Health, domestic abuse and Marac

This content originally appeared in our newsletter between June and July 2014 and reflected our views at the time.

Since taking on the role of Marac representative 18 months ago, hospital and community-based mental health practitioner Gwen Clyde-Evans has helped to oversee a transformation in the way domestic abuse is identified and referred in her local area of Calderdale.

“The work began after the publication of a domestic homicide review in which it was shown that the victim had accessed both Calderdale and Huddersfield's A&E departments,” she explains. “It was highlighted that staff missed opportunities to find out more about what was going on. The team realised how important it was to act on the report's recommendations and decided to take steps to prevent this from happening again.”

Gwen's hard work was recognised earlier this year when she was given the individual award for safeguarding and innovation and the overall champion safeguarding award by Calderdale's adults' and children's safeguarding boards. Here, she shares some advice for other professionals.

Gwen Clyde-Evans, Marac representative, offers tips for health professionals on tackling domestic abuse

1. Establish a simple pathway

To help staff know what to do when a disclosure is made, or if they suspect that a patient is being abused, Gwen worked with colleagues in emergency care and community nursing to establish a domestic abuse pathway. “It's presented as a flowchart to make things as simple as possible, and it also tackles the issue of consent,” she explains.

With patient confidentiality and information sharing a common concern for health professionals working with victims, the team were keen to address this head on: “As well as written guidance, we include examples of situations in which information can be shared without consent. It empowers staff to feel confident about raising their concerns and seeking advice.”

An alert and identification system is also in place across the local NHS, including A&E and GP surgeries. This helps alert all practitioners, regardless of whether they are hospital or community-based, to know of any risks - both past and present.

2. Be flexible

Since implementing the pathway, more work has been done to streamline the process. “Speaking with staff, we found a lot of them were feeling a bit intimidated by doing the full Marac referral form on top of SafeLives' Dash risk checklist, the consent form and the patient notes.”

To help with this, Gwen and Marac coordinator Jill Pilling have taken on the administration associated with referrals, including the referral form itself. “Now all staff need to do is just print out the notes – because all the information we need is usually there anyway – and then do the SafeLives Dash risk checklist, where they can.”

3. Build relationships

For Gwen, it's vital to build relationships so staff know where to go if they have concerns. She adds that having Jill on-side as a Marac coordinator has also been invaluable: “Jill's always there and she'll always get back to people. It's not just about having someone who's able to do the job - it's about having somebody who's really committed to making things work.”

Both Gwen and Jill regularly drop into A&E to collect referrals and speak to staff. The pair have trained health professionals from across the area on Marac and domestic abuse awareness, as well as the local gateway to care team – Calderdale's first point of contact for adult social care enquiries and referrals. They often link up with the local WomenCentre to hold the sessions.

“I think some people are still stuck in the view that domestic abuse only affects certain types of people,” Gwen reflects. “Resources like the Gwent Police film The Devil's Vice are very good at challenging some people's views that, actually, it can happen to anybody and people need support.”

4. Know your hospital

Gwen is a firm believer that the best people to attend the Marac are those who know what services are available on a day-to-day basis, what the criteria is to access them and who to speak to. “The value of Marac is massive – there's so much benefit to it,” she says. “To make the process work, it's all about knowing your hospital and knowing what's worked before and applying this to any system you develop. I think that, together with having a great Marac coordinator, is the key.”

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