The role of healthcare services in addressing domestic abuse

It has been estimated that nearly half a million victims and survivors of domestic abuse seek assistance from medical professionals every year. Guidance for health professionals says that “domestic violence and abuse is so prevalent in our society that NHS and other provider staff will be in contact with adult and child victims (and perpetrators) across the full range of health services.”

The Domestic Abuse Act 2021 received Royal Assent on 29 April 2021. The Act’s provisions will be brought into force in due course in line with the commencement schedule.

The Domestic Abuse Commissioner, Nicole Jacobs, has said that health must be central to strategic thinking. The Commissioner notes that health settings are trusted environments which can reach people “from every background and walk of life subjected to domestic abuse”. And it is therefore “critical” to ensure awareness about domestic abuse is embedded in the practices of all health settings.

A domestic abuse strategy is due to be published by the Government in 2021, alongside a new Violence against Women and Girls Strategy 2021-2024.

Use of healthcare services by victims and survivors

The NHS is directly involved in treating victims and survivors of domestic abuse in several ways. This could include the provision of mental health services, through its role as lead commissioner of Sexual Assault Referral Centres, or by treating physical injuries.

Research has found that around 30% of domestic abuse begins during pregnancy. The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have said it is a “maternal health issue”, with maternity care professionals such as midwives and health visitors “particularly well placed to identify and respond to abuse”.

In some instances, the involvement of healthcare services will be limited to identifying the signs of abuse and directing victims to relevant specialised support. The introduction of health-based Independent Domestic Violence Advisers (IDVAs) following the Pathfinder Project means support services are increasingly provided in a healthcare setting, such as a hospital.

Reaching ‘hidden victims’

SafeLives, a domestic abuse charity, says health settings “encourage higher rates of disclosure, including from groups who face additional barriers to getting support such as BAME, disabled, older and LGBT+ communities”. For example, health services can identify older victims of domestic abuse as they are more likely to use NHS services.

ONS data for March 2019 to March 2020 shows disabled people to be almost three times more likely to have experienced domestic abuse than non-disabled people. Disabled victims of abuse experience barriers in accessing support and it’s been suggested that health professionals could help people disclose domestic abuse by ensuring they see patients alone at some point, without carers present.

Use of healthcare services by perpetrators

The Domestic Abuse Act 2021 includes provisions to widen the scope of Domestic Abuse Protection Orders so perpetrators can be compelled to be assessed for a perpetrator intervention programme, attend a mental health assessment or an assessment for a drugs or alcohol programme.

The Draft Domestic Abuse Statutory Guidance Framework reports that up to 60% of men in perpetrator programmes have problems with alcohol and/or drugs. However, there is not a simple causal relationship between substance misuse and domestic abuse. Against Violence and Abuse (AVA) and Alcohol Concern say in their joint report (2016) that it is critical for alcohol treatment services to screen for domestic abuse and vice versa, otherwise “neither issue can be wholly addressed”.

In written evidence to the Public Bill Committee on the Domestic Abuse Bill 2019-21, the Inter-Collegiate and Agency Domestic Violence Abuse Forum recommended an increase in funded quality-assured programmes for health professionals to refer perpetrators into.

The Drive Partnership, which works with perpetrators of domestic abuse, published a ‘call to action’ in 2020 which identified “an urgent need for a domestic abuse perpetrator strategy for England and Wales underpinned by core statutory support”.

The Domestic Abuse Act 2021 requires the Government to publish a strategy for the prosecution and management of offenders, including reducing the risk they commit further offences involving domestic abuse. The Home Office has indicated this ‘perpetrator strategy’ will be published as part of the “holistic” domestic abuse strategy.

Guidance for healthcare professionals

The Department of Health published Responding to domestic abuse: A resource for health professionals, in March 2017 which draws on recommendations made in the NICE guideline: Domestic violence and abuse: multi agency working. The resource is for all NHS staff and those providing NHS funded services. It aims to “help practitioners identify potential victims, initiate sensitive routine enquiry and respond to disclosures of abuse”.

Research published in the British Journal of Nursing in July 2020 identified potential barriers preventing health professionals from screening women for domestic abuse and concluded “lack of training and education” were the most prevalent.

It’s been suggested that clinicians are unwilling to engage in conversations about domestic abuse if they feel a responsibility to “fix” it and require clear referral pathways to specialist support. Written evidence on the Domestic Abuse Bill 2019-20, from the Inter-Collegiate and Agency Domestic Violence Abuse Forum asserted that further training for healthcare professionals is required alongside funding for referral routes.

Further information is also available in:

Domestic abuse and Covid-19: A year into the pandemic, Commons Library Insight, 11 May 2021

Support for victims of domestic abuse, Commons Library Constituency Casework, 26 April 2021

Domestic Abuse Bill 2019-21: Progress of the Bill, Commons Library Briefing, CBP 8959, 10 April 2021

Support for domestic abuse victims, Commons Library Briefing, CBP 9124, 8 February 2021

Domestic violence in England and Wales, Commons Library Briefing, SN06337, 21 November 2018