The assessment of self-harm as a window of opportunity for addressing domestic abuse: invited editorial on Knipe et al

TL;DR

This editorial discusses how self-harm can be a chance to address domestic abuse, highlighting gaps in health service responses.

Contribution

The paper introduces insights into mental health professionals' responses to domestic abuse in emergency settings.

Findings

Mental health professionals fear deeper exploration of domestic abuse in self-harm cases.

There is a tension between identifying and responding to domestic abuse in clinical settings.

Professional training could improve responses to domestic abuse in liaison settings.

Abstract

Domestic abuse harms children and families. Self-harm is associated with exposure to and perpetration of domestic abuse, but research on health service responses to self-harm in the context of domestic abuse is limited. We discuss recent work examining the response of mental health professionals to domestic abuse in the emergency department by Knipe and colleagues. Thematic analysis of interviews with 15 mental health professionals working in consultation and liaison settings helped to construct themes including a fear of deeper exploration and tensions between identification and response (‘between knowing and acting’). The paper raises important issues for quality improvement in responses to self-harm in liaison settings, including balancing time and resources across different management needs (including domestic abuse response) and professional perceptions of their own actions in clinical settings, such as acknowledging harmful behaviour. The paper demonstrates opportunities for strengthening responses to domestic abuse in professional training.

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