Delivery of Care

What part of no do you not understand?

More than just believing women and their stories, the issue confronting the nation around an epidemic of sexual assault and domestic violence is to believe what the data tells us

Photo courtesy of Sarah Lewis Tozier

A sentiment expressed by many following the controversial confirmation by Brett Kavanaugh to the U.S. Supreme Court, a play on words spoken by President Donald Trump about his own advocacy of sexual assault revealed during the 2016 Presidential campaign.

By Richard Asinof
Posted 10/8/18
The Nobel Peace Prize was awarded to two activists campaigning to end of the use of mass rape as a weapon of war. Another woman was tragically shot and killed in a domestic violence murder-suicide in Woonsocket, with her son present in the home. Neither story, however, became part of the political conversation around believing women who come forward with stories of sexual assault regarding the confirmation of Judge Brett Kavanaugh to the Supreme Court. Why was that?
Why are there no female moderators from the news media for the political debates for the 2018 election in Rhode Island? What is the connection between sexual assault and domestic violence to mental health and behavioral health issues? Would the suggested dashboard of gun violence data in Rhode Island provide an opportunity for a unified data source about domestic violence, sexual assault, and gun violence? What would be the most appropriate question to ask the candidates running for governor in 2018 about domestic violence?
Underneath the conflict over the nomination of Judge Brett Kavanaugh is a more profound challenge to the future of the U.S. and its democracy: American life expectancy is among the lowest in the industrialized world and currently sits about two to three years below most of our counterpart countries. Increases in infant mortality and maternal mortality are seen as two important contributing factors, tied to a lack of health equity.
“The increasing gap between U.S. life expectancy and that of other countries is a serious crisis for a nation that spends more than any other country on health care,” Andrew Fenelon, acting associate director of the Maryland Population Research Center, told Newsweek.
In response, U.S. Congresswoman Debbie Wasserman Schultz recently introduced legislation called the National Strategy to Increase Life Expectancy Act of 2018. The legislation directs the U.S. Department of Health and Human Services to develop a strategy that will analyze the causes of the falling life expectancy and propose solutions to those causes to the most significant causes of premature death, including the opioid epidemic, smoking, obesity, infant mortality, affordable access to high-quality health care, and gun violence.
“Recent startling declines in life expectancy among certain demographic groups and in certain geographic areas of the U.S. suggest an urgent need to examine the causes and potential long-term consequences of these trends for U.S. well-being and viability,” Shannon M. Monnat, Lerner chair for public health promotion at Syracuse University, told Newsweek. “I commend Congresswoman Wasserman Schultz on leading the way for legislation that marks an essential first step toward developing evidence-informed policy strategies to reverse these troubling trends.”
Many of those issues are directly related to political and economic decisions tied to government and corporate actions around women’s health and children’s access to health care – and resolved, or perpetuated, by federal court decisions and the U.S. Supreme Court. To change that equation of politics about who gets what, when, and how much, it requires people to vote.

PROVIDENCE – The story did not get a of lot play in the news media, but it certainly resonates with the national conversation that is happening now between men and women about domestic violence, sexual assault, and gun violence, in wake of the controversial nomination of Brett Kavanaugh to the U.S. Supreme Court.

On Sunday morning, Sept. 30, in Woonsocket, Michelle Berthiaume-Benenuti, 45, was shot and killed by her ex-husband, Glenn Benvenuti, 56; he later took his own life, according to Woonsocket police. Their 7-year-old son was in the house at the time of the murder-suicide. The mother had apparently been picking up her son from an overnight visitation with his father when she was murdered.

It is the third domestic violence homicide in 2018: all three were murder suicides, all three were committed with a firearm, and two of the three had children in the home at the time of the shootings.

The tragic news served as an inauspicious “welcome” to Domestic Violence Awareness Month, beginning Oct. 1. On Tuesday, Oct. 16 at 6 p.m., the R.I. Coalition Against Domestic Violence will be holding a vigil on the steps of the State House to remember and honor all those whose lives have been lost to domestic violence.

On Thursday evening, Nov. 8, from 5:30 to 8 p.m., the fifth annual men’s summit will be hosted by Ten Men, an initiative of the R.I. Coalition Against Domestic Violence, to engage in conversations preventing violence, promoting healthy masculinity, and creating the cultural shift needed to end domestic violence.

Beyond the vigils and the conversations, the results of the Nov. 6, 2018, midterm elections will provide a measurement of how the political landscape has changed regarding women coming forward to report sexual assault and rape in the #MeToo era, heightened by the controversial confirmation of Judge Brett Kavanaugh to the U.S. Supreme Court.

But, more than that, the current inflection point in our partisan divide, which will play out in the mid-term elections, creates an opportunity to ask and answer some critical questions:

Why do men [and some women] not believe the stories of sexual assault as told by women are credible? Is it seen as a threat to preserving the status quo?

If the stories told by women are not seen as being credible, why is the overwhelming evidence of sexual assault, domestic violence and child abuse not accepted as being credible?

What are the opportunities to better document and connect the incidences of domestic violence, sexual assault and gun violence with mental health and behavioral health issues in Rhode Island?

What will prove to be the tipping point for Republican Senators in Congress to pay the electoral consequences for dismissing the stories of women who have survived sexual assault as not being credible?

An endemic epidemic
Sexual violence is endemic to our society – although the victims do not always report the assaults when they occur. The statistics compiled by the Rape, Abuse and Incest National Network are revealing:

  Every 98 seconds, an American is sexually assaulted.

  On average, there are 321,500 victims [age 12 or older] of rape and sexual assault each year in the United States.

  Younger people are at the highest risk of sexual violence; the majority of sexual assault victims are under 30, roughly 54 percent of all victims.

  One out of every six women has been the victim of an attempted or completed rape; 82 percent of all juvenile victims are female, and 90 percent of adult rape victims are female.

  Females ages 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault.

•  Women ages 18-24 who are college students are three times more likely than women in general to experience sexual violence. Females of the same age who are not enrolled in college are four times more likely.

•  One out of every 10 rape victims are male.

  An estimated 80,600 inmates each year experience sexual violence while in prison or jail.

  Sixty percent of all sexual violence against inmates is perpetrated by jail or prison staff.

  The majority of children and teen victims know the perpetrator.

•  Of sexual abuse cases reported to law enforcement, 93 percent of juvenile victims knew the perpetrator: 59 percent were acquaintances; 34 percent were family members; and 7 percent were strangers to the victim.

  Sexual violence on campus is pervasive; 11.2 percent of all students experience rape or sexual assault through physical force, violence, or incapacitation [among all graduate and undergraduate students].

  Among undergraduate students, 23.1 percent of females and 5.4 percent of males experience rape or sexual assault through physical force, violence, or incapacitation.

The data in Rhode Island

There is no one “sole source” for data on domestic violence in Rhode Island, but there are several places to go to get a comprehensive picture, according to Deb DeBare, the former executive director of the Rhode Island Coalition Against Domestic Violence. There is, for instance, a solid database on the numbers of clients served by the Coalition’s member agencies, according to DeBare.

In 2015, there were a total of 8,934 individual victims of domestic violence, according to DeBare. In 2017, according to the annual report of the agency, there were 8,758 individual victims who received help.

The Rhode Island Judiciary website has compiled a database of police reports, but they are four years behind in compiling the data.

The latest data report available for domestic violence enforcement data showed that for the calendar year 2015, Rhode Island police departments reported 7,678 domestic violence complaints, which resulted in 5,597 arrests, 1,757 non-arrests, and 324 cases still under investigation.

Similarly, data reports posted for sexual assault and child molestation for the calendar year 2015 showed that there were 228 sexual assault police reports filed, with 107 arrests, 36 non-arrests, and 85 cases still under investigation.

In addition to the court records based on police reports, there is additional data to be gleaned from the R.I. Department of Corrections and the R.I. Attorney General’s office, because each agency has its own “segment” of criminal justice data. Is there a way to track and measure conviction rates, too?

Connecting the dots on data
In Rhode Island, there are listening tours currently underway about mental health. There is a major push around mental health parity. The R.I. Office of the Health Insurance Commissioner has initiated a new fund to support behavioral health and mental health services.

Yet, there are some significant data gaps that might help focus attention on some of the root causes of the trauma resulting in significant mental health and behavior health problems in Rhode Island – domestic violence:

What is the connection between substance use disorders and trauma from domestic abuse, child abuse or sexual violence?

What is the connection between mental health and behavioral health care resulting from trauma from domestic abuse, child abuse or sexual violence?

How many people currently incarcerated witnessed domestic violence in their homes as a child?

What is the connection between gun violence and domestic violence in Rhode Island and how does it track with national data?

Playwright Eve Ensler framed the question around the root causes of the trauma resulting in significant mental health and behavioral health problems from domestic violence and sexual assault. Ensler wrote, in an open letter on Oct. 4 to white women who support President Donald Trump, after watching the President mock Christine Blasey Ford at a political rally in Mississippi, who had come forward and testified before the Senate Judiciary Committee, alleging that then-candidate and now confirmed Supreme Court Justice Brett Kavanaugh had sexually assaulted her when they were both teenagers: “Violence against women destroys our souls. It annihilates our sense of self. It numbs us. It separates us from our bodies. It is the tool used to keep us second-class citizens. And if we don’t address it, it can lead to depression, alcoholism, drug addiction, overeating and suicide. It makes us believe we are not worthy of happiness.”

And, more than looking at domestic violence as a problem that women have to confront and endure, as something “done” to them, it is also something that men need to look at and confront, too, as something that they “do” to women.

On the data front
There is a potential proposed initiative contained in the recent recommendations of a working group on gun safety that could create a better, unified source of data in Rhode Island around domestic violence, sexual assault and gun violence.

The R.I. Gun Safety Working Group’s recommendations, announced on Thursday, Oct. 4, had, as one of its top priorities, to “improve statewide data collection, data integration and analysis to support reduction in gun crimes, deaths and injuries.”

In particular, a key recommendation was:

Create an Internet-based “dashboard” of key gun statistics for public review modeled on the PreventOverdoseRI.org website. These statistics could include: statewide firearms deaths [suicides and homicides/intentional and accidental]; injuries, crimes involving firearms, types of firearms involved; whether or not legally possessed; source of the firearm; whether the same firearm was used in multiple incidents; and demographics of the perpetrator and/or victim(s).

As part of this proposed dashboard, the working group suggested the inclusion of additional variables that may predict future firearm violence, such as non-firearm assaults.

This dashboard should draw and expand on existing data sources kept by local, state and federal law enforcement agencies, the Centers for Disease Control and Prevention and the R.I. Department of Health, the report said.

One of the tasks by the working group identified is the need to find a source of funding for the website. The report said: “Potential sources include nonprofit foundations and academic institutions supporting public health research in the three area of injuries/death caused by firearms.”

Further, the working group suggested entrusting the dashboard to the R.I. Department of Health in collaboration with a Rhode Island college or university, to ensure inclusion of data from public health agencies, a public health informed approach to data gathering and analysis, and appropriate privacy safeguards.

Questions: Would The Rhode Island Foundation be willing to step up to the plate to fund the creation of such a public health dashboard? Would the Rhode Island College School of Nursing be willing to help research and coordinate the data? Would a physician’s group practice, such as Brown Physicians, Inc., Coastal Medical Group, or Rhode Island Primary Care Physicians be willing to underwrite the data collection efforts around domestic violence and sexual assault?

The global context
In the midst of the political debate around the nomination and confirmation of Judge Brett Kavanaugh to the U.S. Supreme Court, and whether or not to believe the allegations of women coming forward against Kavanaugh as “credible,” the Nobel Peace prizes were awarded on Friday, Oct. 5, to two individuals fighting back against sexual violence and the use of mass rape as a weapon of war.

As The New York Times reported, “In the midst of a global reckoning over sexual violence, a woman who was forced into sexual slavery by the Islamic State and a Congolese gynecological surgeon were awarded the Nobel Peace Prize on Friday [Oct. 5] for their campaigns to end the use of mass rape as a weapon of war.”

The story continued: “The award went to Nadia Murad, 25, who became the voice and face of women who survived sexual violence by the Islamic State, and to Dr. Denis Mukwege, 63, who has treated thousands of women in a country once called the rape capital of the world. They have worked through grave risks to their own lives to help survivors and to bring their stories to the world.”

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