Recognising and referring domestic violence and abuse

A social enterprise is helping to train staff in GP practices to support women affected by domestic violence and abuse. Medina Johnson explains how the programme works and offers advice on how GPs can best support patients.

Medina Johnson, CEO of social enterprise IRISi
Medina Johnson, CEO of social enterprise IRISi

Some 26% of women will experience domestic violence and abuse (DVA) at some point in their lives.1 Two women a week are killed at the hands of a current or former partner, or adult family member.2 

Behind each statistic is a woman, a friend, a sister, a daughter, a mother, a grandmother, an aunt. Many of these women will have had recent contact with health services. How many of them will have found it difficult to say what was happening for them at home during their appointment? How many of them wanted someone to look beyond what they were saying?

DVA impacts on both mental and physical and that this has ramifications throughout the family. We also know that DVA also costs the NHS significant money in terms of appointments, chronic illness and prescriptions.

Clinicians want to know how to best support patients, but we can’t expect them to simply know what to do to assist patients affected by DVA without offering training and advice and onward referral pathways. We need to clinicians to look beyond and we need commissioners to fund this support in a sustainable way.

The IRIS programme

IRISi is a social enterprise aimed at improving the healthcare response to gender-based violence through health and specialist services working together.

Domestic violence and abuse is a gendered issue and disproportionately affects women and the IRIS programme directly supports women affected and offers signposting for men affected and for perpetrators. Research is ongoing into whether an adapted IRIS programme can also support men and children.

Our IRIS programme is a specialist DVA training, support and referral programme for GP practices, which is now used in over 900 practices across the UK who have helped refer over 15,500 women to date.

The programme is first commissioned within a certain geographical area. Local IRIS teams are then recruited and trained and these teams train local GPs and clinicians in recognising signs and symptoms of domestic violent and abuse and how to ask the right questions of the patient. There is also in-house training with the whole practice team enable staff to become better equipped to respond to concerns and disclosures of DVA from all patients, including perpetrators.

If the patient requires help, they are referred to an advocate educator (AE), who provides support to the patient and ongoing help and advice to the practice.

What should GPs do if they suspect DVA?

The IRIS model rests on five principles:

  • Recognise when DVA affects a patient
  • Ask them about it
  • Respond in an understanding way
  • Refer the patient into specialist support
  • Compile a record of the consultation and disclosure.

If you are concerned that a patient may be experiencing domestic violence or abuse, only ask them about this if they are alone. It is unsafe to ask when a child accompanies a patient.

Ask a direct question to ascertain whether the patient is safe to go home.  If not, speak with her about calling the police.

As a minimum, GPs and practices should have national helpline numbers to offer, or the contact information for your local, specialist service (see below for national helpline numbers).

If you have safeguarding concerns then follow your usual safeguarding procedures. Do not prescribe what the patient should do but let them know that support is available. Be sure to record the consultation in the electronic medical record.

  • Medina Johnson is CEO of social enterprise IRISi

Useful resources

  • National 24 Hour Helpline – 0808 2000247
  • Men’s Advice Line – 0808 8010327
  • Respect – 0808 8010327

For more information about IRISi and the IRIS programme visit www.irisi.org

Reference

  1. Office for National Statistics. Crime Survey for England and Wales. March 2016.
  2. Office for National Statistics. Domestic abuse in England and Wales: year ending March 2017.

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