1. Domestic Violence Health Service Perspective Briony Ladbury RN RM FPcert HV BA MSc 6 th May 2008 28 % women ?? % men ?? % children NHS costs estimated as £1.2 billion MAJOR ISSUE FOR HEALTH SERVICES

2. Affects of DV Physical Health –A and E admissions :Injury –A and E admissions : Self harm / OD –Smoking – general poor physical condition Mental Health –Alcohol abuse –Anxiety states, depression, PTSD Sexual Health –STD, pregnancy, exploitation Child Health –Child abuse, neglect, emotional harm, behavioural issues – and all of the above!

3. Influencing the new NHS COMMISSIONERS PROVIDERS Public Health WIC Hospital LAS GP ( commissioners too) FPC / GUM MH Services Community

4. Current Contexts Safeguarding Adults ?? Safeguarding Children DV

5. Influencing Practice Local Serious Case Review Recommendations Responding to domestic abuse: a handbook for health professionals London Board: Supplementary Guidance & Risk Maitrix Individual Trust Policies and Procedures LSCB Policies & Procedures DV Forums and FJCs Health engagement on MARACS/MAPPAs Public Health Campaigns Training opportunities Some room for confusion ? Competency and Core functions

6. Use what we know

7. Use what we have

8. …….and then some Persuading staff to get involved at all levels Using well tried tricks Teaching staff to manage aggressive people Teaching staff about recording incidents Teaching staff to manage risk to staff Teaching staff about community resources