Domestic Violence and Abuse (DVA) Policy (Service Users) - Greater Manchester Mental Health NHS Foundation Trust
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Domestic Violence and Abuse (DVA) Policy (Service Users) Greater Manchester Mental Health NHS Foundation Trust
Domestic Violence and Abuse (DVA) Policy
Document Name: Domestic Violence and Abuse (Service Users)
Executive Summary: To promote good practice in relation to DVA and
ensure practice is aligned to child and adult
safeguarding policies and procedures
Executive Lead: Executive Director for Nursing and Governance
Document Author: Adult Safeguarding Lead
Document Purpose: To promote good practice in relation to DVA and
ensure practice is aligned to child and adult
safeguarding policies and procedures
Target Audience: All employed and seconded staff to Greater
Manchester Mental Health NHS FT (the Trust) and all
volunteers.
Additional Circulation N/A
List:
Date Ratified: 07 August 2017
Ratified by: Joint Safeguarding Group
Consultation: Via SharePoint
Cross Reference: None
Superseded Docs: Former GMW and MMHSCT DVA Policies
Date of Equality Impact 07 August 2017
Assessment:
Board Objective 1, 2, 3, 5, 6
Reference:
CQC Regulation N/A
Reference:
Risk Register Reference: None
Contact Details for further Joanne Glynn
information T: 0161 277 1233
M: 07436 036 493
E: joanne.glynn@gmmh.nhs.uk
E: joanne.glynn1@nhs.net
Document Status This is a controlled document. Whilst this document
may be printed, the electronic version posted on the
Trust intranet is the controlled copy.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 1 of 30Domestic Violence and Abuse (DVA) Policy Contents 1. Introduction ........................................................................................................... 3 1.1 Purpose................................................................................................................. 3 1.2 Scope .................................................................................................................... 3 2. Definitions ............................................................................................................. 4 3. Duties.................................................................................................................... 5 3.1 Board/Lead Committee ......................................................................................... 5 3.2 Chief Executive ..................................................................................................... 5 3.3 Director of Nursing and Governance ..................................................................... 5 3.4 Corporate Safeguarding Team.............................................................................. 6 3.5 Associate Directors/ Heads of Operations/ Managers .......................................... 6 3.6 Employees ............................................................................................................ 6 4. Processes and Procedures ................................................................................... 6 4.1 Key Principles ....................................................................................................... 6 4.2 Pregnancy and increased risk ............................................................................... 7 4.3 Asking about abuse .............................................................................................. 7 4.4 Police Consultation ............................................................................................... 9 4.5 Assessment and management of risks ................................................................. 9 4.6 Safety Planning ................................................................................................... 11 4.7 Mental Capacity .................................................................................................. 12 4.8 Management of risks of perpetrators of DVA ...................................................... 13 4.9 Information Sharing ............................................................................................. 14 5. Training Requirements ........................................................................................ 14 6. Monitoring ........................................................................................................... 14 7. Resource/Implementation Issues ........................................................................ 15 8. Risk Issues.......................................................................................................... 15 9. Requirements, Supporting Documents and References ..................................... 15 9.1 References.......................................................................................................... 15 10. Subject Expert and Feedback ............................................................................. 15 Appendix 1 – Advocacy Contact Details ....................................................................... 16 Appendix 2 – DVA Flowchart & RIC.............................................................................. 17 Appendix 3 – Greater Manchester Police PPIU Referral Form ..................................... 26 Appendix 4 – Support and Contact Details for Victims of DVA ..................................... 28 Appendix 5 – Support and Contact Details for Perpetrators of DVA ............................. 30 Ref: SG02 Issue date: 13/07/2018 Version number: 1.0 Status: Approved Next review date: 13/07/2021 Page 2 of 30
Domestic Violence and Abuse (DVA) Policy 1. Introduction Domestic Violence and Abuse (DVA) is a largely a hidden crime, occurring mainly in homes behind closed doors. As such, it can be difficult to record the context in which abuse is being perpetrated, or accurately measure the impact of the abuse on those who experience it. Living with DVA raises significant public health and child protection issues. ‘Violence and abuse can lead to an increased risk of poor mental health, injuries, chronic physical conditions, unwanted and complicated pregnancy, sexually transmitted infections and substance misuse, and the effects can last a lifetime and into subsequent generations’ (DOH 2010). This policy provides a framework for all staff setting standards for both children and adult safeguarding and promotes the use of accompanying Trust safeguarding procedures to help keep adults, young people, children and families safe from abuse, neglect and exploitation. A key focus for the Trust is to continue to promote awareness and understanding of the safeguards in relation to Domestic Violence and Abuse (DVA). This policy is linked to Trust policies for: • Safeguarding Children • Safeguarding Adults at Risk Whilst recognising their influence and effect, this document does not provide detailed guidance on these areas. 1.1 Purpose This policy aims to support professionals to recognise risk factors for DVA and describes steps required to ensure appropriate support and onward referral where necessary. It covers aspects of effective practice in responding to disclosures of DVA for front line staff, and gives more detail on the management of risk related to mental capacity, adult safeguarding and DVA. 1.2 Scope Reduction of harm from DVA relies on multi-agency approaches. Trust staff members and volunteers need to be aware of relevant local advocacy programmes and support agencies such as Independent Domestic Violence Advocacy (IDVA) services, Sexual Assault Referral Centres (SARC’s), Multi-Agency Risk Assessment Conferences (MARAC); refuge provision and criminal justice interventions for perpetrators of DVA. Arrangements and resources will vary across the Trust’s footprint. Therefore, the policy will require local information to be available and local protocols to be produced to support its implementation. Ref: SG02 Issue date: 13/07/2018 Version number: 1.0 Status: Approved Next review date: 13/07/2021 Page 3 of 30
Domestic Violence and Abuse (DVA) Policy Working Together 2015 requires staff to be alert to the strong links between adult DVA, substance misuse and child abuse, and recognise when a child is in need of help, services or at potential risk of suffering significant harm. Children may suffer both directly and indirectly in households where there is DVA. They experience emotional abuse when hearing or seeing the ill-treatment of another, and they are at increased risk of being harmed in other ways, including physical abuse. Remember that patients and service users may be victims of, or perpetrators of DVA 2. Definitions The Trust adopts the Home Office definition of DVA, which is any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members. It is clear that victims are not confined to one gender or ethnic group (Home Office, 2012). The abuse can encompass, but is not limited to, psychological, physical, sexual, financial and emotional abuse. Types of DVA: • Coercive control (intimate terrorist) • Violent resistance (resisting the intimate terrorist) • Situational couple violence - • Female Genital Mutilation • Forced marriage • Elder/carer abuse • Young people aged under 18 years who are violent towards their parents The Serious Crime Act 2015 creates a new offence of controlling or coercive behaviour in intimate or familial relationships (section 76) and closes a gap in the law around patterns or controlling or coercive behaviour in ongoing relationship between intimate partners or family members. If found guilty can carry a maximum sentence of five years imprisonment, a fine or both. • Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. • Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation or other abuse that is used to harm, punish, or frighten their victim. A term that is sometimes used in the context of a controlling and coercive partner or family member is the “intimate terrorist”. • Violent Resistance: Sometimes DVA can lead to “violent resistance” - a response to being controlled or feeling frightened where violence is used as an act of “self-defence”. • Female Genital Mutilation (FGM): is a violation of the human rights of girls and women. FGM comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. Ref: SG02 Issue date: 13/07/2018 Version number: 1.0 Status: Approved Next review date: 13/07/2021 Page 4 of 30
Domestic Violence and Abuse (DVA) Policy
• Forced Marriage: is a marriage conducted without the valid consent of one or both
parties and where duress is a factor. FM is now a specific offence under s121 of the Anti-
Social Behaviour, Crime and Policing Act 2014 and comes into force on 16 June 2014
• Hitting, shaking, smacking, punching, pushing, kicking, biting, starving, tying up,
stabbing, suffocation, throwing things, using objects as weapons, female genital
mutilation, so called ‘honour violence’. The physical effects are often on areas of the body
that are covered and hidden (i.e. breasts and abdomen).
• Emotional/ Psychological abuse: Intimidation, insulting, isolating the victim from
friends and family, criticising, denying the abuse, treating them as inferior, threatening to
harm children or take them away. Swearing, undermining confidence, making
discriminatory remarks, making the victim feel unattractive, calling them stupid or useless,
humiliating and eroding their independence. In the LGBT community, sometimes the
threat of ‘outing’ (threatening to divulge the nature of someone’s sexuality to family friends
or employers) is used to intimidate individuals.
• Sexual abuse sexual assault: Rape, sexual assault, sexual exploitation,
pressuring an individual to participate in non-consensual sexual activities, sexual insults,
stopping a woman from breast feeding, coerced nudity, taking of explicit photographs
under duress, sexual violence, non-consensual acts during intercourse including
strangulation, beating, restraint and marking. The perpetrator may refuse to use
protection and knowingly expose the victim to infection.
• Financial and material abuse: Not letting a victim work, undermining efforts to find
work or study, refusing to give money, asking for an explanation of how every penny is
spent, and making them beg for money, gambling. Not paying bills and intentional
mismanagement of funds, theft fraud, and financial exploitation. The victim may have no
access to cash or cards and have their accounts or access to money tightly controlled.
Although a large proportion of DVA is perpetrated by men towards women it is
acknowledged that men can also be victims of DVA.
3. Duties
3.1 Board/Lead Committee
The Joint Safeguarding Board will ratify, revise and amend the policy and oversee its
implementation.
3.2 Chief Executive
Delegates’ responsibility to the Director of Nursing & Governance to implement this
policy.
3.3 Director of Nursing and Governance
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 5 of 30Domestic Violence and Abuse (DVA) Policy
The Executive Director for Nursing and Governance is accountable to the Trust board for
all aspects of child and adult safeguarding including implementation of this policy.
3.4 Corporate Safeguarding Team
The Corporate Safeguarding Team will provide specialist advice and support to Trust
staff relating to all safeguarding matters, which includes DVA and the team consists of:
Deputy Director of Governance
Head of Safeguarding for Children and Adult’s
Safeguarding Adult Lead
Safeguarding Children’s Lead
Named Nurse for Safeguarding Children
Deputy Safeguarding Adult Lead
3.5 Associate Directors/ Heads of Operations/ Managers
Managers at all levels have responsibility for ensuring that staff members have access to
relevant information, training, support and supervision in relation to this policy.
3.6 Employees
Staff members at all levels have responsibility for remaining informed and up to date with
all aspects of child and adult safeguarding including this policy.
4. Processes and Procedures
All Trust staff play a key role in supporting service users and their families who are
experiencing DVA and therefore, should be aware of the signs that could indicate DVA is
occurring. However, staff may also become aware of DVA without a full disclosure being
made due to identifying any of the indicators of DVA.
4.1 Key Principles
The key principles are underpinned by Department of Health (DoH) publications:
‘Responding to DVA - A Handbook for Health Professionals’, ‘Improving safety, Reducing
harm - A practical toolkit for frontline practitioners’ and ‘Domestic violence and abuse:
how health services, social care and the organisations they work with can respond
effectively (2014) guidance.nice.org.uk.
Key Principles:
• To ensure the safety of those abused and that of dependent children.
• To enable the healthcare professional to supply those abused with the appropriate
information concerning other agencies providing support services.
• Create a healthcare environment where the abused can talk about their
experience in a safe and confidential environment.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 6 of 30Domestic Violence and Abuse (DVA) Policy
• Ensure that staff have the ability to receive disclosures of abuse and respond to
such disclosures in a supportive, reassuring and appropriate manner.
• To ensure staff respond effectively to ensure compliance with the wider multi
agency response to DVA.
• To establish appropriate referral pathways and support for staff subjected to DVA.
• Any actions undertaken by staff in respect of DVA will only be undertaken with the
consent of the patient unless the risk assessment identifies that there is a
significant risk or a child’s health and well-being, or the capacity of the individual
is such that he/she is unable to consent.
• Professionals may need to escalate concerns based on their professional
judgement following discussion with appropriate specialist professionals.
Professional judgement should be used but the welfare of the child and the adult
should be paramount.
4.2 Pregnancy and increased risk
Violence to women starts or increases both in severity and frequency during pregnancy.
Often involving punches or kicks directed at the women’s abdomen. Once born, the
impact on the mother and child attachment process may be affected, as well as the child’s
capacity to develop normal responses to stressful situations. This can result in a fractious
baby and place both mother and child at further risk from their abuser.
DVA during pregnancy puts a pregnant woman and her unborn child in danger. It
increases the risk of miscarriage, infection, premature birth, low birth weight, foetal injury
and foetal death.
If a woman is pregnant and / or child lives in a household where DVA is believed to be a
factor, and where they is a need of support and/ or protection a referral MUST be made
the relevant Children’s Social Care Local Authority (LA).
Think child, Think parent, Think family’
4.3 Asking about abuse
Some Service Users will find it difficult to disclose DVA for a variety of reasons.
Information should be given to service users where DVA is known or believed to have
occurred.
Trust professionals are required to include ‘the DVA question’ in social and personal
history taking at the point of entry into mental health and substance misuse services, and
at subsequent reviews as indicated, which is supported through training and development
of staff to gain the skills and confidence in asking the question.
Asking the question gives the person the opportunity to disclose historical abuse at an
early point in care. Equally it gives an important opportunity to disclose experiences of
abuse in the present. Professionals should add the prompt ‘and currently?’ to the
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 7 of 30Domestic Violence and Abuse (DVA) Policy
standard violence and abuse question to facilitate this, unless it is unsafe to do so in the
context of an assessment interview.
Recent DoH guidance to professionals on asking about DVA safely is summarised below
and should be followed where the abuse question cannot safely be asked in the standard
way.
Discussions about DVA should take place with the person in question on their own, and
not in the presence of any potential perpetrator who may coerce or intimidate the victim
in to denying that abuse is taking place.
Ensure it is safe to ask: Consider the environment
Is it conducive to ask?
Is it safe to ask?
Never ask in the presence of another family member, friend, or child over the
age of 2 years
Create the opportunity to ask the question
Use an appropriate professional interpreter (never a family member).
Ask: Frame the topic first then ask a direct question. Examples:
“As violence in the home is so common we now ask contacts about it routinely”
“Are you in a relationship with someone who hurts or threatens you?”
“Did someone cause these injuries to you?”
Validate: What’s happening to the individual and send an important message.
“You are not alone”
“You are not to blame for what is happening to you”
“You do not deserve to be treated in this way.”
Assess (Use DASH/ RIC): Assess contact’s safety:
“Is your partner here with you?”
“Where are the children?”
“Do you have any immediate concerns?”
“Do you have a place of safety?”
Action: Prioritise people’s safety. Be aware of the DVA agencies in your local area, if
safe to do so, provide advice and support in a leaflet format, consider a referral to the LA
contact centre if immediate support is needed. This includes:
Advocacy
Floating support, outreach support and refuge support services
Housing Providers
A referral to Multi-Agency Risk Assessment Conference (MARAC) for high-risk
service users.
Document: Consider safety and confidentiality when recording information in patient
notes.
Medical records can be used by survivors in future criminal justice proceedings and
may be called on to be used at MARAC.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 8 of 30Domestic Violence and Abuse (DVA) Policy
4.4 Police Consultation
A. Consent
In all cases staff should attempt to obtain the consent of the person before calling the
police. This is not always appropriate and the requirement to obtain consent may be
overridden or dispensed with, depending on the following points:
The seriousness of the incident
Potential risk to other people
The capacity of the person to make the decision, this must be recorded on the
Adults clinical notes
Where a person refuses to allow contact with the police, an assessment as to what
would be in the best interests of the person and/or other adults at risk or children
must be made and recorded. This should involve consideration of referral to Victim
Support Services – people who have been abused need to be aware that this
service accepts self-referrals
B. Overriding Consent
Consent can be over ridden in cases where:-
The allegation is against a paid carer
Where there are concerns for other adults and/ or children at risk
Where there is a clear public interest and it is alleged that a serious crime has
been committed.
For cases of Domestic Violence and Abuse (DV&A) for scores 14 or more or on
professional judgement and should involve discussions with team manager /
safeguarding team.
Referrals to the police should be made in writing to ensure there is a clear audit trail of
information shared and advice given .
4.5 Assessment and management of risks
Making Safeguarding Personal (MSP)
Since the introduction of the Care Act 2014 there has been a shift in emphasis in
safeguarding from undertaking a process to a commitment to improving outcomes
alongside people experiencing abuse or neglect. Staff should involve the person at risk,
or if the person lacks capacity, their trusted advocate or IMCA in the assessment of risk
as this approach is most likely to produce an accurate, comprehensive and well
evidenced risk assessment. This will also contribute to the confidence and self-esteem
of the person.
Risk Assessment Tools
Staff should use risk assessment tools approved for current use across the Trust to begin
to understand the risks posed to a person and family. Such tools, used in conjunction
with comprehensive assessments of need and social history taking, will help staff to
recognise situations of particular vulnerability and risk of abuse. Carers’ assessments will
similarly assist in identifying situations where there is a heightened risk of DVA. These
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 9 of 30Domestic Violence and Abuse (DVA) Policy
assessments should then lead to care planning that aims to protect and promote the well-
being of the person at risk.
Staff MUST listen and be non-judgemental. If a disclosure of DVA is made the staff
member MUST make every effort to complete a Risk Indicator Checklist (RIC) (see
appendix 1) or what is also referred to as a ‘DVA, Stalking and Honour Based Violence
(DASH 2009) checklist. Staff MUST record the RIC/ DASH score on the patient’s
electronic notes in the safeguarding tile (PARIS) or on special notes (Amigos).
Consideration MUST be given if the criteria for a referral to the Multi-Agency Risk
Assessment Conference (MARAC) has been met, which is:
• Visible high risk/ score of 14 or more
• On professional judgement
• Has previously been referred to MARAC and is a repeat within 12 months
• Potential escalation
MARAC is a risk management meeting where professionals share information on high
risk cases of DVA and put in place a risk management plan.
The MARAC aims to:
• Share information to increase the safety, health and well-being of
victims/survivors, adults and their children
• Determine whether the alleged perpetrator poses a significant risk to any particular
individual or to the general community
• Construct jointly and implement a risk management plan that provides professional
support to all those at risk and that reduces the risk of harm
• Reduce repeat victimisation
• Improve agency accountability, and
• Improve support for staff involved in high-risk DVA cases
Risk Factors: Some of the main risk factors associated with DVA are summarised below.
A useful acronym to remember some key high risk factors is: SPECSS
● Separation/Child Contact: Leaving a violent partner is extremely risky
● Pregnancy (pre-birth and under 1s): a high percentage of DVA starts in pregnancy
● Escalation of violence: Previous DVA is the most effective indicator that further DVA
will occur
● Cultural factors:
Language barriers
Immigration status
Isolation
Within communities where the practices of FGM; forced marriage and ‘honour-
based’ violence are more likely to occur.
● Stalking: Research finds that intimate relationship stalkers use more dangerous stalking
behaviours than non-intimate relationship stalkers
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 10 of 30Domestic Violence and Abuse (DVA) Policy
● Sexual Assault: Where abusers use both physical and sexual violence victims are at
an elevated risk
Minimising or normalising (by both victim and perpetrators)
Multiple perpetrators
The term 'Toxic Trio' has been used to describe the issues of domestic abuse, mental ill-
health and substance misuse, which have been identified as common features of families
where harm to children has occurred. They are viewed as indicators of increased risk of
harm to children and young people. Work in this area has shown that there is large
overlap between these parental risk factors and cases of child death, serious injury and
generally poorer outcomes for children across all ages (Brandon et al, 2008).
High Risk: A risk which is life threatening and/or traumatic, and from which recovery,
whether physical or psychological, can be expected to be difficult or impossible’
If the victim is assessed as being at high risk because of DVA, the staff member must
discuss the case with a view to making a referral to the Local MARAC following the local
area MARAC Pathways and IDVA service (Safer Families) at the point of referral to
MARAC.
Medium Risk: There are identifiable indicators of risk of serious harm. The offender has
the potential to cause serious harm but is unlikely to do so unless there is a change in
circumstances, for example, failure to take medication, loss of accommodation,
relationship breakdown, and drug or alcohol misuse
For advice and support staff can contact:
Team manager/ Assistant Team Manager/ Deputy Ward Manager
Children’s Link Practitioner/ MARAC Marshal
A Designated Safeguarding Lead within their own directory
A member of the Corporate Safeguarding Team
Local IDVA Service (Safer Families) or other Local Support Services and National
Helpline on 0808 2000 247 who will advise on the local support services available
for the Locality.
Standard Risk: Sign post to support agencies for DVA i.e. Women’s Aid, Victim Support.
Advise the victim of the wider support that is available and that you are able to facilitate
access to that support.(supply leaflets, contact numbers or assist in making contact)
Ensure that the provision of this information does not place the victim at further risk and
that opportunities are available for self-referral. Seek consent to inform third party agency.
When children feature or an adult at risk is involved the staff member must also follow
the relevant safeguarding policies i.e. GMMH Safeguarding Children and Adult policies
and relevant LSCB / LSAB safeguarding procedures.
4.6 Safety Planning
People have complex lives and being safe is only one of the things they want for
themselves. Staff should work with the Adult to establish what being safe means to them
and how that can be best achieved.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 11 of 30Domestic Violence and Abuse (DVA) Policy
It is vital when staff are working with victims of DVA they appreciate ‘victims are at a
greater risk of homicide at the point of separation or after leaving a violent partner’. It is
therefore necessary for staff to recognise the limitations in their knowledge and signpost
victims to relevant support services.
Staff should advise the Service User:
• Of wider support that is available and they are able to facilitate access to that
support (supply leaflets, contact numbers or assist in making contact).
• The potential for increased risk, because of escalating behaviours by the
perpetrator.
• Seek consent from the client to enable the sharing of information with other
agencies. For example: the General Practitioner (GP) who may be the ONLY
health agency to remain involved and have contact with the Adult/ Family.
Staff should consider the following points when discussing safety planning with victims:
Further advice on www.endthefear.co.uk
• Have a phone to use in an emergency, and try to keep it with you
• Rehearse an escape plan and plan in advance how you might respond to different
situations, including crisis situations
• Copy all major documents (including passport) and store them safely (friend or
family members if appropriate)
• Have a cash fund if possible for emergency use
• Extra set of keys for house/car (kept in safe place)
• Teach children if appropriate and developmental age/ safety issues have been
considered to call 999 in an emergency and what they would need to say (full
name, address and telephone number)
• Leaving or getting ready to leave– take legal documents, birth certificate, car
documents, money, credit cards, keys, benefit books, medicines, children clothes
and special toys, health records
• Pack an emergency bag for yourself and children, hide it somewhere safe (at a
neighbour or friend’s house) try to avoid mutual friends or family
• Safe place to go or stay should they need to leave
Majority of GP practices now have an Identification and Referral to Improve Safety
(IRIS) service linked to their practice, which is a collaboration between primary care and
third sector organisations specialising in DVA.
4.7 Mental Capacity
The presumption in the Mental Capacity Act (MCA) 2005 is that adults have the mental
capacity to make informed choices about their own safety and how they live their lives.
Issues of mental capacity and the ability to give informed consent are central to decisions
and actions in adult safeguarding. All interventions need to take into account the ability
of adults to make informed choices about the way they want to live and the risks they
want to take. This includes their ability:
To understand the implications of their situation
To take action themselves to prevent abuse
• To participate to the fullest extent possible in decision-making about interventions.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 12 of 30Domestic Violence and Abuse (DVA) Policy
The MCA 2005 provides a statutory framework to empower and protect people who may
lack capacity to make decisions for themselves and establishes a framework for making
decisions on their behalf. This applies whether the decisions are life-changing events or
everyday matters. All decisions taken in the adult safeguarding process must comply with
the Act.
Any action taken MUST be informed by the principles of choice, respect and dignity for
the Adult concerned, with a clear focus at all times on helping them to achieve the
outcomes they want. Always make every effort to establish whether the Adult is being
unduly influenced or coerced by another person. If you believe they are being coerced,
the inherent jurisdiction of the High Court could apply.
An example of the inherent jurisdiction of the High Court may be able to afford protection
to adults who are unable to take a decision for themselves but who do not suffer from an
impairment of or disturbance in the functioning of the mind such as to satisfy the
diagnostic criteria set down in s.2(1) MCA 2005.
The inherent jurisdiction of the High Court is not limited solely to affording an Adult at risk
of abuse and neglect a temporary ‘safe space’ within which to make a decision free from
any alleged source of undue influence. The High Court could impose long-term injunctive
relief to protect the Adult at risk.
4.8 Management of risks of perpetrators of DVA
Service Users/ Perpetrators
Some adults accessing Trust mental health and substance misuse services themselves
can also be perpetrators of DVA and this can often be hidden or go unrecognised by
family members or professionals. Even where the abuse appears to be linked to a
person’s condition or state i.e. dementia or mental illness-it does not mean that it should
be tolerated by the victim or ignored/colluded with by professionals. The abuse may have
been of many years standing and the abuser’s vulnerability may have been used as an
excuse for their behaviour when they could actually control their actions.
Primary Carer’s/ Perpetrators
Staff should identify and manage the risks to the victim and any others exposed to the
abuse. As in all cases of abuse, victims should be reassured that the abuse is not their
fault and that they have a right to be protected and consider what their options are. If the
victim is the perpetrator’s primary carer, these options will include reassurance that the
perpetrator’s care needs can be met in an alternative way. Such perpetrators may need
information about alternative services if they have previously relied on the victim, and
may also need a safeguarding response in line with local multi-agency procedures.
Specialist advice in relation to Perpetrators
Whilst it may be appropriate for perpetrators to be referred to Trust mental health or
substance misuse services to address their needs in these areas, staff in these services
without specialist training should never attempt any interventions specifically to address
their abusive behaviour.
The IRIS service within GP practices also provides information and signposting for
perpetrators of DVA
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 13 of 30Domestic Violence and Abuse (DVA) Policy
4.9 Information Sharing
The Trust fosters a ‘one team’ approach that places the welfare of individuals above
organisational boundaries and recognises that partners who work better together will be
more effective in supporting those at risk of abuse and neglect. The Data Protection Act
1998 permits information to be shared in a situation of ‘vital interest’. For example;
prevent serious harm or where a person’s life is threatened. Staff MUST comply with local
and national information-sharing and multi-agency partnership arrangements.
• Information Governance Alliance (IGA): The Health and Social Care (Safety and
Quality) Act 2015: Duty to share information
• The Care Act 2014 Section 45: Supply of information
• LSCB/ LSAB Multi Agency Policy and Procedures
• MARAC Information Sharing Agreement
Domestic Homicide Reviews (DHR’s) have shown poor information sharing has
contributed to the deaths and serious injuries of victims of DVA and their families. Staff
MUST:
• Be open and honest with the Adult concerned unless it is unsafe or inappropriate
to do so
• Ensure the information they are sharing is necessary, proportionate, relevant,
adequate, accurate, timely and secure
• Record their information sharing activity
Question: When should a concern be acted on without an adult’s consent?
Answer: Action to respond to a concern should be taken even if the adult does not
consent, when:
• There are risks to others. For example if the person alleged to have cause the
harm is in a position of trust with other adults
• The adult’s decision to not consent appears to be made under undue influence,
coercion or intimidation
• The adult lacks capacity to make a decision about their own safety
• If gaining consent would place the person at further risk
5. Training Requirements
Training will be carried out in accordance with the Trust Organisation Wide Training
Needs Analysis (TNA).
6. Monitoring
Minimum Frequency Process for Evidence Responsible Response
Requirement monitoring Individual(s) Committee(s)
Monitor staff Annual Internal Audit Completed Executive Joint
awareness of Audit Director Safeguarding
Nursing & Group
policy and
Governance
relevant
local resources
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 14 of 30Domestic Violence and Abuse (DVA) Policy
7. Resource/Implementation Issues
This policy must be underpinned with education and training, supervision and support for
staff. Appropriate materials to publicise the policy, including suitable materials to be
directly given to service users, will be needed to implement the policy
8. Risk Issues
Failure to implement this policy may lead to failure to meet the requirements of
commissioners and regulators in relation to safeguarding children and adults who may
be at risk of abuse and neglect.
9. Requirements, Supporting Documents and References
9.1 References
GMMH NHS FT Safeguarding Children Policy
GMMH NHS FT Safeguarding Adults at Risk Policy
www.gov.uk/forced-marriage
www.scie.org.uk/publications/mca/index.asp
www.nationaldomesticviolencehelpline.org.uk
DH guidelines for health professionals DH 2013
Adult safeguarding and DVA ADASS 2013
Domestic violence and abuse: NICE public health guidance 50 February 2014
guidance.nice.org.uk/ph50.
Board Objective Reference: Not Applicable
CQC Reference: Outcome 10
NHSLA Reference: Not Applicable
10. Subject Expert and Feedback
Feedback and technical questions related to this policy may be directed to the policy
author via the SharePoint consultation in the first instance.
This document will be reviewed in five years or sooner in the light of organisational,
legislative or other changes.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 15 of 30Domestic Violence and Abuse (DVA) Policy
Appendix 1 – Advocacy Contact Details
Directorate Contact details
Bolton Rethink Mental Illness
T: 07484 002 014
E: boltonadvocacyservice@rethink.org.uk
W: https://www.rethink.org/services-groups/services/bolton-advocacy-
service-imca
Bury Rochdale and District MIND
T: 0161 933 2623
E: info@buryadvocacyhub.org.uk
W: https://www.rochdalemind.org.uk/
Manchester Gaddum Centre
T: 0161 834 6069
E: info@gaddum.co.uk
W: http://www.gaddumcentre.co.uk/advocacy-service/
Salford MIND in Salford
T: 0161 212 4880
E: advocacyhub@mindinsalford.org.uk
W: http://www.mindinsalford.org.uk/advocacy/
Trafford Trafford Mental Health Advocacy Service (TMHAS)
T: 0161 877 4330
E: info@tmhas.org.uk
W: http://www.vcatrafford.org/TMHAS
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 16 of 30Domestic Violence and Abuse (DVA) Policy
Appendix 2 – DVA Flowchart & RIC
DVA Flowchart
During contact with adult or family domestic abuse is identified
Complete the domestic abuse risk indicator checklist in this form (page 2). Always try and
complete this with the victim and from the history you take from the victim / have on this
case
ALWAYS FOLLOW RELEVANT SAFEGUARDING CHILDREN AND ADULT AT RISK POLICY GUIDELINES
Referrals for adults or children can be made to Contact Manchester
(formally MCC Contact Centre) – on 234 5001
NB this relates to the likelihood
of a life-threatening or traumatic
14 ticks on the risk indicator checklist and a recent incident (approx. 3 months), incident occurring imminently.
Use the domestic abuse risk
OR indicator checklist and your
do you believe there is a high risk of homicide or serious injury to this victim? professional judgement to
help with this decision
YES NO
REFER TO MARAC With the consent of the person refer to
– see page 9 Manchester Women’s Aid or signpost to
other agencies on page 9
ALWAYS FOLLOW UP AND REVIEW
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 17 of 30Domestic Violence and Abuse (DVA) Policy
Domestic abuse risk indicator checklist
Recommended Referral Criteria to MARAC
1. ‘Visible High Risk’: the number of ‘ticks’ on this checklist. If you have ticked 14 or more
‘yes’ boxes, and a recent incident in the past three months, the case would normally meet
the MARAC referral criteria – refer to the domestic abuse flowchart on the front of this
document.
2. Professional judgement: if a professional believes that a victim or their family is at
significant risk of harm, then they should refer the case to MARAC. There will be occasions
where the particular context of a case gives rise to serious concerns even if the victim has
been unable to disclose the information that might highlight their risk more clearly. This
could reflect extreme levels of fear, cultural barriers to disclosure, immigration
issues or language barriers particularly in cases of ‘honour’-based violence. This
judgement would be based on the professional’s experience and/or the victim’s perception
of their risk even if they do not meet criteria in point 1 above. Professional judgement
could also include cases where there hasn’t been a recent incident, for example because
the perpetrator has been in prison or out of the country, but where there is a serious threat
to the victim.
The results from a checklist are not a definitive assessment of risk. They should provide
you with a structure to inform your judgement and act as prompts to further questioning,
analysis and risk management whether via a MARAC or in another way.
The responsibility for identifying your local referral threshold rests with your local
MARAC.
What this form is not:
This form is not a full risk assessment for either children or adults at risk (formally vulnerable
adults) although it will provide valuable information about the risks that both of these groups are
living with.
The presence of children increases the wider risks of domestic violence and stepchildren are
particularly at risk.
If risk towards children is highlighted you should consider what action you need to take to obtain
a full assessment of the children’s situation – for example, undertaking a CAF.
If the concerns relate to an adult at risk you should raise concerns with you manager or make a
referral to MCC Contact Manchester
Please explain that the purpose of asking these questions is for the safety and protection of the
individual concerned.
Put a cross [x] in the box if the factor is present.
Please add comments where indicated. It is assumed that your main source of information is the
victim. If this is not the case please add this to your comment.
The boxes will expand as you type text into them.
There is space at the end of the form for additional information where appropriate.
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 18 of 30Domestic Violence and Abuse (DVA) Policy
RISK INDICATOR CHECKLIST
YES NO REFUSED
CURRENT SITUATION
1. Has the current incident resulted in injury?
(Please state what and whether this is the first injury)
Comment:
2. Are you very frightened?
Comment:
3. What are you afraid of? Is it further injury or violence?
(Please give an indication of what you think the abuser might do and to
whom, including children).
KILL (specify self, children or other)
FURTHER INJURY AND VIOLENCE (specify self, children or other)
Comment:
4. Do you feel isolated from family/friends i.e. does the abuser try to
stop you from seeing friends/family/doctor or others?
Comment:
5. Are you feeling depressed or having suicidal thoughts?
Comment:
6. Have you separated or tried to separate from the abuser within the
past year?
Comment:
7. Is there conflict over child contact?
(Please state the nature of the conflict)
Comment:
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 19 of 30Domestic Violence and Abuse (DVA) Policy
YES NO REFUSED
8. Does the abuser constantly text, call, contact, follow, stalk or harass
you?
(Please expand to identify what and whether you believe that this is done
deliberately to intimidate you? Consider the context and behaviour of what
is being done. This question is relevant even if the parties are living
together) Comment:
1.1.1 CHILDREN/DEPENDANTS
9. Are you pregnant or have you recently had a baby (within the last 18
months)?
1.1.2 DOMESTIC VIOLENCE HISTORY
10. Is the abuse happening more often?
Comment:
11. Is the abuse getting worse?
Comment:
12. Does the abuser try to control everything you do and/or is he/she
excessively jealous?
Comment:
13. Has the abuser ever used weapons or objects to hurt you?
Comment:
14. Has the abuser ever threatened to kill you or someone else and you
believed them?
Comment:
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 20 of 30Domestic Violence and Abuse (DVA) Policy
YES NO REFUSED
15. Has the abuser ever attempted to strangle/choke/suffocate/drown
you?
Comment:
16. Does the abuser do or say things of a sexual nature that make you
feel bad or that physically hurt you or someone else?
(Please specify who and what)
Comment:
17. Is there any other person who has threatened you or of whom you
are afraid?
(Consider extended family if honour based violence and please specify
who)
Comment:
18. Do you know if the abuser has hurt anybody else?
(Children, siblings, elderly relative, stranger, other partners – consider
honour based violence and please specify who)
Comment:
19. Has the abuser ever mistreated an animal or the family pet?
Comment:
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 21 of 30Domestic Violence and Abuse (DVA) Policy
YES NO REFUSED
1.1.3 ABUSER
20. Are there any financial issues? For example, are you dependent on
the abuser for money? Has the abuser recently lost his/her job? Are
there any other financial issues?
(Please specify what)
Comment:
21. Has the abuser had problems in the past year with drugs
(prescription or other), alcohol or mental health issues that has
created problems in leading a normal life?
Drugs Alcohol Mental Health
Comment:
22. Has the abuser ever threatened or attempted suicide?
Comment:
23. Has the abuser ever breached bail/an injunction and/or any
agreement for when they can see you and/or the children?
(Please specify what)
Bail Conditions
Non molestation/civil order
Child contact arrangements
Forced Marriage Protection Order
Other
Comment:
24. Do you know if the abuser has ever been in trouble with the police or has
a criminal history?
(If yes, please specify)
Comment:
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 22 of 30Domestic Violence and Abuse (DVA) Policy
YES NO REFUSED
PLEASE CALCULATE THE NUMBER OF “YES” RESPONSES and enter in the box to the
right
For consideration by professional:
Is there any other relevant information (from a victim or professional), which may increase risk levels?
Consider victim’s situation in relation to vulnerability, disability, substance misuse, mental health issues,
cultural/language barriers, ‘honour’-based systems and minimisation. Are they willing to engage with
your service?
Describe:
Consider abuser’s occupation/interests – could this give them unique access to weapons? e.g. ex-
military, police, pest control etc.
Describe:
Is there anything else you would like to add to this? e.g. if the victim has refused to answer any
questions.
Comment:
Your name: Date:
ALL INFORMATION ON THIS FORM MUST BE COMPLETED AS FULLY AS POSSIBLE
1.1.4 Case Number (MARAC
use only)
Date of Referral
Name of Person Referring
Agency Referring
Name
Address
Telephone
Referring to (put X as
appropriate) MARAC MWA Saheli SARC
Reason(s) for referral
If Yes, date when
Is this a repeat? (MARAC use
last at MARAC?
only)
(MARAC use only)
Victim Details
Name:
Alias:
Date of Birth: Gender:
Ethnicity: Religion:
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 23 of 30Domestic Violence and Abuse (DVA) Policy
Sexual orientation: Occupation:
GP details:
Relationships:
Address:
Contact number:
Safe time to call:
Additional risk factors
(e.g. victim is an adult as risk
as a result of disability or
cognitive impairment)
Do you feel that this victim is at
high risk of experiencing
further domestic abuse?
What are the victim's greatest
priorities to address their
safety?
Consent
If No, are there
Service user’s consent grounds to share
obtained? information
without consent?
Grounds to share information
without consent:
Immigration Status
Is victim holder of a British
passport?
Nationality
Immigration status: (e.g.
asylum seeker, refugee,
spousal visa with NRPF, ILR)
Alleged Perpetrator
Name:
DOB
Ethnicity:
Address:
Relationships:
Alcohol or drugs involved?
Drugs involved?
Child
Name:
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 24 of 30Domestic Violence and Abuse (DVA) Policy DOB: Ethnicity: Address: Relationships: School details: GP details: Does the child ordinarily reside at the address? Was the child present at the incident? Did the child witness the incident? Injuries sustained? Give details Child’s first language: Disabilities: Disability details: CAF started: Additional information: Court orders relating: Other associated adults at risk of abuse (Person who is or may be in need of community care services by reason of mental or other disability, age or illness) Name: DOB: Is this adult also living at the same address? If not, are they being affected by the abuse? Give details Did the adult witness the incident? Injuries sustained? Give details Action proposed / taken? (e.g. safeguarding referral) Ref: SG02 Issue date: 13/07/2018 Version number: 1.0 Status: Approved Next review date: 13/07/2021 Page 25 of 30
Domestic Violence and Abuse (DVA) Policy
Appendix 3 – Greater Manchester Police PPIU Referral Form
Greater Manchester Police Adult at Risk Protection Referral Form
Greater Manchester
Public Protection Investigation Unit
Adult Abuse Referral Form
Greater Manchester police are committed to protecting vulnerable adults by adopting a proactive multi-
agency approach and investigating all cases effectively in order to prevent and reduce abuse.
Please complete ALL sections of this document. Once received, this information will be reviewed within
24 hrs, Mon-Fri. If this referral requires a more urgent police response please contact the team direct on
the numbers below or the main GMP switchboard on 0161 872 5050
Section A: Details of person making referral
Date of referral
Referred by (Name)
Profession and location
(e.g. Social Worker, Manchester
Learning and Disability team)
Direct contact details
Your case/ref. No.
Nature of concern
E.g. financial/sexual/physical
Section B: Subject/victim details
Name
Date of Birth
Address/Place of care
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 26 of 30Domestic Violence and Abuse (DVA) Policy
Section C:
Reason for referral / Case summary – Please provide as much detail as possible, including details of the
allegation and if you would want the police to attend the strategy meeting.
Section D: Alleged perpetrator details
Name
Date of Birth
Profession & current
employment status (if
applicable)
Relationship to subject
Section E: Email address of relevant PPIU and PPIU Officers details (if spoken to)
Bolton.ppiu@gmp.pnn.police.uk PPIU Officers Collar Number and details:
Bury.ppiu@gmp.pnn.police.uk
Southmanchester.ppiu@gmp.pnn.police.uk
Manchestermet.ppiu@gmp.pnn.police.uk (Central)
Northmanchester.ppiu@gmp.pnn.police.uk
Salford.ppiu@gmp.pnn.police.uk
Trafford.ppiu@gmp.pnn.police.uk
Referrals containing patient identifiable information MUST be sent securely from @nhs.net email accounts
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 27 of 30Domestic Violence and Abuse (DVA) Policy
Appendix 4 – Support and Contact Details for Victims of DVA
Ensure to provide national as well as local helpline numbers as local services may not
be available 24 hours a day.
FREE National Tel. 0808 2000 247 (7 days a This is a free 24 hour helpline
Domestic week, 24 hours a day) providing information and
Violence emotional and practical support to
Helpline those experiencing domestic
abuse or seeking help on
someone else’s behalf.
There is access to an interpreter
for non-English speaking callers.
Helpline staff can also access the
BT Type Talk service for deaf
callers.
National Centre 0870 9220 704 NCDV is a charity which offers
for Domestic free phone tel. 0800 970 2070 free legal advice and assistance
Violence London Office tel. 0207 0961 to those wishing to escape
(NCDV) 041 domestic abuse. The service is
www.ncdv.org.uk open 24 hours a day 365 days a
year. They can arrange for court
injunctions by the next working
day. They are able to liaise with
police and the courts in order to
pursue criminal convictions
against perpetrators of domestic
abuse.
Refuge www.refuge.org.uk Accommodation and support
Women’s Aid 0161 660 7999 Network of over 500 local
info@manchesterwomensaid.org services
www.womensaid.org.uk
The Hideout www.thehideout.org.uk Provides help and support to
www.ciac.co.uk children and young people living
with domestic abuse.
Rights of Legal Advice Line 020 7251 6577 Free legal advice for women.
Women Sexual Violence legal Advice line
020 7251 8887
Benefits 020 7712 2171
Agency www.dwp.gov.uk
Helpline
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 28 of 30Domestic Violence and Abuse (DVA) Policy
Victim Support 0845 3030 900 Information and support for the
www.victimsupport.org victims of crime.
MALE 0808 801 0327 Men’s Advice Line, for men
www.mensadviceline.org.uk experiencing domestic violence.
Saheli 0161 945 4187 Asian Women’s Project
www.saheli.org.uk
(leaflets in different languages)
SARC 0161 276 6515 Sexual Assault Referral Centre
Email:
stmarys.sarc@cmft.nhs.uk
https://www.stmaryscentre.org
Greater North Manchester 0161 856 3704
Manchester South Manchester 0161 856 6053
Police Public Oldham 0161 856 4551
Protection Salford 0161 856 5171
Investigation Trafford 0161 856 7574
unit
Independent Manchester 0161 234 5393
Domestic
Violence
Advisors
(IDVAs)
Ref: SG02 Issue date: 13/07/2018 Version number: 1.0
Status: Approved Next review date: 13/07/2021 Page 29 of 30You can also read
