Using sexual health services to support people who have experienced domestic violence and abuse

Domestic violence and abuse affects around a quarter of women and a fifth of men in the UK. Health services are crucial in responding to and helping prevent further abuse, by intervening early, providing information, and referring patients to specialist services. Sexual health services are particularly well placed to intervene, because people who experience domestic violence and abuse often use these services because of unintended pregnancies and sexual health problems.

The IRIS (Identification and Referral to Improve Safety) programme is an evidence-based training package for staff working in GP surgeries. It helps them to identify and respond to women who are experiencing domestic violence and abuse, and refer them on to specialist services. In areas where the IRIS programme has been piloted, there has been a significant increase in women being referred to domestic violence agencies.

Following this success in primary care, the IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) pilot looked at using the IRIS approach in a sexual health setting. It provided IRIS-based training to the sexual health workforce, with the aim of increasing professional awareness and improving their responses to women experiencing domestic violence and abuse.

Project aims

We wanted to understand the views and experiences of sexual health clinic staff and domestic violence and abuse advocate workers involved in the IRIS ADViSE pilot.

What we did

We interviewed 17 staff who had been involved in the IRIS ADViSE pilot. Both sexual health clinic staff and domestic violence and abuse advocate workers were included.

What we found and what this means

All the people we interviewed felt that asking about and referring women on to domestic violence and abuse specialist services was appropriate and valuable in a sexual health setting.

The staff described feeling confident and prepared after the training. They were able to tailor how they asked about domestic abuse to suit the patient. Some staff did describe initial difficulties with ensuring a ‘comfortable’ consultation. Also, when a patient disclosed that they’d been abused, the resulting time pressure could also be difficult to manage.

The staff reported that some disclosures were considered relatively simple and easy to handle, when patients can be easily referred to the partner domestic violence and abuse organisation or provided with information.

However, cases with an immediate risk of harm to the patient or their children were more complex in terms of managing the patient’s wishes and navigating safeguarding procedures. This added to the already busy workloads of the staff, and increased the pressure on their limited time.

Increased recognition of the issues around domestic violence and abuse referrals is essential at the policy and commissioning level. And more resources are needed to support the referral process. Commissioners and local NHS trusts need to engage and commit to training workers to identify and support women who have been abused. This should include supporting programmes such as IRIS ADViSE.

What next?

We are investigating if the IRIS approach could be used by community pharmacists.

Links and downloads

Lead collaborators

Partners on this project

Avon and Wiltshire Mental Health Partnership NHS Trust

Avon and Wiltshire Mental Health Partnership NHS Trust provides services for people with mental health needs, drug or alcohol dependency and people with learning disabilities. It covers Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire and provides a specialist service throughout the South West.

Bristol City Council

The council plays a vital role in the health community as public health is part of its remit. Its role is to prevent disease, promote health, and prolong life among the population of Bristol. Its activities aim to provide conditions in which people can be healthy and it focuses on the population as a whole, not on individual patients or diseases.

University Hospitals Bristol NHS Foundation Trust

University Hospitals Bristol NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol, with over 100 clinical services across nine sites. They offer care to the people of Bristol and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation and are the largest centre for medical training and research in the South West.

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.