Domestic Abuse: What Can Dentists Do to Help Prevent It? By Dr Jasmin Sandhu

As a foundation dentist, the thought of having to deal with a safeguarding issue can be quite scary. At a recent regional study day, we had the opportunity to learn more about domestic violence, one part of safeguarding that most of us didn’t know much about and definitely wouldn’t have felt confident in dealing with. Some of what I learned can improve our profession’s knowledge of domestic abuse and the role we play as dentists in its possible prevention.

What is domestic abuse?
It’s defined as any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse, between people age 16 or over who are or have been intimate partners or family members, regardless of gender or sexuality.

The types of abuse can encompass, but are not limited to: psychological, physical, sexual, financial, and emotional. The majority of incidents are carried out by men and experienced by women; however, it can happen to anyone.

Did you know?

• One of every four women experiences domestic violence in her lifetime. (Source: Office for National Statistics [2016] Focus on Violent Crime and Sexual Offences, 2014/15)
• On average, in England and Wales, every week two women are killed by a current or former partner. (Source: Office for National Statistics [2016] Compendium; homicide average taken over 10 years.)
  
• Ten percent of all offences recorded by the police is related to domestic abuse.
• On average, a woman will be assaulted by her partner or ex-partner 35 times before reporting it to the police.

What is the role of the dental team?
The head, neck and face are the most common sites of assault. Dentists regularly examine these sites and deal with facial/dental injuries. Subsequently dental care professionals have a part to play in the issue of domestic violence.

Dentists have an opportunity to see patients regularly and often unaccompanied in an environment that is less stigmatising that other statutory services. This can create an opportunity for patients to reveal domestic abuse and ask for help. It is therefore important that we support and advise our patients appropriately.

Under the CQC and GDC standards we have a responsibility to raise concerns about possible abuse, know about local procedures and who to contact for further advice as well as how to refer concerns.

Guidance
The Department of Health have produced guidance ‘Domestic abuse: a resource for health professionals’. It has a section for health practitioners detailing what we need to know and do. It references the NICE guidelines on domestic violence and abuse, and provides helpful advice for dental practitioners, e.g. what to include in notes.

NICE guidelines state that dentists should have Level 1 training on the awareness of domestic violence and abuse. This includes:

• Staff should be trained to respond to a disclosure of domestic violence and abuse sensitively, and in a way that ensures people’s safety.
• They should also be able to direct people to specialist services.

Level 1 training can be delivered mostly online or by distance learning.

What can we do to help?
‘Asking’ may be enough to encourage victims to seek help; many studies have shown that victims have not been asked about signs of abuse by their dentist.

It is important to remember that it is not our role to advise what direct action they should take and it is important that all staff members that interact with patients get appropriate training.

The ‘AVDR model’ was developed by Dr. Barbara Gerbert and her co-workers at the University of California, San Francisco, School of Dentistry and has been adapted and used in Scotland.

Remember: When working with victims, it’s is important to be confident, supportive and nonjudgmental, and to express concern without accusation or being patronising.

A call to action for DentaltownUK readers
You can be proactive and help raise awareness among your own dental teams by sharing the information in this article. This will mean a greater number of professionals can be more confident when dealing with these situations should they ever arise.

• You could also:
• Identify local services, and put together a policy or protocol for team members to follow if a service is not available.
• Make simple posters and cards with telephone numbers of specialist services or ‘help lines’ that can be displayed in the waiting room or given to patients. Examples of some useful contacts for posters/cards include the 24-hour National Domestic Violence Freephone Helpline (0808 2000 247); the Women’s Aid Federation of England and Helpline, which both help staff the National Domestic Violence Helpline.

Together we can help our profession become more willing to raise the issue of domestic violence and give more victims the chance to seek help.

Dr. Jasmin Sandhu is a foundation dentist who graduated from the University of Birmingham in 2017.