Women’s experiences of Domestic Violence and Abuse

What doctors need to know about domestic violence and abuse

One area of research focusing on domestic violence and health is linked to training and the medical education curriculum. A number of barriers have been identified which might prevent doctors and other health professionals from addressing the issue of domestic violence and abuse. A key barrier was a lack of training, and in the UK, the IRIS (Identification and Referral to Improve Safety) training package has been developed, and proved to be effective. General practice staff are trained to identify, document, and refer patients who might be experiencing domestic violence and abuse to a local specialist agency. Doctors report feeling more prepared and better able to deal with domestic violence. 

The women we interviewed said they want health professionals to learn more about domestic abuse so they can recognise the signs, and understand that it takes time for women to feel safe and able to leave. They said they want doctors, nurses and health visitors not to be afraid to ask women how things are at home, since women experiencing abuse will rarely take the initiative to talk and may not recognise that they are experiencing abuse. They felt that doctors must not collude with ‘normalising’ abusive behaviour, and they could hand out contact cards for Domestic Violence and Abuse Agencies, ‘just in case’.
Helping women to recognise domestic abuse could be done by, for example, having a domestic violence and abuse specialist or a survivor available at a practice, or by running nurse-led discussion groups.
Women said they want GPs to get to know their patients and probe beneath ‘what is presented’. They stressed that listening is more important than giving advice, although giving contact details for domestic violence and abuse organisations is helpful. Shaina suggested that health professionals should be able to put women in touch with other survivors of domestic abuse, who could offer support and understanding.

Women also said they wanted reassurances about confidentiality and opportunities to talk to the doctor on their own, since controlling partners often insist on accompanying women to their appointments. They also want doctors to recognise a women who is suffering from trauma rather than a mental illness.
Doctors need to pick up signs and ask questions

Mandy said doctors should notice if a woman is ‘knackered’, ‘not sleeping’, ‘crying for no reason’, ‘very anxious and twitchy’, or if they or their children are ‘constantly at the doctor’s with pains or other complaints’. Philippa and Jane suggested doctors could start a conversation about women’s lives that could lead to more specific questions, and they should offer information about services even if the woman does not respond at the time.
Doctors need to listen and to reassure women about confidentiality

Many women, like Tina, stressed that doctors need to win their patient’s trust by listening rather than prescribing tablets.
Women wanted assurances about confidentiality before they felt safe to talk about abuse. They needed to be sure their partner would not find out and also that they would not lose their children. Tasha said that doctors should look out for signs of domestic abuse, and if abuse has been identified, they should be more aware of helping women to stay safe, for example if they are in hospital.
Tread gently

Women want doctors to proceed sensitively if they suspect domestic violence or abuse and to be aware of women’s anxieties about disclosure so they do not feel pressurised into taking action when they are not ready or safe to do so. Health professionals need to understand that women are brainwashed and become emotionally dependent on abusive partners which makes it hard for them to leave. Tanya’s support worker suggested she had Stockholm syndrome* so ‘no matter how horrible your abuser is, you’re in love with them’.
Doctors need to recognise trauma

Doctors failed to recognise that some women, such as Min and Alonya, were suffering from trauma, leading to an incorrect diagnosis of a mental health problem and delays in getting proper treatment and support.
*Stockholm syndrome refers to feeling of trust or affection felt in many cases of kidnapping or hostage-taking by a victim towards a captor.

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