Health and social care staff must look out for signs of domestic violence

New draft guidance on identifying and preventing domestic violencei and abuse between family members or between people who are (or who have been) intimate partners is published by the UK’s National institute for Health and Care Excellence (NICE).
The guidance covers adults and young people who are experiencing (or have experienced) domestic violence, and children who are exposed to domestic violence.

Around 1.2 million women and 784,000 men aged 16 to 59 in England and Wales experienced domestic abuse in 2010/11. Almost one third of women and 17 per cent of men in England and Wales have experienced it at some point in their livesii.  Both men and women can perpetrate and experience domestic violence and abuse, but it is more often inflicted on women by men, with women experiencing more severe forms of violence.

Domestic violence can be sexual, emotional, financial or physical (using minor or severe force). ‘Honour’ violenceiii and forced marriage are also examples of domestic violenceiv.  In England, 1.6 per cent of older people aged 66 years and over reported experiencing abuse (psychological, physical, sexual and financial) in the past year from a family member, close friend or care workerv. Thirty one per cent of girls and 16 per cent of boys reported experiencing sexual violence in a relationship in the UK, with 25 per cent of girls and 18 per cent of boys reported experiencing physical violence. One in six girls aged 13 to 17 reported some form of severe domestic violence inflicted on them by a partnervi.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE, said: “Domestic violence and abuse is, sadly, more common than people might expect, often taking place behind closed doors. This new draft guidance recommends that health and social care professionals should receive training so that they can recognise the signs of domestic violence and abuse, and ensure that those affected are aware of the help and support available to them. The draft recommendations also look at assumptions surrounding ‘honour’, and recommend that staff do not let their beliefs stop them from identifying and responding to ‘honour’ violence and abuse.”

Gene Feder, Professor of Primary Health Care at the University of Bristol’s School of Social and Community Medicine and Chair of the group which developed the draft guidance, said: “Domestic violence and abuse poses a major challenge to public health, social care and health care services, yet often goes unrecognised by professionals in those sectors. Health and social care professionals can find it difficult to acknowledge and act on the signs of domestic violence and abuse, and may be uncertain about safe and effective responses to victims and perpetrators. This draft guidance details how health and social care professionals can identify and respond to violence and abuse between family members or between people who are or have been intimate partners. The guidance highlights the important role of specialist domestic violence and abuse agencies, largely based in the voluntary sector, in preventing future violence and improving the life of survivors.  It outlines clear recommendations that, if implemented, will ensure that health care, social care and specialist services engage with domestic violence and abuse as part of a wider societal response to this major breach of human rights.”

Polly Neate, Chief Executive of Women’s Aid, one of the stakeholders of the guidance said: “Nearly two women a week are killed by a partner or ex-partner in the UK, and many more experience abuse. We know from years of experience, research and statistical data that domestic violence has a much greater impact on women. Men are overwhelmingly the main perpetrators of domestic violence. Violence used by men is much more severe and it is women who experience the largest number of repeated incidents of violence. To address the scourge of domestic violence, it’s vital that our health and social care services are set up to identify and protect women at risk of domestic violence, and to prevent abuse wherever possible. This draft guidance reflects best practice in both the health and social care sectors, from commissioning to aftercare, and, if implemented, will give survivors of domestic violence greater confidence in our public services and much more support to escape abuse. We look forward to providing our support to the draft guidance in the upcoming consultation period.”

The draft recommendations are aimed at health and social care service managers, professionals, commissioners, service providers, GPs and specialist domestic violence and abuse staff. The areas covered by the draft guidance include: commissioning and planning services; setting up local partnerships to prevent domestic violence and abuse; creating an environment for disclosing domestic violence and abuse; overcoming barriers to accessing services; identifying domestic violence and abuse in children and young people; and commissioning programmes for people who perpetuate domestic violence and abuse.

The draft recommendations include:

• Health and social care professionals should ensure relevant staff are trained to recognise when domestic violence and abuse may be taking place and ask relevant questions if the evidence suggests it may be occurring.
• Health and social care commissioners and service providers should: 

1. identify any barriers people may face when trying to get help for domestic violence and abuse, and introduce a strategy to overcome these barriers.
2. train staff who have direct contact with people affected by domestic violence and abuse in equality and diversity issues, including those working with people who perpetuate violence and abuse.

Specifically:

• ensure staff assumptions about people’s beliefs and values, for example in relation to ’honour’, do not stop them identifying and responding to domestic violence and abuse.
• ensure interpretation services are confidential, which is often a concern in black and minority ethnic communities.
• ensure interpretation services are carried out by professionals and do not rely on the use of family members or friends.
• ensure people who may be experiencing domestic violence and abuse have the option to be seen alone (a person may have multiple abusers and friends or family members may be colluding in the abuse).