What is Domestic Abuse in Health and Social Care?

Domestic abuse is a serious issue that affects people in every part of society, including those who need support from health and social care services. It refers to any incident, or pattern of behaviour, that is controlling, coercive, threatening, violent, or abusive between people aged 16 and over who are, or have been, intimate partners or family members. It can happen to anyone, regardless of gender, age, race, religion, or background.

The abuse can take many forms and does not always involve physical harm. Sometimes it is emotional, financial, or sexual in nature. The effects can be long-lasting and can harm a person’s mental and physical health. Understanding what domestic abuse is, and how it fits into health and social care, can help professionals provide better support and protection for those affected.

Definition of Domestic Abuse

In the UK, the Home Office definition of domestic abuse, used across public services including health and social care, states that it is:

“Any incident or pattern of incidents 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, regardless of gender or sexuality.”

This definition covers a wide range of abusive actions and highlights that abuse can be repeated or ongoing. Importantly, the relationship between the abuser and the victim can be romantic or familial. It is not restricted to people who live together.

Health and social care professionals need to be aware that domestic abuse is not limited to physical violence. It often involves patterns of behaviour that damage a person’s confidence, independence, and wellbeing.

Types of Domestic Abuse

Domestic abuse can take different forms:

• Physical abuse: This involves physically hurting the victim, such as hitting, slapping, pushing, choking or using weapons.
• Emotional or psychological abuse: This includes belittling, humiliation, intimidation, constant criticism, name-calling, isolation from friends or family, and manipulative behaviour.
• Sexual abuse: Engaging in sexual activity without consent, or where consent is forced or pressured.
• Financial abuse: Taking control of someone’s money, preventing them from working, stealing from them, or refusing to give them access to funds.
• Controlling behaviour: Actions that make the victim dependent, isolating them from support, or limiting their freedom.
• Coercive behaviour: Repeated actions that cause fear or compliance through threats, intimidation, or humiliation.

These forms of abuse can happen together. For example, someone might be physically assaulted while also being controlled financially and emotionally.

Recognising Domestic Abuse in Health and Social Care

Professionals in health and social care settings are often in a position to spot signs of abuse. This can include both visible and hidden indicators. Someone might have injuries they cannot explain, seem unusually anxious, or appear withdrawn. They may repeatedly miss appointments, avoid speaking in front of their partner, or seem frightened at the idea of returning home.

Signs can include:

• Unexplained injuries or frequent medical visits
• Changes in behaviour, such as withdrawal or depression
• Low self-esteem or signs of fearfulness
• Signs of controlling relationships, such as the partner answering questions for them
• Poor physical health due to neglect or stress-related conditions
• Financial hardship without a clear reason

Staff need to be aware that someone may not feel ready to disclose abuse or may minimise its seriousness. Listening, showing empathy, and creating a safe space for disclosure is key.

Legal Framework and Guidance

In the UK, domestic abuse is addressed through both criminal and civil law. The Domestic Abuse Act 2021 provides an updated framework for tackling abuse and protecting victims. It gives a legal definition of domestic abuse and makes clear that it is not just physical violence. The Act recognises children as victims if they see, hear, or experience the effects of abuse.

Other relevant laws and guidance for health and social care include the Children Act 1989, the Care Act 2014, and safeguarding procedures within local authorities. These laws require professionals to protect both adults and children from harm, which includes abuse in the home.

Impact on Health and Wellbeing

The effects of domestic abuse reach far beyond the home. People experiencing it often have lasting damage to their mental and physical health. It can lead to depression, anxiety, post-traumatic stress disorder (PTSD), sleep problems and difficulty in trusting others. Physical injuries can range from minor bruising to life-threatening harm. Long-term stress from abuse can also increase the risk of chronic health problems such as heart disease or digestive issues.

For children, growing up in an abusive home can cause emotional trauma, developmental delays, and behavioural problems. These effects can persist into adulthood.

In health and social care settings, professionals need to consider how domestic abuse might be influencing the person’s overall wellbeing and daily functioning.

Role of Health and Social Care Professionals

Those working in health and social care settings have a duty to safeguard adults and children who are at risk. This can involve identifying possible abuse, recording concerns accurately, and following safeguarding protocols within their organisation.

Steps can include:

• Asking routine questions in private to make it easier for someone to talk
• Recording observations in a clear and factual way
• Referring to safeguarding teams or social services when concerns arise
• Providing information about support services, such as domestic abuse helplines or refuges
• Working with other agencies, including the police, housing services, and charities

Building trust is important. Many people experiencing domestic abuse will only speak about it if they feel safe and heard.

Support Services and Pathways

Health and social care professionals can connect victims to specialist support. This may involve referral to:

• Independent Domestic Violence Advisers (IDVAs) who work with victims at high risk
• Local refuge accommodation for those needing a safe place to stay
• Counselling or therapy services
• Support groups for survivors
• Social services for safeguarding children and vulnerable adults
• Housing teams for emergency rehoming

The pathways vary by area, but all services should aim to protect the individual and help them regain independence and safety.

Barriers to Disclosure

Many victims do not come forward straight away. Barriers can include fear of the abuser, concerns about not being believed, cultural pressures, lack of knowledge about support options, or financial dependence.

Health and social care professionals must be aware of these barriers and approach disclosures with sensitivity. A non-judgemental attitude, privacy during consultations, and reassurance about confidentiality can make a difference.

Recording and Information Sharing

Accurate record keeping is vital in domestic abuse cases. It allows professionals to present clear evidence if legal action is taken or if safeguarding steps are needed. Records should describe injuries, behaviour, and anything the individual says, using their own words when possible.

Sharing information with other agencies should follow legal requirements and organisational policy. In some situations, information can be shared without consent if there is a risk of serious harm. Knowing when and how to share is part of safeguarding practice.

Training and Awareness

Ongoing training helps staff to improve their awareness and response to domestic abuse. This can include recognising non-physical abuse, knowing how to ask the right questions, understanding the law, and staying informed about local support options. Many organisations run specialist domestic abuse awareness sessions for all staff, from care workers to senior managers.

Role of Multi-Agency Working

Domestic abuse cases often need a response from more than one service. Multi-agency risk assessment conferences (MARACs) bring together agencies to discuss high-risk cases and coordinate safety planning for the victim.

This cooperation might include the police, probation services, housing providers, children’s services, and health teams. Health and social care professionals contribute by sharing relevant information about the person’s health, support needs, and any risks to children.

Final Thoughts

Domestic abuse in the context of health and social care is a serious safeguarding concern that goes beyond physical harm. It affects people’s mental, emotional, financial, and social wellbeing. Professionals in these sectors are often in a unique position to spot the signs, provide compassionate support, and take action to protect victims.

Recognising the wide range of behaviours that make up domestic abuse, understanding the legal framework, and building strong links with other agencies can help create a better safety net for those at risk. By listening without judgement and offering clear pathways to support, health and social care staff can make a real difference in breaking the cycle of abuse and helping individuals move towards safer and healthier lives.