By Ruth Cook
Bristol Zero Tolerance is currently undertaking a vital project to involve local dental practices in identifying signs of domestic violence and abuse in their patients. The project aims to equip practices with the information and resources necessary for them to help patients who may not be able to report problems to the police or to be otherwise identified as ‘at risk’, thereby providing critical assistance to those who need it.
Domestic violence and abuse, though often perceived as a marginal issue within society, is currently at levels constitutive of an international epidemic and is a heavily gendered issue that impacts disproportionately on women. Within European countries it is estimated that up to 25% of the female population will experience intimate partner violence within their lifetimes and in England and Wales an average of two women per week are killed by their partner or ex-partner, women being over six times more likely to be murdered by an intimate partner than men are. The problem is also increasing, domestic abuse now accounts for 10% of total crime in the UK and the police receive on average over 100 calls every hour relating to domestic abuse.
Bristol Zero tolerance is currently contacting local dentists and providing them with detailed packs of information on what emotional and physical signs of abuse clinicians should look out for, how to ask a patient about what they are experiencing and what to do in order to then support patients who are identified as survivors of domestic abuse. For example, asking a very direct question out of the blue can make a survivor feel uncomfortable or threatened so instead it is recommended that clinicians first ask a framing question that introduces the topic of domestic abuse in a general manner, before making a more direct inquiry.
Often incidents of domestic violence are not reported because survivors do not identify the behaviour of their partner as abusive due to the carefully calculated nature of psychological coercion and control, or feel unable to report the abuse and/or violence they experience to the police or to seek help from another organisation, due to fear of retaliation either from society or from their partner. It is found that in the year before survivors first seek help, professionals including GPs, police and A&E staff miss on average five opportunities to provide assistance and referral and some women can be subject to more than 50 separate incidents of violence before their abuser is stopped by authorities.
For this reason it is an extremely valuable opportunity for those at risk to be identified and offered assistance as part of a routine dental check up, as it overcomes many of the barriers to people being provided with help. As an estimated 75% of injuries inflicted through domestic violence occur within the head and neck region, also the area of focus for dental work, dentists are in a particularly advantageous position to spot physical indicators. These can include signs of strangulation, facial fractures apparent in radiographs, bruising of the mouth or face that can indicate forced penetration, and injuries to the teeth, face or neck. As medical professionals, dentists occupy a position of trust with patients that may be key in enabling communication around this difficult subject and, whilst it should never be considered the dentist’s responsibility to stop the violence and abuse, they can play a key role in referring a patient to the appropriate services and in documenting physical and verbal evidence that can be used in future court cases. A common tactic of domestic abuse is to undermine the confidence of the survivor/victim through coercive control and to make them feel that they are the cause of their partner’s abusive behavior. By encouraging dentists to listen non-judgmentally and to validate the experience of patients by confirming that this behaviour is unacceptable, a significant difference can be made in encouraging patients to seek help.
Great progress has already been achieved by the IRIS (Identification and Refferal to Improve Safety) programme, a similar project that works with GPs to provide training on domestic violence. In practices that IRIS has worked with, women are 22x more likely to speak to a GP about referral to a domestic violence advocate than those that have not received training. One participant of IRIS’ workshops commented:
“A complete revelation. By becoming more aware of the signs and symptoms that suggest abuse – long term anxiety and depression, repeat visits to the surgery for minor symptoms, unexplained gynaecological problems – I became much more aware of patients who were living with abuse and the negative impact that this was having on their health outcomes. The penny drops and you realise the exact scale and extent of the problem amongst your patient population.”
The Ask Support Care (ASC) initiative run by charity Medics Against Violence provides training courses to anybody who might experience survivors of domestic violence in their working lives and aims to change attitudes towards violence and reduce levels of injury. ASC works in various settings within Scotland, adapting a basic model to work with student dentists, medical students, hairdressers, firefighters and qualified dentists. Uniquely, through adoption of a ‘train the trainers’ method, in which one representative from an organisation will come to receive training and then disseminate this information within their workplace, ASC is able to greatly increase the number of people it reaches. By leading their attending professionals through visualisation sessions and relating hard-hitting statistics on domestic violence to the relevance within their own lives, people are really made aware of the importance of being an active bystander and are given more confidence to act. The ASC initiative currently operates exclusively in Scotland but equivalent services exist throughout the UK and in the Bristol locality also.
Anybody can become subject to domestic violence and abuse, it appears across all boundaries of ethnicity, social background, age and education. The work of organisations such as Bristol Zero Tolerance, ASC and IRIS means that increasingly more and more professionals are equipped to identify and respond to this insidious societal issue, bringing help to survivors as part of their everyday routines. At the same time, anybody can be an active bystander or a first responder for somebody who they suspect to be at risk, sometimes an outside perspective from a friend or family member is all that is required to give a survivor the validation they need to seek help. If you believe that somebody you know is at risk, or would like to find out more about domestic violence, please visit Bristol Zero Tolerance’s help and advice page or reach out to one of the services listed below.
Bristol Zero Tolerance 0117 916 6555
The National Domestic Violence Helpline 0808 2000 247
Next Link 0117 925 0680
You can also download the leaflet for dentists here:Leaflet dentists_FINALEDIT
IRIS, 2017. About IRIS. Identification and Referral to Improve Safety (IRIS) [Online]. Available at: <http://www.irisdomesticviolence.org.uk/iris/about-iris/about/>
ITV, 2015. How I Escaped Domestic Violence. This Morning [online]. 25 Feb. Available at: <http://www.itv.com/thismorning/hot-topics/domestic-violence-survivor-sue-mills> [Accessed 20 Sept 2017].
HMIC, 2015. Increasing Everyone’s Business: A Progress Report on the Police Response to Domestic Abuse [PDF] p28. Available at: <http://www.justiceinspectorates.gov.uk/hmicfrs/wp-content/uploads/increasingly-everyones-business-domestic-abuse-progress-report.pdf>
Leeds City Council, 2017. One Minute Guide: Coercive Control Offence. Child Friendly Leeds [PDF] Available at: <http://www.leeds.gov.uk/docs/Coercive Control Offence.pdf>
Medics Against Violence, 2017. Harder- A Short Film About Domestic Abuse.
25 June. Available at: <https://www.youtube.com/watch?v=ay4dQy6vzPI> [Accessed 20 Sept 2017].
NHS England. Safeguarding adults [PDF] Available at: <https://www.england.nhs.uk/wp-content/uploads/2017/02/adult-pocket-guide.pdf> [Accessed 17 Aug 2017].
Office for National Statistics, 2017. Crime Statistics, Focus on Violent Crime and Sexual Offences, Year ending March 2016, Chapter 2: Homicide [online] Available at: <https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/compendium/focusonviolentcrimeandsexualoffences/yearendingmarch2016/homicide – statistical-interpretation-of-trends-in-homicides> [Accessed 20 Sept 2017]
Sweet, D., 1996. Recognizing and Intervening in Domestic Violence: Proactive Role for Dentistry. Medscape women’s health, 1(6), pp.3-3. Available at: < https://www.ncbi.nlm.nih.gov/pubmed/9746630>
Gracia, E., 2004. Unreported cases of domestic violence against women: towards an epidemiology of social silence, tolerance, and inhibition. J Epidemiol Community Health 58, 536. Available at: <http://jech.bmj.com/content/58/7/536>