Domestic violence and abuse can affect anyone, both women and men regardless of their age or where they are from. The National Institute for Health and Care Excellence says there needs to be a wider understanding in health and social care, as well as in society as a whole, about how we can help people experiencing it.

NICE has published new guidance which aims to help identify, prevent and reduce domestic violence and abuse. It outlines how health services, social care and the organisations they work with can respond effectively to domestic violence and abuse.

Domestic violence and abuse can be physical abuse, threats, emotional abuse, sexual assault or stalking by a partner, ex-partner or family member. Both men and women may perpetrate domestic violence and abuse, but it is more commonly inflicted on women by men. This is particularly true for severe and repeated violence and sexual assault.

Each year at least 1.2 million women and 784,000 men experience domestic violence and abuse in England and Wales, with one in three women and nearly one in five men experiencing it at some point in their lives [1]. These figures are likely to underestimate the problem, because all types of domestic violence and abuse are under-reported in health and social research, to the police and other services.

Professor Mike Kelly, Director of the Centre for Public Health at NICE said: "Domestic violence and abuse are far more common than people think. Everyone in society needs to understand both the extent of the problem and the damage it causes. It can affect anyone - particularly women and children, but also men, regardless of age, geographical location, income, relationship type, family set-up or ethnic origin. It causes significant short and long term health problems, not only for the victim, but for those around them and can lead to criminal and civil sanctions. This new 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."

Professor Gene Feder, Professor of Primary Health Care at the University of Bristol and chair of the group which developed the NICE guidance, said: "Domestic violence and abuse are criminal acts that cause long term damage to health and quality of life. Around one in three women and nearly one in five men will have experienced some form of domestic abuse over their life time. Women experiencing domestic violence and abuse have a three times greater risk of depression, four times greater risk of anxiety and seven times greater risk of post-traumatic stress disorder. This guidance promotes a more active role for health and social care services which have always dealt with the consequences of domestic violence, even when professionals did not realise the abuse was occurring. We need patients to feel safe to tell us what really happened to them.

"GPs and their teams see families over long periods of time. We need to wake up to the high prevalence of domestic abuse and its impact on our patients. The doctors and nurse in general practice need training: to ask safely about abuse, about how to respond effectively, and about how to help by encouraging patients to go to local specialist domestic violence services. Those services are an essential part of an effective health and social care response to domestic violence and abuse."

Professor Susan Bewley, Honorary Professor of Complex Obstetrics at King's College London and guidance developer, said: "Domestic violence often starts or escalates in pregnancy. This is why it is important for those of us working on the frontline in maternity services to know what to look for, but also be able to ask women about it in such a way that they will tell us. We train midwives and obstetricians to look out for domestic violence, but we need to do more to raise the standard of this training to ensure everyone knows how to create a safe and confidential environment.

"Women need to know there are sources of help we can refer them to - including specialists who can help them make choices to keep them and their children safe. This guidance will help ensure that pregnant women experiencing domestic abuse, who come to the trusted environment of the NHS will receive a high standard of help and support wherever they are in the country."

Dr Adrian Boyle, Consultant Emergency Physician at Addenbrookes Hospital and Honorary Visiting Senior Research Fellow, Cambridge University and guidance developer, said: "In emergency departments we see a lot of patients who are experiencing domestic violence, including those who don't feel able to tell us what is happening to them. What happens next is variable - there are places which do excellent work identifying and responding to these individuals, and have specialist services they can refer to, but equally there are places with no extra support for those who come forward. At the moment there is no requirement for staff to be trained, but what this new guidance recommends is that all staff should be trained to respond well to patients who chose to confide what is happening to them. I hope that women and men who are living with domestic violence will be able to go to emergency departments and feel confident and safe in telling their nurse or doctor what is happening."

Linda Davies, Domestic Abuse Training Consultant and guidance developer, said: "Every case of domestic violence or abuse is different. If people come forward and tell their doctor or a social worker that they have problems in their home, they need to know that they will receive the help and support that they, as an individual, need. This new guidance is essential because, although there are good services out there, in some areas it can be patchy. There are a lot of women and children, as well as men, who don't know where to go or who to talk to and what would happen if they did. Many women worry that they will lose their children if they come forward - this is not the case, it rarely happens, especially if they seek help.

"These recommendations will make a huge difference as there will be more people out there with a good understanding of the effect of domestic violence and how to help those affected get the help they need. I hope that this guidance will give people the confidence to confide in someone, whether it is a social worker, a health visitor or children's centre worker."

Recommendations from the new guidance include:

• Information in waiting areas and other suitable places about the support on offer for those affected by domestic violence and abuse should be clearly displayed. This includes contact details of relevant local and national helplines. It could also include information for groups who may find it more difficult to disclose that they are experiencing violence and abuse.
• Frontline staff in all services should be trained to recognise the indicators of domestic violence and abuse and ask relevant questions to help people disclose their past or current experiences of such violence or abuse. The enquiry should be made in private on a one-to-one basis in an environment where the person feels safe, and in a kind, sensitive manner.
• People's safety should be prioritised and regularly assessed to determine what type of service someone needs - immediately and in the longer term.
• Those responsible for safeguarding children, and commissioners and providers of specialist services for children and young people affected by domestic violence and abuse should address the emotional, psychological and physical harms arising from a child or young person being affected by domestic violence and abuse, as well as their safety. This includes the wider educational, behavioural and social effects.
• Specific training should be provided for health and social care professionals in how to respond to domestic violence and abuse.

The new NICE guidance on how health services, social care and the organisations they work with can respond effectively to domestic violence and abuse will be published on the NICE website on 26 February.

The 24-hour National Domestic Violence Freephone Helpline number is 0808 2000 247. The Helpline can give support, help and information over the telephone, wherever the caller might be in the country. The Helpline is staffed 24 hours a day by fully trained female helpline support workers and volunteers. All calls are completely confidential. Translation facilities for callers whose first language is not English and a service for callers who are deaf or hard of hearing are available. Further information can be found on the website.

The Men´s Advice Line (free from landlines and most mobiles) is a confidential helpline offering support, information and practical advice to male victims of domestic violence: 0808 801 0327. Further information can be found on the website.

The Respect Phoneline is a confidential helpline for domestic violence perpetrators: 0808 802 4040. Further information can be found on the website.

Ends

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

Explanation of terms

1. At least 1.2 million women and 784,000 men aged 16 to 59 experienced domestic violence and abuse in England and Wales in 2010/11 and at least 29.9% of women and 17.0% of men in England and Wales have, at some point, experienced it (Smith et al. 2012).

About the guidance

1. The guidance will be available on the NICE website from 26 February 2014. Embargoed copies of the draft guidance are available from the NICE press office on request.

2. 1 in 4 people will experience domestic abuse during their lifetime, 1 in 10 at any one time.

3. This guidance has been developed jointly by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) who provided particular input into the early scoping of the guidance.

4. Domestic violence and abuse cost the UK an estimated £15.7 billion in 2008 (Walby 2009). This included:

• just over £9.9 billon in ‘human and emotional' costs
• more than £3.8 billion for the criminal justice system, civil legal services, healthcare, social services, housing and refuges
• more than £1.9 billion for the economy (based on time off work for injuries).

Further comments on the new guidance

Justin Varney, Consultant in Public Health Medicine for Adults at Public Health England, said: "PHE welcomes the NICE domestic violence guidance and call to raise awareness. Domestic violence is a preventable cause of death in this country that affects far too many people, and we know that the impact of domestic violence on children plays out across a lifetime. This guidance is an essential new tool for local authorities to use in their efforts to reduce domestic violence and provide appropriate support to victims.

"PHE is actively working at a national level to support the Violence Against Women and Girls cross-government action plan and in the last year has commissioned specific resources to support domestic violence awareness and prevention in both university and workplace settings, as well as developing the new national indicator on domestic violence in the Public Health outcomes Framework."

Amanda Edwards, Deputy Chief Executive at the Social Care Institute for Excellence, said: "We welcome this guidance as a valuable contribution to addressing the issue of domestic violence. As with other issues that often require a multi-agency response, domestic violence is something that can be identified, prevented and reduced through the hard work of, and good communication between, a range of professionals in social care and other sectors. We were pleased to take part in the scoping stage of this guidance and we hope that it will lead to more safety for more families who are vulnerable to domestic abuse."

Polly Neate, Chief Executive of Women's Aid said: "One in four women experience domestic violence in their lifetime, and most will come into contact with health and social care workers. It's vital these professionals have the confidence to recognise and safely ask women about domestic violence, as they often work in the only safe spaces a woman can visit and be supported without arousing the perpetrator's suspicion. We welcome this guidance for those workers, especially the recognition that domestic violence is most often perpetrated by men against women. We would encourage health care professionals using this guidance to keep this at the fore in terms of both policy and practice. We urge decision makers in health and social care to implement the recommendations on training for frontline staff and recognising and utilising the expertise available in specialist domestic violence services. We hope these guidelines will empower social and healthcare professionals to watch out for domestic violence, and act alongside specialist services to support the women experiencing it."

Gordon Miles, Chief Executive of The College of Emergency Medicine, said: "The College of Emergency Medicine welcomes this guidance. Fellows and Members commonly care for people who are suffering domestic abuse, both as a consequence of injury and the subsequent psychological problems. We welcome the advice not to screen all patients for abuse, as this may cause more harm than good. We note the requirement for healthcare staff to be trained in responding to domestic violence and hope that hospitals will make this a priority for training."

Maureen Baker, Chair of the Royal College of General Practitioners (RCGP), said: "We are delighted that NICE have chosen a GP to lead the work on this very important issue as it recognises the frontline role that GPs have in helping those experiencing domestic violence and abuse. The difficulty for GPs in identifying patients and their children exposed to violence is that they rarely present with physical signs of abuse or disclose spontaneously during the consultation.

"We are particularly pleased that the guidance highlights the need for greater awareness of the whole range of people in our society who can experience domestic violence. In particular, men experiencing abuse in heterosexual relationships and people in same-sex relationships, as they are often overlooked. We would welcome more research into how GPs can respond appropriately and safely to these patients we suspect are in violent relationships but who are worried about speaking out and seeking help."

Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists (RCOG) said: "We welcome the recommendation that service planning to tackle domestic abuse by local commissioners should adopt a multi-agency approach. These guidelines will help health and social care professionals to work closer together so that high quality care can be provided to female victims.

"Domestic violence during pregnancy can have fatal consequences for mother and baby and some women are known to suffer from other problems such as depression and/or alcohol misuse. These women have very complex needs. They don't know about the support that is available to them, some don't even attend antenatal care and as a result tend to have poor outcomes.

"We need to identify such girls and women sensitively so that we can monitor their progress and provide them with the support and protection they need."

Diana Barran, Chief Executive of CAADA (Co-ordinated Action Against Domestic Abuse) said: "We warmly welcome the NICE guidance on domestic violence and abuse. Health and social care agencies have an important and exciting role to play in addressing this issue, which every year causes many needless deaths and thousands of damaged lives. We believe this guidance offers practical, evidence-based recommendations which will make a fundamental difference to local families living with domestic abuse."

Davina James-Hanman, Director, AVA (Against Violence and Abuse), said: "This comprehensive guidance sets out evidence based recommendations for health and social care professionals which - if fully implemented - have the potential to not only save the NHS millions of pounds but which could save their patients years of untold misery."

Mark Brooks, Chair of the ManKind Initiative, said: "The full recognition of male victims in these welcome guidelines is a crucial landmark in the way we tackle domestic abuse in this country. The fact it clearly sets out the responsibilities that organisations such as local authorities and the NHS have in recognising and supporting male victims is a huge leap forward. No longer should the hundreds of thousands of men who suffer every year find there is no support for them in their local community."

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

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