Practitioner advice: practical considerations

We should get consent, where we possibly can, to refer people to services. But where you’re really, really worried about somebody, it’s effectively a safeguarding issue, in the same way as it would be if it was a child or a vulnerable adult. So it’s about thinking, if that person leaves here and goes home, am I worried that something bad is going to happen to that person. And I’ve got evidence to make me think that there is a likelihood that something bad is going to happen to that person, then you don’t need consent in that situation.

Where you can see other stresses in a situation, other stresses in a family, such as substance misuse, such as mental health issues - if you’ve got substance misuse and mental health issues going on, you might well have domestic abuse going on. So why not ask about it? Why not ask, you know, are there problems at home? How are things at home? Anything you want to talk to me about? So domestic abuse is, unfortunately, relatively common. It’s about 21,000 people affected every year in Sheffield, on a rolling basis. So it is likely that where you’ve got those stresses and strains in the family, that domestic abuse is there, as well. So best ask about it, really.

So it’s about having confidence to ask about it and not to be - I think, for professionals, sometimes it’s feeling like - well, if I ask about it and somebody says, ‘Yes, that is going on. Yes, I am having problems,’ then they’ve got to think, ‘Well, what am I going to do now?’ And that’s the scary thing. But I think it’s fine to say, ‘Well, I’m going to find out what we can do now and how to support you.’ If somebody has experienced domestic abuse and they’re wanting support but they don’t want to be referred on, there are leaflets that have lots of information. And I tend to repeat quite a bit of that.

So it’s things like, if you can tell one other person what’s going on, so that if you need to, you can contact them quickly. Have your mobile phone with you at all times, charged, if you can. If you feel that you’re at risk of harm, get to a room with a lock on it. Now, that could be the bathroom or the toilet, and it often is those rooms. But they are places of safety if they’re lockable. Don’t argue in the kitchen. That’s where you get stabbed. That’s where there’s access to plenty of weapons. Having said that, obviously bathrooms are places of risk of drowning. So it is a difficult decision to make.

If you’ve got children, consider whether you need to let them know a code word to leave the house quickly. Think about whether you want to get your passports and money, maybe children’s clothes and books and your precious things, out of the house. Is there somebody else who could look after those things for you, in case you needed to leave quickly? We know that the first two weeks after leaving a relationship that has been abusive is the highest risk of harm. That’s the time when that person’s loss of control has gone because you’ve gone. That’s when we need to support those people.

So if we can plan to leave - and that’s something that the IDVA service can work through with people - if you play to leave, it’s safer. I’ve had some very eloquent, very confident women who are experiencing domestic abuse, who have not known how to get that conversation started. In which case, what I’ve done is I’ve made the first phone call, introduced the other person, and handed the phone over. And that has made that a lot more comfortable for that person. So I often say, when I’m talking to other GPs, if somebody is at that moderate level, maybe in the upper end of risk of harm, ask them to come back. And if they haven’t managed to self-refer, help them.

Because actually speaking those words, I am experiencing this and I’ve been told it’s not right, is really difficult. Usually what we would do is make the patient very aware that we were kind of concerned about their safety, make them aware that we were going to discuss that with a supervisor. So we have weekly supervision, and we would kind of discuss any kind of risk issues really, in supervision. And then, kind of take it from there on a case-by-case basis. So if someone was kind of at immediate risk, I would want to know that they had a very clear idea of how they were going to get help, if they needed it.

And I would probably want to come up with some kind of written plan in the session, about how they could do that. Obviously, taking into account that we don’t want to run the risk of making things worse for them. So really trying to work with the patient to think about what’s going to be the safest way to do this. And I would also always want to inform the patient’s GP, so that they were kind of up-to-date on what’s going on, as well.