Call For Doctors To Tackle Unspoken Epidemic Of Domestic Abuse

In a newly published report the British Medical Association (BMA) is calling on doctors and all health professionals to be increasingly aware of domestic abuse as an issue that needs urgent attention.

The report “Domestic Abuse” produced by the BMA’s Board of Science says doctors need to ask their patients the right kind of questions about domestic abuse and respond appropriately. It recommends that training in dealing with domestic abuse should be provided to all health professionals.

Domestic abuse is extremely common and it is important for doctors to recognise this, says the report. While this is a crime which affects both men and women, statistically 80% of reported domestic abuse victims are women.

The report states that domestic abuse is prevalent in all parts of society. Domestic abuse does not discriminate and affects many vulnerable groups, including disabled and older people.

Key points in the report include:

• around 750,000 children a year witness domestic abuse
• around 30% of domestic abuse begins during pregnancy
• partner abuse is as common and as prevalent among same-sex couples as among heterosexual couples
• the total cost of domestic abuse to services in England and Wales [criminal justice, health, social services, housing and legal] amounts to around £3.1 billion a year
• the direct health impact of domestic abuse can include fractures, burns, depression, post-traumatic stress disorders, chronic pain syndromes, arthritis, hearing or sight deficits, seizures and frequent headaches.
• the indirect health outcomes include stomach ulcers, coronary artery disease and raised blood pressure.

Dr Vivienne Nathanson, Head of the BMA Science and Ethics, said: “The figures we provide in this report are shocking, but perhaps more alarming is that they are likely to be grossly underestimated. Domestic abuse is an unspoken scar on our society and many individuals never report that they are victims. Sometimes this is because of social stigma or simply because they do not know who to turn to. Other times it can be because the victims are so vulnerable that they are not in a position to seek help.”

She added: “Doctors and other health professionals are well placed to help victims and their families and our message to them today is, ‘if you suspect abuse is taking place, it is important that you help your patient to discuss this’. It is also very important for doctors to realise that men can be victims too. Men are less likely to be believed and therefore they tend not to seek help.”

The report highlights the need for health professionals to be aware of domestic abuse occurring in minority groups. For example, within the Asian community, some women are expected to uphold the honour of the family and this may even mean tolerating domestic abuse rather than leaving the family home. In extreme cases ‘honour crimes’ can take place, either in the form of assault or killings. Domestic abuse can occur in a forced marriage, where duress, physical or mental, is used to force a marriage to take place without the real consent of one or both parties.

Key recommendations from the report include:

• All health professionals should receive training in identifying and helping patients who are victims of domestic abuse – this needs to be implemented on a national scale within emergency medicine.
• Health professionals should ask patients appropriate questions in a sensitive and non-threatening manner in order to encourage disclosure of abusive experiences.
• Health professionals should recognise that men can also be victims of domestic abuse.
• The government should promote a ‘zero-tolerance’ attitude to domestic abuse
•  Refuges should be more accessible to transgender, lesbian, gay, bisexual individuals.
• Domestic abuse education programmes should be implemented in all primary and secondary schools
• A good research base already exists on domestic abuse but there needs to be more research in the following areas: domestic abuse within ethnic minority groups, the experience of disabled people who are victims of abuse, pregnant victims of domestic abuse and the number of refuges which exist for male victims.