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Australia Concern over clinical trial seeking potential solution to domestic violence, as victims, advocates speak out

06:10  11 february  2021
06:10  11 february  2021 Source:   abc.net.au

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A multi-million-dollar clinical trial that is assessing if a common antidepressant drug can help domestic violence perpetrators manage their anger is at the centre of a growing controversy. Key points: The NSW Government has spent .9 million on the ReINVEST program so far. The study says it has recorded a 44 per cent reduction in violence and 33 per cent reduction in domestic violence among participants. But one victim survivor has spoken out , saying the trial has enabled her husband's violence .

Because domestic violence is more about control than anger, often the victim is the only one who sees the dark side of the perpetrator. Many times, others are shocked to learn that a person they know could commit violence . Help the victim create a safety plan that can be put into action if violence occurs again or if they decide to leave the situation. Just the exercise of making a plan can help them visualize which steps are needed and to prepare psychologically to do so. Because victims who leave their abusive partners are at a greater risk of being killed by their abuser than those who stay, it is

a close up of a box: The NSW Opposition is asking questions about a program targeting the behaviour of convicted domestic violence perpetrators that uses a common antidepressant. (ABC News: Brendan Esposito) © Provided by ABC Health The NSW Opposition is asking questions about a program targeting the behaviour of convicted domestic violence perpetrators that uses a common antidepressant. (ABC News: Brendan Esposito)

A multi-million-dollar clinical trial that is assessing if a common antidepressant drug can help domestic violence perpetrators manage their anger is at the centre of a growing controversy.

The ReINVEST trial, developed by the Kirby Institute at University of New South Wales, involves the subject taking a small dose of antidepressant medication to boost serotonin levels in their brain to manage impulsivity.

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Female domestic violence victims advocate Mercè Ordovas said that the strict requirement to stay at home prevented them from meeting potential supporters and enabled perpetrators to constantly surveil their victims and obstructed them from making calls. While statistics are not available in 2020 to measure precisely the impact of COVID on domestic violence in Switzerland, there are concerns about the risks of raising risks and Alain Berset, interior minister Alain Berset participated to the European Union Conference on Gender Equality.[79] The figures were on the rise for 2019 already.

domestic violence : (a) physical violence , the intentional use of physical force with the potential . domestic violence , same-sex interpersonal violence , review of literature, gay, lesbian, clinical . More recently, 122 young MSM were assessed at three time points over 18 months to explore. Obstacles in accessing services. Seeking shelter is difficult for SSDV victims as they tend

Shellharbour MP Anna Watson, who is working to introduce 'coercive control’ legislation to the New South Wales Parliament, says health workers and women's groups have contacted her raising serious concerns about the trial and its effects on women's safety.

"How is it possible that this government is putting almost $7 million into programs for men, when the women's services are critically underfunded?" Ms Watson asked.

Ms Watson tabled a notice of motion in the NSW Parliament this week on the issue calling on the Government to respond.

She said the Labor Party would also look at the Budget estimates process to test how funding was provided for the ReINVEST trial.

Ms Watson's action comes amid growing concerns that some men are using the drug trial as a way to continue their violence while appearing to be trying to change their behaviour.

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Reports about a potential increase in domestic violence due to quarantine measures have been circulating since the lockdowns began. The UN special rapporteur on violence against women, Dubravka Simonovic, even issued a warning to the United Nations in Geneva on March 27. Women experiencing violence during quarantine are also more likely to write to an NGO for help than pick up the phone, since this is less noticeable to those around them, explained Anna Rivina, the director of the advocacy group “ Nasiliu.net ” (No to Violence ), in an interview with The Village .

The violence typically escalated over time, in some cases lasting years, and had a severe and lasting impact on the survivors’ physical and psychological health. Human Rights Watch interviewed women who described being choked, punched, beaten with wooden sticks and metal rods, burned intentionally, threatened The lack of a standalone offense reinforces an impression, held by many, that Russian authorities do not see domestic violence as a significant crime which has public rather than simply private ramifications. It also makes it difficult for Russian government agencies to maintain consistent

Consultant psychiatrist Karen Williams said she was so alarmed by reports of increased violence by trial participants that she believed the program should be paused and every victim survivor contacted to ensure their wellbeing and that they had a plan of action in case the violence became worse.

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Advocacy groups are sounding the alarm on what is being described as an epidemic of domestic violence in Canada, as victims are confined to their homes with their abusers amid the ongoing COVID-19 pandemic.

Domestic violence — also called intimate partner violence — occurs between people in an intimate relationship. Domestic violence can take many forms, including emotional, sexual and physical abuse and threats of abuse. Your district court can help you obtain a restraining order that legally mandates the abuser to stay away from you or face arrest. Local advocates might be available to help guide you through the process. It can be hard to recognize or admit that you're in an abusive relationship — but help is available.

Survivor says trial makes things worse

The trial is based on a well-established link between poor impulse control and aggressive behaviour, including violent offending.

Because there is also a link between impulsivity and reduced levels of the neurotransmitter serotonin, the trial is trying to determine if regulating serotonin with sertraline, an antidepressant, can reduce participants' impulsivity and aggression.

But one domestic violence survivor has spoken about the impact of the ReINVEST program on her and her family.

The woman, who wished to remain anonymous due to fears for her safety, said she was not consulted about her husband's involvement in the trial or provided with any safety options.

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She said she believed her husband agreed to participate because he, "thought it would be an easy way to appear like he wanted to change" and "therefore it could be used as a tool to get what he wanted".

"My experience was him taunting me that there would be no consequences for what he had done," she said.

"He was able to suggest that he was accepting responsibility for what he had done by taking a pill every day.

"He said this treatment had fixed him this time, and then he beat the s**t out of our child."

She said if she had been given a choice, she would never have supported him joining the program.

"If I thought it might put us at risk, I should have been able to tell the researchers that," she said.

"I should have had a point of contact so when things did escalate, I could access help.

"We live our lives walking on the eggshells of when he will next appear and enact his vengeance, every f*****g day.

"The fact I still can't speak out in person shows me we aren't safe, it also shows, like in the trial, the systems in place still don't protect us, or hear us, or work for us.

“In fact, I've never been asked, 'What has this done to you?' or 'What would help you?'

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"It’s like I didn’t exist."

Call to pause trial over safety fears

Dr Williams, who is based in the Illawarra and works with patients who have suffered complex trauma, said she had taken her concerns about the program to Ms Watson.

She said since the , she had been contacted by several women.

"I have had a number of women talk to me about how they experienced increased violence after their partner was put on this medication," she said.

Dr Williams said she would have hoped the study captured data about the victim survivors, but "they are not actually measuring from those women".

"Are they still being attacked? Are they still being stalked? Has there been ongoing domestic violence after their partner is put on the medication?"

Dr Williams said while the antidepressant medication being tested could make people calmer, it could also cause other symptoms.

"This medication can induce a condition called hypomania or mania and create a pathway to more violence," she said.

"It can also make people have sexual dysfunction, which could create more violence in a family situation."

She said she believed the trial should be paused and all of the participants' partners contacted to make sure they were OK and that they had a plan of action in case the violence became worse.

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Trial creators claim 'remarkable success'

The co-creator of the trial, Professor Tony Butler, who heads up the justice health research program at the Kirby Institute, said the trial was proving to be successful.

"We detected a 44 per cent reduction in violence and 33 per cent reduction in domestic violence," Professor Butler said.

"Also, remember half of the participants are still on the placebo medication so that 44 per cent reduction in violence, 33 per cent reduction in domestic violence, is likely to be larger than that."

Clinical advisor and behavioural neurologist Professor Peter Schofield said the study had considered adverse symptoms of the drugs and screening helped to address those issues.

"Part of the study involves a very careful screening of individuals to eliminate people who appear to be at risk of becoming agitated with the commencement of the drug, and close monitoring once they start on the drug, so that should such a change occur we would detect it," he said.

"To date this has not been an issue."

The trial organisers confirmed they were relying on the participants to honestly self-report on their progress during weekly phone consultations.

They said the participants also had clinical support nurses, some of whom had contact with a number of the men's partners.

Feedback from the nurses to the trial organisers indicates that some women are reporting improvements in their partners' behaviour.

ReINVEST commenced with funding from the National Health and Medical Research Council in 2014.

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Since then, 140 participants have been involved, including 88 who have completed the 12-month trial since the NSW Government started funding ReINVEST in January 2018.

Professor Butler said partners were invited to attend the initial assessment if they were still involved with the participant.

"We do have a level of involvement and we are mandatory reporters," he said.

"We haven’t had such feedback to date that people on ReINVEST are somehow going back and accessing partners and families and that is causing subsequent problems."

Not a silver bullet, part of a package

Professor Butler conceded that there was a data gap and said in the future he would like to include more capacity to monitor survivors or help them provide confidential information on their partners' behaviour.

"We don’t believe this is the silver bullet to solve domestic violence, but we do believe it could be a very, very useful part of the overall package of support for women," he said.

Professor Schofield said they were not capturing data on the survivor experience because it was not the purpose of the methodology.

"I guess the question would be whether people who participate in our study are any worse than, or victims would be any worse than they would be, if their partner were not participating in the study," he said.

'Worth taking a chance'

The NSW Attorney General and Minister for the Prevention of Domestic Violence, Mark Speakman, said the trial was only one part of the Government’s program to reduce violent reoffending.

In a statement, he said:

"Any suggestion that money was diverted from existing women’s programs to fund this research is false.

We all owe to victim-survivors, and the community, a duty to explore every possible avenue to prevent reoffending. We should be prepared to consider programs that are outside the norm to ultimately help reduce recidivism.

By its very nature ReINVEST is a trial, which means we didn’t know how successful or not it would be at the outset. But I believe it was worth taking a chance because while it mightn't work for everyone, each of those participants who were successful could help change lives for generations.

The Government has provided funding for ReINVEST from 2018 to 30 June 2021.

We will make an evidence-based decision about the program’s future in due course, including considering the perspectives of victim-survivors involved in the trial."

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