Domestic abuse: is it any of our business in dentistry?

For Domestic Violence Awareness Month this October, Gemma Forsythe talks to Preetee Hylton about the signs of domestic abuse and why dental professionals need to understand them.

For Domestic Violence Awareness Month this October, Gemma Forsythe talks to Preetee Hylton about the signs of domestic abuse and why dental professionals need to understand them.

October is Domestic Violence Awareness Month and this is a very important issue to highlight.

Preetee Hylton RDN discusses the signs to look out for, organisations to signpost patients or colleagues to and the importance of the dental team looking out for signs and offering support to their patients who may be going through domestic violence. Preetee is very passionate about this topic and I have been lucky enough to catch some of her lectures on this.

What constitutes domestic abuse?

In the UK, domestic abuse and violence have been delineated by the government as: ‘Any instance or repeated occurrence of controlling, coercive, or menacing conduct, as well as violence or maltreatment, involving individuals aged 16 or older who have been or currently are intimate partners or family members, irrespective of their gender or sexual orientation.

This encompasses various forms of abuse, including but not limited to:

  • Psychological
  • Physical
  • Sexual
  • Financial
  • Emotional.

Controlling behaviour encompasses actions aimed at subjugating and rendering a person reliant by isolating them from support systems, exploiting their resources for personal gain, depriving them of the means for independence, thwarting resistance, and dictating their daily life.

Coercive behaviour refers to acts or patterns of acts involving assault, threats, humiliation, intimidation, or other abusive tactics intended to harm, punish, or intimidate the victim.’

It is important to note that the above definition, although not legally binding, incorporates so-called ’honour’-based violence, female genital mutilation (FGM), and forced marriages. This emphasises that victims span diverse genders and ethnicities.

A summary of the legal framework in the UK

The Domestic Abuse Act 2021, enacted in the UK, serves to enhance protection for domestic abuse victims. This legislation extends the scope of domestic abuse to encompass coercive and controlling behaviour, rendering it a criminal offense. Furthermore, it mandates the establishment of a domestic abuse commissioner to oversee the governmental and public service response to domestic abuse.

The act introduces new instruments such as domestic abuse protection notices and orders. These empower the police to safeguard domestic abuse victims. It also introduces a domestic abuse perpetrator programme designed to support the rehabilitation of offenders. Additionally, the legislation addresses improvements in responding to domestic abuse within family courts and ensures better support for victims, including provisions for safe accommodation.

Is domestic abuse our problem as dental professionals?

Domestic violence and abuse (DVA) is a pervasive issue that frequently permeates our discussions with family, colleagues, and friends. It also inundates news reports and our social media feeds.

When confronted with these distressing accounts, feelings of hopelessness and apprehension may overwhelm us, compelling us to seek a deeper understanding of the signs of domestic abuse and its profound impact on our mental and physical wellbeing.

Often, our quest for knowledge leads us to websites offering disheartening statistics on the prevalence of domestic abuse. It is incumbent upon us, as dental care professionals, to equip ourselves with the knowledge of recognising the warning signs of domestic abuse. This will enable us to offer assistance and guidance when necessary.

Statistical insights

According to the crime survey for England and Wales, covering the year ending March 2022, approximately 2.4 million adults aged 16 and over (5.0%) experienced domestic abuse within the past year. Notably, there was no significant change in the prevalence of domestic abuse for adults aged 16 to 59 between the year ending March 2022 and the preceding year, unaffected by the COVID-19 pandemic.

During the same period, the police recorded approximately 1,500,369 domestic abuse-related incidents and crimes, with 910,980 categorised as domestic abuse-related crimes. The figures show a steady increase in police-recorded domestic abuse-related crimes in recent years, with the latest statistics indicating a 7.7% rise from the previous year and a 14.1% surge from the year ending March 2020.

This escalation may be attributed to an uptick in reporting domestic abuse, as the survey reported no significant alterations prior to the pandemic.

Identifying potential signs of domestic abuse

  • Exhibiting signs of social withdrawal and detachment from loved ones and peers
  • Manifesting visible indications such as bruises, burns, and bite marks, notably around the neck, ears, shoulders, and arms
  • Experiencing financial control, which may encompass inadequate access to essential necessities like food or medication, or complete control over bank accounts by the abuser
  • Being coerced into marriage under threat of harm by relatives
  • Suffering confinement within the home, hindering attendance at work, school, or social gatherings
  • Enduring continual belittlement and verbal abuse, whether privately or in public. A ‘smear campaign’ is often used to discredit the victim and shift the blame from the perpetrator
  • Falling victim to coerced sexual acts or non-consensual intercourse, which qualifies as rape and should be reported to the authorities. Marital rape is also a crime and must be reported to the police
  • Encountering stealthing, defined as the non-consensual removal or damage of a condom during intercourse, constituting sexual assault and being illegal in the UK
  • Experiencing gaslighting, where the abuser denies abuse or shifts blame onto the victim – a manipulative and dangerous tactic that leaves the victim questioning their own thoughts, words, actions, and sanity
  • Facing surveillance across all forms of communication such as messages and emails, including social media and online activities
  • Compelled to always share their location with the abuser through various apps. There have been instances where perpetrators have installed software/apps on the victims’ phones to be able to keep track of their locations, without them being aware of it.

Safeguarding training for dental professionals

Instances of child abuse, elder abuse, modern slavery, and domestic abuse frequently feature in media reports, prompting us to question how such occurrences went unnoticed.

As dental professionals, our unique position affords us the ability to observe shifts in behaviour, physical injuries or marks, and non-verbal cues. Consequently, it becomes our duty to voice any concerns we may harbour, given our responsibility to the welfare of our patients, colleagues, and the broader community.

In alignment with NHS England, safeguarding entails shielding an individual’s health, wellbeing, and human rights. This ensures their existence remains free from harm, abuse, and neglect.

Safeguarding constitutes a collective responsibility, demanding the presence of adequate measures and their activation when necessary.

Safeguarding of children and young people

  • Level 1: Inclusive of non-clinical staff such as receptionists and practice managers
  • Level 2: Encompassing most dentists and dental care professionals
  • Level 3: To be determined based on need and risk within larger organisations.

Adult safeguarding:

  • Level 1: Encompassing non-clinical staff, including receptionists and practice managers
  • Level 2: Covering the majority of dentists and dental care professionals.

My personal opinion is that all members of staff, including non-clinical team members, in a dental practice/organisation must receive level 2 training in both safeguarding of children and young people and adult safeguarding.

How to offer support if someone is experiencing abuse

  • If you suspect someone is enduring abuse, convey your availability to listen and support them
  • Find a private and secure setting and time to engage in conversation, mindful that they may not be prepared to discuss their experiences yet
  • When someone confides in you, refrain from judgment and commend their courage in speaking out
  • Reiterate that no one deserves to endure abuse and emphasise their right to safety and happiness
  • Extend your support, encourage them to express their emotions, and respect their personal decisions
  • Refrain from pressuring them into decisions they may not be ready for, such as leaving the abusive relationship or reporting the abuse
  • In cases of physical harm, offer to accompany them to seek medical attention at their GP or a hospital
  • Assist them in reporting the abuse to the police if they choose to do so
  • Be prepared to provide information about organisations offering assistance to those experiencing domestic abuse
  • In cases involving children, contemplate seeking assistance from social services.

Call 999 in an emergency or if someone is at immediate risk of danger

Ensuring the safety and wellbeing of our patients remains paramount, underscoring the critical importance of adhering to training guidelines set forth by the General Dental Council (GDC) and the Care Quality Commission (CQC).

This standard of care should be uniformly applied to our fellow dental professionals, while the onus lies on employers to provide support to team members who may be grappling with domestic abuse.

It becomes our ethical duty to foster a workplace environment that is both secure and supportive for all staff members. Shockingly, the grim reality is that fewer than one person per year chooses to divulge their experience of domestic abuse to their employers or supervisors – a statistic we are compelled to change.

Services to signpost patients and team members to

Email [email protected] for references

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