“I was angry at everything. Angry that my mother was dead, I was sad as well. I was angry that my dad was in prison, I wanted to see him but that wasn’t allowed. That made me angry.”

This is a quote by a young Dutch girl whose father killed her mother. More than a third of female homicides worldwide are perpetrated by an intimate partner. Many of these women are parents. Since I’m back in Australia, I’ve tried to look into the local figures: in total, probably over 1,000 Australian children have been bereaved by fatal domestic violence in the past 20 years.

It is an understatement to say that losing a parent at the hands of the other parent has a major and lasting impact. It turns children’s worlds entirely upside down: at once they lose both parents – one to murder and one to prison or suicide – as well as their home and school environment.

Professionals have to make fundamental decisions for children after a domestic homicide. Where should the children live? Can it be with the family of the victim, or with the family of the perpetrator, or should it be a ‘neutral’ family? Should they have contact with the perpetrating parent? What kind of mental health support do the children and their caregivers need?

Many health professionals only see one or two cases of domestic homicide in their whole career, which makes it difficult and stressful to provide good support. The evidence base is limited and more guidance is needed.

Children’s mental health after domestic homicide

Overall, research shows that children can have a range of psychological symptoms post-homicide. Examples are fears, grief, intrusive memories, regression (such as language deterioration), and high irritability.

I remember a child who felt so guilty that he hadn’t been able to save his mother despite trying to stop his father. He was struggling with sleep problems, something we see among many children in similar situations.

In an American study, a grandmother said about her 7-year-old grandson: “He is loud…destructive, impulsive,… and fights kids at school. Immediately after [the homicide], he was full of anger and rage. He…had nightmares almost every night. If the hall light was not on, he screamed until I got up and turned it on.”

Colleagues in the UK reported that among 95 children referred to their clinical services after domestic homicide, 40 per cent had symptoms of emotional disorders, 50 per cent had post- traumatic stress disorder (PTSD) or PTSD symptoms, and 60 per cent had behavioural problems.

Some children also struggle with relationship difficulties; sometimes it is hard for them to accept new caregivers or develop healthy relations with them. Also, identity questions come up; being the child of a victim and of a murderer is an entirely different challenge going through adolescence than what most peers may struggle with.

Exposure to previous family violence and to the homicide itself

The descriptions above are all based on case studies or case series, often among children who received mental health care. While their stories are very important, these children may not be representative of the whole group. Requested by the Dutch government, we studied all children bereaved by domestic homicide in the Netherlands over a period of 10 years. Although we wanted to understand children’s experiences, our first goal was to find out how many children were affected and what they had been exposed to.

We cross-examined eight different types of data for the decade running from 2003 to 2012, from legal verdicts to news reports and from criminology books to child protection information. In total, 256 children had lost a biological parent due to intimate partner homicide, in most cases their mother.

Three key findings emerged

First, many children had a history of exposure to domestic violence. We know from research that living with domestic violence places a large burden on children (see also last month’s blogpost); it shapes their whole life. Often, the family violence was only revealed after the homicide however, so the children had not received professional support or protection.

Second, the majority of children were present at the location of the homicide, often their own home. Some of them may have been in bed and asleep when it happened, but for others we are certain that they saw either the killing or the crime scene afterwards. The weapons most used were guns and knives, causing graphic scenes.

Finally, children from immigrant families were overrepresented compared to the general population. We do not see that overrepresentation in our clinical services, which means that some of these children ‘fall through the cracks’ for mental health support. We should look at improving our outreach to them.

What are the implications?

Domestic homicide cases are often ‘high stakes’ for many reasons other than the obvious direct impact on the victim and the children. The impact on family members and the community, as well as the sometimes unsettling media attention, make adequate care and support a challenging task.

This makes it even more important to be well prepared.

My questions for Ausralia – and any country really, are: Are we well prepared? Do we know enough about children’s perspectives here?

It may be unnecessary for all professionals within (mental) health care and child protection systems to be competent in all aspects of care after intimate partner homicide – from grief counselling and trauma treatment to placement and contact decisions – but every system should be able to make the expertise available at short notice. Children and young people whose life is turned upside down deserve the best possible care.

This blogpost is a slightly adapted version of a recent piece on Croakey, which is an independent, in-depth social journalism project for health.