I am pleased that Brooker and colleagues have highlighted their finding of poor recording of sexual violence and abuse in care programme approach (CPA) documentation in England. Reference Brooker, Tocque, Brown and Kennedy1 It seems timely to highlight the international developments in this area, which are of relevance for staff seeing patients with mental disorders in general, not only patients receiving CPA support.
It is now well established that people with mental disorders are more likely to have been victims of violence and abuse (and/or to have witnessed it as children) than the general population, and that they continue to be at increased risk of being a victim of violence. Reference Khalifeh, Johnson, Howard, Borschmann, Osborn and Dean2,Reference Davies3,Reference Anderson, Howard, Dean, Moran and Khalifeh4 The World Health Organization (WHO) has a violence prevention strategy (http://www.who.int/violence_injury_prevention/violence/en/), and both the WHO and the World Psychiatric Association 5 have highlighted domestic and sexual violence as major determinants of mental ill health; a competency-based curriculum has recently been published for medical students and psychiatrists. 6 In the UK, the National Institute for Health and Care Excellence (NICE) public health guideline PH50 has recommended routine enquiry about experiences of domestic violence in mental health settings, and NICE clinical guideline CG89 recommends that childhood maltreatment is considered when assessing a range of physical, sexual and emotional problems. Violence and abuse, including physical, sexual and emotional abuse, are sadly still highly prevalent and, as England's Chief Medical Officer has argued, general practitioners and mental health professionals need to routinely ask people with mental health problems about current and historical violence and abuse. Reference Davies3 However, routine enquiry alone is not enough; services need to train professionals so they know how to ask and respond sensitively and have protocols in place for appropriate care when violence or abuse is identified. In addition, there is a small but growing evidence base on the association between mental disorders and perpetration of domestic violence and abuse; therefore, domestic violence and abuse perpetration also need to be identified by mental health professionals for comprehensive risk assessment. Reference Oram, Khalifeh and Howard7
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