The NICE guidelines for domestic abuse state that, health and social care practitioners:
- recognise indicators of possible domestic violence and abuse and respond appropriately
- make sensitive enquiries of people presenting with indicators of domestic violence or abuse about experiences as part of a private discussion and in an environment in which the person feels safe.
What are the indicators and what questions should staff ask? There can be any number of small signs that will trigger a concern in health care staff. There is no definitive list but a poor historian, generally behaviour which is at odds with other things or someone who is very defensive or difficult to engage could be cause for concern. Generally the signs or symptoms will act as a ‘red flag’ they may be seen in isolation or in combination or not at all.
The NICE Domestic abuse quality standard (QS116) highlights symptoms or conditions which are indicators of possible domestic violence or abuse:
- symptoms of depression, anxiety, post traumatic stress disorder, sleep disorders
- suicidal tendencies or self-harming
- alcohol or other substance misuse
- unexplained chronic gastrointestinal symptoms
- unexplained gynaecological symptoms, including pelvic pain and sexual dysfunction
- adverse reproductive outcomes, including multiple unintended pregnancies or terminations
- delayed pregnancy care, miscarriage, premature labour and stillbirth or concealed pregnancy
- genitourinary symptoms, including frequent bladder or kidney infections
- vaginal bleeding or sexually transmitted infections
- chronic unexplained pain
- traumatic injury, particularly if repeated and with vague or implausible explanations
- problems with the central nervous system – headaches, cognitive problems, hearing loss
- repeated health consultations with no clear diagnosis. The person may describe themselves as ‘accident prone’ ‘silly’
- intrusive 'other person' in consultations, including partner or spouse, parent, grandparent or an adult child (for elder abuse).
There is no definitive list but having some key questions to help start the conversation when concerns are triggered is helpful. The following may help nursing and midwifery staff screen for domestic violence. The NICE guidelines advocate that these conversations need to have time and they need to be carried out in privacy and with an official interpreter if the individual does not speak English.
- has anyone ever hit, slapped, restrained or hurt you physically? Or emotionally?
- at times, are you afraid of your partner? Previous partner? (it could be any other significant person in their life, i.e; children, parents or other family members?)
- have you ever felt unsafe in your home situation?
- does your partner* like to boss you around?
- if he/she does not get their own way, how do they act?
- have you been forced to have sex or do sexual things you are uncomfortable doing?
- when arguing with your partner, do they threaten to hurt you or the children, or someone else?
- has your partner ever stopped you from leaving home, visiting family or friends, or going to work or school?
- do you have a say in how to spend money?
- are any of these things going on now?
*partner or spouse or boyfriend/girlfriend or ex-spouse or old boyfriend/girlfriend, or any other significant person in their life. For example it might be a grown up child, perpetrators in “forced marriages” are often the mother/grandmother. Other family members might also be the perpetrators.