Introduction

Introduction

Domestic abuse is chronically underreported to service providers but British Crime Survey data suggest that one in four women and around one in six men will be affected in their lifetime. As such domestic abuse constitutes a public health issue of pandemic proportions.

While there are pockets of good practice across the country the fact remains that the health system generally fails to diagnose the true cause of most victims of domestic abuse deteriorating physical and mental health.

Professionals in the health system are afforded an opportunity to provide a lifeline. Almost all woman and children in London use the healthcare system at some point and we know that those who are subject to abuse will have more contact than their non abused peers. Health staff generally come into contact with women at a different point than police (which is usually at crisis) and thus we have a different window of opportunity to offer support and information.

We also understand that victims often have a limited timeframe in which to access support. We are committed to ensuring that we create an organisational culture whereby information and support is available before a victim is convinced, coerced or forced to return to her abuser.

NHS London recognises that domestic abuse prevention is paramount to effective service delivery, not only because we deal with the physical and mental injuries sustained by its victims, but also because we are an employer of staff who may be victims or abusers.

Health professionals often state that they do not consider domestic violence within their work because of a lack of time, training and easy access to services that help these patients This website has been developed to address this gap, so that health professionals can work collectively to ensure that we utilise every opportunity to provide victims with a lifeline to safety.

Morbidity and Mortality rate

Some health professionals see domestic violence primarily as a criminal justice issue, resenting the expectation that they should respond to domestic abuse when they already have so much pressure to deliver the basics in the time that they have with patients. However the mortality rate in particular should speak for itself:

  • Domestic violence is the leading cause of morbidity for women aged 19-44 - greater than cancer, war and motor vehicle accidents .
  • In England and Wales, two women a week die at the hands of their domestic violence abuser.
  • Home Office figures published in February 2008 reveal that thirty three children were murdered by their parents in the previous year.
  • Amongst a group of pregnant women attending primary care in East London, 5% reported that domestic abuse had at sometime in the past caused them to miscarry.

Injuries

The impact of domestic abuse on individuals' health and well being is substantial:

  • Victims are more likely than most to present with psychological and psychiatric problems such as depression, anxiety, despair, post traumatic stress disorder. Indicators may be self medication of drugs and alcohol; post traumatic stress, self harm and or suicide attempts.
  • Victims of domestic abuse are more likely than most to present with symptoms related to musculoskeletal disorders and chronic pain, genitor-urinary disorders, and respiratory illness . Typically injuries can include contusions, abrasions, lacerations, burns, fractures, dislocations, bruises, lost teeth, internal injuries, gynaecological problems and miscarriages.

The ‘undiagnosed' cause of death

Most health professionals could probably count the number of abuse disclosures they have had from patients on one hand. However, we know that two women die a week at the hands of their abuser. Therefore, it is our intention to provide an opportunity to disclose whenever possible.

We believe it would be wrong for us to wait for other professionals to help vulnerable patients when we have the ability to provide an environment in which victims feel comfortable to disclose abuse and access support.