19th October 2018
Kathryn Lake is a Mental Health Community Nurse for the Norfolk and Suffolk Foundation Trust. She has previously worked as an advocate for those experiencing domestic abuse and has been involved in public awareness raising campaigns such as “Norfolk Says No”. In this blog, Kathryn offers Community Mental Health Nurses practical guidance on responding appropriately to domestic abuse.
Domestic violence and abuse is becoming a public health emergency which costs lives, and negatively impacts on the long-term health of individuals, families and their communities. Women who have experienced domestic violence and abuse generally have poorer health than other women. Health issues include chronic problems with digestion, kidney and bladder function and headaches, poorer pregnancy outcomes, lower birthweight babies, eating disorders and substance misuse.
Recognition by community mental health nurses is vital to be able to address the underlying cause of poor health, promote positive wellbeing and increase social inclusion to aid recovery. From personal experiences and years of research, women who are experiencing domestic abuse are unlikely to ask for help or disclose unless they are directly asked by healthcare professionals.
And as difficult as it is for victims of domestic abuse to talk about, we too as healthcare professionals find it difficult to approach such an emotive subject for many reasons. However, the World Health Organisation highlights the important role that healthcare providers have in recognising and responding safely to domestic abuse.
As community mental health nurses we must be vigilant to psychological indicators such as:
- Anxiety, panic attacks, stress and/or depression;
- PTSD symptoms
- Substance misuse;
- Sleeping and eating disorders;
- Suicide attempts,
- Missed appointments/rescheduling appointments
You may also notice other factors that warrant exploring;
- That the person seems nervous, ashamed or evasive;
- They are uncomfortable or anxious in the presence of their partner;
- They are accompanied by their partner, who does most of the talking;
- They give an unconvincing explanation of the injuries or their mental wellbeing;
- They have recently experienced a relationship breakdown
- They are reluctant to follow medical and health promotion advice.
We need to be confident in the enquiry of abuse and be direct with the questions. Yes, this depends on how well you know the person and what indicators you have observed. But either way we should begin with these questions:
- 'How are things at home?'
- 'How are you and your partner relating?'
- 'Is there anything else happening that may be affecting your health?'
Even if we have misread the situation or cues, research has found that this has not damaged the therapeutic relationship but actually demonstrates positive regard for the patient’s wellbeing and situation.
Specific questions linked to our clinical observations that could be asked:
- 'You seem very anxious and nervous. Is everything all right?'
- 'When I see injuries like this, I wonder if someone has hurt you?'
- ‘When I hear you recall your symptoms, I wonder if it’s a response to someone hurting you?’
- 'Is there anything else that we haven't talked about that might be contributing to you feeling this way?'
More direct questions could include:
- 'Are there ever times when you are frightened being at home with your partner/family?'
- 'Are you concerned about your safety or the safety of your children?'
- 'Does the way your partner treats you ever make you feel unhappy or depressed?'
- 'I think there may be a link between your illness and the way your partner treats you. What do you think?'
Responding to a disclosure
Our responses as community mental health nurses can have a profound effect on a person’s willingness to disclose and seek guidance and support. It is vital that we are aware of how we respond:
- Demonstrate active listening: being listened to can be the most empowering experience for a survivor of domestic abuse. Give eye contact, sit with them and give them time to talk.
- Validate feelings: use statements such as "that must have been so very frightening for you."
- Validating the decision to disclose: tell them "It must have been difficult for you to talk about this." "I'm glad you were able to tell me about this today.'
- Emphasising the unacceptability of the violence or abuse: tell them "You do not deserve to be treated this way."
- Give information: provide information about domestic abuse and the services and options available.
It is imperative to assess the person’s safety and the safety of any children involved. You could ask questions along the lines of;
- Are you safe? Are your children safe?
- Do you need an immediate place of safety?
- If immediate safety is not an issue, ask about future safety.
- Do they have a plan of action if they need to leave quickly?
- Do they have emergency telephone numbers?
- Help draw up an emergency plan: Where would they go if they had to leave? How would they get there? What would they take with them? Who do they have for support?
- Document these plans for future reference and include them in their care plan.
Just as we reassure victims of domestic abuse that they are not alone in this situation – we need to remember as community mental health nurses that we too are not alone in this. We have the support of our colleagues, safeguarding leads, clinical supervision and other professionals to seek support, advice and guidance to ensure the safety and wellbeing of the patients we work with and ourselves.
Follow our Spotlight on domestic abuse and mental health for blogs, podcasts, guidance and more over the coming weeks.