The Role of Doctors in Recognising and Treating Coercive Control

Not all family, domestic and sexual violence (FDSV) is physical. Abuse has complex forms – some that do not involve any direct physical assault at all and some that lead to physical dviolence. Hence, it is imperative to define and recontextualize abusive behaviors to encompass all forms of violence experienced by victims. 

New South Wales has recently become the first Australian state to criminalize coercive control as a stand-alone offense. 

While intimate-partner violence is most commonly associated with verbal and physical abuse, coercive control is often a precursor to intimate partner domestic homicide with almost 77 out of 78 victims having experienced coercive control prior to physical violence.  

This step to criminalize the insidious nature of coercive control will potentially save hundreds of lives by encoding patterns of behavior, in law. This becoming a criminal offence will allow victims to access several resources and seek asylum.

Watch our Founder’s address to the NSW Parliament. Our advocacy has led to Australia’s largest state enshrining coercive control in law!

But what is coercive control? And why is it important that front line workers including healthcare employees understand it? 

Women’s Safety NSW described coercive control as “… the use by one person of controlling and manipulative behaviors such as isolation, emotional manipulation, surveillance, psychological abuse and financial restriction against another person over a period of time for the purpose of establishing and maintaining control….”  

The Youth Affairs Council of South Australia (YACSA) describes coercive control as a tactic to create a dependency on the perpetrator to render the victim completely powerless which includes actions like 

  • Prohibiting victims from interacting with family, friends and wider society. 
  • Controlling access to healthcare, education, resources like money. 
  • Creating a climate of fear by including threats towards children. 

The national Essential Media poll of 1,074 Australians that was commissioned by White Ribbon Australia revealed that 70% of respondents support the idea of criminalizing coercive control.

Many Australians believe that a perpetrator would not get charged by police unless they physically injured or stalked someone, or broke a domestic violence order. Many thought that the pre-existing law did not protect people from a pattern of harmful controlling behaviour which the perpetrators could take advantage of. 

However, overwhelming support to criminalize coercive control means that Australians resonate and recognise the damage that coercive control does and condemn its prevalence in society. Many agree that one of the biggest advantages will be that the perpetrators will know that their behaviours are unacceptable. This step will allow for easier access for victims as well as improve training amongst front-line workers to watch out for more identifiers amongst their patients. 

Doctors have a vital role to play in reducing domestic violence. Over 1 in 5 women make their first disclosure of domestic violence to their GP. Research indicates one in 10 women attending general practice have been afraid of their partners in the previous 12 months, and one in three women have experienced fear of a partner over their lifetime. Click here to view this article by RACGP on coercive control.

Many suggest the police and the law enforcement to be the first step in reporting cases of violent threats however in many cases reports require evidence of apprehended violence. NSW’s criminalisation of coercive control, is an important first step to ensuring this.

And doctors and healthcare workers can provide a safer sanctuary to confess fears of abuse. Doctors can often provide statements of belief which can be used to obtain some emancipation from the perpetrator – especially in the cases of renting property. 

Considering that controlling partners sometimes insist on accompanying women to their sessions, women also expressed a desire for assurances about confidentiality and the ability to consult with a doctor alone. Women also want medical professionals to distinguish between a woman’s trauma and a mental disorder. 

Regulation will aid medical professionals and other front-line staff in learning trauma-based care and in becoming more alert to symptoms of abuse, even when the victim has not disclosed such information. It may be possible to avoid the long-term effects of violence and stop further abuse by identifying survivors, giving them appropriate referrals, and assisting them safely on a pathway to recovery.

The clinician’s duties encompass instances of identifying abuse, determining the patient’s level of safety and that of her family, and offering on-going medical care and compassionate support. This includes discussing the nature and progression of DV with the patient and determining their level of readiness to make changes. It also involves educating the patient about the variety of support services available and making the appropriate referrals. It also entails reviewing the results and ensuring follow-up. Doctors must have the necessary training, communication skills, and awareness of community resources in order to perform this function effectively. This is one of our key focuses at Doctors Against Violence.

This law is a monumental step towards ensuring safety of all victims from all forms of abuse and providing a safe recovery environment. 

If you or anyone you know are experiencing violence, below is a list of organizations that may assist you. This list is not exhaustive. We encourage you to see your GP who will have more details about services in your location. If you are in immediate danger, please contact the police on 000.