Domestic violence has considerable implications for the NHS-particularly in Accident and Emergency departments, primary care and in specialist settings such as maternity services and child and adolescent mental health services. Healthcare costs are considerable; personal costs even more so-perhaps, especially if not acknowledged or recognized.
(Department of Health [DoH] 1997a: 23)
Measuring the impact of domestic violence on health is problematical, if not impossible, and undoubtedly extends beyond the immediacy of physical injury. Growing evidence illustrates how women and children living within a violent and abusive relationship may experience lifelong, adverse, health consequences. Nevertheless, there is an increasing realization that appropriately educated and trained healthcare practitioners can perform a significant role in supporting family members within violent relationships (British Medical Association [BMA] 1999).
Whilst this book mainly focuses on men's violence against women, it should be remembered that violence in intimate partnerships occurs in same-sex relationships, and that women do abuse men, both physically and mentally. Therefore, the following sections could relate to abuse in any intimate relationship.
Virtually every woman in the United Kingdom uses the healthcare system at some point in her life, whether for care for herself or in the role of carer for children or elderly people, putting healthcare practitioners in a unique access position. Nevertheless, many of these women continue to hide the fact that they are being abused at home and perhaps more importantly may never be asked the question. Women who have been abused, access health services with short-, medium- and long-term healthcare needs. A woman may visit her GP's surgery on a regular basis with vague, indeterminate signs and symptoms. Equally, she may visit the Accident and Emergency department with severe bruising and broken bones, or following an episode of deliberate self-harm. It is the role of each health-