Dental nurse Preetee Hylton explores the statistics relating to domestic abuse and explains that dental professionals have a statutory duty of care to all patients, colleagues and the wider public.

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©Malte Mueller/fStop/Getty Images Plus

On 13 May this year, I was invited by Pam Swain from the British Association of Dental Nurses (BADN) to speak about domestic abuse at the British Dental Conference and Dentistry Show in Birmingham, and was kindly sponsored by the National Examining Board for Dental Nurses (NEBDN). It was an honour to have the support of Jacqui Elsden, President of the BADN and Kate Kerslake, CEO of the NEBDN.

Domestic abuse is one of those topics we seem to be unwilling to openly address, despite numerous campaigns by various organisations. The highly publicised Johnny Depp vs Amber Heard trial was an opportunity to learn about recognising signs of domestic abuse in our near and dear ones, including our colleagues.

The current definition of domestic violence and abuse according to the Home Office is:

'Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse:

  • Psychological

  • Physical

  • Sexual

  • Financial

  • Emotional.

'Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

'Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

Dental professionals are in a privileged position to observe any changes in behaviour, notice any bruising or marks around the face, and we are also trained to notice changes in body language.

'This definition includes so called "honour" based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.'1

Possible signs of domestic abuse

  • Being withdrawn and isolated from family, friends, and colleagues

  • Signs of bruises, burns and bite marks on the body, especially around the neck, ears, shoulders, and arms

  • Having finances controlled eg, not being given enough to buy food, medication or to pay bills or the perpetrator having complete control of the victim's bank accounts

  • Not being allowed to leave the house, or stopped from going to school or work or attending social events

  • Being continuously belittled privately or humiliated in front of relatives and friends

  • Being pressured into sex or other forms of sexual contact; non-consensual sex is rape and is a criminal offence, which must be reported to the police

  • Being 'gaslighted' by being blamed for the abuse and/or the perpetrator pretending that the abuse never occurred

  • All communication routes being monitored, including social media and all online activities.

Exploring statistics

Research carried out by the Office for National Statistics (ONS) in November 2020 shows that there are approximately 2.3 million victims of domestic abuse each year2 and according to Refuge, calls for help to various helplines went up by 61% during our very first lockdown during the pandemic.3 Sadly, it is suspected that two women every week and one man every month are murdered by a current or previous violent partner/spouse, in spite of the Home Office recording that two in ten offences recorded by the police in 2019 are related to domestic abuse.4

Safeguarding in dentistry

We have all heard about or read about high profile cases in the media - child abuse, elder abuse, modern slavery, domestic abuse, which is upsetting; we often wonder how they happened without anyone noticing. Dental professionals are in a privileged position to observe any changes in behaviour, notice any bruising or marks around the face, and we are also trained to notice changes in body language. Dental teams should not feel worried when it comes to raising a concern; we have a statutory duty of care to all patients, our colleagues and the wider public.

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©Emma Anastasi

NHS England states that 'Safeguarding means protecting a citizen's health, wellbeing, and human rights; enabling them to live free from harm, abuse and neglect. It is an integral part of providing high-quality health care. Safeguarding children, young people and adults is a collective responsibility.'5

We must all make sure that there are safeguarding arrangements in place and that these are acted on whenever needed.

Safeguarding training for dental professionals

Safeguarding of children and young people

Level 1: All non-clinical staff including receptionists, practice managers and staff without patient contact

Level 2: Most dentists and dental care professionals

Level 3: To be determined locally in larger organisations based on an assessment of need and risk

Adult safeguarding

Level 1: All non-clinical staff including receptionists, practice managers and staff without patient contact

Level 2: Most dentists and dental care professionals.

Introducing the Employers' Initiative on Domestic Abuse

The Employers' Initiative on Domestic Abuse (EIDA)is a growing network of employers who come from a wide variety of sectors, working collectively to take action on domestic abuse by continuously gathering information, collating data and learning from them. They assist employers in providing better care for their employees by implementing effective internal policies on domestic abuse and offer easily accessible practical support and tools, through information, regular meetings and digital resources from various organisations. We can have access to a toolkit for employers, as well as personalise Sharon's Policy template (which is a domestic abuse policy for employees in the workplace) according to our own practice. All members are able to download a handbook and we may become an EIDA beacon as well - which will allow us to display our organisation or practice logo on their website to show our support. Visit https://www.eida.org.uk/.

Supporting our colleagues

  • Listen actively to them with an open mind without applying any judgement

  • Acknowledge their experience and their emotions and take care not to blame them for their circumstances

  • Support them by attending medical appointments, ensuring they have food and shelter, and encourage them to report domestic abuse

  • Call 999 if there is an immediate risk of danger to them.

Hestia - Life Beyond Crisis

I would like to thank the charity Hestia - Life Beyond Crisis for the resources and information they provided me with, to support my presentation on domestic abuse.

Hestia provides support for victims of domestic abuse in 25 refuges across 11 London boroughs and the south east and their campaign 'UK Says No More' provides 6,000 Safe Spaces in pharmacies and banks across the country. Safe Spaces can be used by anyone experiencing domestic abuse and sexual violence, to safely call a helpline, support service or friend. They also run the 'Everyone's Business' programme which provides businesses with the information and resources they need to support staff who have experienced domestic abuse. Their Respond to Abuse Advice Line provides free and confidential guidance to employers on how they can respond to disclosures of domestic abuse.

I am passionate about educating my colleagues in the dental industry about the detrimental impacts of domestic abuse.

Hestia also runs the 'Butterfly Project', which is a community-based women's group working in partnership with the charity Angelou - it is led by survivors for survivors of domestic abuse and provides emotional support and signposting for women who have experienced or are currently experiencing domestic abuse. https://www.hestia.org/

Signposting

  • Women can call the National Domestic Abuse Helpline, run by Refuge on 0808 2000 247 for free at any time, day or night

  • Talk to a doctor, health visitor, midwife or dental professional

  • Men can call Men's Advice Line on 0808 8010 327 (Monday to Friday 9 am to 8 pm) or visit the webchat at Men's Advice Line (Wednesday to Friday 10 am to 11 am and 3 pm to 4 pm)

  • Men can also call ManKind on 0182 3334 244 (Monday to Friday, 10a m to 4 pm)

  • If you identify as LGBT+ you can call Galop on 0800 999 5428 for emotional and practical support

  • Anyone can call Karma Nirvana on 0800 5999 247 (Monday to Friday 9 am to 5 pm) for forced marriage and honour crimes

  • You can also call 020 7008 0151 to speak to the GOV.UK Forced Marriage Unit.

A duty to raise awareness about domestic abuse

I am a domestic abuse survivor. I did not have much support from my previous employers when I was going through domestic abuse, which is why I am passionate about educating my colleagues in the dental industry about the detrimental impacts of domestic abuse. We have a responsibility to care for one another in this vast network - anyone can be a victim.

Useful resources

Safeguarding in general dental practice: A toolkit for dental teams: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/791681/Guidance_for_Safeguarding_in_GDP.pdf

Care Quality Commission (CQC): https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-13-safeguarding-service-users-abuse-improper

General Dental Council (GDC): https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf

Employers' Initiative on Domestic Abuse (EIDA): https://www.eida.org.uk/

Hestia - Life Beyond Crisis: https://www.hestia.org/Listing/Category/domestic-abuse-prevention

NHS England - Safeguarding: https://www.england.nhs.uk/safeguarding/