Chris Melson

The importance of screening for domestic violence in the UK

10 December 2021

female doctor speaking to female patient

Effective screening by healthcare professionals may be a key preventive measure against domestic and intimate partner violence.

Domestic violence is an umbrella term to describe violence within the family. It is often used to denote intimate partner violence, which refers to behaviours that cause harm in a relationship. Gender-based violence concerns harmful acts that are directed towards a person based on their gender.

In recent years, these types of violence have been increasingly framed by policymakers as a public health issue. The World Health Organization has called gender-based violence against women a ‘major public health problem’, affecting nearly one in three women globally.

The annual Global 16 Days Campaign, which takes place from 25 November to 10 December each year, aims to prevent and eliminate gender-based violence against women around the world. Although people of all gender identities experience domestic and intimate partner violence, women are cited as being at the highest risk of severe physical and psychological health implications.

Tackling a significant public health issue

Addressing domestic and intimate partner violence starts with implementing a public health approach to monitor the scale of the problem. Understanding this enables effective planning of intervention strategies and appropriate resource allocation. Screening – an important monitoring tool – can identify people affected by these types of violence and direct them to sources of support. However, undertaking surveillance is challenging, owing to domestic and intimate partner violence often being hidden, with those affected being hard to reach.

In the UK, it is estimated that 80% of women in a violent relationship seek help from health services at least once. Healthcare settings, such as general practitioner (GP) practices, give healthcare professionals an opportunity to routinely screen individuals for possible signs of intimate partner violence and offer specialist help.

campaign poster with the text 'violence against women is a health priority'

In the UK, it is estimated that 80% of women in a violent relationship seek help from health services at least once.

Screening requires training

Over the past decade, a series of policies have been created by UK health bodies and charities seeking to integrate domestic and intimate partner violence services into healthcare. In 2017, for example, the Department of Health published guidance to help NHS staff to ‘identify potential victims, initiate sensitive routine enquiry and respond to disclosures of abuse’. Initiatives such as IRIS, a programme piloted in Wales in 2015 to train GPs how to identify signs of domestic abuse, have garnered promising results. It is unclear, however, how available training is to healthcare professionals for domestic and intimate partner violence screening. In July 2020, the British Journal of Nursing published research which identified that a lack of training and education for healthcare professionals is a barrier to implementing effective screening. This mirrors the results of a YouGov survey, which found half of UK healthcare professionals in GP surgeries and NHS hospitals felt that they had not received adequate training to identify a person experiencing domestic violence.

COVID-19 measures have made it more difficult to screen for domestic violence in a healthcare setting

Domestic violence increased during the UK’s national lockdowns in 2020 and 2021. Although the measures were introduced to curb the spread of COVID-19, they left many people stuck in an abusive environment. The pandemic also led to a shift from face-to-face to remote consultations, impacting the ability of healthcare professionals to develop trust with people living in an abusive situation. For screening to be effective, people must feel that they can safely share their experiences of domestic violence. Building positive and trusting relationships can facilitate this, as can continuity of care and spending more time with the person. However, people may also be less likely to talk about domestic abuse during remote consultations, as perpetrators may be present.

woman sitting on the sofa with blanket wrapped around them holding a mug and looking out of window

How can we make screening more effective in future?

To improve the effectiveness of domestic violence screening in healthcare settings, policymakers should focus on rolling out targeted training programmes nationally. Incorporating education around domestic violence identification into medical undergraduate programmes may also bolster healthcare professionals’ confidence in engaging with screening in practice, building a foundation for additional training.

Despite political and clinical consensus around the importance of screening for domestic violence, there remains a disconnect between centralised policy and the practice of healthcare professionals. Improvements in the quality and availability of training, aimed at developing the skills needed to engage in challenging conversations with people who are potentially experiencing domestic violence, are needed to support healthcare professionals in delivering effective routine screening. To prevent further domestic violence, and improve care for survivors, it is essential that training is improved so people living in an abusive home are identified sooner.

The importance of screening for domestic violence in the UK

Effective screening by healthcare professionals may be a key preventive measure against domestic and intimate partner violence.

Tackling a significant public health issue

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Screening requires training

COVID-19 measures have made it more difficult to screen for domestic violence in a healthcare setting

How can we make screening more effective in future?

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.