Recognising domestic abuse during COVID-19

With a rise in domestic abuse during the COVID-19 pandemic, Bindiya Thakrar explores how the dental team can recognise early signs.

The rise in domestic abuse

On the 23 March, the government implemented a lockdown for the entire country. For most of us, this presented a necessary, albeit slight uncomfortable safety measure to protect us from an external threat. However, for some, this amplified a threat they already faced within their own homes.

Since the lockdown began, we have seen a huge rise in the incidence of domestic abuse. Within the first three weeks, 16 people were killed as a result of domestic violence, two of those being children. This was the largest reported number of deaths in a three-week period for 11 years. Calls to the National Domestic Abuse Helpline had gone up by 49% in the first three weeks. And calls to the Men’s Advice Line jumped by 35% in the first week alone.

Protecting the patient

We know as dental professionals it is our responsibility to recognise the signs of abuse and neglect. We should respond to these concerns in an appropriate manner. Studies show that ‘over 80% of women in violent or abusive relationships will seek help from a healthcare professional’. It is also important to remember that witnessing domestic abuse is a form of child abuse. So our aim must always be to protect the patient, but also other members of the household.

Even in a normal practice setting, approaching this issue can understandably cause anxiety amongst dental professionals. The prospect of broaching the subject with the victim and getting it wrong or causing offense, or worse lacking the confidence or being too afraid to raise it at all, can be quite daunting.

However, with things the way they are, dealing with suspected domestic abuse cases has suddenly become a much harder task. At a time when it is also more important than ever. Even with the announcement that dental practices can resume service from 8 June, we are unlikely to be able to treat the same volume of patients for quite some time. This will undoubtedly leave some of the most vulnerable members of our society without access to face to face healthcare. This article will focus on ways in which dental professionals can help suspected victims of domestic abuse.

What to do if you suspect domestic abuse

I must begin by stressing that this is information I have collected from the resources provided below. It is simply to provide an overview on how to manage suspected cases of domestic abuse. It is not exhaustive, and I urge anyone reading this to explore the guidance below in full.

First and foremost, it is important to know that the current lockdown and household isolation rules do not apply if you need to leave home to escape domestic violence. If a patient makes a self-disclosure to you, be sure to make them aware of this fact. However, as we know, patients seeking help from a healthcare professional may not openly admit to the abuse.

Without face to face to consultations, we must now rely on what we are being told over the phone. It is important to keep in mind that domestic abuse is one of the most common causes of non-accidental injuries for women in the UK (Foster, 2019). Some of these cases will present at a dental practice before a GP surgery.

Since the lockdown began, some consultations with GPs are being done via video contact as well as over the phone. To my knowledge, this service is not available within dental practices. Given we are unlikely to resume full service for a while, it may be prudent for dental practices to employ a method for video consultations that complies with data protection laws. Nevertheless, it is still possible to remain vigilant for the tell-tale signs of domestic abuse.

Questions to ask

If a patient reports a suspicious injury, make sure you take thorough notes. Ask for more information about the cause. Asking for picture evidence to help diagnose the problem may also be a good way to gain further evidence and could also prove useful in the future if the perpetrator was to be prosecuted. If the patient seems reluctant to go into detail, or there seems to be inconsistencies in their story, this is a red flag and should warrant further investigation. It is important to remember that the perpetrator may be with the patient during the call. Sometimes this becomes obvious if you can hear them in the background. But if you become suspicious during a call, it is better to ask closed questions such as:

‘Are you alone?’
‘Is it safe to ask you some questions about your relationship with __?’

If, however, you suspect you are on speakerphone or the patient tells you as much, do not ask any further questions. If the patient is unable to speak, try and arrange a time to call the patient back when they are home alone.

Once you can speak to the patient in private, you should agree on a trigger sentence for the patient to indicate they are suddenly unable to speak again to ensure their safety. You should confirm the patients address and contact details along with the details of any other members of family living at home.

Here are some questions you can ask that may encourage your patient to discuss their situation:

Some women have these symptoms/injuries when they are at risk of abuse. Are you afraid of anyone at home…?’
‘Has someone hurt you?’
‘Do you feel safe?’
‘Are you ever afraid of, humiliated, or hurt by anyone?’

Taking the next step

It is important to remember that if the patient feels they are facing imminent danger, they can call 999. Or indeed, you can offer to do this for them. The emergency services also offers a ‘silent solutions’ service, whereby anyone in need of genuine help but unable to speak can call 999 and when prompted dial 55. This will let the operator know it is not a hoax call, but you need assistance.

When speaking to a victim, it is important to be empathetic and validate the patient’s experience with phrases like ‘I believe you’ or ‘This is not your fault.’ If following this call, you still have any concerns about potential domestic abuse, you must inform the practice safeguarding lead and establish what services are still available with your local safeguarding team before making any referrals.

Even if the individual has not answered any of your questions, you should still consider a referral and discuss this further with your safeguarding lead. It is always good practice to seek permission to refer although it is not essential. Nevertheless, you should inform the patient of your intentions. Here is a useful way to explain this and worth keeping to hand: ‘I don’t routinely share information without your consent. However, if you tell me that you, or someone else, is at a serious risk of harm, I can’t keep that information to myself. If I do need to share information, I will let you know who with and can support you to find out the answers to any questions you may have’.

When dealing with any safeguarding issue, it is of utmost importance that you take thorough notes and where possible and safe, you follow up with the patient. Always involve your safeguarding practice lead, even if you choose not to pursue this issue, it is a good idea to talk it through with a colleague.

Safeguarding is everyone’s business

Our duty to patients remains the same even though our method of interaction may have changed. It is imperative that we all remain vigilant to the signs of domestic abuse and remember, safeguarding children, young people and vulnerable adults are recommended CPD topics by the General Dental Council.

You should always trust your instincts and utilise your safeguarding knowledge. Set your bar for concern low. As with any safeguarding case, it’s better to raise an issue than to ignore it.

References

Foster M (2019) Domestic abuse and dentistry: your duty of care. BDJ Team 6: 18–20

Recognising domestic abuse during the COVID-19 pandemic