Clinical Notes : Medico-legal

111. Domestic Partner Abuse

Adapted from NB Medical Education Out of Hours 2015

 

NICE 2014

  • DVA is a common hidden problem

  • Complex issue needs sensitive handling by all health care professionals,

  • Cost (human and economic) are huge

    • Chronic health problems, PTSD, depression, anxiety, substance misuse

    • A&E attendance/ OOH care

  • Don't forget that men too can be victims

 

Types

  • Partner abuse amongst adults

    • 26% of women and 14% of men report to have suffered

    • 50% of female murders were by their partner, 12 % of men by their partner

  • Affects same sex relationships as well as heterosexual

  • Partner abuse amongst young people is common

    • 72% girls and 51% boys aged 13-16 in intimate relationships

  • Abuse between parents is the most frequently reported form of trauma for children

    • 24.8% of those 18-24 citing domestic abuse during their childhood

  • Honour based violence and forced marriage

  • Abuse of older person

  • Abuse of parents by children

 

Essential features of NICE guidance 2014

  • Have a high index of suspicion

    • Repeat attenders, chronic health problems, PTSD, depression, anxiety, substance misuse

  • Clear and good lines of communication when people are considered at risk

    • Integrated working with all health care and social care groups

  • Create an environment to disclose abuse

    • Posters on waiting room walls

    • Leaflets in consultation rooms

    • Ensure front line staff including reception and admin teams are aware of referral processes and local support networks

  • Ensure you ask about abuse if suspected

    • Tailor support to each individual. Have a card/ leaflet to hand out with support networks information

    • Prioritise patient safety

    • Refer children to social services if domestic violence is suspected or disclosed

  • Recommended training for GP's from NICE

    • How to ask about domestic violence and abuse in a way to make it easier to disclose

    • Understand epidemiology and how it affects lives

    • How to respond with empathy and understanding

    • Assessment of immediate safety

    • How to refer to specialist units

Tips on asking about Domestic Violence and abuse

 

  •   Have a high index of suspicion in

    • Repeat attendee

    • Chronic physical and mental health problems

    • Substance misuse

  •   Create an environment which supports disclosure

  •   Ask about abuse if suspected

  •   Be safe

    • Do not ask about DV in presence of another family member

  •   Be gentle

    • Do not 'force' a disclosure; this may take years, but just asking is helpful for victims

  •   Start with non-judgemental open questions:

    • 'are there any problems at home?'

    • `sometimes people who attend here often have expeirenced abuse at home — might that be happening to you?'

  •   Move on to more direct questions:

    • 'are you afraid of your partner/relative?'

    • 'have they hurt you, now or in the past?'

  •   The HARK questions have been developed & validated in primary care

    •   Does your partner humiliate or hit you?

    •   Are you ever afraid of your partner?

    •   Has your partner ever raped you?

    •   Has your partner ever kicked or physically hurt you?

  •   Acknowledge admission of abuse

    •   Thank you for trusting us to tell us/You are not alone/Help is available

  •   Provide details of local agencies

  •   Consider child protection

    •   Guidelines suggest child protection referral in all cases where a child under 12 is in the household

  •   Assess safety and risk of immediate harm

    •   Are you safe to go home? Discuss police.

  •   Document injuries clearly

    •   photographs