Why safeguarding victims of domestic abuse is more important than ever

As England goes back into lockdown to limit the spread of Covid-19, those experiencing, or at risk of domestic abuse, can find themselves isolated. Adult safeguarding lead nurse specialist Anoushka Khorramian shares her thoughts on the role of healthcare professionals in helping to identify and safeguard people who are vulnerable to domestic abuse – and why it’s especially important now.  

In his address to the nation on Monday evening to announce a new lockdown, the Prime Minister explicitly stated that lockdown rules do not apply to people fleeing domestic abuse. As a safeguarding specialist, I welcome the fact that the Prime Minister highlighted this issue. It’s always important that victims of domestic abuse have unrestricted access to support and feel as free as possible to get away from difficult and dangerous situations; this is especially important now, as for many people the pandemic will have made a bad situation even worse. 

The Covid-19 pandemic has had serious and wide-ranging effects on all established organisations and services, meaning that agencies and institutions that exist to protect vulnerable people may not be operating at the same capacity as they did before.  
At the same time, the anxieties and restrictions associated with the pandemic may have forced many issues to the surface, exacerbating problems that existed in intimate family relationships. This is especially true when other negative social factors are involved, such as poverty, drug use, mental health issues, chronic illness and/or legal insecurity.  
Social distancing and restrictions on travel have meant that most of us have had to change the way we live and work. Some people who were already at risk of isolation have lost what vital outside contact they had. Where, previously, work or school may have allowed a person to get away from pressures at home, this avenue of respite may have been closed off. This can increase tension and, in some cases, an escalation of existing abuse. 
Lack of community has left many vulnerable people even more at risk – whether that's young people with no access to school support or lone-living adults with care needs who previously relied on connections with others. All of this can negatively affect wellbeing, which can increase people’s vulnerability to exploitation. This is why safeguarding is even more important at the moment, and it will continue to be so – not just ensuring the safety of the people we look after, but also safeguarding ourselves and our own systems of support. 

How we can all help 

It’s part of human nature that we run to extremes in response to difficult topics, especially when we are inexperienced; in terms of safeguarding, this can mean, at one end of the scale, getting too involved in a situation where you believe someone needs support, or, at the other, avoiding the situation entirely.  
People who survive abuse will often have keenly developed intuition in order to cope with the volatility of living with an abuser. 


Anoushka Khorramian"You will often hear safeguarding specialists talk about the importance of being ‘professionally curious’; it’s so easy to take a person’s report at face value, but with curiosity and conversation, a person might feel they can trust us, open up and tell us what’s really going on."


Sometimes we see people who regularly attend hospital with traumatic injuries and whose account of what happened doesn’t add up. Emergency and trauma staff are really good at reporting discrepancies and raising concern, and this helps the safeguarding teams to form stronger safety nets around people who might not be able to protect themselves. 
Many who experience abuse will minimise, lie and cover things up to protect an abuser, either because they love them or because they are ashamed. It’s a very complex area and we cannot force people to open up before they’re ready; but awareness and space can provide a valuable opportunity to a person who has been silenced for a very long time. 

What to do when someone opens up to you 

It is often the bit after disclosure that causes clinicians the most anxiety: what do I do with this information? 

The first concern should always be safety – that of the victim/survivor and any minors or at-risk adults that may be affected. Think family; think about the systems around the person in front of you. You might check what support is already in place for that person by asking them, or checking with their local social care service to see if they are known.  
The second thing to consider is what the person wants. Sometimes a person may have been living with abuse for years. They might just want to talk about what they’ve been going through. It may be that they just want to know who they could speak to. Domestic abuse specialist advisors are often referred to as IDVAs or independent domestic abuse and violence advisors. You might supportively refer, or offer signposting details to the person, and this will depend on their wishes.  

If the victim/survivor is especially at risk due to their own care and support needs, you might consider informing the local authority safeguarding team of the actions you’ve taken by completing a concern form. 

Sometimes you will come across a case where the risk of serious harm to that person is significantly higher, either due to risk factors such as pregnancy, recent separation, stalking and recent escalation. In these cases, we recommend a referral to the MARAC – a multi-agency risk conference where cases are heard based on the information held by an array of agencies local to that person. We don’t always need express consent to make this referral if the professional judgement is that this person is at risk of significant harm. If you are not sure, you can always discuss with senior colleagues or contact the safeguarding team for advice. 

In healthcare, our role is time-limited, but our input is really vital to the coordinated community response, which allows us to work alongside other agencies to keep the population safe. 

Some of the best safeguarding work I’ve seen has been down to the quality of communication: effective, multiagency information sharing, supported, reflective practice, and, most importantly, inclusion of the victim/survivor. The patient or the victim/survivor can get lost in the chatter sometimes – it’s so important that we put them at the centre of what we do. 

Looking ahead  

Each year – from 25 November to 10 December – an informal annual awareness event called 16 Days of Activism Against Gender-Based Violence aims to raise awareness of issues including domestic violence. The safeguarding team at Imperial participated in the last event by sharing our experiences and views on social media

The message from the campaign is that, as healthcare professionals, we need to try to be aware of the various layers of disadvantage and discrimination that exist in our 
society, and to understand how these affect people’s life experiences; we also have to remember that people have a right to live free from abuse and to make decisions about their own lives.   

This festive period has been very different for most of us and, even at the best of times, Christmas can be a flashpoint for domestic abuse. For many, this one will have been even worse. As we begin a new year, it’s important that we’re clear that our focus on the victims of domestic abuse must not just be an annual campaign of 16 days – we need to take the message forward and we make safeguarding part of our daily practice. 
A final thought: when you spend your working life invested in the safety and wellness of others, it can be easy to forget about yourself. Good support needs to start with ourselves and the people around us; while it can be difficult to ask for help, it’s so important that we look out for ourselves and one another.  

If you are – or have been – affected by domestic abuse, you can find information and support here. For employees of Imperial College Healthcare NHS Trust, information and support can be found on our intranet.

Please note that the support on our intranet is currently being redesigned to improve clarity and give access to more training tools.