BMJ 2014;348:g1797 doi: 10.1136/bmj.g1797 (Published 26 February 2014)
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NEWS Doctors need training to respond to domestic violence, NICE guidance says Ingrid Torjesen London
All doctors should receive training to recognise and respond to domestic violence, similar to their mandatory training on child protection, guidance from the National Institute for Health and Care Excellence has said.
The guidance, published on 26 February, outlined how health services, social care, and the third sector organisations they work with could respond effectively to domestic violence and abuse.1 It said that each year 7.4% of women and 4.8% of men experienced domestic violence or abuse and that 30% of women and 17% of men will experience it at some point in their lives. The guidance is the first that NICE has produced on domestic violence. Mike Kelly, director of the Centre for Public Health at NICE, said that it was designed to provide a “wake-up call for the system as a whole.”
Gene Feder, professor of primary care at the University of Bristol and chairman of the NICE guideline development group, said, “At the heart of the recommendations is training . . . Domestic violence and abuse is virtually absent from undergraduate medical education. That absence then carries on in postgraduate education, and then in continuing professional development. It is not the doctors’ and nurses’ faults that they do not feel competent in asking and responding appropriately. The training that we are recommending will set that right.” The guidance recommended four levels of training targeted at different groups: • Level 1 is for allied health professionals, care assistants, and receptionists and covers how to respond to a disclosure of domestic abuse sensitively and direct it to specialist services
• Level 2 teaches doctors, nurses, ambulance staff, and social care staff to ask about domestic violence in a way that makes it easier for people to disclose it, and to then refer it to specialist services • Levels 3 and 4 are for specialist services and are designed to safeguard staff and domestic violence workers, respectively.
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Feder said that the training required by doctors was not complex. He said, “What we really want to get out of the training is the competence for health professionals to ask about abuse, given that it is very difficult for the victim to disclose spontaneously. We want them to respond appropriately and supportively. We want them to be able to offer referral to specialist domestic violence support.” He said that the training should follow a similar format to “breaking bad news” and needed to be face to face rather than online because the necessary “asking skills” had to be practised. Feder added that training also needed to cover the types of third sector services specialising in domestic violence and abuse to which patients could be referred, because many medical students and doctors were unaware of them. “If we don’t know that these services exist, we are not going to be able to refer our patients to them,” he said. He added that the other key recommendation of the NICE guidance was to highlight to clinical commissioning groups the need to commission such specialist third sector services. “These services are absolutely essential, because if doctors and nurses don’t feel that these services are there and are able to take referrals, they will find it very difficult to ask, respond [to] and support their patients appropriately,” said Feder. The guidance stated that the cost of domestic violence abuse in human and economic terms “is so significant that even marginally effective interventions are cost effective.” It said that domestic violence and abuse cost the United Kingdom an estimated £15.7bn (€19.1bn; $26.2bn) a year: this comprised just over £9.9bn in “human and emotional” costs, more than £3.8bn in costs for the criminal justice system, healthcare, and housing, and more than £1.9bn in days off work. 1
National Institute for Health and Care Excellence. Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. NICE public health guidance 50. Feb 2014. www.nice.org.uk.
Cite this as: BMJ 2014;348:g1797 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g1797 doi: 10.1136/bmj.g1797 (Published 26 February 2014)
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Page 1 of 2
News
NEWS Doctors need training to respond to domestic violence, NICE guidance says Ingrid Torjesen London
All doctors should receive training to recognise and respond to domestic violence, similar to their mandatory training on child protection, guidance from the National Institute for Health and Care Excellence has said.
The guidance, published on 26 February, outlined how health services, social care, and the third sector organisations they work with could respond effectively to domestic violence and abuse.1 It said that each year 7.4% of women and 4.8% of men experienced domestic violence or abuse and that 30% of women and 17% of men will experience it at some point in their lives. The guidance is the first that NICE has produced on domestic violence. Mike Kelly, director of the Centre for Public Health at NICE, said that it was designed to provide a “wake-up call for the system as a whole.”
Gene Feder, professor of primary care at the University of Bristol and chairman of the NICE guideline development group, said, “At the heart of the recommendations is training . . . Domestic violence and abuse is virtually absent from undergraduate medical education. That absence then carries on in postgraduate education, and then in continuing professional development. It is not the doctors’ and nurses’ faults that they do not feel competent in asking and responding appropriately. The training that we are recommending will set that right.” The guidance recommended four levels of training targeted at different groups: • Level 1 is for allied health professionals, care assistants, and receptionists and covers how to respond to a disclosure of domestic abuse sensitively and direct it to specialist services
• Level 2 teaches doctors, nurses, ambulance staff, and social care staff to ask about domestic violence in a way that makes it easier for people to disclose it, and to then refer it to specialist services • Levels 3 and 4 are for specialist services and are designed to safeguard staff and domestic violence workers, respectively.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Feder said that the training required by doctors was not complex. He said, “What we really want to get out of the training is the competence for health professionals to ask about abuse, given that it is very difficult for the victim to disclose spontaneously. We want them to respond appropriately and supportively. We want them to be able to offer referral to specialist domestic violence support.” He said that the training should follow a similar format to “breaking bad news” and needed to be face to face rather than online because the necessary “asking skills” had to be practised. Feder added that training also needed to cover the types of third sector services specialising in domestic violence and abuse to which patients could be referred, because many medical students and doctors were unaware of them. “If we don’t know that these services exist, we are not going to be able to refer our patients to them,” he said. He added that the other key recommendation of the NICE guidance was to highlight to clinical commissioning groups the need to commission such specialist third sector services. “These services are absolutely essential, because if doctors and nurses don’t feel that these services are there and are able to take referrals, they will find it very difficult to ask, respond [to] and support their patients appropriately,” said Feder. The guidance stated that the cost of domestic violence abuse in human and economic terms “is so significant that even marginally effective interventions are cost effective.” It said that domestic violence and abuse cost the United Kingdom an estimated £15.7bn (€19.1bn; $26.2bn) a year: this comprised just over £9.9bn in “human and emotional” costs, more than £3.8bn in costs for the criminal justice system, healthcare, and housing, and more than £1.9bn in days off work. 1
National Institute for Health and Care Excellence. Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. NICE public health guidance 50. Feb 2014. www.nice.org.uk.
Cite this as: BMJ 2014;348:g1797 © BMJ Publishing Group Ltd 2014
Subscribe: http://www.bmj.com/subscribe
BMJ 2014;348:g1797 doi: 10.1136/bmj.g1797 (Published 26 February 2014)
Page 2 of 2
NEWS
Figure
For personal use only: See rights and reprints http://www.bmj.com/permissions
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