Domestic Violence: The General Practitioner’s Role Mehreen yousaf st2
Domestic Violence • Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality • Women are the overwhelming majority of the most heavily abused group • 1 in 4 women experiencing it in their lifetime and between 1 in 8 to 1 in 10 women experiencing it annually
Domestic Violence: Statistics • There are no reliable national data on the general incidence of domestic violence in the UK. • In 2011/12, 7.3% women (1.2 million) and 5% men (800,000) report having experienced domestic abuse (ONS) • In 2011/12, the police reported nearly 800,000 incidents of domestic violence • Domestic violence has consistently accounted for between 16% and 25% of all recorded violent crime.
GP Consultation • General practice may be the first formal agency for presentation • Possibility of violence is seldom raised directly • Estimate that only a ¼ of women reveal that they have been beaten • ‘Calling card' an apparently unimportant physical symptom to seek help indirectly • On average a woman will be assaulted by her partner or ex-partner 35 times before actually reporting it to the police • Women who have experienced domestic violence suffer a high incidence of psychiatric disorders
The Consultation • Emphasize confidentiality • Speak to the patient alone • Exceptions to confidentiality- when a dependant child is at risk • Patient may wish to talk to a female health worker • Concept of confidentiality may not be understood by first generation immigrant women; involve translators, advocacy workers or ethnic community linkworkers as appropriate and consented by patient • ASK THE QUESTION
The Question • I noticed you have a number of bruises. Could you tell me how they happened? Did someone hit you? • You seem frightened of your partner. Has he ever hurt you? • Many patients tell me they have been hurt by someone close to them. Could this be happening to you? • You mention your partner loses his temper with the children. Does he ever lose his temper with you? What happens? • Have you ever been in a relationship where you have been hit, punched, kicked or hurt in any way? Are you in such a relationship now? • You mentioned your partner uses drugs/alcohol. How does he act when drinking or on drugs? • Does your partner sometimes try to put you down or control your actions? • Sometimes, when others are over-protective and as jealous as you describe, they react strongly and use physical force. Is this happening in your situation? • Your partner seems very concerned and anxious. That can mean he feels guilty. Was he responsible for your injuries?
Accurate documentation, over time at successive consultations, may provide cumulative evidence of abuse • May be used as evidence in court • Photographs can convey the severity of injuries much more effectively than verbal description • If not possible for general practitioner advise patient to take elsewhere
Assess The Situation • History of abuse (include past and present physical, emotional and/or sexual abuse). • Attempts by patient to remedy her situation (for example, through police, courts etc) • Sources of emotional support. • Current living situation • Present danger: • Is abuser verbally threatening her? • Is abuser frightening friends and relatives? • Is abuser threatening to use weapons? • Is abuser intoxicated? • Does abuser have criminal record? • Are the children in danger?
Provide Information • Explain to the patient that violence in the home is as illegal • Explain the physical and emotional consequences of chronic battering • Provide written information about legal options and help offered by: • Police domestic violence units • Women's Aid National Helpline (Tel: 0345 023468) • Local authority social services departments • Local authority housing departments • Department of Social Security • Offer help in making contact with other agencies
Safety Planning • No pressure into following any particular course of action • If she does not wish to return to the abuser, advise her on the services available from local agencies and offer help with contacting them • If she chooses to return to the abuser: • Give her the phone number of the local women's refuge/local Women’s Aid. • Advise her to keep some money and important financial and legal documents hidden in a safe place, in case of emergency. • Help her to plan an escape route in case of emergency. • If children are likely to be at risk, consider referral to social services
References • Office for National Statistics (ONS), 2013. • http://www.womensaid.org.uk • http://www.rcgp.org.uk • British Medical Association (1998) Domestic Violence: a health care issue? London, British Medical Association. pp. 51-53.