17th December, 2002
Dr. Henry: It is unfortunate to have to deal with such a Bill but following the ruling of the Supreme Court we all realised it was essential to amend the legislation at the earliest opportunity. The Leader was correct to ensure that all Stages of the Bill would come before the House today.
It is sad to think that violence against women can be judicial as well as domestic. On the Order of Business earlier, we heard Senator Leyden refer to the case in Nigeria where a woman who had a child outside marriage has been sentenced to be stoned to death. There is a serious incidence of violence against women throughout the world.
Domestic violence is particularly sad, of course, and apparently at this time of year it becomes worse than ever. As a doctor, I have often wondered if the medical profession could not do more to address the issue of domestic violence.
I wish to place on the record of the House some details of the splendid work undertaken by a colleague of mine, Dr. Fiona Bradley, who, sadly, died recently at the age of 41. She carried out some incredible research on domestic violence in this country, with reference to hospital patients and general practice in Trinity College, Dublin. Dr. Bradley collaborated on the research project with Mary Smith, research nurse, Jean Long, lecturer in international health and development, and Professor Tom O'Dowd, professor of general practice in Trinity College, Dublin. Their work was published in the British Medical Journal of 2 February 2002 and won the JMS Doctor award in the category of general practice. Sadly, the award was presented at a ceremony on the day of Dr. Bradley's funeral. However, her work is a great memorial to her interest in domestic violence.
We know that domestic violence is under-identified and there is considerable physical and psychological morbidity associated with it. Community surveys have indicated that up to one in four women in the United States experience domestic violence. However, according to various surveys carried out in the United States and Australia, some general practices are better at identifying domestic violence than others.
Dr. Bradley set about studying the situation here and obtained the co-operation of 22 practices from all over the country. From March 1996 to May 1997, for two weeks in each practice, the receptionist was asked to hand female patients, over the age of 16, a pack comprising a consent form, a study briefing, a questionnaire for self-completion and a return envelope.
The measure of domestic violence included in the questionnaire was adopted from various surveys on controlling behaviour, violent incidents and consequent injuries. The questionnaire also included questions as to whether general practitioners had ever asked if the women had suffered domestic violence, and if they felt it was right that a person's regular GP should ask such questions. Some 72% of patients responded to the survey, which is a good response rate, and the results were very interesting. The average age of the women who responded was 36.6 years. Some 75% of them were in a current sexual relationship and another 15% had been in such relationships formerly.
Some 48% of the respondents said they had experienced domestic violence of some sort. Of those, 24% said they had experienced one form of violence, 25% said they had experienced two or three types of violence, 20% said they had experienced four to seven types of violence; and 31% of these women had experienced eight or more types of violence.
The most commonly experienced behaviour was where a partner punched or kicked the walls or furniture, shouting at and threatening the children, and where the woman was pushed, grabbed or shoved. More serious violent incidents occurred as well. Some 10% of the women reported having been punched in the face; 10% were punched or kicked on the body, arms or legs; 9% were choked; and 9% were forced to have sex. These admissions are pretty shocking.
Two of the most common controlling behaviours reported by the women who responded to the questionnaire were that their partners shouted or screamed at them, and also that they threatened violence against or were violent towards their children. It is not just the woman who is on the receiving end of domestic violence, it is the whole family. The effect on the children must be really dreadful.
Many of these women did not present in the practice with injuries, but did present with anxiety and depression. A considerable number of them had received treatment for many years for anxiety and depression, and what is described as somatisation, which is where their mental anxiety causes them to have physical problems. The cost of this to the health service must be quite astonishing.
Some 77% of the women who responded said they felt it would be right for the general practitioner whom they commonly attended to ask about domestic violence. In my own practice, I have only infrequently asked female patients about domestic violence. Only 5% of the respondents to Dr. Bradley's survey said they had ever been asked by their general practitioner if domestic violence could have been involved in their cases. The survey's findings provide much food for thought, particularly for those of my medical colleagues who are involved in general practice.
Dr. Bradley carried out a similar survey in accident and emergency units where she or a nurse interviewed women who came in. In all such cases, a woman interviewed another woman and the survey was undertaken privately. It was found that a high percentage of the women who came in with bruising, broken noses or broken fingers had not suffered such injuries in falls but as a result of domestic violence. Hospital accident and emergency departments must ensure privacy for female patients so they can speak in confidence to medical and nursing staff who can then discover if domestic violence has caused them to attend the unit.
It was not only young women who attended the accident and emergency units; women in their 60s and 70s frequently attended also. In these cases, the older women had not necessarily suffered violence as a result of their partner beating them up - in some cases their children were involved. We are not doing enough to address this serious issue.
I wish to acknowledge the work that Dr. Bradley undertook. If only more of us in the medical profession were so concerned about examining the epidemiology of illness, perhaps we would not have such a serious situation in our casualty departments. I am quite sure that with counselling and investigation into family problems, a considerable amount of domestic violence could be addressed.
4 o'clock
The lack of privacy in family courts was raised by Senator Walsh. That is unacceptable. The family courts should sit in private. The Court Services has attempted to examine the issue of what happens in the family courts and I have raised it in this House also.
Often we do not realise how serious these cases are. An attempt was made last year to appoint a barrister to the courts to compile a report in this regard. However, the then Attorney General felt the in camera rule would be breached if this were to happen. The barrister concerned is no longer employed by the Court Services as her contract expired in April. She was unable to produce reports even though they would have been anonymous and undertaken with people who had given consent for their cases to be addressed.
We have to find some way of addressing this issue. I am sure the Minister is as concerned as I am - I see him nodding - about this matter. People do not understand just how serious these cases frequently are. Senator Terry's concerns regarding the eight days need to be taken into account in this regard also.
Men are often injured in domestic violence incidents. They, too, feel threatened and abused in the home. I have worked in casualty departments and it is only in approximately one out of every seven cases that such incidents arise. The main reason women are abused is that they are physically smaller.
Ms O'Rourke: Physical force.
Dr. Henry: I have heard many stories. A heavily pregnant woman told me her arm was broken when her husband rolled over it in the bed. We need to make a greater effort to deal with these cases, not just in the courts but in accident and emergency units and within general practice. We should look closely at the work carried out by Dr. Bradley in this regard to see if we can prevent such incidents and thereby reduce the need for barring orders. We should also seek a satisfactory outcome within partnerships.
Dr. Henry: Like Senators Terry and Brian Hayes, I have received representations about the wording. We must take into account the Supreme Court's pronouncement that these words are meaningless. I do not say that because half of them are constituents of mine, although that is part of the equation. While we are not run by them, it seems unusual to put back into the legislation wording which has been thus described.
Dr. Henry: I support the amendment. Problems have arisen in the courts from the way in which things have been allowed to run on and on without set dates for the return of cases.
Dr. Henry: We should be grateful to Senator Tuffy for bringing this worthwhile amendment before the House. I agree with the Minister of State. I would be concerned that applicants might be deterred from proceeding with cases in circumstances where they should do so. People, particularly those of limited means, have to rely on legal advice.
As a solicitor, Senator Tuffy would have more knowledge than I of the family courts. I am always concerned about the numbers urged to go forward with personal injury or medical cases. An enormous number of those cases are lost, but in many instances the legal adviser has not told the unfortunate applicant about the large amount of money he or she may have to pay. These people have often been encouraged to sign indemnities saying they will pay the fee if the case is lost. Whereas in such cases I would like the applicant to obtain more information about the financial penalties they might incur if they lose the case, I believe applicants could be deterred from bringing cases altogether.
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