Resources for GPs
Indicators of Domestic and Family Violence
Over 1 in 5 women make their first disclosure of domestic violence to their GP. You may be the only person she will tell. Your skills and sensitivity are essential.
For Adults
Physical
Unexplained bruising and other injuries
Bruises of various ages
Head, neck and facial injuries
Injuries on parts of the body hidden from view (including breasts, abdomen and/or genitals), especially if pregnant
Injuries sustained do not fit the history given
Bite marks, unusual burns
Chronic conditions including headaches, pain and aches in muscles, joints and back
Psychological/Behavioural
Emotional distress, e.g. anxiety, indecisiveness, confusion and hostility
Sleeping and eating disorders
Anxiety / depression / pre-natal depression
Drug abuse
Self-harm or suicide attempts
Evasive or ashamed about injuries
Multiple presentations at the surgery / client appears after hours
Partner does most of the talking and insists on remaining with the patient
Seeming anxious in the presence of their partner
Social isolation / no access to transport
Frequent absences from work or studies
Submissive behaviour
For Children
Psychological/Behavioural
Aggressive behaviour and language
Depression, anxiety and/or suicide attempts
Appearing nervous and withdrawn
Difficulty adjusting to change
Regressive behaviour in toddlers
Delays or problems with language development
Psychosomatic illness
Restlessness and problems with concentration
Dependent, sad or secretive behaviours
Bedwetting
‘Acting out’, for example cruelty to animals
Over protective or afraid to leave mother
Feelings of worthlessness
Physical
Difficulty eating / sleeping
Slow weight gain (in infants)
Physical complaints
Eating disorder
How to ask your patient
In any situation that you suspect underlying psychosocial problems you can ask indirectly and then directly about partner abuse. If you have concerns that your patient is experiencing domestic violence, you should ask to speak with her alone, separate from her partner or any other family members.
You can always ask broad questions about whether your patient’s relationships are affecting her health and wellbeing. For example:
“How are things at home?”
“How are you and your partner getting on?”
“Is anything else happening which might be affecting your health?”
It is important to realise that women who have been abused want to be asked about domestic violence and are more likely to disclose if asked.
If appropriate, you can ask direct questions about any violence. For example:
“Are there ever times when you are frightened of your partner?”
“Are you concerned about your safety or the safety of your children?”
“Does the way your partner treats you make you feel unhappy or depressed?”
“Has your partner ever physically threatened or hurt you?”
“Has your partner forced you to have sex when you didn’t want it?”
“Violence is very common in the home. I ask a lot of my patients about abuse because no one should have to live in fear of their partners.”
If you see specific clinical symptoms, you can ask specific questions about these (eg bruising). These could include:
“You seem very anxious and nervous. Is everything alright at home?”
“When I see injuries like this, I wonder if someone could have hurt you?”
“Is there anything else that we haven’t talked about that might be contributing to this condition?”
Responding to disclosure
Your immediate response and attitude when your patient discloses domestic violence can make a difference. Women require an initial response to disclosure, where they are listened to, validated and their own and their children’s safety is assessed.
They also need to be assisted on a pathway to safety.
Listen
Communicate belief
Validate the decision to disclose
Emphasise on the unacceptability of violence
Be clear that she is not to blame
Do not ask:
“Why don’t you leave?”
“What could you have done to avoid this situation?”
“Why did he hit you?”
Initial Safety Planning
Assist your patient to evaluate their immediate and future safety, and that of their children. Best-practice risk assessment involves seeking relevant facts about their particular situation, asking them about their own perception of risk, and using professional judgment. You may need to refer your patient to a specialised domestic violence service such as the Domestic Violence Line.
For initial safety planning, you will at least need to:
Speak to your patient alone
Check for immediate concerns
Do they feel safe going home after the appointment?
Are their children safe?
Do they need an immediate place of safety?
Do they need to consider an alternative exit from your building?
If immediate safety is not an issue, check your patient’s future safety:
Has the perpetrator’s behaviour changed/ escalated recently?
Does the perpetrator have access to weapons?
Does your patient need a referral to police or a legal service to apply for an Apprehended Violence Order?
Do they have emergency telephone numbers
Services and resources to refer to victims
Renting
Victims of domestic violence can end their tenancy immediately, without penalty, if they, or their dependent child are in circumstances of domestic violence. You can help your patient end her tenancy immediately by completing:
a Medical Practitioner Declaration Form16 or;
a Medical Practitioner Declaration Form – Dependent Child. 17
The declaration is one of four permitted types of evidence your patient can use to attach to their Domestic Violence Termination Notice. The reason medical practitioners can provide this evidence is so that victims of domestic violence who are too fearful to report the violence to police are supported to end their tenancy.
By signing a declaration, you are providing evidence, that based on your professional assessment, your patient or their dependent child is a victim of domestic violence perpetrated by a person with whom they are in a ‘domestic relationship’ (see page 2). You do not have to prove that an incident of domestic violence has taken place nor do you need other evidence of domestic violence, such as a police report or an Apprehended Violence Order, to complete the declaration.
For more information, and to access the forms, visit www.fairtrading.nsw.gov.au
Victims Support Scheme
If your patient has experienced domestic violence in NSW, they may be entitled to free counselling and financial support through the victims support scheme, administered by Victims Services NSW. Financial assistance may be awarded to pay for immediate needs (such as relocation expenses, or emergency medical or dental expenses.) Further financial assistance for economic loss can be applied for to cover ongoing costs, such as loss of earnings.
Some victims may also be granted a recognition payment depending on the nature of violence that occurred. In most cases, applicants for financial support need evidence they suffered an injury as a direct result of an act of violence. Making accurate and detailed notes of domestic violence related injuries might help your patients obtain financial support. There are strict time limits in making an application for financial assistance.
Refer your patient to www.victimsservices.justice.nsw.gov.au for more information.
Centrelink Crisis Payment
If your patient has experienced domestic violence, they may be entitled to a crisis payment. An application must be made within 7 days of their ‘crisis’. If your patient is in receipt of a government payment and experiencing domestic violence, they may be exempted from certain mutual obligation requirements. They may require a medical report to assist in applying for an exemption from these requirements.
Mandatory Reporting
As a mandatory reporter, if a patient talks about experiencing or perpetrating violence, and you believe you have reasonable grounds to suspect that a child is at risk of significant harm, you may need report this to Community Services. You are not obliged to report violence experienced by adults.
Reporting violence experienced by adults without their consent could put them at greater risk of harm. Exposing children to domestic violence can have a serious psychological impact on children. In some cases you may feel there is risk of significant harm to a child even though it seems unlikely that the violent person in their home would physically hurt them. Use your professional judgment about the individual circumstances and the nature of the violence. The Child Story Mandatory Reporters Guide will assist you in assessing child protection concerns and provide a directive on how to proceed.
See: reporter.childstory.nsw.gov.au/s/mrg
Important to note
You can support the Police investigation and future legal proceedings by making detailed notes
Describe physical injuries, record what patient said, record relevant behaviour and consider taking photographs
You may be You may be served with a subpoena relating to a patient.
Treat with caution and check for validity
This content was adapted from a GP DV Toolkit by Women’s Legal Service NSW.
Click here to access the toolkit.
