and giving up smoking.
How does empathy lead to better clinical outcomes
1) Improves patient satisfaction and concordance with treatment
2) Patients feel less anxious with an empathetic doctor
3) The patient is more likely to trust the doctor and reveal more information, this improves diagnostic accuracy and prediction of treatment pitfalls
4) Patients are more likely to make a positive lifestyle choice
