NICE has published guidance on addressing domestic violence and abuse, making a number of recommendations covering the following: 1

  • planning of services based on need
  • local multi-agency partnerships
  • integrated commissioning
  • appropriate environments and training to encourage disclosure
  • information sharing protocols
  • tailored help to access support
  • specialist services for children and young people, and women who need treatment for mental health problems
  • advice, advocacy and support as part of a comprehensive referral pathway
  • interventions for perpetrators
  • training and continuing professional development for all health and social care staff.

The Identification and Referral to Improve Safety (IRIS) service was established in England in 2007 in response to evidence showing a high prevalence of domestic violence among women attending GP surgeries.  The programme trains primary health care professionals to identify domestic violence and creates a mechanism for women to be referred to specialist domestic violence services. The findings of a 2011 randomised controlled study provides a strong evidence base for the effectiveness of IRIS and have helped to reduce uncertainty about the benefit of training and support interventions in primary care settings for domestic violence. 2 

Women who attended one of the intervention practices were 22 times more likely than those attending control practices (whose staff had not undergone specific training) to have a discussion with their clinician about a referral to an advocate. This resulted in them being six times more likely to be referred to an advocate. Women attending intervention practices were three times more likely than those attending control practices to have a recorded identification of domestic violence and abuse in their medical record.

A report published by SafeLives in 2016 suggests that co-locating Independent Domestic Abuse Advisors (IDVAs) within a hospital setting could significantly improve health and wellbeing outcomes for victims of domestic abuse. 3  This report showed that when compared to community domestic abuse services, hospital IDVAs were more likely to engage with victims who disclose high levels of complex or multiple needs related to mental health and substance misuse.  In addition, the report highlighted that victims who engaged with hospital IDVAs tended to access support at an earlier point (having experienced abuse for an average of 30 months, compared to an average of 36 months for victims engaged with a community service).


  1. National Institute for Clinical Excellence: Public health guidance PH50, “Domestic violence and abuse: multi-agency working (PH50),” 2014.
  2. G. Feder, R. Angnew Davies and K. Baird, “Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial,” The Lancet, vol. 378, no. 9805, pp. 1788-1795, 2011.
  3. SaveLives, “A Cry for Health: why we must invest in domestic abuse services in hospitals,” 2016.