Domestic and Sexual Violence

Question 1

Understanding the nature of abuse

Answer 1

Overall, the ultimate cause is power and control.

Question 2

How does the abuser gain control and power?

Answer 2

• Using coercion and threats - making/carrying out threats to do something to hurt them, threatening to leave them or commit suicide or report them, making them drop charges, making them do illegal things.
• Using intimidation - making them afraid by using looks, actions, gestures, by smashing things, destroying their stuff, abusing pets, displaying weapons.
• Using emotional abuse - by putting them down, making them feel bad about themself, calling them names, making them think they’re crazy, playing mind games, humiliating them, making them feel guilty
• Using economic abuse - taking control of the financials and not letting them know naything about it or have access to it, stopping them from getting a job
• Using male privilege - making them like a servant, making all the big decisions, defining the roles
• Using isolation - controlling their movements, who the see, limiting outside involvement, using jealousy to excuse actions
• Using children - threatening to take the kids away, using visitation to harass them, using children to relay messages, making them feel guilty about the kids.
• Minimising, denying and blaming - saying abuse didnt happen, saying they caused it, making light of the situation and not taking their concerns seriously, shifting responsibility for the abusive behaviour.

Question 3

Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill

Answer 3

The bill would mean health boards must provide forensic medical services. This is offered to the victims of sexual offences.

Question 4

Policies to help victims of domestic and sexual violence

Answer 4

• Sustainable Development Goal 5: Gender Equality (UN, 2015)

- Equally Safe Strategy (ScotGov 2016)

Question 5

Recognising signs of abuse

Answer 5

• Marks and bruising
• Multiple pregnancies, multiple terminations, repeated STIs and UTIs, long term GI symptoms
• Dissociation, anxiety, low mood, poor self esteem, emotional dysregulation, intoxication, sleep disorder, suicidal ideation/self-harm
• injuries and long term pain
• Missed appointments, repeated vague appointments, disengaging from care, attending with company, being spoken for/over

Question 6

Dealing with cases of abuse in Psychiatry VS other areas of clincal medicine

Answer 6

• Psychiatry - higher prevalence, patients are less likely to be believed, only 10-30% of cases are known to psychiatric services, women are the fastest growing group in Scotland’s drug related deaths.
• Other areas - higher prevalence in obstetrics, sexual health and acute medicine, considerations for paediatrics, intersections with psychiatry.

Question 7

Enquiring about abuse in a clinical setting

Answer 7

• Create a disclosure friendly environment.
• Asking the question - “Is everything okay at home?” “I have noticed…” “Are you feeling afraid?”
• Acting upon a disclosure of abuse.

Question 8

Responding to abuse following a disclosure

Answer 8

• Immediate safety - ask about threat to life and safety, inform line manager, call the police.
• Ongoing safety - DASH assessment, MARAC referral, signposting
• Safeguarding children - enquire, notification of concern, duty social worker
• Signposting - FRASAC, Fife Woman’s Aid, KASP
• Referring - MARAC, Social Services, GBV Nursing TEam
• Consent - seek consent, keep patient informed.

Question 9

DASH risk assessment

Answer 9

Identifies high risk cases of domestic abuse, stalking and “honour based violence”

Question 10

Multi Agency Risk Assessment Conference

Answer 10

Where you refer high risk cases. They do:

• Multidisciplinary working
• Case notifications
• Information sharing
• Risk management plans

Question 11

Female Genital Mutilation

Answer 11

• It can and does happen anywhere but mainly Western, Eastern and North-Eastern regions of Africa, Middle East and Asia.
• It happens due to beliefs about sexual purity, modesty and femininity, power dynamics and beliefs of those in authority, no religious scripture prescribes the practice of FGM.
• There are different type of FGM - clitoridectomy, excision, infibulation and all other types of mutilation of the female genitalia.
• There is an immediate risk of complications and death. Clinical complications include menstruation, scarring, mental health and UTI. Also brings up safeguarding concerns and follow up support.