'Once you've opened that can of worms': qualitative study to understand why liaison psychiatry staff are not asking about domestic abuse following self-harm

Background Domestic abuse is a significant risk factor for self-harm and suicide. A large proportion of people presenting to healthcare services following self-harm have experienced domestic abuse. In the UK, routine enquiry for domestic abuse is recommended for people who present having self-harmed, but evidence indicates that this is not happening. Aims An exploratory qualitative study to explore liaison psychiatry staff experiences of asking about domestic abuse, including the barriers and challenges to asking. Method Semi-structured qualitative interviews with active adult liaison psychiatry staff in the UK. Recruitment was via online platforms and professional networks. A reflexive thematic analysis of the narratives was carried out. Results Fifteen participants were interviewed across a variety of disciplines (ten nurses, four doctors, one social worker). The generated themes include the following: asking about domestic abuse - the tension between knowing and doing; 'delving deeper' and the fear of making things worse; the entanglement of shame, blame and despondency; domestic abuse was different from other clinical problems (mental illness/substance misuse); and biases, myths and misassumptions guiding practice. Participants indicated the need for better training and education, and clear protocols for eliciting and acting on disclosures. Conclusion There is a clear need to improve the support offered to victim-survivors of domestic abuse who self-harm and present to healthcare services. National implementation of education and training to better equip liaison psychiatry teams with the skills and knowledge to sensitively support victim-survivors of domestic abuse is required.