National Institute for Health and Clinical Excellence (NICE)
Printable version E-mail this to a friend

NICE delivers wake-up call to NHS on domestic violence

Health care professionals should receive training so that they can recognise the signs of domestic violence and abuse and ensure that those affected are aware of the help and support available to them, says NICE.

Domestic violence and abuse includes physical abuse, threats, emotional abuse, sexual assault or stalking.

Each year at least 1.2 million women and 784,000 men experience domestic violence and abuse in England and Wales, with one in three women and nearly one in five men experiencing it at some point in their lives.

“Domestic violence and abuse are far more common than people think,” said Professor Mike Kelly, Director of Public Health at NICE. “It can affect anyone - particularly women and children, but also men, regardless of age, geographical location, income, relationship type, family set-up or ethnic origin.”

Despite being a common problem there are currently no basic training requirements for all health professionals in the undergraduate curriculum on how to respond to domestic violence.

This latest NICE guidance breaks new ground as the first major review across all of the evidence around domestic violence, and sets out recommendations for training to help identify, prevent and reduce domestic violence.

The guidance calls for society as a whole to take action against domestic violence and abuse, with integrated working between primary care, secondary care, social care, the police, local government, and the third sector. Domestic violence costs the country around £15 billion a year, of which £9.9 billion is in health and social care costs.

Gene Feder, Professor of Primary Health Care at the University of Bristol and the Chair of the group which developed the guidance, said: “We need to wake up to the magnitude of the problem. Women who experience domestic violence and abuse have a three times greater risk of depression, four times greater risk of anxiety and seven times greater risk of post-traumatic stress disorder. We tend to deal with the medical problems but don't recognise the underlying abuse.

“This guidance gives a clear set of recommendations about how to respond appropriately. It recommends training for doctors so that they have the confidence to be able to ask about abuse and offer referral to support services.”

Training should be centred on practical face-to-face role-plays around asking questions about abuse, added Professor Feder.

Dr Adrian Boyle, Consultant Emergency Physician at Addenbrookes Hospital, Cambridge and guidance developer, said: “In emergency departments we see a lot of patients who are experiencing domestic violence. There are a lot of people who won't tell the police, only a health professional.

“What happens next is variable - there are places which do excellent work identifying and responding to these individuals, and have specialist services they can refer to, but equally there are places with no extra support for those who come forward.

“At the moment there is no requirement for staff to be trained, but what this new guidance recommends is that all staff should be trained to respond well to patients who chose to confide what is happening to them. I hope that women and men who are living with domestic violence will be able to go to emergency departments and feel confident and safe in telling their nurse or doctor what is happening.”

Susan Bewley, Honorary Professor of Complex Obstetrics at Kings College London and also a member of the guidance development team, said: “Sadly some pregnancies start in abusive relationships and this escalates and worsens in pregnancy. This can lead to stress, anxiety, miscarriage and even deaths of the women and babies.

“This is why it is important for those of us working on the frontline in maternity services to know what to look for, but also be able to ask women about it in such a way that they will tell us.

“Women need to know there are sources of help we can refer them to -including specialists who can help them make choices to keep them and their children safe. This guidance will help ensure that pregnant women experiencing domestic abuse, who come to the trusted environment of the NHS will receive a high standard of help and support wherever they are in the country.”

If you think compliance is hard, try non-compliance