We are very keen to highlight one of the ‘hidden’ issues within healthcare – Domestic abuse. This guest blog post from Sarah Blake revels some alarming statistics and how domestic abuse is truly a health and social care issue.
Approximately 27% of women, 15% of men and 24% of children will experience an abusive relationship at some point in their lives. People who are experiencing domestic abuse will have more contact with health services than an average patient. A study conducted in Hackney showed that approximately 17% of women in a general practice waiting room may have experienced physical violence within the last year. With high rates of prevalence, it is essential that health services are well equipped to understand and respond to domestic abuse appropriately.
In England and Wales, two women a week are killed by their abusive partner. Domestic violence is the leading cause of morbidity for women under the age of forty-five. Physical injuries can include abrasions, lacerations, burns, fractures, dislocations, bruises, lost teeth, internal injuries, gynaecological problems and miscarriages. Patients experiencing abuse are more likely to present with chronic medical problems such as chronic pain, neurological symptoms, coronary artery disease and raised blood pressure. Domestic abuse is strongly connected to mental health conditions. A study of women who access mental health services identified between 50% and 60% had experienced domestic violence, and up to 20% were currently being abused. Approximately 50% of women who experience domestic abuse develop post-traumatic stress.
As well as the trauma and increased mortality and morbidity rates for the individual, domestic abuse impacts on the family. In households where there is domestic abuse present, children have a higher-risk of being abused themselves and will almost certainly witness the abuse at home. In 2007, thirty-three children were murdered by their parents. Children often display signs of emotional trauma and develop physical symptoms as a consequence of living in unpredictable and hostile environments. Child contact visits can also be traumatic for the family. Abusers often abuse the children and can use the visits as a way of causing further abuse to their ex-partners. The impact of supporting family and friends has also been documented. Research has shown that supporters can also experience chronic psychological problems and a secondary traumatic stress from assisting the victim. Society suffers in many ways from the abuse. In monetary terms, domestic abuse costs our society £23 billion a year.
Domestic abuse services are in a prime location to reach patients who are experiencing domestic abuse. Many of the patients who have contact with services will be of a pre-contemplative mindset. This means that they may not have fully understood what is happening to them or spoken about their experience before. Some patients may be so worn down and fearful that they may not be able to make those first steps to initiate assistance. Research shows that victims want to be asked about the abuse. They want to feel safe, to be believed, to be taken seriously and to be treated with respect. Health services can play a vital role in supporting patients with these initial steps to receiving support. Health care professionals should be able to RECOGNISE signs of domestic abuse, RESPOND appropriately and to be able REFER patients on to appropriate services.
The NICE guidelines (February 2014) recommend that all professionals who have contact with patients receive domestic abuse training. Increasingly services are asked to support victims and to participate in multi-agency safety planning or homicide reviews. Level 2 training is aimed at clinicians and health or social care workers. Level 1 training is aimed at receptionists, interpreters and community sector workers.
I have worked in various frontline services for fifteen years and have a broad understanding of the dynamics of domestic abuse and the systems which are in place to support people experiencing domestic abuse. I have experience of working in domestic abuse in health and legal settings with expertise in high-risk cases, confidentiality, data protection and maintaining systems and policies with a victim or patient-centred approach. Find out more here.
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