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10 December 2014

Our researchers developed specialist training materials to enable mental health professionals to help victims of domestic violence.

Our researchers developed specialist training materials to enable mental health professionals to help victims of domestic violence.

Research led by Professor Louise Howard

© Alamy
© Alamy

NHS professionals need to be trained to properly to support someone with mental health problems who is a victim of domestic violence – it’s not just about asking if someone is experiencing abuse at home, it’s knowing how to ask and then knowing how to help.

Our research has shown that up to two thirds of women who use mental health services have experienced domestic violence at some point in their adult lives, yet mental health professionals are unaware of the majority of these experiences.

‘Our research showed that mental health professionals often don’t discuss experiences of violence with service users,’ Professor Howard says. ‘We found that staff are reluctant to ask because they lack expertise and confidence. If people do say they are the victims of violence at home, professionals are not sure what to do with that information. Staff uncover less than 30 per cent of service users’ experiences.’

Training is therefore vital to help professionals know how to ‘enquire safely’, offer support themselves, or liaise with an organisation that specialises in helping victims of domestic violence.

‘Enquiry may have adverse effects, particularly if the perpetrator finds out about the disclosure. Enquiry is only effective if professionals can ask safely, offer interventions and / or refer people on,’ she says. ‘It’s very important to build a close relationship with local organisations in the domestic violence sector.’

Training materials for health professionals were originally developed under the auspices of the LARA (Linking Abuse and Recovery through Advocacy) study and successfully piloted with staff at the South London and Maudsley NHS Foundation Trust within community mental health teams.

Professor Howard is currently using her research findings and the LARA training manual to adapt an existing online course by the Royal College of General Practitioners (RCGP) on violence against women and children to make it more pertinent for mental health professionals.

The creation of the RCGP’s web-based training for GPs was financially supported by the Department of Health after the NHS Taskforce on Violence Against Women and Girls stressed the importance of training. Professor Howard was also commissioned by the Royal College of Psychiatrists (RCPsych) to write a book, Domestic Violence and Mental Health, based on the LARA manual, and has contributed to the development of the RCPsych’s core curriculum for undergraduate psychiatry which specifies that all medical students should be taught about the link between domestic violence and mental health problems, and similar recommendations in the Chief Medical Officer’s report on mental health for GP trainees.

‘Our research indicates that domestic violence can damage mental health but also that mental health problems render a woman more vulnerable to domestic violence,’ she says. ‘The medication, the illness itself, living conditions or co-occurring substance misuse can make people more vulnerable. We have also shown that when domestic violence is experienced in pregnancy, not only is the woman at increased risk of mental health problems such as depression, anxiety, or post-traumatic stress disorder, but also her child is at risk of developing behavioural problems by age three.’

Professor Howard has written continuing professional development papers about domestic violence for both psychiatrists and nurses and her work was cited in 2011 best practice guidance from the Department of Health about commissioning services for women and children who experience violence or abuse, and and in the Annual Report of the Chief Medical Officer 2013 which focused on mental health.


  • Howard LM et al. Domestic violence and severe psychiatric disorders: prevalence and interventions. Psychol. Med, 2010 June; 40(6): 881-93
  • Rose D et al. Barriers and Facilitators of Disclosures of Domestic Violence by mental health service users: a qualitative study. British Journal of Psychiatry, 2011; 198: 189-94
  • Trevillion, K., Byford, S., Cary, M., Rose, D., Oram, S., Feder, G., Agnew-Davies, R., Howard, L.M. Linking Abuse and Recovery through Advocacy: an observational study. Epidemiology and Psychiatric Sciences, 2013 Apr; 30: 1-15
  • Flach C et al. Antenatal domestic violence, maternal mental health and subsequent child behaviour: a cohort study. BJOG, 2011 Oct; 118(11): 1383-91
  • Khalifeh H, Johnson S, Osborn D, Borschmann R, Moran P, Howard LM Domestic and sexual violence against people with severe mental illness. Psychol Med, 2014 Sep; 4: 1-12