Domestic abuse disclosure and the vital role of GPs

Australian statistics on domestic violence paint a harrowing picture. One in four women has experienced violence since the age of 15.¹ One in five has experienced sexual violence since the age of 15;¹ 85% of Australian women have been sexually harassed.² Impact reported that in 2020, 56 women, 18 men and 20 children were killed as the result of domestic and family violence.³

It has been estimated that full-time GPs are seeing up to five women per week who have experienced some form of intimate partner abuse in the past 12 months.⁴ One or two of these women will have experienced severe intimate partner abuse — for example, being raped, attacked with a weapon, locked in their home or not allowed to work.

GPs play an important role in responding to family abuse and violence in Australia, and they are often the first point of contact for people who are experiencing family abuse or violence. According to the RACGP White Book, Abuse and violence: Working with our patients in general practice (4th edition), GPs’ roles can include identifying risk factors and noting early signs and symptoms; assessing for violence and safety within families; managing consequences of abuse to minimise morbidity and mortality; knowing and using referral and community resources; and advocating for changes that promote a violence-free society.

Violence doesn’t necessarily present in an obvious way, and a patient may not identify being a victim of domestic violence as the reason for their GP visit. Studies show that there is a need for patients to be encouraged to discuss abuse and to see it as affecting their health. Women are significantly more likely to disclose if they are asked by their doctor about the abuse.

Safety planning

An important part of a GP’s response in the case of domestic violence is safety planning, which involves the development of a plan to achieve and maintain safety of women and their children. GPs can refer to a series of questions that help to assess a woman’s immediate safety. The RACGP White Book details that safety planning includes:

• compiling a list of emergency numbers
• helping to identify a safe place for the woman to go to and how she will get there
• identifying family and friends who can provide support
• ensuring cash is available
• providing a safe place to store valuables and important documents.
   

Safety behaviours can include hiding money and keys, asking neighbours to call police if they witness a violent situation, establishing a code with family or friends to signal that help is needed, removal of weapons and ensuring quick access to important documents such as passports and Medicare numbers.

Developing a referral pathway for GPs

Brian Gue is a GP registrar from Adelaide who is conducting research as part of the Australian General Practice Training program (AGPT) Academic Post Program. His research focuses on how GPs can be supported in their approach to patients who are victims of domestic violence and the establishment of an evidence-based referral pathway.

During the first month of Gue’s work as a GP registrar, he saw six or eight patients who divulged that they had previously experienced abuse. “The patients came from different backgrounds and had different experiences, from an abusive, controlling partner, to an elderly patient whose partner had dementia and had become abusive,” Gue explained. “I wanted to know what I should do if they said they needed my help. This led me to look more closely into this area and find a way to focus on a referral pathway to help GPs steer their patients to the services best suited to their needs and situation.”

Gue explained that there are many great services available in South Australia, but they are not currently organised into a formalised referral pathway that GPs can use at the point of care. He is working with Adelaide Primary Health Network (PHN) and Country Health SA PHN to assess services in the state and provide GPs with clarity regarding what services are out there and how they cater to different subgroups and needs categories. Qualitative research, involving discussions with professionals specialising in domestic abuse, will explore current challenges and barriers faced by GPs to inform the referral pathway so that services can be recommended to patients at the point of care to optimise patient outcomes.

“Better understanding of the services on offer will make sure these services are used to the best of their ability and will mean that GPs can have confidence they are referring their patient to the service that can help them,” Gue said.

Brian Gue’s research focuses on how GPs can be supported in their approach to patients who are victims of domestic violence and the establishment of an evidence-based referral pathway.

References

1. Australian Bureau of Statistics. Personal Safety, Australia. https://www.abs.gov.au/statistics/people/crime-and-justice/personal-safety-australia/latest-release.
2. AHRC (2018). Everyone’s business: 4th national survey on sexual harassment in Australian workplaces. Retrieved from: https://whiteribbon.org/2Ea7Q6C.
3. Impact. https://www.impactforwomen.org.au/australias-death-toll-2020.html.
4. Hegarty K. What is intimate partner abuse and how common is it? In: Roberts G, Hegarty K, Feder G, editors. Intimate partner abuse and health professionals: new approaches to domestic violence. London: Elsevier, 2006. p. 19–40.

Image credit: ©stock.adobe.com/au/Monkey Business