What immediate safety planning steps should I discuss with a patient who discloses domestic abuse?

When a patient discloses domestic abuse, immediate safety planning steps to discuss should focus on ensuring their safety, providing information, and offering appropriate support while maintaining confidentiality and respecting their autonomy NICE CKS,NICE CG110.

• Discuss Confidentiality and Information Sharing:
  • Emphasise that any discussion about domestic abuse will be confidential NICE CKS.
  • Explain that information sharing without consent risks losing the patient's trust and may endanger their safety NICE CKS.
  • Clarify that there are limits to confidentiality in exceptional circumstances, such as a risk of serious harm to a child or vulnerable adult NICE CKS.
  • Reassure the patient that they will be involved in all stages of decision-making and retain as much control as possible over disclosures of information NICE CKS.
  • Inform the patient that disclosed information will be kept in a confidential record and will not be included in their hand-held record or accessible online records NICE CKS,NICE CG110.
• Provide Information and Support Resources:
  • Offer information about local and national agencies, including third-sector organisations, that provide support for individuals experiencing domestic abuse NICE CG110,NICE.
  • Give the patient a credit card-sized information card that includes local and national helpline numbers NICE CG110.
  • Highlight that information on where to get support is clearly displayed in waiting areas and available in various formats and languages, potentially including discreet options like pens or key rings with helpline numbers NICE.
• Offer Referral to Specialist Services:
  • Discuss the option of referral to a local specialist domestic abuse service, such as an Independent Domestic Violence Advisor (IDVA) service NICE CKS,NICE CG110.
  • Explain that IDVAs can help assess risk levels, discuss options, and create safety plans, working with other agencies to increase safety NICE CKS.
  • Mention that for high-risk cases, a Multi-Agency Risk Assessment Conference (MARAC) may be considered, which brings together agencies to jointly support victims at high risk of serious harm NICE CKS.
• Emphasise Patient Autonomy:
  • It is important not to advise the person on what action to take, as risks can escalate when they try to leave or after separation NICE CKS. The focus should be on empowering them with information and support options NICE CKS.