Interpersonal, domestic, and family violence is a pervasive issue that affects people across many socioeconomic, cultural and community demographics. Medical practitioners play an important role in identifying and addressing domestic and family violence, often treating patients who are hesitant or afraid to disclose incidents for fear of escalation, legal involvement, or financial distress.

Despite increased awareness and reporting, an alarming number of people in NSW continue to be affected by domestic violence. According to recent figures released by the NSW Bureau of Crime Statistics and Research, approximately 1 in 6 women and 1 in 16 men experience interpersonal violence, with over 1 in 5 women making their first disclosure of domestic violence to their GP. Understanding the legal obligations and responsibilities in managing patient can help support medical practitioners in delivering effective patient care and prevent further patient harm.

Understanding interpersonal abuse and violence:
Interpersonal abuse and violence encompass a range of forms, including intimate partner abuse, sexual assault, child abuse, bullying, elder abuse, and adult survivors of child abuse. Practitioners must recognise that violence extends beyond physical harm, encompassing emotional, sexual, economic, and social abuse. Both men and women can be perpetrators, and healthcare professionals need to be aware of the prevalence and complexity of these issues.

Prioritising safety and support:

• Safety: Ensuring the safety of patients experiencing abuse and violence should be the primary focus for healthcare professionals.
• Comprehensive systems: Health practitioners should establish systems that encompass the entire practice, providing referral pathways to guide patients toward recovery and safety.
• Addressing attitudes and assumptions: Training programs should encompass healthcare professionals' attitudes and assumptions about abuse and violence, as these factors can significantly impact the response to patients.

Prevalence of interpersonal abuse and violence:
Data from the Australian Bureau of Statistics reveal that young people aged 18-24 are most likely to have experienced some form of interpersonal violence. While both men and women can be victims, women are more likely to experience sexual violence.

Determining appropriate levels of involvement and intervention:

• Identification and Validation: Healthcare professionals should proactively ask patients displaying clinical indicators of the mental and physical effects of abuse about their experiences. Patients disclosing abuse should be provided with first-line support, including active listening, validation of their experiences, and enhancing their safety.
• Safety and Risk Assessment: While expressing concern for a patient's safety and likelihood of risk is crucial, it is equally important to respect patient autonomy in deciding the most suitable pathway to safety.
• Mandatory Reporting: Healthcare practitioners are considered mandatory reporters and are required by law to report suspected child abuse and neglect to government authorities. There are two ways mandatory reporters can make a child protection report:
  • By eReport through the Childstory Reporter website
  • By calling the Child Protection Helpline on 13 21 11

In cases of intimate partner abuse where children are not directly affected, referral to a vulnerable children’s organisation or a report to Child Protection may still be considered.

• Counselling and Support: Intimate partner abuse often coexists with mental health issues. Healthcare professionals should ensure a comprehensive understanding of interpersonal violence and employ counselling approaches tailored to meet each patient's specific needs. Careful planning is necessary during separation to ensure the safety of women and their children.
• Collaborative Intervention: Healthcare practitioners should view themselves as part of a wider support network, collaborating with domestic violence services, legal professionals, police, and housing agencies to effectively assist survivors.

Understanding legal requirements
While healthcare practitioners are primarily responsible for medical care, it is recommended doctors have a basic understanding of the legal issues surrounding family violence and sexual assault. It is imperative to promptly document physical injuries and specific descriptions of violence, while the interpretation of these observations should be referred to qualified experts. Healthcare professionals can offer information on legal options and facilitate access to legal services. In cases of recent sexual assault, patients should be offered referral to specialist forensic service and counselling to help the patient make an informed decision about whether they wish to pursue forensic examination.

The importance of self-care
Treating a patient who has experienced domestic violence can be distressing for practitioners, particularly when patients face barriers to reporting violence, or there is evidence the violence is causing persistent harm. Working with patients experiencing abuse and violence can result in vicarious trauma for healthcare professionals. It is imperative to prioritise self-care on both an individual and practice-wide level, creating an environment that safeguards against burnout and vicarious trauma. Establishing peer support systems and fostering an environment conducive to discussing distressing cases can help mitigate stress and encourage psychological safety.

Key take-way 
Medical practitioners must understand reporting and intervention obligations for treating patients presenting with domestic violence-related health concerns. Despite growing community awareness, interpersonal violence continues to affect many communities in NSW, and doctors are an important resource in identifying and addressing incidents of violence.

Prioritising safety, providing patient support, understanding the legal framework, and ensuring self-care, can help doctors effectively intervene in cases of intrapersonal violence, as well as mitigate further patient harm, and meaningfully contribute to survivor resilience.

Further resources
RACGP Abuse and Violence (4^th Edition)
NSW Health: Domestic violence
Domestic violence – A toolkit for GPs in NSW