Domestic Abuse

What to do if you have concerns?

If you are concerned a patient is a victim of domestic abuse and they have indicated they would like support or you think your patient is at risk of significant harm and would like to refer to MARAC (Multi-Agency Risk Assessment Conference) without their consent, please contact Somerset Domestic Abuse Service to make a referral.

 

What is Domestic Abuse?

The UK definition of domestic abuse is “any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to psychological, physical, sexual, financial, emotional.” It includes coercive control, which is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim (SafeLives, 2023).

Women, girls and men can be victims of gender-based violence however the majority of gender-based violence affected are women and girls. It manifests itself in an unequal power relationship between men and women and a violation of women’s human rights. The Crime Survey for England and Wales estimated 6.9% of women (1.7 million) and 3.0% of men (699,000) experienced domestic abuse in the last year (CSEW, 2022).

SafeLives (2018) found that on average, a victim/survivor will experience abuse for three years before getting effective help and will visit their GP on average 4.3 times.

 

Signs of Domestic Abuse and Asking the Question

NICE guidelines have created four quality statements which GPs should use as a guide in their response to domestic abuse:

1. People presenting to frontline staff with indicators of possible domestic violence or abuse are asked about their experiences in a private discussion.
2. People experiencing domestic violence and abuse receive a response from level 1 or 2 trained staff.
3. People experiencing domestic violence or abuse are offered referral to specialist support
4. People who disclose that they are perpetrating domestic violence or abuse are offered referral to specialist services.

NICE guidelines also state that there is insufficient evidence to recommend screening or routine enquiry in most healthcare settings. Therefore, GPs are recommended to practice clinical enquiry, which sets the threshold for asking low and uses the information from the interaction with the patient to make an assessment. Some physical and mental health issues, such as anxiety, depression, chronic pain, difficulty sleeping, facial or dental injuries, chronic fatigue and pregnancy and miscarriage have a strong link to being a victim/survivor of domestic abuse. Patients who present with such symptoms should always be asked about abuse. In addition, in heterosexual relationships abusive perpetrators often exert control over a woman’s reproduction; GPs should be alert to indicators such as urinary tract infections, unprotected sex, lesion of nipple, STIs, pregnancy and requests for a termination.

What questions to ask:

Four questions have been developed, called the HARK framework for helping to identify victims/survivors of domestic abuse, and have been found to be a sensitive and accurate tool:

Humiliation: "In the last year, have you been humiliated or emotionally abused in other ways by your partner/family member?" "Does your partner/family member make you feel bad about yourself?" "Do you feel you can do nothing right?"

Afraid: "In the last year have you been afraid of your partner or ex-partner/family member?" "What does your partner/family member do that scares you?"

Rape: "In the last year have you been raped by your partner or forced to have any kind of sexual activity?" "Do you ever feel you have to have sex when you don't want to?" "Are you ever forced to do anything you are not comfortable with?"

Kick: "In the last year have you been physically hurt by your partner/family member?" "Does your partner/family member threaten to hurt you?"

It is not just about what questions you ask but also how to ask them. It is important that you are confident in your enquiry- being comfortable will send a message to the patient that this is not a shameful topic. So, ask the questions in your own words which feel comfortable for you (SafeLives, 2023).

Responding to disclosures

It takes a lot of courage for a patient to disclose an experience of domestic abuse- your initial response is important. You should respond with empathy and understanding, letting your patient know you believe them and remind them the abuse is not their fault.

You should be prepared to assess the patient’s immediate safety by utilising the DASH (Domestic abuse, stalking and harassment) tool. Following this assessment, the victim should be provided with options for ongoing support. In Somerset, this support is provided by Somerset Domestic Abuse Service. If the victim does not wish to be referred to a specialist service, provide them with Somerset Domestic Abuse Service phone number/website (0800 6949999 8am – 8pm 7 days a week/ https://somersetdomesticabuse.org.uk/). If the victim is BME, please consider they may prefer to access specialist BME services. The National Domestic Abuse Helpline 0808 200 0247 which runs 24/7 will be able to assist with this. They are a member of language line and can provide interpreters.

Children and Domestic Abuse

Domestic abuse has a significant impact on children and young people. Children may experience domestic abuse directly, as victims in their own right, or indirectly due to the impact the abuse has on others such as the non-abusive parent.

Under the Domestic Abuse Act 2021, children are recognised as victims of domestic abuse in their own right, if they see, hear, or experience the effects of the abuse, and are related to the perpetrator of the abuse or the victim of the abuse. Abuse directed towards the child is defined as child abuse.

It is essential that unborn baby/children’s needs are considered when relationships are affected by domestic abuse. Primary care practitioners have a responsibility to safeguard unborn baby/children by requesting support from Children's social care if they are at risk of significant harm. To help inform your decision, you may wish to utilise Effective Support for Children and Families in Somerset alongside the Southwest child protection procedures regarding domestic abuse.

Children who have experienced domestic abuse can receive specialist support from Barnardo's children’s charity.

Advice and referrals for those who cause harm

Somerset Domestic Abuse Service also work with people who cause harm and provide advice and guidance for practitioners working with them. Nationally, the charity Respect also provide support for perpetrators and professionals.

 

Further information and resources

galop national domestic abuse helpline number for LGBT+ victims/survivors 0800 999 5428 (Monday to Friday at varying times).

SignHealth provide advice and support for deaf adults and young people experiencing domestic abuse.

Karma Nirvana run the national Honour Based Abuse Helpline and support victims of honour based abuse.

SafeLives UK-wide charity working to end domestic abuse. Contains resources for professionals and support for victims.