This chapter explores issues to be considered when identifying domestic violence. A ‘best practice’ approach has been taken to the advice given, based on evidence where available, with guidelines for health and mental health professionals supplementing the evidence base (e.g. Department of Health & Home Office, 2000; Department of Health, 2005, 2009; British Medical Association, 2007; Foreign & Commonwealth Office, 2007; Greater London Domestic Violence Project, 2008; Ethnic Alcohol Counselling in Hounslow (EACH), 2009).

Indicators of domestic violence

As discussed in previous chapters, people attending mental healthcare services are more likely than the general population to be victims of domestic violence and professionals therefore need to be aware of current and previous domestic violence their patients may be experiencing. In addition to physical and mental health symptoms there are other indicators of possible domestic violence which should alert healthcare professionals (Box 3.1, p. 30). These are likely to occur across all in-patient and outpatient settings as there is a high prevalence of both previous and recent domestic violence in all mental health service users (Oram et al, 2013). Evidence to date suggests that women are at greatest risk of domestic violence (Barnish, 2004) and most of this chapter therefore refers to women rather than men. However, similar principles apply to men suffering from domestic violence and of course they too deserve appropriate support.

Barriers to disclosure

Only 10–30% of recent violence is asked about and identified in clinical practice (Howard et al, 2010). There may be powerful barriers preventing disclosure, which include the stages of change in victims’ understanding of their experiences. Disclosure can seem an insurmountable challenge in the context of intimidation by the perpetrator/perpetrators, pressure to remain in the relationship from the wider family or community and suffering consequent on the abuse. A perpetrator may have tried to enforce secrecy and silence by threats, shaming and humiliation. They may control medication and undermine the victim's credibility with her social network, including her fitness as a parent.