[6 min read] Identifying & managing domestic abuse victims in primary care

Domestic violence is estimated to affect up to one in six Australian women in their adult lifetime, and in 75 per cent of cases, the perpetrator is male. A general practitioner (GP) will expect to see one or two female patients each week who are victims of domestic abuse.

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Domestic abuse includes a wide spectrum of controlling, coercive, threatening or degrading behaviour by a perpetrator towards a victim. Domestic abuse also includes domestic violence, also known as intimate partner violence, and sexual violence.

Domestic abuse can have profound knock-on effects on victims such as an increased risk of homelessness, ill health, hospitalisation and suicide.

The first stage in supporting victims of domestic abuse is recognition. Victims often present to their GP with seemingly unrelated issues such as anxiety, depression, chronic pain, sleep disorders and psychiatric illness. Physical injuries may be present; however, these may be associated with a delay in seeking treatment, and the victim may be evasive as to the mechanism of injury.

GPs should be mindful of the possibility of domestic abuse in all consultations, and develop confidence in asking key questions such as “how are things at home?” It is recommended to speak to any suspected victims alone and to specifically ask if the victim feels safe at home.

The most important response following a disclosure of domestic abuse is to offer an empathetic and non-judgemental listening ear. Often simply being listened to is a therapeutic and empowering experience. The GP should validate the victim’s feelings, acknowledge their difficulties and reinforce that they are not to blame. All consultations should be conducted with a trauma-informed approach, being sympathetic to triggers and minimising the risk of re-traumatisation.

The immediate safety of the victim should be assured, and a decision made if an immediate onward referral is warranted. A safety assessment may include asking if the victim has a place of safety, what kind of abuse they have been subjected to, and if the perpetrator is known to have any weapons.

There are several resources the GP can signpost victims to, such as the National Sexual Assault, Family & Domestic Violence Counselling Line. The GP, alongside these services, can help the victim to formulate a safety plan, including emergency telephone numbers, safe locations and a plan of how they would remove themselves from an unsafe situation. A safety plan should be documented in the victim’s records, with the reassurance that this will remain confidential.

It is important to also ask about children in the household, as child safeguarding issues can often coexist with domestic abuse. Sexual violence should be sensitively asked about, with onward referral to a sexual assault centre where appropriate.

Finally, timely and accessible follow up should be offered, aiming to preserve continuity of care where possible. All consultations with victims of domestic abuse should be accurately documented, as medical records may be used as evidence if charges are pressed against the perpetrator.

Dr Samantha Miller, MBChB

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References

  1. Samuel, S (2016). Editorial: Considering domestic violence in clinical practice. Australian Family Physician 45(4):116. https://www.racgp.org.au/afp/2016/april/editorial-considering-domestic-violence-in-clinica
  2. Hegarty K et al (2016). Identifying and responding to men who use violence in their intimate relationships. Australian Family Physician 45(4):176–81. https://www.racgp.org.au/afp/2016/april/identifying-and-responding-to-men-who-use-violence-in-their-intimate-relationships/
  3. Domestic Violence Resource Centre. https://www.dvrcv.org.au/about/what-domestic-violence
  4. Domestic Violence Resource Centre (2004). Identifying and responding to family violence: a guide for general practitioners. https://www.dvrcv.org.au/publications/books-and-reports/guide-for-general-practitioners
  5. Australian Institute of Health and Welfare (AIHW) (2018). Family, domestic and sexual violence in Australia, 2018. https://www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-in-australia-2018/summary
  6. Women’s Aid. What is domestic abuse? https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/
  7. The Australian Government: Respect Support Services. https://www.respect.gov.au/services/#nat

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