6.4 Domestic Abuse

Domestic abuse is an incident or pattern of incidents of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence, in the majority of cases by a partner or ex-partner, but also by a family member or carer.

Domestic abuse can include, but is not limited to, the following:

• Coercive control (a pattern of intimidation, degradation, isolation and control with the use or threat of physical or sexual violence)
• Psychological and/or emotional abuse
• Physical or sexual abuse
• Financial or economic abuse
• Harassment and stalking
• Online or digital abuse

Anyone can be a victim or perpetrator of domestic abuse, regardless of gender, age, ethnicity, socio-economic status, sexuality or background.

• Evidence of single or repeated injuries with unlikely explanations
• Frequent use of prescribed pain medication
• Injuries to the breast, chest and abdomen especially during pregnancy
• Evidence of sexual or frequent gynaecological problems
• Frequent visits to GP with vague complaints or symptoms
• Stress or anxiety disorders; isolation from friends, family or colleagues; depression, panic attacks or other symptoms alcohol and/or drug abuse; suicide attempts or child presenting with behavioural difficulties at school
• Appearing frightened, ashamed or evasive; a partner who is extremely jealous or possessive; minimisation of abuse accepting blame for 'deserving' the abuse 
• Irregular or late attendance for ante-natal care
• Changes in behaviour from previously
• Hyper-vigilant
• Partner always present at appointments, will not allow them to speak/make decision for themselves
• Physical evidence in their home (hole in walls, broken possessions)
• Debt and no/restricted access to money

When a victim is not being seen alone, professionals should also be alert to the following combination of signals:

• The victim waits for her/his partner to speak first
• The victim glances at her/his partner each time s/he speaks, checking her/his reaction
• The victim smoothes over any conflict
• The partner speaks for most of the time
• The partner sends clear signals to the victim, by eye/body movement, facial expression or verbally, to warn them
• The partner has a range of complaints about the victim, which s/he does not defend

Key steps to follow to ensure you respond appropriately include:

ASK

This question should also be asked in ways that accommodate those with learning disabilities. For example: “Have you been upset because someone talked to you in a way that made you feel ashamed or threatened?”, “Has anyone hurt you/taken money belonging to you/upset you?”

There are barriers to victims disclosing abuse including fear of what will happen as a result and what your response as a professional will be. The victims may be unaware that their situation includes domestic abuse or where they can get help.

VALIDATE

“What you are describing sounds like abuse”. “The abuse is not your fault”. “You have options and we can help you find support”.

ASSESS

Consider immediate risks, the specific support needs of the patient/client/service user, their capacity to make decisions in their own interest, and if they are at risk of serious injury or homicide. This might involve questions such as: “Is your home accessible without support from someone else? Is the person who is abusing you in possession of any medication you require?” Identifying someone’s immediate concerns, including for example finances, is also important.

To determine the level of risk (high, medium or standard), the DASH form and professional judgement are used. For organisations less familiar with domestic abuse, seek advice from a specialist service.

ACTION

If you have a concern about an adult or child and they are in immediate danger you should contact the relevant emergency services by ringing 999.

If there is a child who may be impacted, the Multi-Agency Safeguarding Hub (MASH) needs to be notified. For safeguarding adults, a concern needs to be raised where the adult has needs for care and support (whether or not the local authority is meeting any of those needs).

This link has online forms for safeguarding referrals: https://www.milton-keynes.gov.uk/social-care-and-health/safeguarding-people-at-risk

You should document domestic abuse within patient/client/service user records to ensure repeat incidents experienced by the survivor are more likely to be identified and ensure that survivors don’t have to repeat their story which can be re-traumatising. Keep clear, detailed notes with no conjecture in a secure location. Keep the patient/client/service user informed of what information you are writing down and who it might/will be shared with. All referrals, whether internal or external, should be followed up.

Signposting alone may not be effective since the victim will have limited opportunities to access support. Consider making a referral on the patient/client/service users’ behalf.  Online referral forms can be accessed from Milton Keynes Council by clicking on the following link: https://www.milton-keynes.gov.uk/social-care-and-health/safeguarding-people-at-risk

• MK Act supports people experiencing domestic abuse focusing on medium and high risk victims. They provide refuge, a crisis intervention service (risk assessment and safety planning), perpetrator programme and peer support programmes. http://www.mkact.com/
• Victims First Hub offers emotional and practical support (standard risk) to victims and witnesses of crime as well as family members of victims. https://www.victims-first.org.uk/
• Safe! Support young people aged 5 – 17 years old who have witnessed or been a victim of domestic abuse and sexual violence. http://www.safeproject.org.uk/
• Aylesbury Vale & Milton Keynes Sexual Assault & Abuse Support Services (AVMKSASS) support people who have experienced rape, sexual assault or sexual abuse recently or in the past; including FGM and forced marriage. https://avmksaass.org.uk/
• Flag DV offer free legal advice. https://www.flagdv.org.uk/
• MKC Childrens Services offer peer support programmes and support to families experiencing domestic abuse, it is accessed through Children and Family Centres or a Childrens Services referral.
• National helplines available at: https://www.gov.uk/guidance/domestic-abuse-how-to-get-help
• Survivors Handbook offers safety plan guidance for victims: https://www.womensaid.org.uk/the-survivors-handbook/making-a-safety-plan/
• Multi-Agency Risk Assessment Conference (MARAC) a meeting where information is shared on the highest risk domestic abuse cases between representatives of local police, health, child protection, housing practitioners, Independent Domestic Violence Advisors (IDVAs), probation and other specialists from the statutory and voluntary sectors. The primary focus of the MARAC is to safeguard the adult victim. At the heart of a MARAC is the working assumption that no single agency or individual can see the complete picture of the life of a victim, but all may have insights that are crucial to their safety. Further details available at: https://safelives.org.uk/sites/default/files/resources/MARAC%20FAQs%20General%20FINAL.pdf
• Specialist Domestic Violence Courts take place on Wednesdays in Milton Keynes where a MK Act IDVA is present to support victims. These court systems provide a specialised way of dealing with domestic violence cases in magistrates’ courts. Magistrates sitting in these courts are fully aware of the approach and have received additional training.

Organisations are responsible for requesting and receiving training. MK Act offers a multi-agency programme and individual sessions for teams. For details contact Training@mk-act.org

Clare’s Law to make enquiry on someone’s history if they may pose a risk. Details available at:https://www.thamesvalley.police.uk/advice/advice-and-information/daa/domestic-abuse/af/clares-law/

Serious Crime Act 2015 controlling and coercive behaviour became criminal offence. Controlling behaviour is behaviour that makes people subordinate or dependent by isolating them from sources of support, taking control of their resources and depriving them of their independence. Coercive behaviour includes acts of assault, threat, humiliation or intimidation that are used to harm, punish or frighten another person. Legal Advice can be sourced through MK-Act or NCDV or FlagDV.