Domestic Violence and Safeguarding NHS

🚨 Domestic violence (also known as domestic abuse) refers to any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence, or abuse between individuals aged 16 or over who are or have been intimate partners or family members.
It encompasses physical 💥, emotional/psychological 😔, sexual 🚫, financial 💸, or coercive control 🔗.
The NHS plays a vital role in identifying victims, providing support, and safeguarding those affected. 👩‍⚕️👨‍⚕️

Types of Domestic Violence 🔍

• Physical Abuse 💥: Use of physical force causing injury, pain, or impairment—hitting, slapping, punching, kicking, or other harm.
• Emotional or Psychological Abuse 😢: Actions that undermine self-worth or well-being, like intimidation, threats, isolation, manipulation, gaslighting, or constant verbal abuse.
• Sexual Abuse 🚫: Non-consensual sexual acts, including rape, assault, or forcing unwanted sexual activity.
• Financial or Economic Abuse 💰: Controlling finances without consent, preventing employment, sabotaging work, or exploiting assets.
• Coercive Control 🔗: Pattern of behaviour to isolate, manipulate, and dominate—monitoring movements, restricting social contacts, controlling daily life, or using threats.

Risk Factors ⚠️

• Previous history of abuse or childhood exposure to domestic violence.
• Substance misuse by victim or perpetrator 🍷.
• Mental health challenges, such as depression, anxiety, or trauma 🧠.
• Socioeconomic pressures: unemployment, poverty, or financial instability.
• Social isolation from friends, family, or support networks.
• Cultural/societal norms that tolerate or minimise abusive behaviour.

Signs of Domestic Violence 👀

• Unexplained or repeated injuries, frequent healthcare visits for "accidents". 🤕
• Fearfulness, anxiety, depression, or low self-esteem 😔.
• Social withdrawal, isolation from friends/family, or loss of confidence.
• Sudden personality changes: increased agitation, irritability, or defensiveness.
• Lack of access to money, bank cards, or personal documents 💳.
• Partner/family member always accompanying to appointments and speaking for them 🗣️.

Management and Safeguarding 🛡️

• Identification 👁️: Be alert to signs; use sensitive, private questioning to explore concerns.
• Confidentiality & Safety 🔒: Speak privately without the potential abuser present; assess immediate risk to the person and any children/dependents.
• Documentation 📝: Record disclosures, observations, and actions accurately in records.
• Referral & Support ❤️: With consent, refer to specialist services; provide info on helplines/shelters.
• Multi-Agency Collaboration 🤝: Work with police, social services, and others to create safety plans per local protocols.
• Legal Obligations ⚖️: Report if children/vulnerable adults are at risk; follow mandatory duties.

Safeguarding Procedures in the NHS 🏥

• Training 🎓: Mandatory training for staff to recognise and respond to domestic abuse effectively.
• Policies & Guidelines 📜: Follow NICE guidance (current PH50 multi-agency working; full update in development) and local protocols.
• Risk Assessment Tools 📊: Use tools like the DASH (Domestic Abuse, Stalking and Honour-Based Violence) checklist to evaluate risk levels.
• Information Sharing 🔄: Share info promptly with agencies when safe to do so, balancing confidentiality and protection.
• Access to Services: Provide details on counselling, legal aid, refuges, and emergency support.
• Follow-Up 🔄: Arrange ongoing reviews to monitor safety and engagement with services.

Legal Framework ⚖️

• Domestic Abuse Act 2021 📘: Statutory definition of abuse (including economic/coercive control); protections like Domestic Abuse Protection Orders, no cross-examination of victims in family courts, and duties for support accommodation.
• Care Act 2014: Duty on local authorities to enquire into abuse/neglect risks for adults.
• Children Act 1989 & 2004: Child welfare paramount; consider impact on children exposed to domestic abuse.
• Mental Capacity Act 2005: Protects decision-making for those lacking capacity in safety matters.

Support Resources 📞❤️

• National Domestic Abuse Helpline ☎️: 24/7 confidential support — 0808 2000 247 | nationaldahelpline.org.uk (run by Refuge)
• Refuge: Safe accommodation and support for women and children escaping abuse — refuge.org.uk
• Victim Support: Emotional/practical help for crime victims — victimsupport.org.uk
• Men's Advice Line: Confidential support for male victims — 0808 801 0327 (Mon-Fri 10am-8pm) | mensadviceline.org.uk
• GALOP: Support for LGBTQ+ people experiencing domestic abuse — galop.org.uk

Conclusion

Domestic violence is a serious, widespread issue that demands a compassionate, coordinated response. NHS professionals are often the first point of contact and have a crucial role in recognising signs, offering non-judgemental support, ensuring safety, and linking to specialist help. By following protocols, using risk tools, and collaborating across agencies, we can empower victims, hold perpetrators accountable, and work towards safer lives for everyone affected. You are not alone—help is available. 🛡️❤️