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What to do if you suspect a patient is being emotionally abused

What to do if you suspect a patient is being emotionally abused

Calls to domestic violence helplines rose dramatically after the start of the Covid-19 pandemic earlier this year. The National Domestic Abuse Helpline saw a 77% increase in calls in June. Non-physical forms of abuse can be as destructive and as undermining as physical violence. However, the signs are not always as easy to spot. Here domestic violence charity Refuge gives nurses some advice on what to do if they suspect a patient is being emotionally abused.

What signs would you look for in a patient to judge whether they might be a victim of non-physical abuse?

Just as there is no blueprint for domestic abuse, there is no blueprint for signs that it is happening. Every woman’s experience is different, and women may respond differently to their experiences. Many women will not know or realise that they are experiencing emotional abuse – it is often like water dripping on a stone and happens over a long period of time. The simplest question to ask a woman is whether she has changed her behaviour because she is scared of her partner’s reaction. That is domestic abuse.

When discussing domestic abuse try to ask her the question directly, but only if she is alone and it is safe to do so. Some indicators of a woman experiencing domestic abuse could be that:

  • She makes frequent visits to A&E and/or the GP
  • She appears fearful, evasive, ashamed
  • She is always accompanied for medical appointments by her partner or a family member
  • Her partner answers questions on her behalf
  • She is using drugs or indicates excessive alcohol use
  • She expresses suicidal thoughts, is depressed, or self-harms
  • She delays presenting her injuries
  • There are signs of injury to her genitals or she has an STI

If she is experiencing emotional abuse, warning signs can include:

  • She lacks self esteem
  • She is always putting herself down
  • She blames herself for everything
  • She is unable to make decisions

If you suspected someone is a victim of domestic abuse should you ask questions to probe a little more? 

You should only ever ask a woman about domestic abuse if she is alone and it is safe for you to do so.

If your appointment with her is happening virtually, you must be very careful to ensure that your conversation is confidential. You’ll need to be certain there is no one in her vicinity who could be listening in to the call or tracking it

Women often tell us that they wish health professionals would ask them about abuse, as they may be afraid to bring it up themselves. Try to ask clear and direct questions such as:

  • Is there anyone you are afraid of?
  • Do you ever feel frightened of anyone at home?
  • Has anyone at home ever pressurised you into doing something you didn’t want to?

If she discloses anything to you, make sure you give her validation. Take time to listen and be non-judgmental. Thank her for sharing her experiences with you, tell her you believe her and that you can help her to find and receive support. Above all else, reassure her that she is not alone, and she should call 999 if she is in immediate danger.

Do not tell her to leave her abuser or try to intervene in the situation yourself. Leaving an abuser is a process – remember that on average it takes seven attempts before a woman is able to finally leave. Importantly, the point at which a woman leaves her perpetrator is one of the most dangerous times and when the majority of homicides occur.

What should you do if you strongly suspect someone is a victim of domestic abuse or it is confirmed to you?

You will need to make sure you follow local procedures for safeguarding adults and children and share safeguarding concerns with the relevant agencies as necessary. You should try to assess her risk factors by using a risk indicator checklist, as you may need to share your concerns with other agencies – again this should be done by following the local safeguarding procedures. 

If you have already asked a woman if she is being abused and she has responded that she isn’t, you may still have concerns. In this instance, you should speak to your safeguarding lead and/or line manager to discuss what the next steps are. 

If a woman does disclose abuse to you it is your duty to act and connect her to appropriate support. It is always best to seek her consent to make a referral to a support agency, rather than signposting her to services. It will have taken a lot of courage for her to speak out about her experiences, so try to avoid asking her to do this herself. 

You can also tell her about Refuge’s freephone National Domestic Abuse Helpline, where confidential and non-judgmental support is available by phone or online 24 hours a day. She can call 0808 2000 247 to speak to a member of our all-female, highly-trained helpline staff, or she can visit to book a safe time to be called back or use our live chat service, Mon-Fri, 3-6pm. 

Finally, healthcare professionals should access specialist training wherever possible as the issues are complex, and there may be local safeguarding procedures at play.

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