By Dr. Paul Mendis, Chief Medical Officer of Neighborhood Health Plan

Has your partner ever left you out of a major financial decision, forged your signature on important documents, or created debt in your name? If so, you may be one of the millions of Americans who experience economic abuse.

Economic abuse is a serious, and often overlooked, form of domestic violence, which can leave a partner completely dependent on an abuser to supply basic material needs for economic security. An abuser will control a partner's finances and prevent him or her from accessing resources, maintaining control of earnings, and gaining financial independence. The abuser may also interfere with a significant other's work performance or prevent education, job training, and the ability to find and keep a job.

Typically, economic abuse goes hand-in-hand with domestic violence, which is experienced by one in four women in their lifetime, constituting a significant public health issue. We usually associate domestic violence with physical or verbal abuse, but economic abuse is just as significant and can have long-lasting and devastating effects. The National Coalition Against Domestic Violence reports that over 1.75 million workdays-or $3 to $5 billion-are lost each year as a result of absenteeism, decreased productivity, and health and safety costs associated with domestic violence.

Economic abuse can also affect a victim's access to health care and medicine. A victim of abuse may resist leaving an abusive partner because his or her children are dependent on that partner's health insurance. Or, the victim may avoid medical care altogether because transportation options have been withheld or limited, or because he or she cannot pay for copayments while a partner controls the finances.

It is important to remember that economic abuse, like other forms of domestic violence, can happen to anyone, regardless of age, race, gender, sexual orientation, marital status, or income. Controlling someone's finances and opportunities for advancement limit the resources that are needed when a partner decides to leave. Victims of economic abuse often feel forced to choose between staying in an abusive relationship or face economic hardship and possibly poverty and homelessness.

These far-reaching consequences signify the need to do more to address domestic violence. If you or a loved one might be experiencing economic abuse, there are steps you can take and resources you can access to get help.

The key steps for achieving financial independence include:

Taking a financial inventory;

Obtaining a copy of your credit report to see if anything looks suspicious or unexpected;

Keeping personal financial information in a safe place (i.e. at a friend's);

Keeping copies of home or car keys in your wallet along with extra money and emergency phone numbers;

Determining what it would cost to live on your own and start setting aside money in a safe space (even if it's a few dollars at a time); and

Considering public assistance programs such as TANF or unemployment benefits, which can be accessed at your local Department of Health and Human Services.

Evidence shows that addressing domestic violence in a health care setting can have a positive impact on health and wellness. Abused women of all backgrounds repeatedly use medical services for treatment of injuries and chronic conditions resulting from violent relationships.

At Neighborhood Health Plan (NHP), we work at the intersection of health care and the communities we serve by partnering with community health centers (CHCs) and local organizations. Through the NHP Domestic Violence Initiative, we are strengthening awareness and resources, including working with CHCs to provide trainings and implement screening policies; and creating deeper community collaborations and gathering data on community needs.

Remember, if you or someone you know is in an abusive relationship, there are resources to help. The multilingual Massachusetts SafeLink Hotline is available at: 1-877-785-2020, TTY: 1-877-521-2601. If you are in immediate danger, dial 911.

Paul Mendis, MD is the Chief Medical Officer for Neighborhood Health Plan. A graduate of Princeton University and Harvard Medical School, Dr. Mendis is board-certified in internal medicine and has practiced primary care for more than 20 years in urban health center environments.