Domestic violence: What is really going on?

Case​ study:

A 48 year old woman with advanced primary progressive multiple sclerosis confides in her MS nurse about being physically, sexually and mentally abused by her husband. She is wheelchair bound (EDSS 8.0) and relies on her husband, her carer, for activities of daily living.

Objective​:

This webinar will cover safe guarding legislation and how to approach and manage a problem of physical, mental or sexual abuse in vulnerable patients.

CPD accreditation

'Domestic violence: What is really going on?' has been approved by the Federation of the Royal Colleges of Physicians of the United Kingdom for 1 category 1 (external) CPD credit(s). Full conditions of approval are listed in our guidelines.

Summary

In 2021, twice as many disabled women experienced abuse as in 2014, and women with disabilities are seven times more likely to experience sexual assault than those without.

Such figures, published by the charity Safe Lives, show how important it is to consider the issue when working with pepe with a chronic condition such as MS, said Professor Helen Ford.

“We need to raise our awareness and develop our comfort in addressing this,” she said.

Defining abuse

“We often think about violence, but abuse is much more than physical violence. We need to be aware that there are many ways to abuse a person.”

The official definition of domestic violence and abuse is any incident of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members. This is regardless of gender or sexuality.

It is a pattern of behaviour in any relationship that is used to gain or maintain power and control over an intimate partner.

It could be physical, psychological or emotional, sexual, or financial. It may feature neglect, “honour”-based violence or modern slavery.

Investigating and managing domestic abuse

In a North American Research Committee on MS (NARCOMS) survey published last year, 50% of American adults with MS reported mistreatment by their caregivers. The most common types of abuse were psychological (44.2%) and financial (25.2%).

MS healthcare professionals need to be aware of the signs and the risk factors of domestic violence and abuse (DVA), because every contact counts, said Dr Heather Wilson.

“We know our patients really well, so are there any signs that there could be an issue? Are they looking unkempt? Are they looking stressed?,” she said.

Teams will often look for signs of low mood, anxiety, and depression linked to MS, but DVA rather than their health condition, could be the cause. Physical signs to look out for include bruising, of course, but factors such as dehydration or malnutrition may point to neglect.

Risk factors among caregivers include stress, or a history of alcohol or substance misuse.

“We need to utilise our rapport and our relationships with people to enable disclosure. It’s allowing yourself to hear the cues that someone might want to open that discussion,” said Heather.

Teams also need to ensure they are aware of their local services, so they can offer effective sign posting for additional support. That might include local safeguarding teams and specialist domestic violence support teams.

“When someone does disclose DVA, we need to be able to listen and take care not to blame them. We need to acknowledge that it has taken strength to talk about it. We need to give them the time to talk, and not push them,” Heather said.

“You've got to acknowledge that they're in a frightening and difficult situation, and reassure them that nobody deserves to be threatened or hurt, whatever their abuser might be telling them. We need to allow them to express their feelings and allow them to make their own decisions.”

Disclosure

It is essential to provide somewhere private to talk if you think a patient may be ready to disclose DVA, Heather said. This has, she explained, become more challenging in the era of video and telephone consultations.

Documentation is important, but teams must be mindful that partners may have access to electronic patient records.

Heather said: “After disclosure, safety is the priority. Is that person safe? Do they feel safe going home? We should be asking that person their consent to share information with the relevant teams, and letting the person know that we are going to do that.

“But we also need to be aware that the Data Protection Act doesn’t stop us sharing information if we think there is an issue with that person’s safety.”

Indications for safeguarding

Rachel Morrison listed some of the signs that could indicate the need for safeguarding. These included a decline in self-esteem, a feeling that the abuse is their fault, and physical evidence of violence, such as bruising, cuts, or broken bones.

Verbal abuse in front of others and humiliation are strong warning signs, as is damage to the home or property, the person fearing intervention, or being isolated from family or friends.

Rachel highlighted the NHS England safeguarding app, which provides a wealth of information and advice on signposting, and reporting.

She also pointed to the “five Rs of safeguarding”, which all NHS staff have a duty to follow. They are recognise, respond, report, record, and refer.

Be aware

Concluding the talk, Noreen Baker said it was important to be aware of the different types of DVA and to recognise the risk factors.

HCPS should also be aware of the local safeguarding policies and how to access the safeguarding team.

“If in doubt about a situation, discuss it with your safeguarding team,” she added.

Podcast

Our Multiple Sclerosis webinars are available on SoundCloud:
soundcloud.com/neurologyacademy