Domestic Abuse (inc. DASH/MARAC)

SJT Textbook: Domestic Abuse (inc. DASH/MARAC)

Domestic Abuse MSRA

This guide covers the critical safety protocols for Domestic Abuse MSRA scenarios. In the Professional Dilemmas paper, you must look beyond physical injury to identify “Coercive Control” and “Non-Fatal Strangulation,” understanding that these are predictors of homicide.

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🎯 THE CORE PRINCIPLE

Domestic abuse (DA) includes controlling or coercive, psychological, physical, sexual, and economic abuse between personally connected people aged 16 or over. Children who see, hear, or experience DA are also victims. Health professionals must enquire in private, validate disclosures, and assess risk systematically rather than treating DA as a purely social issue.

In practice, you use DASH to structure risk assessment, involve an Independent Domestic Violence Advocate (IDVA), and refer high-risk cases to a Multi-Agency Risk Assessment Conference (MARAC) for a coordinated safety plan. Non-fatal strangulation is a critical red flag that demands urgent clinical assessment and rapid safeguarding escalation.

In the MSRA SJT, high-scoring answers show you: create a safe, private space; believe and validate; check immediate safety; complete a proportionate DASH; share the minimum necessary information via secure routes; refer to IDVA/MARAC; and document verbatim with a clear, realistic safety plan.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. See the person alone in a private setting and use sensitive, non-judgemental questions to explore DA.
2. Validate and believe disclosures, explicitly stating that abuse is not their fault and that help is available.
3. Assess immediate safety (including risk of returning home), treat injuries, and consider urgent police involvement where there is imminent danger.
4. Complete a proportionate DASH risk checklist, paying special attention to red-flag items such as strangulation, threats to kill, escalation, stalking, pregnancy, and separation.
5. Ask specifically about children, pregnancy, and others in the household and make safeguarding referrals where indicated.
6. Involve an IDVA (or local specialist service) and refer high-risk cases to MARAC based on DASH or professional judgement.
7. Share information lawfully on a need-to-know basis, even without consent when necessary to prevent serious harm, and use secure communication channels.
8. Document disclosures verbatim, record DASH findings, referrals, discussions, and agreed safety measures, including what you have shared, with whom, and why.

Trap answers typically minimise risk, prioritise perceived confidentiality over safety, involve the perpetrator directly, or rely on passive signposting rather than structured risk assessment, lawful sharing, and multi-agency protection.

💬 MODEL PHRASES (Use These in SJT Logic)

* “Because I am worried about serious harm, I may need to share limited information with the right services; I will explain and document what I share and why.”
* “I would like to go through a short risk checklist with you (DASH) to help us understand how dangerous the situation is.”
* “With your agreement, I will involve our specialist advocate (IDVA), and if the risk is high, I will refer your case to MARAC today.”
* “Can we talk about any children at home, so we can make sure they are also safe?”

Screen privately • Acknowledge and validate • Flag children • Evaluate risk (DASH) • Help safety-plan • Options (IDVA, legal, police) • MARAC for high risk • Evidence in clear documentation

📋 QUICK FAQ

When can I share information without consent in DA?
When it is necessary to prevent or reduce serious harm, protect children, or for other safeguarding/public interest reasons. You must share the minimum necessary via secure channels and record your lawful basis and rationale.

What is DASH?
DASH is a structured 24-item risk checklist for Domestic Abuse, Stalking and Honour-based Violence, used by health, police, and specialist services to identify high risk and support MARAC referrals.

What is MARAC?
A Multi-Agency Risk Assessment Conference for high-risk DA cases. Agencies share relevant information and agree a coordinated safety plan to reduce the risk of serious harm or homicide.

Why is non-fatal strangulation so important?
Non-fatal strangulation is strongly associated with an increased risk of serious harm and homicide. It needs urgent clinical assessment (airway, neurological, imaging if indicated) and rapid safeguarding escalation, including police, IDVA, and MARAC involvement.

Should I ever recommend couples counselling in active DA?
No. Couples counselling is unsafe while abuse is ongoing, as it can increase risk and may minimise the perpetrator’s behaviour. Prioritise safety, advocacy, and legal/safeguarding pathways instead.

📚 GMC ANCHOR POINTS

• Disclose relevant information when necessary to protect patients and others from serious harm (GMC: Confidentiality).
• Take prompt action if you believe a patient or child is at risk of abuse or violence (GMC: Good medical practice; Protecting children and young people).
• Work collaboratively with other agencies and respect local safeguarding procedures (GMC: Good medical practice).
• Keep clear, accurate, and contemporaneous records of disclosures, discussions, assessments, decisions, and referrals (GMC: Recording information).
• Treat patients with kindness, respect, and compassion, particularly when they disclose abuse or trauma (GMC: Good medical practice).

💡 MINI PRACTICE SCENARIO

A 32-year-old woman attends with anxiety and vague injuries. When seen alone, she quietly discloses that her partner controls her finances, often shouts at her, and recently “grabbed her by the neck” leaving her unable to speak for a few seconds. Two young children live at home.

Best action: Thank her for telling you, ensure a private and safe environment, assess urgently for non-fatal strangulation, complete a proportionate DASH risk assessment, involve the IDVA, refer to MARAC if high risk, and make safeguarding referrals for the children. Share the minimum necessary information via secure routes and document verbatim with a clear safety plan.
Why: Validates the disclosure, recognises non-fatal strangulation as a serious red flag, uses DASH and MARAC appropriately, safeguards children, and balances lawful information-sharing with detailed documentation.

🎯 KEY TAKEAWAYS

✓ Domestic abuse includes coercive control and economic abuse, not just physical violence.
✓ Private, validating enquiry is essential; never explore DA with the suspected perpetrator present.
✓ DASH structures risk assessment; high scores or professional concern should trigger MARAC and IDVA involvement.
✓ Non-fatal strangulation, threats to kill, escalation, stalking, pregnancy, and separation are key red flags.
✓ Law permits sharing without consent to prevent serious harm or safeguard children; share minimally and record rationale.
✓ Clear, verbatim documentation and a realistic safety plan are central to safe, defensible practice.

🔗 RELATED TOPICS

* → Safeguarding Adults at Risk (Care Act; Section 42)
* → Safeguarding Children and Young People (Child Protection)
* → Information Sharing, UK GDPR, and Safeguarding
* → Capacity, Consent, and Confidentiality in Risk Situations
* → Non-Fatal Strangulation: Assessment and Management

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 29-year-old woman attends your GP surgery with headaches and poor sleep. When you see her alone, she discloses that her partner regularly shouts at her, monitors her phone, controls all the money, and has recently “put his hands round my neck when angry”. There is a 3-year-old child at home. She says she is frightened but begs you not to tell anyone.

Options:
A. Invite her partner into the room so you can “hear both sides” and see if the stories match.
B. Thank her for telling you, reassure her that the abuse is not her fault, and ask if she feels safe to go home tonight.
C. Complete a proportionate DASH risk checklist, paying particular attention to non-fatal strangulation, threats, escalation, and child exposure.
D. Suggest couples counselling to help them “improve communication” and book a joint appointment.
E. Share the full story in a staff WhatsApp group to get colleagues’ advice before doing anything else.
F. With her agreement if possible (or on a safeguarding/public interest basis if she refuses and risk is high), refer to the local IDVA service and make a MARAC referral if indicated; make a children’s safeguarding referral for the 3-year-old.
G. Give a generic leaflet for a helpline and arrange a routine review in a month.
H. Document her disclosure in detail, including verbatim quotes, and record what information you share, with whom, and why.

Example SJT — Rank 5 (best → worst)

In ED, a 26-year-old presents with hoarseness, neck pain, and mild headache after “a row with my boyfriend; he grabbed my throat but I am fine now”. There are no obvious marks. She repeatedly asks you not to “make a fuss” or tell anyone. Two school-aged children are at home with the partner.

Options:
A. Assess urgently for non-fatal strangulation (airway, breathing, neurological status; imaging if indicated), document verbatim, complete a proportionate DASH risk assessment, involve IDVA, consider immediate police involvement and MARAC referral, and make a children’s safeguarding referral.
B. Treat with simple analgesia and discharge her with advice to see her GP, making no record of the assault.
C. Call her partner from ED to get “his side of the story” and update him on her injuries.
D. Suggest that the couple attend joint counselling sessions and provide them with a leaflet.
E. Write “domestic issues?” in the visible electronic summary so the partner can see it on shared records.