Cry for health

Diana Barran urges physio staff to play their part in tackling domestic abuse.

Domestic abuse cannot be solved by one agency or one profession.  To inflict violence and fear on another is a crime, but we cannot expect it to be tackled by the police alone.  Indeed, we know that four out of five victims of domestic abuse do not call the police.  
We need a wraparound, holistic approach that meets victims where they are, where they go, to places they trust.  And that is why we launched an extensive piece of research about domestic abuse support in health settings.  At the end of last year, we published our findings and recommendations in Cry for Health
We need specialist domestic abuse professionals in health settings to spot the signs and know how to signpost victims; this requires better training and support for health professionals.  We also need greater support for NHS staff themselves, as we estimate 50,000 NHS employees are victims of abuse right now.
This means 44,000 women and 6,000 men that work at the NHS are living in fear of a partner, ex-partner or family member.  We need help for staff as well as patients.  With domestic abuse – there is no ‘us’ and ‘them’.  Only us. 
Physio staff come into direct contact with victims and will often see the physical repercussions of the violence.  It may also be that a patient becomes more distant or evasive, disengages or becomes secretive about their injuries.
We spoke to one NHS employee who told us that they know of patients making physio appointments in order to be able to access professional support without raising suspicions from their abusive partners.  Physio staff see reoccurring injuries; they see the reaction on the patient’s face when they ask why injuries are happening in the same place week in, week out. 
But what do professionals do if they are concerned?  Well, the first thing to say is that victims of domestic abuse want to be asked.  They may not disclose the first time someone asks; but they want to be noticed, they want to know there is support there.  Asking the question can never be a one-time thing, or a last minute enquiry at the end of an appointment.  The question needs to be asked and the time and patience available for the answer.  We need to ensure all NHS professionals have the proper training to help them ask the question, and respond to the answer properly and safely.  
And then if abuse is present, we need to have domestic abuse professionals on site to refer to.  We want Idvas (independent domestic abuse advisers) to be on site in health settings; they have the training and expertise to know how to provide the best, wraparound support for each victim, providing practical and emotional support to someone at an incredibly difficult time.  It is important to remember that disclosing and leaving a partner is also terrifying.   The person might have to move to a new community, go to court, and face custody disputes, financial concerns and, of course, the fear of their ex-partner’s anger at losing control.  A patient needs long-term support to navigate this: disclosure is the start of their journey, not the end. 
We know physios, like all NHS staff, are busy and stretched.  We are not advocating that you become experts, but rather that you are given the training and support to spot the signs, and have clear and immediate care pathways on site.  Health professionals are key to tackling domestic abuse – it makes moral, economic and societal sense. 
  • Diana Barran is chief executive, SafeLives
Diana Barran is chief executive, SafeLives

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