Routine enquiry for domestic violence is not enough

We read with great interest the paper by Morgan et al ¹ on the prevalence of domestic violence and acceptability of clinical enquiry about abuse among female psychiatric patients. This study is highly topical, as our own review of the academic literature identified a dearth of research on prevalence of domestic violence in psychiatric settings and low rates of staff detection in routine clinical practice, particularly in the UK. ² Morgan et al's paper reported that the majority of patients sampled perceived clinical enquiry about domestic violence as acceptable. This finding, alongside high reported prevalence rates, led the authors to advocate routine enquiry about domestic violence by mental health professionals.

However, although our review found that the introduction of routine clinical enquiry in mental health services is associated with an increase in clinician identification of domestic violence, we do not believe that sufficient evidence currently exists to justify its implementation, unless it is introduced with training on how to ask, and is carried out with a referral and care pathway that can address the domestic violence. As well as Morgan et al, we have highlighted that, to date, research on the effectiveness of screening for domestic violence has not found evidence that enquiry leads to reductions in patient morbidity. Furthermore, routine enquiry is not a benign intervention and can lead to adverse consequences. ³ The report from the Department of Health Violence Against Women and Children (VAWC) National Health Service (NHS) taskforce ⁴ has also stressed the importance of prior clinical training and care pathways for domestic violence in ensuring efficacy of routine clinical enquiry. The Department of Health delivered an NHS awareness-raising campaign to coincide with End Violence against Women Day on 25 November 2010. This has led to support for primary care trusts and NHS trusts to raise the profile of VAWC locally. We hope that all mental health trusts will take advantage of the associated resources that have been sent to all trusts to raise awareness among staff and their local communities to address this highly prevalent issue for our patients.