Domestic Abuse and Violence as a Public Health Issue: Closing the Gaps in Healthcare Response

Policy Brief, by Riya Mohan

Executive Summary “Two million women and girls are estimated to be victims of violence each year in England and Wales in an epidemic so serious it amounts to a national emergency”, National Police Chiefs[1] warned. Recent data from the National Police Chiefs' Council (NPCC) highlights that one in six homicides in England and Wales is linked to Domestic Abuse and Violence (DVA)[2]; 30% of DVA cases start in pregnancy and [3]disabled people are almost three times as likely to experience it. The economic and social toll is vast: DVA costs £66 billion annually in response costs, lost productivity, and harm to individuals. If the UK government is to meet its Safer Streets ambition of halving violence against women and girls (VAWG) within a decade, greater, targeted investment is needed in prevention and early intervention. The Coordinated Community Response (CCR) model, championed by Standing Together Against Domestic Abuse, has proven to be the most effective in identifying domestic abuse early, intervening effectively, and saving both lives and public resources. However, if healthcare as an institution is not included as a channel within tackling VAWG pathway, gaps will continue to exist. This policy brief highlights those critical gaps in the health system’s response to DVA and sets out recommendations for government action including recognising DVA as a public health issue, embedding a Whole Health Approach across healthcare systems, ring fencing funding in Health and Social Care budgets, and providing standardised and mandatory training for healthcare professionals in DVA identification and response.

Domestic Abuse as a Public Health Issue

For too long, Domestic Violence and Abuse (DVA) has been seen as a criminal justice issue. Although police responses remain critical, evidence shows that only one in five victim-survivors of DVA report abuse to law enforcement[4]. By contrast, the majority interact with health services, presenting health professionals with unique opportunities for early identification and intervention.

For example, 46% of the victim-survivors experiencing high-risk Domestic Violence and Abuse (DVA) visited their General Practice (GP) in the 12 months before receiving support from specialist services[5]. Over one-quarter (27.5%) of intimate partner violence (IPV) victim-survivors who experienced physical injury or other DVA effects also received some sort of medical attention[6], and nearly a quarter (23%) of victim-survivors at high risk of harm and one in 10 victim-survivors at medium risk attended A&E (Accident and Emergency Departments) because of acute physical injuries[7].

Despite this, systematic gaps in recognition and response persist, delaying support and exacerbating harm. Research such as the Patchwork of Provision[8] report underscores that Healthcare Professionals (HCPs) are frequently the first professionals to whom survivors disclose abuse, given their position of trust and contact at critical life stages. Yet without appropriate training[9], opportunities to protect adult and child victim-survivors and reduce public costs are routinely missed.

To provide the best support to victim-survivors of DVA, HCPs must have the tools, resources and confidence required to identify potential victim-survivors sensitively, intervene at an early stage where possible, and refer on as appropriate to specialist services (Standing Together, 2025).

Cross-Cutting and Intersectional Impact of DVA

Too often, the needs of victim-survivors are seen as homogenous, when in reality they experience distinct health needs, often exacerbated by their experience of abuse.

DVA is a gendered issue that exacerbates existing health inequities and disproportionately affects women facing intersecting forms of discrimination.

• Neurological harm: Survivors commonly experience blows to the head and non-fatal strangulation, leaving lasting psychological and physical trauma. The symptoms are often ‘unseen’ and unrecognised by services, including health services. For example, a report by the Disabilities Trust found that nearly two-thirds of female offenders (64%) at Her Majesty’s Prison (HMP) Drake Hall reported “a history indicative of a brain injury”. Of those, 62% had sustained their injury through DVA[10].

• Reproductive and sexual health: Women experiencing DVA are three times more likely to suffer gynaecological or sexual health issues, including pain during intercourse, chronic pelvic pain, vaginal bleeding and recurrent urinary tract infections.[11]

• Maternal and infant health: Approximately 30% of DVA starts or escalates during pregnancy and exposure to DVA during pregnancy leads to lifelong implications for brain development and emotional wellbeing of babies[12]. Furthermore, women who experience DVA during or after pregnancy experience anxiety, depression, and emotional detachment which significantly affects the way a mother bonds with her child[13].

• Cancer care disparities: Experiencing domestic abuse also affects the health outcomes of patients living or being diagnosed with cancers. Some victim-survivors are less likely to attend routine breast, colorectal, and cervical screening than the general population.[14] They also have 2.74 times the odds of receiving an abnormal pap smear result, a 1.5-fold increased risk of discontinuing subsequent follow-up care, and over twice the odds of being diagnosed with different types of cancers.

• Mental health: 69% of women in contact with mental health services for severe mental illness had experienced domestic and/or sexual abuse.[15] Research shows that women and girls are more likely to suffer mental health problems than men and boys, which is related to their disproportionate experiences of violence and abuse.[16] 

• Disability: People with a disability are almost three times more likely to have experienced DVA than non-disabled people.

This evidence underscores the need for a tailored, trauma-informed training framework that equips healthcare professionals to identify abuse in diverse populations, respond sensitively, and make effective referrals to specialist services.

Policy Recommendations

Over the last few years, there has been recognition by the UK government that health is definitely a missed area of VAWG prevention and intervention. However, to ensure that health systems play a much more active role in supporting victim-survivors of domestic abuse, this policy brief recommends:

• Recognising domestic abuse as a public health priority

Reframing responsibilities across the government and the NHS

Domestic abuse is often framed primarily as a criminal justice issue. While policing remains essential, this framing neglects the significant health implications of abuse and the vital role that healthcare professionals play at critical intervention points. Recognising DVA as a public health issue would reframe responsibilities across government and the NHS and position domestic abuse alongside other major public health priorities, ensuring it is embedded in national and local health strategies.

Embed a Whole Health Approach across the NHS and public health systems, as championed by Standing Together Against Domestic Abuse

Coordinated action across all parts of the healthcare system — including primary care, emergency medicine, maternity services, sexual health, and mental health (as well with specialist services outside of healthcare, such as police, DVA charities, etc.) will ensure that every survivor is provided with timely, trauma-informed, and effective support at any stage of their journey.

Secure ring-fenced funding Dedicated funding streams within Health and Social Care budgets are essential to ensure that investment in DVA responses is sustainable, rather than dependent on short-term or discretionary funding. Stable financing would allow local areas to recruit Domestic Abuse Coordinators, provide training, and commission specialist support services with confidence.

• Standardised and Mandatory training for healthcare professionals

Currently, training on domestic abuse is inconsistent, with significant variation in content, delivery, and uptake across NHS Trusts and Integrated Care Boards. This results in a “postcode lottery” of support for survivors. A nationally mandated programme is proposed which would:

Establish agreed learning outcomes: All healthcare professionals (HCPs) and Domestic Abuse Coordinators (DACs) would be trained to the same minimum standard, ensuring survivors receive an equivalent quality of care regardless of where they live.

Ensure accessibility and efficiency: Training must be concise and flexible, enabling HCPs to undertake it alongside busy workloads. Digital modules, combined with in-person workshops, could ensure both reach and depth.

Provide continuous professional development: Domestic abuse training cannot be a one-off exercise; it must be reinforced through refresher sessions, peer learning, and ongoing supervision to keep practice current.

Integrate specialist content: Training should include modules on trauma-informed practice, intersectionality, and health-specific consequences of DVA such as head injury, reproductive health, cancer care disparities, and mental health impacts.

Conclusion and Call to Attention

Domestic abuse is both a criminal justice issue and a public health crisis, with annual cost to the UK economy of about £66 billion. Recognising domestic abuse as a public health issue and equipping healthcare professionals with systematic, trauma-informed training is an urgent and necessary step toward halving VAWG within the next decade. Investing in this approach will enhance survivor safety and recovery, and deliver measurable savings to the public purse. Investing in this approach will not only support the government’s Safer Streets mission but also key government priorities, including creating an NHS fit for the future.

REFERENCES

[1] National Police Chiefs' Council, "Call to Action as Violence Against Women and Girls Epidemic Deepens," NPCC News, February 14, 2024, https://news.npcc.police.uk/releases/call-to-action-as-violence-against-women-and-girls-epidemic-deepens-1.

[2] Women’s Aid, The Impact of Domestic Abuse, accessed February 28, 2025, https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/the-impact-of-domestic-abuse/.

[3] Office for National Statistics, Disability and Crime, UK: 2019, March 2, 2020, https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/bulletins/disabilityandcrimeuk/2019.

[4] Office for National Statistics, Domestic Abuse in England and Wales: Year Ending March 2017, November 30, 2017, https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/domesticabuseinenglandandwales/yearendingmarch2017.

[5] Christina J. P. M. Coates et al., “The Role of the Voluntary Sector in Supporting Domestic Abuse Survivors: A Mixed-Methods Study,” BMC Health Services Research 19, no. 1 (2019): 504, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4621-0.

[6] Office for National Statistics, Domestic Abuse Prevalence and Trends, England and Wales: Year Ending March 2024, November 30, 2024, https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabuseprevalenceandtrendsenglandandwales/yearendingmarch2024#:~:text=Main%20points,abuse%20in%20the%20last%20year.

[7] SafeLives, IDVA Insights Dataset 2022-23, 2023, https://safelives.org.uk/wp-content/uploads/Idva-insights-dataset-2022-23.pdf.

[8] Domestic Abuse Commissioner, National Mapping of Domestic Abuse Services, accessed February 28, 2025, https://domesticabusecommissioner.uk/national-mapping-of-domestic-abuse-services/.

[9] Health, Standing Together Against Domestic Abuse, accessed February 28, 2025, https://www.standingtogether.org.uk/health#:~:text=Thus%2C%20it%20is%20vital%20that,support%20(Pathfinder%2C%202020).&text=Health%20services%20see%201.5%20million,victims%2Fsurvivors%20(NHSE).

[10] Brainkind, Making the Link: Female Offending and Brain Injury, December 2023, https://brainkind.org/wp-content/uploads/2023/12/Making-the-Link-Female-Offending-and-Brain-Injury.pdf.

[11] Women’s Aid, The Impact of Domestic Abuse, accessed February 28, 2025, https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/the-impact-of-domestic-abuse/.

[12] Women’s Aid, The Impact of Domestic Abuse, accessed February 28, 2025, https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/the-impact-of-domestic-abuse/.

[13] Recognising Babies and Children as Victims of Domestic Abuse, For Baby's Sake, December 10, 2024, https://forbabyssake.org.uk/news/2024/12/10/recognising-babies-and-children-as-victims-of-domestic-abuse/#:~:text=When%20a%20parent%20is%20experiencing,%2C%20emotional%2C%20and%20neurological%20development.

[14] Macmillan Project, Standing Together Against Domestic Abuse, accessed February 28, 2025, https://www.standingtogether.org.uk/macmillan-project.

[15] Maria A. M. Lima, Andre L. L. Diniz, and E. J. R. Moreira, “Impact of Domestic Violence on the Health of Women: A Systematic Review of the Literature,” National Center for Biotechnology Information, 2015, https://pmc.ncbi.nlm.nih.gov/articles/PMC4413870/.

[16] Violence and Abuse Are Driving Mental Illness in Women and Girls, Psychiatrists Warn, Royal College of Psychiatrists, March 8, 2024, https://shorturl.at/kEZzB