NICE has today (2 August) published new draft guidance on identifying and preventing domestic violence [i] and abuse between family members or between people who are (or who have been) intimate partners. It covers adults and young people who are experiencing (or have experienced) domestic violence, and children who are exposed to domestic violence.

Around 1.2 million women and 784,000 men aged 16-59 in England and Wales experienced domestic abuse in 2010/11. Almost one third of women and 17% of men in England and Wales have experienced it at some point in their lives [ii].

Both men and women can perpetrate and experience domestic violence and abuse, but it is more often inflicted on women by men, with women experiencing more severe forms of violence.

Domestic violence can be sexual, emotional, financial or physical (using minor or severe force). ‘Honour' violence[iii] and forced marriage are also examples of domestic violence [iv]. In England, 1.6% of older people aged 66 years and over reported experiencing abuse (psychological, physical, sexual and financial) in the past year from a family member, close friend or care worker [v]. 31% of girls and 16% of boys reported experiencing sexual violence in a relationship in the UK, with 25% of girls and 18% of boys reported experiencing physical violence. One in six girls aged 13 to 17 reported some form of severe domestic violence inflicted on them by a partner [vi].

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: “Domestic violence and abuse is, sadly, more common than people might expect, often taking place behind closed doors. This new draft guidance recommends that health and social care professionals should receive training so that they can recognise the signs of domestic violence and abuse, and ensure that those affected are aware of the help and support available to them. The draft recommendations also look at assumptions surrounding ‘honour', and recommend that staff do not let their beliefs stop them from identifying and responding to ‘honour' violence and abuse.”

Gene Feder, Professor of Primary Health Care at the University of Bristol and Chair of the group which developed the draft guidance, said: “Domestic violence and abuse poses a major challenge to public health, social care and health care services, yet often goes unrecognised by professionals in those sectors. Health and social care professionals can find it difficult to acknowledge and act on the signs of domestic violence and abuse, and may be uncertain about safe and effective responses to victims and perpetrators. This draft guidance details how health and social care professionals can identify and respond to violence and abuse between family members or between people who are or have been intimate partners. The guidance highlights the important role of specialist domestic violence and abuse agencies, largely based in the voluntary sector, in preventing future violence and improving the life of survivors. It outlines clear recommendations that, if implemented, will ensure that health care, social care and specialist services engage with domestic violence and abuse as part of a wider societal response to this major breach of human rights.”

Polly Neate, Chief Executive of Women's Aid, one of the stakeholders of the guidance said: “Nearly two women a week are killed by a partner or ex-partner in the UK, and many more experience abuse. We know from years of experience, research and statistical data that domestic violence has a much greater impact on women. Men are overwhelmingly the main perpetrators of domestic violence. Violence used by men is much more severe and it is women who experience the largest number of repeated incidents of violence. To address the scourge of domestic violence, it's vital that our health and social care services are set up to identify and protect women at risk of domestic violence, and to prevent abuse wherever possible. This draft guidance reflects best practice in both the health and social care sectors, from commissioning to aftercare, and, if implemented, will give survivors of domestic violence greater confidence in our public services and much more support to escape abuse. We look forward to providing our support to the draft guidance in the upcoming consultation period.”

The draft recommendations are aimed at health and social care service managers, professionals, commissioners, service providers, GPs and specialist domestic violence and abuse staff. The areas covered by the draft guidance include: commissioning and planning services; setting up local partnerships to prevent domestic violence and abuse; creating an environment for disclosing domestic violence and abuse; overcoming barriers to accessing services; identifying domestic violence and abuse in children and young people;and commissioning programmes for people who perpetuate domestic violence and abuse.

The draft recommendations include:

• Health and social care professionals should ensure relevant staff are trained to recognise when domestic violence and abuse may be taking place and ask relevant questions if the evidence suggests it may be occurring.
• Health and social care commissioners and service providers should:
  • identify any barriers people may face when trying to get help for domestic violence and abuse, and introduce a strategy to overcome these barriers.
  • train staff who have direct contact with people affected by domestic violence and abuse in equality and diversity issues, including those working with people who perpetuate violence and abuse. Specifically:
  • ensure staff assumptions about people's beliefs and values, for example in relation to 'honour', do not stop them identifying and responding to domestic violence and abuse.
  • ensure interpretation services are confidential, which is often a concern in black and minority ethnic communities.
  • ensure interpretation services are carried out by professionals and do not rely on the use of family members or friends.
  • ensure people who may be experiencing domestic violence and abuse have the option to be seen alone (a person may have multiple abusers and friends or family members may be colluding in the abuse).

Ends

NICE has not yet issued final guidance to the NHS; these decisions may change after consultation.

Final guidance is expected to be published in February 2014.

Notes to Editors

References and explanation of terms

i. Domestic violence and abuse refers to any incident or patterns of incidents of controlling, coercive, or threatening behaviour, violence or abuse between men and women aged 16 or over who are, or have been, intimate partners or family members. It includes psychological, physical, sexual, financial or emotional abuse.

ii. Smith K (ed), Osborne S, Lau I et al. (2012) Homicides, firearm offences and intimate violence 2010/11: supplementary volume 2 to Crime in England and Wales 2010/11. London: Home Office.

iii. This refers to a crime or incident committed (or possibly committed) to protect or defend the perceived ‘honour' of a family or community.

iv. Department of Health (2011a) Commissioning services for women and children who experience violence or abuse: a guide for health commissioners. London: Department of Health.

v. Department of Health (2007) UK study of abuse and neglect of older people. Prevalence survey report. London: Department of Health. The draft NICE guidance does not cover domestic violence and abuse between close friends and care workers. It covers domestic violence and abuse between intimate partners or family members.

vi. Barter C, McCarry M, Berridge D et al. (2009) Partner exploitation and violence in teenage intimate relationships. London: NSPCC

About the draft guidance

1. The draft guidance is available on the NICE website.

2. Closing date for comments is Friday 27 September 2013. The next meeting is Tuesday 12 - Wednesday 13 November 2013.

3. Final guidance is expected to be published in February 2014.

4. The draft guidance covers:

• adults and young people who are experiencing (or have experienced) domestic violence
• those who are perpetrating domestic violence
• children who are exposed to domestic violence (that is, the violence is not perpetrated on them directly, but they witness or experience it), including those who are taken into care
• the general population (for the purposes of prevention generally).

5. The draft guidance does not cover:

• People whose violence is directed at children.
• Paid carers who abuse vulnerable older people.
• People who endorse, or carry out, female genital mutilation.

6. NICE public health guidance applies in England but is not subject to a mandatory requirement regarding funding.

7. The NHS, local authority and the wider public, private and voluntary community sectors in England should take it into account.

Related published NICE guidance

1. Common mental health disorders. NICE clinical guideline 123 (2011)

2. Depression in adults (update) NICE clinical guideline 90 (2009)

3. Psychosis with coexisting substance misuse. NICE clinical guideline 120 (2011)

4. Alcohol dependence and harmful alcohol use. NICE clinical guideline 115 (2011)

5. Pregnancy and complex social factors. NICE clinical guideline 110 (2010)

6. Looked-after children and young people. NICE public health guidance 28 (2010)

7. Alcohol-use disorders: preventing harmful drinking. NICE public health guidance 24 (2010)

8. When to suspect child maltreatment. NICE clinical guideline 89 (2009)

9. Antisocial personality disorder. NICE clinical guideline 77 (2009)

10. Antenatal care. NICE clinical guideline 62 (2008)

11. Antenatal and postnatal mental health. NICE clinical guideline 45 (2007)

12. Postnatal care. NICE clinical guideline 37 (2006)

13. Post-traumatic stress disorder (PTSD).NICE clinical guideline 26 (2005)

About NICE

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