Domestic Abuse Flashcards
What is domestic abuse?
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality
What can domestic abuse encompass but not be limited to? (List)
psychological
physical
sexual
financial
emotional
What does the domestic abuse act of 2021 state the defintion of domestic abuse is?
Behaviour of a person (“A”) towards another person (“B”) is “domestic abuse” if— (a) A and B are each aged 16 or over and are “personally connected” to each other, and (b) the behaviour is abusive.
Behaviour is “abusive” if it consists of any of the following— (a) physical or sexual abuse; (b) violent or threatening behaviour; (c) controlling or coercive behaviour; (d) economic abuse; (e) psychological, emotional or other abuse; and it does not matter whether the behaviour consists of a single incident or a course of conduct.
Two people are “personally connected” to each other if any of the following applies — (a) they are, or have been, married to each other; (b) they are, or have been, civil partners of each other; (c) they have agreed to marry one another; (d) they have entered into a civil partnership agreement (whether or not the agreement has been terminated); (e) they are, or have been, in an intimate personal relationship with each other; (f) they each have, or there has been a time when they each have had, a parental relationship in relation to the same child (see subsection (2)); (g) they are relatives.
Grace and Sam’s Story: Please Read
Grace is 32 years old and 34 weeks pregnant with her first child by donor insemination. She is in full-time work and lives with her partner Samantha.
It is the first time you have seen Grace without Sam, and she says she is a bit anxious about going on maternity leave. She says Sam has lost her job and is around all the time. Grace tells you Sam is becoming very controlling and possessive and thinks this is because Sam is drinking more as she cannot find a job.
As she is going to leave, Grace tells you that a few weeks ago, Sam “slapped” her and “pushed her about”. This was because Grace had told her Mum she could be there for the birth and Sam didn’t want that to happen; it has now been sorted out and Grace’s Mum won’t be there.
She does not intend to leave the relationship and is concerned Sam does not find out about your conversation.
Jody and Kyle: Read the story please
Jody is 17 and has been in and out of care, but now has her own flat. She is 16 weeks pregnant with her first child and split up with Kyle, the baby’s Dad, 3 weeks ago.
Jody says this was because he had become very jealous and verbally aggressive. She says he has not actually hurt her since leaving prison 6 months ago, when he had served 9 months for an assault on her. He also has convictions for drugs offences previously.
He hasn’t been round to the flat since, but has sent threatening messages telling her to get rid of the baby and suggesting the baby is not his and she had been seeing someone else when he was in prison. Jody says she is frightened of Kyle and his “druggy” mates.
Rubena and Junaid’s story
Rubena is 27 and is 22 weeks pregnant with her third child. She has been married to Junaid, 38, a full-time cab driver, for 8 years.
Rubena tells you that the police came out a year ago following a verbal argument. She says he is unkind to her, calling her names and putting her down.
He is moody but doesn’t talk to her about work or his problems. She is worried they have financial problems as Junaid is is giving money to his father and his brother is coming round a lot.
Rubena’s sister lives nearby and has told her that she thinks Junaid is seeing someone else.
What are the risk levels of domestic abuse?
STANDARD – current evidence does NOT indicate likelihood of causing serious harm
MEDIUM – there are identifiable indicators of risk of serious harm. Offender has potential to cause serious harm but unlikely unless change in circumstances
HIGH – there are identifiable indicators of imminent risk of serious harm. Dynamic – could happen at any time and impact would be serious
What tool is used to help assess risk in Domestic abuse suspicions?
Dash Tool
https://sheffielddact.org.uk/domestic-abuse/resources/marac-information-and-forms/
What effects can domestic abuse have on children?
Living with domestic abuse affects children’s physical and psychological health & well-being; and has long term impacts on self esteem, education, relationships, stress responses. One Canadian study found 50% of children in refuges meet the diagnostic criteria for PTSD.
Clear link between child abuse and domestic abuse, often starting/escalating in pregnancy.
Your response to D.A. must always consider your child safeguarding responsibilities.
What is the dynamic risk assessment?
Look at slide 13 of Domestic Abuse slides
What should you do to help victims of domestic abuse?
Standard/Medium risk: Give contact details for Domestic Abuse services, keep good records, ensure follow up as needed.
Sheffield Domestic Abuse Helpline. Phone0808 808 2241 run by IDAS charity
Men’s Advice Line on 0808 801 0327 Telephone & email supportMonday–Friday 10am-5pm phoneline https://mensadviceline.org.uk/ webchat available on certain days too.
National Helpline for LGBT+ Victims and Survivors of Abuse and Violence Call: 0800 999 5428
Jake’s story:
You are an F2 in Accident and Emergency.
Jake is 26 and has come to be seen at 21.00 during your late evening shift. His partner Liam needed to bring him in the car, so Jake waited until after he finished work, rather than come during the day.
He fell over the cat three days ago, and banged his face into the corner of a kitchen worktop when he was on his own at home. He was not knocked out, and has not vomited since but does have some double vision.
He has extensive bruising to the left side of his face, with oedema around the eye. His left cheek looks flattened.
What should you do?
Questions to be raised about domestic abuse?
What might be barriers for male patients disclosing abuse?
Might there be particular issues to consider for LGBT+ patients?
What might be different/need to be considered if there are children in the household?
What do you need to know as an A&E doctor about Domestic Abuse?
- 20-30% of injuries that send women to A&E departments are caused by physical abuse from partners
- Majority present with assault injuries (55%), trauma (8%) or abdominal complaints (7%). Bruising, fractures and cuts were most common injuries, usually to head and chest
- Best indicator is ‘reported as unwitnessed by anyone else’. Others: repeat attendance, delay in seeking help, multiple minor injuries not requiring treatment [Wu, Huff & Bandari, 2010]
- 31% presented 7pm - 7am (non D.A. 19% at these times)
- 76% of women felt comfortable being asked about domestic abuse in A&E; 61% felt they should always/usually be asked
What is the doctor’s role in domestic abuse?
- Women experiencing domestic and sexual abuse are most likely to be in contact with their GP and other health professionals (but may not disclose the abuse
The professional women say they would most wish to be able to tell is a doctor. - Women want you to take the initiative. Time and again survivors of domestic abuse have said they wish somebody had asked them. Consider the even greater barriers to those who are not cis-het women.
- Many victims are prevented by the perpetrator from seeking medical help, but for many, health care may be the only situation in which they can be seen alone.
