by Eszter Szilassy
Senior Research Associate
Centre for Academic Primary Care
While violence against men continues to fall in the UK, women affected by violence and domestic abuse are bearing the brunt of a hidden rise in violent crime. This rise coincides with the austerity-led cutting of domestic violence services.
Domestic violence and abuse (DVA) damages physical and mental health resulting in increased use of health services by survivors of abuse. The prevalence of DVA among women attending general practice is higher than in the wider population. Women experiencing DVA are more likely to be in contact with GPs than with any other professionals. Reduced investment in specialist domestic violence services further increases the demand for direct general practice responses to DVA. Although victims tend not to disclose spontaneously to their GP, they have an expectation, often unfulfilled, that doctors can be trusted with disclosure, and can offer them safe, non-judgemental and practical support.
One of the strengths of general practice is that it can respond to the needs of multiple family members, including victims and perpetrators of DVA and their children. While knowledge of the impact of DVA on health is increasing, the subject of DVA is virtually absent from our medical and nursing undergraduate and postgraduate curricula and has a patchy presence in continuing professional development. Despite the commissioning of the IRIS general practice training and support programme in many areas of the UK, the majority of primary care clinicians still do not receive any formal training about DVA.
Although there is considerable research evidence associating DVA with poor outcomes for exposed children, there is scant understanding of how general practice should respond to the needs of these children.
The RESPONDS (Researching Education to Strengthen Primary care ON Domestic violence and Safeguarding) study, led by Professor Gene Feder, found that many GPs and practice nurses are uncertain how to manage consultations involving children exposed to DVA. A research participant GP said that ‘I talk to children a lot about their parents dying and things. And I find that a lot easier, funnily enough, than talking to them about violence.’
Our study highlighted that general practice doctors and nurses need more support in managing the complexity of this area of practice. The findings of the study informed the development of the RESPONDS training, which was designed to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children.
The results of this study and the promising outcomes of our pilot intervention pointed toward the need for further research. The identification and appropriate referral of all family members exposed to DVA would benefit from an increased focus on the needs of children. Our study also suggests that general practice training on DVA and children could usefully be integrated with training addressing the identification of and response to both women and male victims. The feasibility, acceptability, effectiveness and cost-effectiveness of such an integrated training programme (IRIS+) will be fully evaluated within the REPROVIDE Programme (funded by NIHR) starting in February 2016.
The RESPONDS training materials, which includes videos of different scenarios and how they can be managed and information about the project, are freely available from www.bristol.ac.uk/responds-study.
The RESPONDS project is independent research commissioned and funded by the Department of Health Policy Research Programme (Bridging the Knowledge and Practice Gap between Domestic Violence and Child Safeguarding: Developing Policy and Training for General Practice, 115/0003). The views expressed are those of the author(s) and not necessarily those of the Department of Health.