Routine enquiry of domestic abuse was introduced in 2008 following the issue of Chief Executive Letter 41: GBV Action Plan (PDF 19.5KB). This detailed the actions required from NHS Boards to improve NHSScotland’s response to gender based violence (GBV).
Here you can find information on how routine enquiry of abuse can help address health inequalities aligned with GBV. You can also find information on implementation and training.
- The prevalence of domestic abuse and childhood sexual abuse, and its adverse impact on health has significant implications for the NHS.
- Increased detection provides survivors with the opportunity to access support and services, allowing for earlier intervention and improved health outcomes.
- Evidence shows that some staff are reluctant or uncomfortable to broach the subject of abuse.
- Survivors of abuse may be reluctant to disclose without direct questioning because of stigma or fear of not being believed.
- The majority of women find it acceptable to be asked about abuse.
- Evidence indicates that mental health service users expect to be asked about adverse life experiences, including abuse.
Overview of routine enquiry
Routine enquiry involves asking all women at assessment about abuse regardless of whether there are any indicators or suspicions of abuse.
It was established in maternity, sexual health, health visiting, substance misuse and mental health settings. This was due to the disproportionate number of women accessing these services who have experience of abuse.
Routine enquiry of sexual abuse for all new patients, male and female, presenting at substance misuse and mental health services was also introduced. This was due to the very high number of their service users who have been abused.
Recently there has been a programme of work to support the use of the DASH Risk Identification Checklist. This is a structured, validated tool designed to identify people at high risk of serious or lethal harm in the context of domestic abuse.
This approach to routine enquiry is supported by the Royal College of Midwives, Royal College of Nursing, Royal College of Psychiatrists and the National Institute for Health and Care Excellence (NICE) public health guidance, ‘Domestic violence and abuse: multi-agency working’.
Selective enquiry involves acting on suspicion or concerns that someone is experiencing abuse, for example through observation of physical or behavioural indicators, rather than asking everyone as a matter of standard practice.
Survivors of GBV can present in any setting in the NHS, and it is important that all staff are aware of potential signs of abuse and are able to respond appropriately. Equally, it is crucial that this applies to both male and female service users. The absence of routine enquiry does not mean that concerns about abuse should be ignored.
Some men are abused by their female or male partners and it is important that their needs are recognised, taken seriously and addressed sensitively. Frontline staff should be aware of the indicators of abuse and if they have concerns, staff should ask relevant questions to aid disclosure and identify support needs.
Selective enquiry of domestic abuse is more appropriate to men as
- the prevalence for men is not as significant as that for women
- men do not experience similar levels of injuries
- the dynamics of abuse for men and women are different – women are more likely to be fearful of their partners and to experience sustained abuse, resulting in considerable implications in particular for mental health and substance misuse
- women are more likely to experience sexual violence and degradation
- there is a lack of evidence about the acceptability to men of being asked about abuse
- there is lack of evidence about effective interventions for men.
Implementation of routine enquiry
Each NHS Board has an Executive Lead and Operational Lead for GBV to support and direct implementation of the work on GBV across NHS Scotland.
NHS boards provide ongoing routine enquiry training for new and existing staff. Frontline staff should be trained in the approach before putting it into practice.
Frontline staff are not expected to be experts in dealing with abuse but through implementing routine and/or selective enquiry they can
- provide a supportive environment to help disclosure
- gather information on the health problems associated with the abuse
- assess immediate and long-term health and safety needs
- provide information/signpost and refer on where appropriate
- document disclosure of abuse and action taken in case files.
You can contact your local lead for information on local policies, training opportunities and support for staff.