Battered lives

Physios are among the healthcare professionals ideally placed to identify and support victims of domestic abuse. Louise Hunt looks at moves to raise awareness.

Every week, on average two women are killed by a current or former partner, according to the Department of Health. One in four women and one in six men will be a victim of domestic violence in their lifetime, with women at greater risk of repeat victimisation and serious injury. Seventy-five per cent of cases of domestic violence, meanwhile, result in physical injury or mental health problems. Treating the physical injuries alone cost the NHS £1.2 billion in 2004. The statistics, bad as they are, still fail to show the true picture however, because domestic abuse is notoriously under-reported and because they don’t include violence against men. Concerns about how NHS staff respond to domestic violence has led the DH to set up the Violence against Women and Girls taskforce. It reports next year on issues such as identifying victims, increasing awareness among staff and those commissioning services, improving staff training and partnership working with other agencies. The CSP has no physiotherapy-specific guidance on identifying and supporting victims because no member has ever asked for advice. In view of the statistics on domestic violence, this is more likely to reflect a lack of awareness of the problem rather than a paucity of victims among physiotherapy patients or confidence among members in dealing with them. Guidance could and would be developed should the Society start receiving requests said CSP head of professional policy and information Andrea Peace. ‘And of course we would support members if they came to us with concerns,’ she added. That support would include referring members to the DH handbook Responding to Domestic Abuse, which presents domestic violence as a health issue and gives guidance for health professionals, policy makers and managers. The End Violence Against Women coalition, supported by the CSP through the TUC, has criticised the DH in the past for not doing enough to educate health workers about their role in supporting victims. TUC women’s equality policy officer Narmada Thiranagama says health professionals are often the first port of call for women experiencing violence and are thus in a key position to provide support. Marion Winterholler, manager of the Haven Paddington, a support service for sexual assault victims run by Imperial College Healthcare trust, wants the NHS to put domestic violence against women on the same footing as the protection of children and vulnerable adults. ‘This would mean trusts having local coordinators to act as a resource and develop and implement local policies,’ she said. FURTHER INFORMATION For Department of Health guidance go to and search under Responding to Domestic Abuse To contribute to the work of the Violence against Women and Girls taskforce.

Hidden trauma

When midwifery colleagues were offered training on domestic violence Isobel A. Campbell, team lead physio at the Princess Royal Maternity hospital, Glasgow, asked to be included. All her staff have now been trained. She believes there is a big gap in awareness among physios. ‘I find a lot of rotational staff are generally very clued up but they’ve have never had this topic brought to their attention,’ she said. During her long experience in women’s health, several patients have disclosed abuse to her. ‘Sometimes you just have a gut feeling something is wrong,’ she explained. ‘They keep coming back, complaining about the same thing, and they don’t get better. Then you find something deeper is going on.’ With the right encouragement, women then often go on to disclose abuse, often to a health professional they have got to know. The first step for the professional is not to back away but equally not to rush to action or even, perhaps surprisingly, to sympathise, Isobel Campbell said. ‘They don’t want you saying: “Oh, how terrible”.   They want to be listened to and, of course, believed.’ The next step is often to act as an advocate. ‘They might say, for example, that they can’t have a vaginal examination – some women have terrible flashbacks in certain situations. I say that I don’t have to know why but that we do need to talk to the obstetrician in order to deal with the situation. The woman might then ask me to go with her.’ Physios are by nature ‘hands on’ but victims of abuse often respond badly to touch, Isobel Campbell said. ‘But if you can get over that barrier I have found that some respond very positively to massage’.  

Possible signs of domestic abuse include:

  • Frequent appointments for vague symptoms
  • Injuries inconsistent with explanation of cause
  • Patient hides injuries or minimises their extent
  • Partner always attends appointments unnecessarily
  • Patient reluctant to speak in front of partner
  • Frequent missed appointments

Source: Department of Health (2005). Responding to Domestic Abuse.

Advice to healthcare workers:

  • Be aware of local support services and have information to pass on
  • Know how to ask the right questions so a patient knows she can talk to you about abuse
  • Be aware of signs that could indicate abuse
  • Explain the limits of confidentiality. If you need to share information follow guidelines

Source: Department of Health (2005). Responding to Domestic Abuse.

Louise Hunt

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