Domestic Abuse Flashcards
(36 cards)
what is domestic abuse?
The Police Definition:
• Any form of physical, verbal, sexual, psychological or financial abuse which might amount to criminal conduct and which takes place within the context of a relationship
• The relationship will be between partners (married, cohabiting, civil partnership or otherwise) or ex-partners
• The abuse can be committed in the home or elsewhere including online
Stalking and surveillance can be carried out easily online and this can be part of the abusive cycle of domestic abuse
what are the types of domestic abuse
• Situational Couple Violence
○ Fighting or verbal aggression not involving control
○ Probably on a regular basis
• Coercive and Controlling Behaviour
○ Violence may also be a feature
○ Doesn’t have to involve violence
○ Invades every part of somebody’s life
what is the domestic abuse (scotland) act 2018
- The Domestic Abuse (Scotland) Act 2018 created a specific criminal offence of domestic abuse
- It recognised that it can be a course of conduct which takes place over a sustained period of time
- The act covers physical violence and psychological and emotional abuse
○ It criminalised coercive control ~ for the first time
what is the leading cause of morbidity for women aged 19-44 globally
domestic violence
what is the prevalence of domestic abuse in Scotland
1 in 5 women
1 in 6 men
However, women are much more likely to experience repeated incidents over time, have greater injuries and suffer more psychological and sexual violence than men
where does domestic abuse happen
- victims home (most common)
- other house
- joint home
- street
- accused home
- licensed premises
what is gender based violence
Violence directed against a person on the basis of their gender
what is included in gender based violence
- domestic abuse
- rape and sexual assault
- childhood sexual abuse
- sexual exploitation and trafficking
- sexual harassment and stalking
- harmful traditional practices eg FPM
what are teh different types of abuse
Verbal Emotional Physical Sexual Financial
what is coercive control
- a pattern of behaviour
- isolation
- degradation
- micro-regulation of all aspects of life (money, dress ~ told what to wear etc, surveillance)
- abusers are often very charming to everyone else which serves to increase the isolation
who is most at risk of domestic abuse
- Women
- Age 16-24 (women) or age 16-19 (men)
• Long term illness or disability = almost doubles the risk
○ Classed as vulnerable adults
• Mental health problem
• Women who are separated
○ There is an elevated risk of abuse around the time of separation
○ Dangerous time for people who are being abused
• Pregnancy
○ Domestic abuse sometimes starts during pregnancy or will escalate to violence at this time
○ Studies show that it can be because another person is coming into the relationship who may perhaps be more important than the abusive partner
but can affect anyone
what are non-fatal outcomes of domestic abuse
- physical issues
- chronic conditions (TMJ dysfunction)
- reproductive health problems
- mental health
- health harming behaviours (such as smoking or drinking or taking drugs ~ ways patients try to self-medicate)
what are fatal outcomes of domestic abuse
- femicide
- suicide
- maternal
- mortality
how can domestic abuse impact children even if they are not physically harmed
• Anxiety or depression
○ PTSD
- Sleeping issues
- Nightmares
- Heightened startle response
- May develop physical symptoms
- Behavioural issues
• Lowered sense of self-worth, feelings of guilt
○ Believe the situation has been caused by them
○ Try and protect the partner who has been abused
• Health harming behaviours
• Truanting from school
○ Can become classroom disruptive to take this into account to help them
It is NOT inevitable that they will grow up to become abusers or victims BUT think ACEs
ACE = Adverse Childhood Experiences
what are adverse childhood experiences
People to whom certain things happened in childhood had a higher risk of various health (mental and physical) and social issues later in life
ACE’s change ow your brain responds to stress
• They make you more likely to get involved in health harming behaviours:
○ Smoking
○ Alcohol
○ Drug misuse
• They influence your social determinants of health things like:
○ Education
○ Employment
○ Income
what are examples of ACEs
- abuse
> physical
> emotional
> sexual - neglect
> physical
> emotional
- household dysfunction > mental illness > incarcerated relatives > mother treated violently > substance abuse > divorce > domestic abuse
what happens if someone has 4 or more ACEs
○ Are more likely to have a range of medical problems
○ Are 2x more likely to binge drink
○Are 7x more likely to have been involved in violence in the last year
why should clincians get involved in domestic abuse
• Violence is a public health issue; everyone has a role in prevention
• You have a duty of care to your patients
○ Need to make sure we are patient centred and we do our best for them regardless of the problem they are facing
○ We can refer / sign post
• As a group you can have a role in advocating for social change and in changing attitudes
• You are in a good position to spot the signs - both physical and behavioural
○ Clinical training helps
• You might be the only person they tell
○ Confidential relationship with the patient
• Many abused women (and men) will initially talk to someone they trust who is not a close friend or family member
○ Dynamics of domestic abuse mean that some of the other family members are witnesses to what is going on they may or may not believe what is going on
how many attempts does it take someone to leave an abusive relationship
6-7 attempts
how can you recognise abuse in a patient’s behaviour
○ Low self-esteem
○ Victims may appear fearful, anxious or sad
○ Constant phoning or texting by a partner while they are with you
§ Especially if the appointment runs late
○ Alcohol
§ Somebody you wouldn’t be expecting to be drinking during the day may smell like alcohol
○ If the partner is present he may do all the talking, patient may not speak while partner is present
§ He or she
§ Patients in an abusive situation may not be allowed to speak
§ Ask patient question but someone else is answering
§ Be suspicious of this especially if they can speak english
○ Partner may insist on female clinician
§ Can be other reasons for this eg cultural reasons
○ Missed or frequent appointments
• It is important to realise some of these issues may be due to other things which is why it is important to give people room to speak
And to listen
what are physical features of domestic absue
- Repeated injuries to the head and neck
- Bruises at different stages of healing
- Dental / maxillofacial injuries
- Unlikely explanations for injury
• Facial bruising, bruising or strangle marks around the neck, fingertip bruising on the arms or neck or behind the ears (BOS#)
○ If someone is wearing a scarf and won’t take it off ~ suspicious
○ Bruising behind the ears could indicate a base of skull fracture
• Delay in seeking help for injury
○ Had injury for a number of days before it gets so uncomfortable / painful they need to get pain
• TMJ problems
○ Chronic pain is common in victims
○ Can also get chronic back pain etc
• Orofacial pain ~ 69% had a history of abuse
• Think if asked about emergency contraception
○ Remember incidence of rape
○ Rape is common in domestic abusive relationships
what is our role as clinicians
• We see victims at a different time frame from the police
○ Usually they are called in at crisis point
- We have a different window of opportunity
- We can provide a lifeline
Healthcare professionals not trained to identify domestic violence and abuse may mislabel and misdiagnose people’s problems, resulting in unnecessary treatment and investigation
what is the gender based violence action plan
○ Priority health care settings ~ everyone working in these setting should ask about domestic abuse § Accident and emergency § Maternity services □ Happens regularly and reliably in these services § Mental health § Sexual and reproductive health § Addiction § Primary care
○ Key deliverables
§ Routine enquiry
□ Doesn’t happen in every service - people are busy
□ Sometimes best to just ask when suspicious instead of asking everybody
§ Revised guidance on abuse
§ Employee policy on gender based violence
Multi-agency collaboration
what is the rationale for routine enquiry
• Domestic abuse is common amongst particularly women using NHS services
• People find it acceptable to be asked
• Abuse is a key contributory factor in many presentations
• Knowing about a person’s experience of abuse will help inform assessment and care
Potential for increasing safety
