In the past few days alone, I have read multiple headlines describing the acts of men convicted of abusing their female partners. The stories are painfully familiar: physical violence, sexual assault, threats, overt cruelty. We recognise these acts immediately as abuse because they are visible, and fit the abuse narrative we have come to expect.

But these stories represent only a part of what abuse looks like. There is a kind of abuse that is so quiet, so insidious, that it remains almost invisible – to victims, families, and even therapists. My research calls it subtle abuse, and it can leave scars as deep as physical violence.

In my clinical work as a psychotherapist, I sit with women whose lives appear intact from the outside. They are accomplished, capable, and often highly educated. Yet they feel confused and undeserving of care, often suffering from depression and anxiety. When asked what has brought them to therapy, they often say: “I think I’m the problem.” They do not look to their intimate partner relationship as the cause and yet, as they talk, I hear of partners who “need patience,” who “just get stressed,” who seem thoughtful yet leave them walking on eggshells.

Take Anna. She described herself as “too demanding,” “overly critical,” “difficult to love.” She spoke about how patient her husband was, how much he “put up with.” But as I listened, a different story emerged. Her husband was emotionally inconsistent, dismissive of her needs, skilled at reframing events so that she always ended up at fault. He crossed boundaries quietly, persistently. Over time, Anna stopped trusting her own perceptions about her relationship and herself. She became smaller, more cautious, increasingly focused on keeping him comfortable.

What I was witnessing was abuse – a pattern of behaviours acted out by intimate partners on my clients almost entirely invisibly. But, for years, I struggled to articulate this pattern and why I called it abuse. When I spoke with friends and colleagues they would ask, “Aren’t relationships complicated?” or “Isn’t he just unpleasant?” Beneath those questions was a deeper challenge: What makes this abuse?

So, I decided to find out. In my doctoral research into subtle abuse I read about many situations where abuse occurs. I found that across all types of abuse there are four defining elements. Whenever these four elements are present, abuse is happening. And, naming it matters.

1. Abuse is underpinned by power, dominance and control and embedded in a power based societal structure

All abuse stems from a misuse of an imbalance of power. Intimate partner abuse mirrors other abuses of power by individuals and groups, such as the treatment of prisoners of war, the methods of cults, and exploitative workplaces. Much of what has been written about intimate partner abuse links it to how control and power operate in society and, in particular, to society’s pervasive power imbalance: the patriarchy. This accepted power imbalance explains why one partner’s power is normalised and their anger excused while the other partner’s discomfort is minimised.

2. Abuse is based on an attitude of entitlement

Alongside structural power sits entitlement: an individual’s personal misuse of power reflecting their belief that their needs, feelings or preferences carry more weight than their partner’s. When someone in a relationship engages in behaviours that privilege their rights to the detriment of their partner’s, the relationship is not respectful or healthy. When viewed through the lens of entitlement, even loving behaviours can be understood as ways an abuser keeps their partner tied in, confused and controlled.

3. Abuse is ongoing, not incident specific

Our legal and cultural frameworks focus on incidents of abuse over patterns. This is changing as we realise that abusive incidents are actually part of ongoing patterns of behaviour routed in societal and individual abuse of power. Subtle abuse confuses and changes victims through the quiet rewriting of what is reasonable behaviour, the slow normalisation of harm, and the gradual confusion and diminution of the victim. This is why victims so often struggle to explain what is wrong—not because nothing is happening, but because everything is happening incrementally.

4. Abuse creates a personality change process in the victim

The most devastating element is that abuse alters us, and in ways that can be dramatic and long-lasting. Over time, an abuser’s inconsistent behaviour, such as being loving one moment and moody the next, leaves their partner feeling confused. Victims wonder “Is it my fault”. They doubt their instincts, lose confidence and silence their needs.

Women I interviewed described losing connection with their ‘gut’. I believe that this is a large part of why it can take victims so long to realise they are being abused: they can no longer hear the voice inside themselves that is trying to say “This doesn’t feel right.” Women privilege their partner’s perceptions, fear their partner’s undermining, withholding and limiting behaviours, focus increasingly on meeting their partner’s needs. All these are adaptive responses to the ongoing psychological and emotional threat. Women’s subsequent anxiety, depression and low self-esteem is why my clients seek therapy.

This is abuse

When abuse is subtle, an abuser can deny it, friends and family can minimise or dismiss it and victims can be left circling the question “Was it that bad?”. This is why naming subtle abuse matters. When these four elements are present, then the experience is abuse, no matter how subtle that abuse is. It is not a tough relationship with a difficult man. It is abuse.

Recognising subtle abuse can be a profound relief for victims. They are able to tell themselves “It is not my fault. Something was done to me. I am a victim of abuse.” This then allows them to start to reconnect to and trust themselves again. There is hope, and recovery is possible.

For more information about subtle abuse including a questionnaire please visit my website: www.rosemaryparkinson.co.uk

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Our Domestic abuse campaign resources

Domestic violence (DV) doesn’t stop at the hospital door. Doctors, like everyone else, can be victims of physical, sexual, psychological or financial abuse. Because of the demands and culture of medical work, the consequences for clinicians can be especially harmful: compromised wellbeing, impaired performance, risk to patient safety, and career damage if abuse goes unrecognised or unsupported. The good news is help exists, and there are practical, legal and financial steps survivors can take to protect themselves and their assets.

How domestic abuse affects doctors

Doctors facing abuse often suffer the same health and safety harms as other victims: physical injury, anxiety, depression, post-traumatic stress, for example. However, there are additional professional pressures:

• Stigma and fear about disclosure: doctors may worry about being judged, losing professional standing, or triggering workplace reporting that affects their licence or job.

• Impact on work: abuse can cause absence, reduced concentration during clinical care, trouble with on-call duties, or impaired career progression. NHS employers recognise DV as a workplace issue because it often crosses into the working day (stalking, threats, abusive contact at work).

• Safety at work: perpetrators may target the workplace (showing up at clinics, contacting colleagues) creating real safety risks for the doctor and their team.

Because of these overlapping harms, professional bodies such as the BMA have produced reports emphasising that doctors need confidential, non-judgmental support tailored to the healthcare setting.

Financial abuse: an invisible weapon

Economic or financial abuse is common in abusive relationships: it can include controlling bank accounts, restricting access to money, hiding assets, running up debts in the victim’s name, or sabotaging employment. Financial control is a major reason victims stay in or return to abusive relationships. UK regulators, charities and banks have guidance and codes recognising financial abuse as part of DV.

For doctors, financial abuse may take particular forms: a partner misusing access to joint accounts, interfering with mortgages or pensions, or threatening professional liabilities (e.g. threatening to publicise alleged conduct to employers or regulators). Recognising financial control early is crucial to preserving future independence.

Immediate protective steps (safety first)

If you (or a colleague) are in immediate danger call 999. For non-emergency safety planning, consider:

1. Create a safety plan — Safe contacts, discreet exit plans, keep important documents somewhere safe (or make copies). Use safe devices when searching for help online. Women’s Aid and Refuge provide clear guidance on “covering your tracks”.

2. Tell your employer on your terms — Occupational Health, HR, or a trusted manager can put workplace safety measures in place (change rotas, call-screening, security). NHS Employers and many trusts have workforce policies to support staff.

3. Secure finances — If safe to do so, freeze or separate joint accounts, change passwords and email addresses, open a separate bank account, and ask your bank to note your vulnerability on the file. Many banks and specialist services will work confidentially with victims to limit access or set safeguards. Surviving Economic Abuse and charity guidance explain how banks can help.

4. Legal protection — Consider applying for a non-molestation order or occupation order to keep an abuser away from you or the home. These are injunctions available through family courts; emergency applications are possible. Government guidance explains how injunctions work.

Separation and divorce: financial implications for doctors

When a relationship ends, doctors should understand the likely financial landscape:

• Division of assets: In England & Wales, the courts aim for a fair division based on needs, resources (including pensions), and contributions. This is a discretionary test, not a strict 50:50 split, and judges consider children, health, and earning capacity. Mediation is usually required before going to court unless domestic abuse makes mediation inappropriate. Government and Citizens Advice pages explain these steps.

• Pensions: A doctor’s pension can be a significant marital asset. It can be split or offset. NHSBSA has further information on how your NHS Pension can be affected by divorce.

• Maintenance: Spousal maintenance (post-separation) depends on need and the parties’ ability to pay. If you were married, you may be eligible; unmarried cohabitants have fewer automatic claims. Citizens Advice explains entitlement and practical steps.

• Debts and joint accounts: Shared debts remain joint liabilities unless a court order changes that. Close joint accounts where possible or freeze them and notify banks of the risk. Citizens Advice advises freezing/closing joint accounts to prevent misuse.

Listen to the Medics Money podcast episode on divorce for more info

Protecting assets proactively

• Document everything: Keep records of income, assets, bank statements and any financial control or threats. This helps legal advisers and courts.

• Get tailored legal advice early: Family law solicitors experienced in financial abuse and high-value professional assets (like medical pensions and property) are invaluable. If you cannot afford a solicitor, Citizens Advice and Legal Aid eligibility pages can help determine options.

• Prenuptial / postnuptial agreements: Prenups are not automatically binding in England & Wales but can be influential if entered into freely with full disclosure and independent legal advice. Recent parliamentary and Law Commission discussions mean their role is evolving, take specialist advice if you’re considering one.

• Formalising mediated agreements: Agreements reached in mediation should be made legally binding (a consent order) and approved by a court where appropriate; otherwise they are not automatically enforceable. Mediate UK

Where doctors can reach out (see our resources section)

• Refuge / National Domestic Abuse Helpline: 24/7 support and refuge access.

• Women’s Aid: information, safety tools and local services. Cover-your-tracks guidance online.

• BMA: guidance and workplace recommendations for doctors; reports on domestic abuse in the health profession. Confidential advice resources may be available through local BMA reps.

• NHS Occupational Health / HR / local Trust DV policies: speak to Occupational Health or HR for workplace safety adjustments; many trusts have domestic abuse workforce policies.

• Surviving Economic Abuse / MoneyHelper / Citizens Advice: practical financial advice and steps to protect money, pensions, and property.

• Family mediation services / Family Mediation Council: mediation options and registered mediators (unless mediation is unsafe).

• Professional indemnity/support bodies — Medical Defence Union (MDU), Medical Protection Society (MPS) and your regulator’s guidance can help with professional worries about disclosure and fitness to practise (contact them confidentially). (Search your provider for member helplines.)

Closing note and a safety reminder

If you are a doctor experiencing abuse, you are not alone, and your profession does not disqualify you from support. Start with immediate safety, then bring in occupational health, a trusted colleague, and specialist charities who understand confidentiality and risk. For legal and financial decisions, get specialist family law and pensions advice, and consider practical safeguards like freezing joint accounts, documenting financial control, and seeking injunctions if necessary. This article provides general information and signposts authoritative UK resources; it is not a substitute for legal advice. If you are in immediate danger dial 999.

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Of all the professions in public service, the judiciary remains the only one shielded from meaningful accountability.

Although judges are still publicly viewed as one of Britain’s most trusted professions,¹ that perception shifts dramatically when we listen to those who have been through the judicial system.
The Ministry of Justice’s Harm Panel identified systemic failures in how the family courts handle domestic abuse and risk to children.² The UN Special Rapporteur on Violence Against Women and Girls has criticised the UK family courts.³ The Domestic Abuse Commissioner’s 2025 study found evidence of domestic abuse in 87 per cent of closed case files and 73 per cent of observed hearings, yet it was often not treated as a central issue.⁴ The Victims’ Commissioner has repeatedly warned that survivors have little confidence the courts will protect them and in the 2024 Annual Survey, fewer than half of victims said they had confidence in the criminal justice system.⁵ By contrast, over 90 per cent of patients using GP services report confidence in their practice.⁶

Why is it that so many of those who encounter the justice system first-hand emerge disillusioned? What are healthcare professionals doing that judges are not?

Safety-netting and Differential Diagnoses

In safety-critical professions, second opinions and reflective review are routine.
Doctors make working diagnoses, agree management plans, and safety-net: patients are told what to expect, and encouraged to return if symptoms worsen or fail to improve. If that happens, we re-examine the differential diagnosis.
We reconsider whether the original assessment was sound, research alternatives, and consult colleagues when needed. Treatment plans are revised and individualised. We are trained to assume that our first diagnosis may be wrong - and to revisit it without ego or defensiveness.

Not so in the judiciary.

A judge’s default starting point is that all previous judgments were correct. Errors are therefore rarely revisited and frequently perpetuated. Those who raise concerns are treated as ‘difficult’ and urged to ‘accept the judge’s decision’. There is little redress.

Bizarrely, judges are not required to consider all the relevant evidence before reaching a conclusion. Judicial discretion gives extraordinary latitude: they may restrict oral evidence, exclude documents, or rely on selective material. In any other safeguarding profession, making decisions without reviewing the full evidence would be negligence.

Appeal is theoretically available, but vanishingly rare. Fewer than one in a thousand cases reach an appeal court, and of those that do, only around 5% succeed. Appeal judges have no statutory obligation to correct error.

This creates a professional landscape where judges believe they are infallible and are permitted to act as if error were impossible.

Continuing Professional Development and Evidence-Based Practice

Most of the currently serving judges were born before women could obtain a mortgage or open a bank account without a man’s signature. Yet there is no requirement for judges to keep pace with changes in the law, safeguarding practice, or societal norms.

The result is a profession whose culture and assumptions do not necessarily evolve at the speed of the society it governs.

Judges are not required to demonstrate competence. The Judicial College provides training, but attendance is largely discretionary and unmonitored. A family judge may determine cases involving coercive control, trauma, neurodiversity, or child safeguarding without ever receiving specialist training in any of these areas. There is no requirement that cases be heard by judges with relevant expertise.

In medicine, practising without current, evidence-based knowledge would breach professional standards. In the judiciary, it is routine.

Unlike the judiciary, modern healthcare operates on an evidence-based model. NICE guidelines standardise assessment, diagnosis and treatment so that decisions are transparent, accountable and consistent across the country. Deviating from the evidence requires justification. Judges, however, are not required to anchor their decisions in any equivalent framework. Findings of fact, assessments of risk and decisions about child safety can vary dramatically between judges, not because the evidence differs, but because the individual decision-maker does.

Serious-case reviews and media investigations have repeatedly identified unsafe judicial decisions in child-safeguarding cases^7-9 yet no judge has ever been subject to independent investigation or retraining as a result. Even the recent national outcry over the Sara Sharif review - which warned of unsafe decision-making and failures to recognise clear risk - has not shifted judicial practice, as illustrated by the case reported just this week by Suzanne Martin in which overnight contact was granted to a father despite repeated family court findings of non-fatal strangulation.¹⁴

Independent Regulation, Accountability and Indemnity Cover

Healthcare is not only evidence-based - it is accountable. Doctors are held to the Bolam test: whether a responsible body of professionals would have acted similarly. It is not a high bar; it is the lowest acceptable standard of competence. The judiciary, by contrast, have no independent regulatory body and are almost entirely insulated from external accountability.

The judiciary today stands where medicine stood before the Shipman Inquiry.
When Dame Janet Smith examined the General Medical Council’s failure to act on repeated warnings about Dr Harold Shipman, she found an organisation ‘designed to look after the interests of doctors, not patients.’ She described it as secretive, self-protective, biased in favour of its members, and fundamentally flawed in ways that placed professional reputation above public safety.

The Inquiry forced a complete overhaul of medical regulation: greater lay involvement, transparent hearings, routine revalidation, a public complaints helpline, and statutory accountability to Parliament. Modern medical regulation occurs via the GMC - with Good Medical Practice making competence and accountability enforceable.¹⁰ Doctors must maintain up-to-date knowledge, practise safely, and hold adequate indemnity cover. The Nursing and Midwifery Council imposes the same principles: registrants must have appropriate indemnity arrangements and comply with explicit behavioural standards, with the power to remove those who do not.¹¹ Similar frameworks govern many other professions including dentistry, veterinary medicine, engineering and teaching.

Accountability in healthcare also extends to colleagues. Good Medical Practice states:

‘You must take prompt action if you think patient safety is or may be seriously compromised by the practice or behaviour of a colleague.’

This culture of peer responsibility is surely a cornerstone of professional integrity.

The Judiciary’s Regulatory Void

Judicial oversight is standard across comparable democracies; the UK is now an outlier for maintaining a judiciary with no independent regulator.

The Guide to Judicial Conduct is not a code, contains no enforceable rules, and relies entirely on individual judges to monitor their own compliance.¹² The upcoming Hillsborough Law demonstrates that Government accepts there must be a statutory duty of candour on public authorities; yet the judiciary remains excluded from this regime. Complaints are handled by the Judicial Conduct Investigations Office - an internal body where other judges examine behaviour but not competence, bias or error. Its decisions are made in private with minimal sanctions.¹³

Judges enjoy complete statutory immunity from civil suit, even for gross negligence or misconduct. Those harmed by judicial error have no right to compensation and can seek redress only through expensive, inaccessible appeals.

Finally, there is no culture of collegial responsibility. In healthcare and teaching, practitioners must act when a colleague’s conduct endangers the public; in the judiciary, closing ranks is considered loyalty, not misconduct. Whistleblowing triggers disciplinary action.

The result is predictable: judicial knowledge gaps endure and complaints disappear into opaque processes that protect the institution rather than the public it serves.

The implications of this unregulated culture are reinforced in the family court by a lack of transparency. Hearings are private, reporting is restricted, and judgments are inconsistently published. Even recent transparency pilots permit only limited media attendance, with parents, professionals and victims remaining unable to speak about their own cases without risking imprisonment. No other public institution in the UK operates with so little external scrutiny.

Lessons from Healthcare Professionals

If the judiciary wishes to retain public trust, it must adopt the principles that underpin every genuinely professional vocation - principles long established in healthcare and mirrored across teaching, engineering and other regulated fields:

1. Revalidation and continuing assessment – periodic review of competence and conduct.

2. External oversight – an independent regulator with lay participation and sanctioning powers.

3. A duty of candour – obligation to acknowledge and correct error.

4. Transparent reporting – publication of complaint data and outcomes.

5. Professional indemnity or equivalent redress – a mechanism to compensate those harmed by judicial failings.

6. Specialist training and allocation – mandatory CPD and assignment only within areas of demonstrated expertise.

7. Collegial accountability – expectation to act when peers fall below standards.

These are not threats to judicial independence; they are the conditions of legitimacy in every other trusted profession.

Earning, Not Assuming, Trust

Eighty per cent of people still trust judges - but that represents faith in the idea of justice, not in judicial decisions themselves.
Healthcare learned that trust must be earned through transparency and external scrutiny. The judiciary needs to do the same.

In my professional life, I have sworn both the Hippocratic oath and the Judicial oath. There is only one profession I am proud to belong to.

References

1. Ipsos Veracity Index - Ipsos (2024) Ipsos Veracity Index 2024: Trust in Professions. London: Ipsos MORI. https://www.ipsos.com/en-uk/ipsos-veracity-index-2024

2. Ministry of Justice Harm Panel (2020) – Ministry of Justice (2020). Assessing Risk of Harm to Children and Parents in Private Law Children Cases. https://www.gov.uk/government/consultations/assessing-risk-of-harm-to-children-and-parents-in-private-law-children-cases

3. UN Special Rapporteur on Violence Against Women and Girls, Reem Alsalem (2023–2024 statements). Report to the Human Rights Council https://digitallibrary.un.org/record/4086522?v=pdf

4. Domestic Abuse Commissioner (2025). Domestic Abuse in the Family Courts: An Observational and File-Review Study, conducted with Loughborough University and UCL. https://www.gov.uk/government/publications/everyday-business-addressing-domestic-abuse-in-the-family-court

5. Victims’ Commissioner Annual Survey - Victims’ Commissioner for England and Wales (2024) Victims’ Voice Annual Survey 2024. London: Office of the Victims’ Commissioner.

https://victimscommissioner.org.uk

6. NHS England (2022) GP Patient Survey 2022 results. London: NHS England. https://www.england.nhs.uk/statistics/statistical-work-areas/gp-patient-survey/

7. The Bureau of Investigative Journalism (2025) Domestic Abuse in the Family Courts: Evidence that domestic abuse features in nine out of ten cases, The Bureau of Investigative Journalism. https://www.thebureauinvestigates.com/stories/2025-10-13/domestic-abuse-features-in-nine-out-of-10-family-court-cases

8. “Paul and Jack were murdered by their abusive father. Why had the family courts granted him contact?” – The Guardian, 1 Oct 2024. https://www.theguardian.com/society/2024/oct/01/paul-and-jack-were-murdered-by-their-abusive-father-why-had-the-family-courts-granted-him-contact

9. Samuel, M. (2025) ‘Sara Sharif murder: safeguarding failures over many years laid basis for severe abuse, review finds’, Community Care, 14 Nov. https://www.communitycare.co.uk/2025/11/14/sara-sharif-murder-safeguarding-failures-over-many-years-laid-basis-for-severe-abuse-review-finds

10. General Medical Council (2024) Good Medical Practice. London: GMC.
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

11. Nursing and Midwifery Council Professional Standards Code. https://www.nmc.org.uk/standards/code/

12. Judicial Office (2023) Guide to Judicial Conduct. London: Judiciary of England and Wales. https://www.judiciary.uk/guidance-and-resources/guide-to-judicial-conduct

13. Judicial Conduct Investigations Office (2025) Annual Report 2024–2025. London: JCIO.

https://www.complaints.judicialconduct.gov.uk/

14. Martin, S. (2025) ‘Court orders overnight contact with father after findings of non-fatal strangulation’, Suzanne Martin Journalist, 21 November.

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Abuse rarely ends at separation – often it intensifies in the form of post‑separation coercive or controlling behaviour. Although the Domestic Abuse Act 2021 and the Home Office guidance recognise post‑separation abuse^1,2, frontline agencies still struggle to identify or respond to it.

What post‑separation abuse looks like

Post‑separation abuse is continued coercive control using children, systems and institutions as tools of dominance. Abusers continue their campaign for domination via paperwork with multiple court hearings, emails, solicitor communications and child maintenance review and tribunals. It typically involves:

• Financial/administrative abuse - obstructing child‑maintenance, passports, schooling or paperwork to exhaust and destabilise.

• Parental/relational abuse - using contact to intimidate, interrogate or undermine, or forcing children to relay information.

• Reputational abuse - alleging ‘alienation’ or portraying the protective parent as unstable or hostile.

• Systems/institutional abuse - manipulating police, social care or schools so professionals unknowingly further the perpetrator’s control.

• Surveillance/monitoring - misusing parental access to track movements or gather information.

In the words of survivors:

“When he first left he would send me 50+ messages a day. If I didn’t respond he would send the exact same message over and over until I replied.”

“He blocked the sale of the family home keeping me trapped in a house I couldn’t afford”

“He accused my parents of child abuse and reported them to social services”

“His post-separation abuse caused my mental health to suffer. Then he told professionals I was unstable and he was the better parent. They gave him custody.”

“He threatened to stab me and my 15 year old son in the face because I wouldn’t allow him access to our daughter at 11pm – she was 2.”

“He got custody in family court. Then stopped my contact for the 4^th time because my partner said my child’s name, in his own home.”

“He had me arrested when I was trying to see our child”

“I found an ‘anonymous’ unlit petrol bomb on my doorstep with my name written on it in his handwriting.”

How institutions become unwitting enablers

Each public body treats the family court as the final authority. Once an order exists, agencies defer - assuming the evidence was fully examined and risk properly assessed. That assumption is often wrong.

• Family courts continue to apply the presumption of parental involvement, reframing protective behaviour as obstruction even where abuse is known or suspected.⁵

• The Child Maintenance Service forces long‑term financial entanglement, enabling ongoing economic control.

• Police frequently classify renewed coercion or breaches as a ‘civil matter.’

• Courts describe abuse as ‘historic’ or ‘not relevant to the children’s welfare.’

• Children’s Services reframe coercive control as ‘high conflict’ and prioritise paternal contact over safety.

• Schools see a court order and stand back, unwilling to contradict it.

There is no standard risk‑assessment tool, no trigger for review when new abuse emerges post‑order, and no expectation that agencies question judicial conclusions. Each service acts lawfully within its silo – yet collectively, the system enables ongoing coercion until the children reach 18.

For victims, the result is devastating: every professional interaction becomes a continuation of the perpetrator’s control, legitimised by the state.

How Family Court Compounds Child Harm

The family court does not merely fail to safeguard abused children – it generates a national burden of harm that accumulates year on year. Around 60,000 children enter private law proceedings annually with roughly 90 % of cases containing credible allegations of abuse, largely coercive and controlling behaviour³. With overnight contact being ordered in around 60 % of cases, approximately 30,000 children each year suffer court‑ordered exposure to post‑separation coercive control.

These children do not simply ‘move on’. Many require repeated intervention from Children’s Services, CAMHS, GPs, schools, police and youth justice to cope with trauma, anxiety, behavioural crises and recurrent safeguarding incidents. Over a decade, more than 300,000 children will have been exposed to court‑mandated post‑separation abuse - representing up to 1.6 million child‑years of coercive control.

“He turned up and tried to get in the house, shouted at the children and then pissed on the rhubarb in direct view of my child’s room. Then sat outside in his car threatening to come back whenever he liked – unless I submitted to his requests.”

“He stole a Pomeranian - literally grabbed it off the street - and gave it as a present to our son. I had to return it when the missing posters went up. I was left to deal with an upset child.”

“He bought mixed sex bunnies, failed to have them neutered and when they died from over-breeding the children were devastated.”

“He blocked an autism assessment, leaving my child with unmet needs.”

The impact does not stay within the family court. It spills into every major public service. Children living under coercive control show markedly higher rates of mental‑health need, safeguarding referrals, school breakdown, youth offending, emergency‑healthcare use and crisis interventions. Mothers attempting to protect them often require GP care, mental‑health support, police involvement, IDVA services, housing assistance and prolonged social‑care oversight.

This creates a vast and unnecessary financial burden on the state. Domestic abuse currently costs the UK an estimated £78 billion per year⁴, with billions falling on the NHS, policing, social care and education. By repeatedly placing children back into unsafe contact arrangements, the family court does not reduce this cost –it multiplies it, generating a conveyor belt of avoidable trauma that pushes tens of thousands of women and children into long‑term, high‑cost public‑sector dependency.

If the family court took a zero‑tolerance approach to domestic abuse and stopped facilitating post‑separation abuse, the state could prevent an enormous proportion of this expenditure. Ending court‑mandated coercive control would not only protect children; it would save government agencies billions.

Reforming the Response: Zero Tolerance – Start with Coercive Control

Every family-court case involving domestic-abuse allegations must begin with a coercive-control assessment and a zero-tolerance approach to perpetrators. The simplest starting question is often the most revealing: who controls the money?

A coherent national response would include:

1. Mandatory coercive-control assessments at the outset of all cases involving domestic-abuse allegations.

2. Immediate safeguarding action where coercive control is identified – including no child contact and removal of the perpetrator’s parental responsibility.

3. Automatic lifelong restraining orders protecting victim-survivors and children across civil and criminal jurisdictions.

4. Specialist judicial and professional training and external accountability so that patterns of control, not isolated incidents, drive findings and protective measures.

Coercive control is the underlying mechanism of most domestic abuse⁶, yet our courts still treat it as peripheral, focusing on incidents rather than patterns. Recognising and disrupting coercive control early would reduce harm to women and children and cut the enormous financial burden on the NHS, policing, education and social care.

Abuse will end only when the system stops enabling it: sign this letter requesting safeguarding training for the judiciary

References

1. Domestic Abuse Act 2021 https://www.legislation.gov.uk/ukpga/2021/17/contents/enacted

2. Home Office (2023) Controlling or Coercive Behaviour: Statutory Guidance Framework. GOV.UK. https://www.gov.uk/government/publications/controlling-or-coercive-behaviour-statutory-guidance-framework

3. Domestic Abuse Commissioner, “Everyday Business: Addressing Domestic Abuse in the Family Court” (2024).

https://www.gov.uk/government/publications/everyday-business-addressing-domestic-abuse-in-the-family-court

4. Home Office (2019), The Economic and Social Costs of Domestic Abuse.https://www.gov.uk/government/publications/the-economic-and-social-costs-of-domestic-abuse

5. Ministry of Justice (2020), Assessing Risk of Harm to Children and Parents in Private Law Children Cases (“The Harm Panel Report”). https://www.gov.uk/government/consultations/assessing-risk-of-harm-to-children-and-parents-in-private-law-children-cases

6. Stark, E. (2007) Coercive Control: How Men Entrap Women in Personal Life. Oxford: Oxford University Press.

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Find out more about NHS Domestic Abuse Awareness Day and our resources: https://dauk.org/campaigns/compassionate-culture/nhs-domestic-abuse-awareness-day/

About the speakers:

Dr Becky Cox

Becky is a GP specialist working in gynaecology and an academic GP with an interest in violence against women. As a survivor of domestic abuse as well as sexual harassment and assault at work she advocates and campaigns to end the culture of misogyny in healthcare. From lecturing at Oxford University to medical students on domestic abuse, writing and publishing scientific papers, national and international speaking, and charitable work she has worked to bring a focus to violence against women in the healthcare sector. From sharing her own experience of sexual violence and abuse she recognises the power of survivor stories in bringing forth change.

https://www.survivinginscrubs.co.uk

Dr Sarah Jacques

Sarah is co-GP lead of DAUK and co-opted member for campaigns for MWF. She is a GP with 22 years of experience. In August 2022, Sarah experienced a significant breakdown due to burnout and made the difficult decision to step away from clinical practice. She continued to advocate for general practice and the NHS, realising more people took notice because she was no longer working as a doctor. She has now recovered enough to work as a part-time salaried GP.

‘This is coercive control’. The words from my solicitor still echo in my mind. It was time to face reality and stop suppressing the inner voice that told me something was wrong in my relationship. I had been struggling for some time with the increasingly aggressive behaviour from my partner, but I had felt completely trapped and powerless. I was unable to shake the fear that my children could be taken away from me. My awareness of the reality of family courts and how victims can be treated added to this. I see this and hear about this regularly in my role as a healthcare professional supporting victims of abuse.

I received kindness and compassion from many work colleagues, but this was drowned out by the response from within my GP partnership, one of dismissal, judgement and and feeling othered. Suggestions were made that I was to blame, even querying whether my sex life might have had anything to do with it. There was no confidentiality and at no point was I ever asked about my experiences from a safeguarding perspective. I felt disbelieved. This compounded the trauma and I started to feel deeply unsafe at work. I found it increasingly challenging to trust people and I started to withdraw. I was seeing a therapist regularly, who helped me to understand that I was traumatized, but healing is slow whilst trauma is ongoing. I had no choice but to consider an exit plan from my GP partnership. Again, I felt trapped. I had started to recognise the same insidious behaviours in my partnership, but over time these had become more overt, isolating me from colleagues and this had led to me feeling bullied and alone.

As a now single mother, the additional stress of loss of income was enormous. Leaving my partnership was just as traumatic as leaving my relationship with echoes of post-separation abuse and feeling that I had failed my colleagues and patients. Like in my relationship, I also felt disbelieved by external authorities, which was painful. The sexist cultural norms and systemic forces that perpetuated abuse in my home were mirrored in my workplace, forming a deep psychological wound.

In my own relationship, coercive control took many forms: volatile outbursts, days of silence, withdrawal of affection, financial abuse, criticism of my parenting, humiliation and gaslighting. There were many tactics, a pattern of abuse that left me traumatised and exhausted. My self-esteem seeped away, and I was constantly treading on eggshells. My trauma responses such as overworking, trying to keep the peace and dissociating were misinterpreted as the problem, rather than recognised survival strategies in the face of abuse.

In my GP partnership, I experienced similar power dynamics from a male colleague: exclusion from decision-making and information, being denied access to business finance, a disproportionate workload, bullying, humiliation and sexual harassment. Gaslighting was another common feature, drawing others in and making me out to be the problem for being ‘emotional’ and unprofessional when I attempted to set boundaries. Once again, my coping mechanisms, such as working hard, staying quiet and trying to avoid conflict were framed as weaknesses. I was ‘too nice’.

Over time I have started to heal. With support from family and friends, therapy and EMDR. My fragmented memory has been restored with added wisdom. I now understand the parallel processes involved and the profound impact of trauma on mind, body and behaviour. I have been rebuilding my life with hope and I have acknowledged the strength and resilience it took to navigate those harmful situations. I see this strength in my patients and my experience has brought heightened insight and compassion towards those in similar situations. I hope in future to be a strong advocate for trauma-informed care and compassionate workplace culture. Due to the high prevalence of abuse in society, I can only hope that increased awareness brings change. I hope the NHS can strive towards creating a world where it cannot thrive so easily, both at home and at work.

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Financial abuse is rooted in the desire of one partner to have power and control over the other. A partner who chooses to abuse may control their partner’s finances or their ability to provide for themselves’ . Ninety five percent of women who experience domestic abuse also report experiencing financial (or economic) abuse.

The Domestic Abuse Intervention Project in Duluth, MN. created the Power and Control Wheel which is widely used to help recognise domestic violence. The wheel diagram illustrates tactics abusive partners use to keep survivors in a relationship - and tactics that they use to maintain their control over their partner. It was this wheel that my therapist used to shed light on how many ways my ex partner had abused me.

It took me a long time to recognise that I was in an abusive relationship. My stereotypical image for what I thought victims of domestic violence looked like was in no way connected to how I saw myself. And in the same way, my image of a victim of financial abuse was not connected to how I saw myself. But I was abused. And this abuse was not recognised by myself, my friends or the court system who should have tried to protect me.

Insidious start

My abuser’s tactics were those of degradation and a total disregard of anyone elses interests other than his own. He entered the marriage with no finances and limited job options. I was in my house officer years, with my own property and good job prospects. As soon as we were married he thought of all of our finances as his own. Within a year of being married, he wanted to sell my premarital home and use all my savings to move city and start a business. He wanted to relocate to another country with no thought about how I could continue with my general practice training, and he thought it was entirely unreasonable that he should have to go to work to contribute to our joint income.

Any of these things could have been justified and reasonable, had there been an agreement between us, but his response to me not following his desires was to degrade me and complain of feeling trapped. It was impossible to have any sensible discussions with him about finances so I continued to ensure that there was enough money coming into our account to cover our spending.

Increasing the costs

Within a couple of years we had moved home to a larger property with a larger mortgage. The stamp duty wiped the remains of any savings. Although my partner had been the instigator for the move, once the responsibility of paying the mortgage became a reality he claimed he didn’t care about living where we lived and dissolved himself from any responsiblity to meet the bills. I naively believed him and continued to ensure that bills were met - it was easier to find an extra shift to pay for a broken washing machine than to have a sensible financial discussion with him.

Throughout this time he kept Amazon in business with his daily delivery of things he wanted. He covered himself with private health insurance and was able to fund multiple ‘health’ remedies for himself. When challenged about this, he would shame me in front of our friends, justifying that his health was ‘priceless’ and how could I limit what he could spend on his ‘health’. The health insurance did not cover myself or our kids.

He reduced his working hours so he could train to progress his photography and counselling career. Our babies were born and I went back to work much sooner than I wanted to cover the bills. At no point did he increase his work to provide for his growing family. Our third boy was born and we calculated how much money he would need to bring home to allow me to stay at home for longer with our small children. He said he would increase his earnings to facilitate this but he didnt. In the end - as always- it was easier for me to work to bring in the finances than negotiate a reasonable arrangement with him.

Is it so bad?

In many ways I had the family I had always dreamed of. I had a partner that was a bit crap - but didnt everybody? I was able to work and provide and my partner seemed to be able to live the life that he wanted. I might have chosen to live life differently but my job was interesting and well paid and we were able to do the things we wanted. It was important to me that my kids grew up with good local schools in an area where I felt safe. It was important to me that if our kids wanted to go to university, then we would have some funds to support them, and that my pension ensured that in later years I would be financially secure. My ex claimed none of those things were important - he was developing a career where he intended to work long into retirement, he didnt think that providing financial support for his children was a necessary or positive thing, he thought that living in a rougher area with more challenging schools, would ‘build resilience’. It seemed that if I wanted things different to what he wanted then I would need to be responsible for the finances.

Tip of the iceberg

He never recognised my efforts - he still had expectations that I would clean. He would tell me that ‘I domesticated him’ by asking him to contribute to the housework. He complained bitterly about us having a cleaner. He complained when I was tired at the end of my shifts or if I ever had to stay at work late. He considered the evenings that I was at work as evenings that I was out - and so did not account for those when he negotiated free time for himself. At no point was he ever grateful for the money that I brought in and I tried not to mention the inequality as he found this ‘emasculating’. He did not limit what he spent on himself and if I bought something for myself - he would then buy something bigger. This had the effect of controlling my spending. Throughout this time he described me as the ‘soap in his bubblebath’ - that I restricted the way he could live and took his joy away.

Financial abuse was only part of the story. I now see that I was emotionally abused, silenced and made to feel inadequate. So I just kept providing for what I thought was my ‘perfect family’ whilst he took more and more.

If I had been educated in abuse then maybe I would have recognised what was happening and maybe I could have predicted the ending. I wonder if people around me had started to be concerned - I remember my partner being described as ‘an accessory that I couldnt afford to keep’ and comments were made that he ‘lived the life of Riley’. However, my boys were thriving and I was fulfilled, providing for them and creating a home environment where I thought everyone could flourish.

Pandemic pressures

Covid came. I worked intensely to clear the decks for an emerging health crisis, I helped the kids with their homeschooling. My partner didnt believe that home schooling was necessary. He stood on the doorstep and cheered every Thursday for all the key workers who were working in the pandemic but didnt support me. The kids went to school on the days that I was at work, but this just meant that he didnt have to care for them and had protected time for himself.

One day, totally out of the blue, he left - claiming that he couldnt be his authentic self in a relationship which required commitment and compromise. I was left realling, emotionally uprooted and trying to make sense of the situation.

The Family Courts

Divorce and Financial proceedings followed rapidly. He refused to have any reasonable discussion about finances and pushed our case through the courts. He took me through the child courts - making false allegations and ensuring that the process was as drama-filled as possible. I was heartbroken, not sleeping, and definitely not in a fair state to represent myself effectively. He pushed me for more than half of the house and half of my pension. He had no pension. An unequal settlement was reached, where he received more than half of everything. He seemed fully entertained by the court process and the law says that he is entitled to half of the marital income so he had nothing to lose. His entirely different views on the values of finances or his contributions to family life were not taken into account. The law wants to ensure that each parent can move forward and the outcome of the case was that each of us had a home where we could care for the boys. Throughout the case he racked up as many court costs for me as he could. At no point did he consider the boys and their stability.

However the settlement passed and I was able to move forward. I still found that, with a few more shifts and with careful money management I was able to continue to provide a safe home for the boys.

Post-separation abuse

I thought that I was now free of the control that I had lived under in the marriage. However, I was totally unaware about how the child maintenance system can be used to control, manipulate and abuse. A quick glance at the google reviews of the service highlight that it is a service that is not fit for purpose. In many cases it facilitates ongoing abuse and control and this was certainly the case for me. He submitted a false claim to the service that one of the boys was living with him for more than half the time. He claimed that he was the main carer and expected me to pay. An inadequate system meant that his claim was not closed down when it should have been, and I received multiple demands to pay and weekly threats from the child maintenance system advising me that if the money wasn’t paid then I would face further court action. The case was finally closed and I owed nothing. However there was no recognition of the stress caused.

Moving forward

Time has passed and the boys have grown. Now they have more choice they spend most of their time at mine. My ex contributes nothing and I wont go through the child maintenance system again due to the distress that it has caused. I hope one day that my boys will want to go to uni - and I hope that I will be in a position to support them - but i know that they will not receive a penny from my Ex.

I turned 50 last week. It’s five years ago now that he left. I had a birthday party but for me it was really a celebration of having got up again. In many ways I feel I should be dead in a ditch. I have been treated abhorently and my ex has abused me as much as he has had the ability to do so. I am not dead, neither am I in a shelter for domestic abuse victims and neither do I fit the image that I have of domestic abuse survivors. But it was abuse. I wonder how many other professional women have been financially abused like I have but because we don’t fit the mould it passes unrecognised?

Help available here: Surviving economic abuse

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NHS Domestic Abuse Awareness Day is Wednesday 10 December - Follow our campaign and see how you can get involved

Domestic abuse is common among healthcare workers - affecting more than half of participants in a recent UK survey.¹ Doctors are also mandated reporters, legally and ethically obliged to act when adults or children are exposed to abuse. We therefore occupy a unique dual position in safeguarding: professionally responsible for referring victims, yet personally vulnerable when those systems fail.

For many doctors, the abuse most likely to be experienced is not physical violence but coercive control - a sustained pattern of psychological and emotional domination made up of small, often imperceptible acts that isolate, intimidate, and erode autonomy.² It is the foundation upon which most other forms of domestic abuse are built.⁷

Victims - particularly educated, professional women - are often entrapped not by overt violence, but by the progressive erosion of confidence, freedom, and credibility through systematic manipulation and control. Coercive control rarely ends with separation; it frequently intensifies afterwards, as perpetrators maintain dominance through child contact, financial control, and legal processes.

Safeguarding should mean protection from harm. In England, it too often means something else: referral into a system that misidentifies risk, rewards the perpetrator, and perpetuates post-separation abuse.

Knowledge gaps and myths

Social workers are not trained in coercive and controlling behaviour (CCB). A recent BBC investigation found that in England, fewer than one in ten had received specific training on coercive control.⁴ This results in victims being misclassified as ‘hostile,’ ‘high-conflict,’ or even responsible for the abuse they are trying to escape. Such misunderstandings are reinforced by a series of deeply rooted myths,^5,6 among them the belief that:

· the relationship itself is the problem - rather than the perpetrator’s attitudes of entitlement and control

· domestic abuse consists of isolated incidents. In reality, coercive control is continuous; what professionals perceive as “episodes” are simply flare-ups within a daily regime of fear and compliance

· mutual abuse is common. Both partners cannot be dominant; what is often mislabelled as ‘mutual conflict’ is more accurately a victim’s self-defence or resistance

· victims are overreacting to minor things - coercive control operates through hundreds of small acts that cumulatively destroy autonomy - a form of death by a thousand cuts

· children’s welfare will be diminished if they do not have a relationship with their father – even if he is an abuser

· non-physical abuse is somehow less serious – coercive control is now recognised by the UN as a form of torture ⁸

The Mother-Blaming Paradigm

Because most social-work education still frames domestic abuse as parental conflict or maternal dysfunction, practitioners are trained to monitor the mother’s behaviour rather than the perpetrator’s control. A mother’s anxiety, hypervigilance or anger - natural responses to trauma - are too often logged as signs of instability or ‘failure to protect.’

Perpetrators of coercive control, meanwhile, present as calm, polite and plausible - the very qualities many professionals equate with credibility. Social workers untrained in coercive-control dynamics often misread trauma as pathology and composure as reliability, thereby inverting victim and perpetrator roles.

Misuse of pseudo-scientific theories

This distorted perception is reinforced by frameworks that have little or no empirical basis but remain deeply embedded in social-work and family-court culture:³

• Parental Alienation (PA) reframes children’s resistance to contact with an abusive father as maternal brainwashing, even when their rejection reflects fear or emotional harm.

• Fabricated or Induced Illness (FII) allegations are increasingly levelled at protective mothers who seek medical or therapeutic help for traumatised children.

• ‘False-allegation’ rhetoric implies that mothers commonly invent abuse, despite consistent evidence that deliberate false reporting is exceptionally rare.

Each of these constructs redirects professional scrutiny away from the perpetrator and onto the protective parent, transforming victims into the subjects of investigation.

When safeguarding systems confuse care with crime

Local authorities occupy an impossible position: they are expected to care for families while simultaneously investigatingthem; social workers are tasked with both supporting and policing.

They are not trained or empowered to determine culpability in complex abuse. Yet their reports shape every subsequent professional response - from police to courts. Once social care misidentifies the victim as the source of risk, the error cascades through the entire system.

When protection turns punitive

Social workers must stop treating victims of coercive control as problems to be managed and instead confront the institutions that perpetuate coercion in their name.
Coercive control is a profoundly gendered crime:¹¹ most perpetrators are men, and their victims are women and children. Yet social work and family-court systems persist in treating abuse as gender-neutral, overlooking structural realities and pathologising mothers instead.

Domestic abuse is the rule, not the exception, in the family courts: around 87%¹² of private-law cases involve allegations of domestic abuse, yet ‘shared care’ remains the default outcome. This creates a paradoxical model that promotes continued contact with abusers under the guise of co-parenting, placing women and children at sustained risk of harm.

In private-law proceedings, most mothers ultimately do not lose custody of their children - but almost all will be threatened with that outcome along the way. The threat of removal operates as a powerful tool of institutional coercion, silencing disclosure and enforcing compliance. When custody is transferred to an abusive father, it represents the perpetrator’s final and most destructive act of control, legitimised through state authority. Such outcomes are often the culmination of disbelief, professional misjudgement, and institutional complicity.

In public-law proceedings, children are often removed from mothers who have survived domestic abuse on the very grounds that the abuse has left them in poverty, trauma, or mental ill-health. These are not parenting failures but predictable consequences of sustained coercive control. By removing children for the very harms inflicted by perpetrator fathers, the state punishes victims and extends the abuser’s control by proxy. Even when mothers leave the relationship, they are frequently treated by social workers as “risky” rather than protective, ensuring that separation brings not safety but further, state-sanctioned loss.

Regulation and accountability

Local-authority complaints are circular, time-consuming processes that rarely result in change. Reviews are usually conducted by colleagues or managers within the same authority, creating a culture of mutual defence and reputational protection rather than transparency.

CAFCASS conducts internal reviews - effectively marking its own homework - while external ombudsmen can only examine whether procedures were followed, not whether decisions were right, safe or fair.

Social Work England (SWE) headlines that 94 % of fitness-to-practise referrals from the public are closed at the triage stage.¹⁰ The Professional Standards Authority has repeatedly found that SWE fails to meet its own target of triaging cases within four months.⁹ Reports and statements prepared by social workers for family-court proceedings are exempt from complaint altogether.

Although family courts are nominally judicial, in practice social workers - particularly through CAFCASS - function as their operational arm. Judges depend on their reports for welfare assessments, findings of fact, and child-contact recommendations. Social workers therefore wield decisive influence over judicial outcomes while operating within a profession that is largely unregulated, unaccountable, and untrained in coercive control.

What doctors can do

Doctors are mandated to refer abuse victims into safeguarding systems. Our responsibility cannot end at the point of referral – we must understand the structures into which we refer. Clinicians must use their professional authority to identify systemic failures, advocate for victims, and exemplify trauma-informed care.

Accurate documentation. Describe abusive behaviour as a sustained course of control, not isolated events. Name the perpetrator and the victim. Record children’s words verbatim.

Audit outcomes of referrals and challenge social work institutions. Track what happens after you refer. Challenge social workers if interventions retraumatise or victims are wrongly classified as perpetrators.

Demand structural reform. Call for child protection work to be police-led and social care to be a distinct function to solely support welfare. Where abuse is alleged, investigation must rest with specialist police officers trained in coercive control; welfare planning should then follow from those findings.

Believe and advocate for mother and child victims. If you encounter a family where a mother has lost custody of her children, start from the assumption that she is a victim of post-separation or institutional abuse - guilty only of trying to protect them. Do not assume the system got it right.

References

1. University of Bristol (2025) New survey reveals hidden toll of domestic abuse on NHS healthcare workers. Bristol: University of Bristol, Centre for Academic Primary Care. Available at: https://www.bristol.ac.uk/primaryhealthcare/news/2025/hidden-toll-of-domestic-abuse-on-healthcare-workers.html

2. Home Office (2022) Domestic Abuse Statutory Guidance Framework. London: Home Office.

3. Ministry of Justice (2020) Assessing Risk of Harm to Children and Parents in Private Law Children Cases (Harm Panel Report). London: Ministry of Justice.

4. BBC News (2025) ‘Fewer than 1 in 10 social workers trained in coercive control, investigation finds’, BBC News, 7 November. Available at: https://www.bbc.co.uk/news/articles/cn4970jdgq7o

5. Katz, E. (2025) Coercive Control: Myths vs Truths. Substack. Available at: https://dremmakatz.substack.com

6. Kelly, L. and Westmarland, N. (2015) Domestic Violence Perpetrator Programmes: Steps Toward Change. Durham: Durham University.

7. Stark, E. (2007) Coercive Control: The Entrapment of Women in Personal Life. Oxford: Oxford University Press.

8. United Nations, Office of the Special Rapporteur on Torture (2019) Statement on Domestic Violence as a Human Rights Violation. Geneva: United Nations.

9. Professional Standards Authority (2024) Performance Review: Social Work England. London: PSA. Available at: https://www.professionalstandards.org.uk

10. Social Work England (2025) Annual Report and Accounts 2024–25. Sheffield: Social Work England. Available at: https://www.socialworkengland.org.uk

11. Women’s Aid (2024) What is Coercive Control? London: Women’s Aid Federation of England. Available at: https://www.womensaid.org.uk/information-support/what-is-coercive-control/

12. Domestic Abuse Commissioner (2025) Everyday business: Addressing domestic abuse and continuing harm through a family court review and reporting mechanism. England & Wales: Office of the Domestic Abuse Commissioner. Available at: https://www.domesticabusecommissioner.uk/wp-content/uploads/2025/10/Everyday-Business-full-report-web.pdf

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Last summer, I experienced the mother of all existential crises. The cocktail of post-partum hormones, sleep deprivation and burn-out from working as a GP in a busy NHS practice, had taken its toll. It was a high-functioning crisis, a hallmark of millennials- the plates were spinning in perfect synchrony but something undeniable was rising within.

As a doctor with a lived experience of domestic abuse, I had kept the memories of my past locked in the vaults of my brain, but they were being awoken in a dysfunctional healthcare system and a dystopian world. Sometimes, I wish I could wipe them, but they are part of me now, imprinted in my DNA and to be carried on for generations to come. My experience has changed the lens through which I see everything- from the way we speak to children to the medical misogyny I witness in the NHS.

Violence against women and girls remains the other global pandemic, a silent one, that threatens the very fabric of our society. Trump’s attack on bodily autonomy has shown how precarious hard-earned progress can be. Human rights can be eroded overnight leaving women and girls vulnerable, even in a supposedly enlightened Western world that gloats about its upholding of equality. The world is frighteningly unstable, and wars demonstrate how women and girls are once again affected in affronting ways- from period poverty to the weaponisation of their bodies in conflict zones.

Closer to home, the fight for equality continues yet equality remains elusive. This was my story- re-living the trauma of my past in the workplace, like many professional women who have experienced abuse will do. The NHS is one of the largest employers of women in Europe, yet women remain underrepresented at the highest level. Sexual misconduct in the workplace is rife. Ethnic minority women will face additional struggles, forgotten at the intersection of race and gender. Even the science that underpins our medical practice is sexist. Medicine marginalizes women’s health by under-researching it and failing to recruit adequate numbers of women into research studies. Women are silenced professionally but also as patients. In the words of Dr Mosconi, a neuroscientist with an interest in women’s health: ‘we owe women a century of research’

During the filming of ITV’s documentary Breaking The Silence: Kate’s Story, I met the brave and brilliant Kate Kniveton who waived her right to anonymity to shed light on the injustice of the family court system. Like Kate, the professional women in this documentary flip the narrative on what a victim of abuse looks like; our collective voice has power.

As I shared my experience with Kate, she nodded in the way only someone with a lived experience of domestic abuse does. The symmetry of our experience was palpable. Ultimately all the educational attainment, the titles, the letters I had accrued after my name - none of it could protect me. The experience of abuse fractured my identity and threatened my self-concept– how could I have picked someone like this? The moral dissonance was jarring. My trauma inflicted brain struggled to process what was happening- the gaslighting, minimising and denial; my head was in constant knots trying to decode the Orwellian doublespeak of psychological abuse.

The rise of online misogyny as depicted in Netflix drama Adolescence shows how this beast is mutating to become more pernicious, creating new depths of despair for future generations. Yet there was criticism of Adolescence for focussing on the fictional perpetrator- a teen who had succumbed to the manosphere and had killed a girl in his school. As a survivor, one of the biggest questions I asked was why did he do this? It plagued me endlessly – what were the systems, cultures and microclimates that enabled him. I urge advocates do not shut this discourse down; it is necessary.

In my medical role, I see too often how interventions are aimed at treating disease at late stages. Domestic abuse not only has a huge economic cost, but it has an immeasurable human cost. Strategies must turn to prevention. The research landscape in this field is patchy at best, the Government must inject the funds to find the evidence. With the rise of toxic online influencers like Andrew Tate we are running out of time. A new generation is being targeted, their values shaped by warped ideology in poisonous echo-chambers. We are not doing enough to safeguard our children and young adults.

Whist the patriarchal systems of society were never meant to benefit women and girls they absolutely do not serve boys and men. Encourage emotional literacy in boys, empower girls and deliver equity teaching from primary school age upwards across the country. Open the dialogue, collaborate with researchers and social enterprises. Lean on creative industries to deliver messages in novel ways that can connect with individuals.

As I find my way in the world of advocacy, I struggle to know where I belong. There is so much anger, and it is undeniably legitimate but as a survivor the anger depletes me. I choose to advocate with hope. Hope energises and mobilises us. Hope connects our past, present and future. Hope was the light that danced through the dark where she met courage, burning brightly to show me a way out. Hope is healing. I choose hope- always.

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Research

• Domestic Abuse among female doctors: thematic analysis of qualitative interviews in the UK. BJGP (2021) Donovan, E et al

  • BJGP Life Podcast about the above article with Emily Donovan

• Healthcare Professionals’ Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences. Trauma, Violence and Abuse (2022) Dheensa, S et al

• Healthcare professionals as domestic abuse survivors: workplace impact and support-seeking. Occupational Medicine (2024) Dheensa, S et al

• ‘I felt paralysed to ask for help for myself’: domestic abuse experienced by healthcare professionals. InnovAit (2023) Gregory, AC et al

• Domestic abuse: nurses experience it too. BJN (2025) Gregory, AC et al

Reports

• RMBF - Spotlight on Domestic Abuse

• Cavell Nurses Trust - Skint, shaken, yet still caring

• Royal College of Midwives - Safe places? Workplace support for those experiencing domestic abuse

• BMA - Domestic abuse in the health profession report

• NHS England - Domestic abuse and sexual violence leadership update

• Standing together against domestic abuse - Never again report

Further information

• Understanding Narcissism - Dr Supriya McKenna

• Subtle Abuse - Dr Rosemary Parkinson

More than one in five of us in England and Wales has experienced domestic abuse. For a range of reasons, healthcare professionals may experience domestic abuse at especially high rates and face a number of profession-specific barriers to recognising abuse and getting support.

Healthcare workplaces generally offer no, or inadequate, support.

You may think you are the only doctor or HCP this has happened to, but you are not alone.

Specialist Support

Multiple specialist organisation exist to assist with specific types of abuse and are listed on the government website. We’ve listed the largest organisations with resources below:

• Women’s Aid

  • The Survivor Handbook

  • Making a safety plan

  • The Friends and Family Handbook

  • Find local support near you

• Refuge

  • What are my rights?

• Victim Support

• National Centre for Domestic Violence (emergency injunction service)

• The Freedom Programme

Financial Support

• Royal Medical Benevolent Fund

• The Domestic abuse fund for nurses and midwives

• The Cameron Fund (GPs)

• Cavell (nurses), nursing associates and midwives)

Bright Sky app

Bright Sky is a mobile app and website for anyone experiencing domestic abuse, or who is worried about someone else.

The app can be downloaded for free from the app stores. Only download the app if it is safe for you to do so and if you are sure that your phone isn’t being monitored.

Clare’s Law

If you are concerned that a new, former or existing partner has an abusive past you can ask the police to check under the Domestic Violence Disclosure Scheme (also known as ‘Clare’s Law’). This is your ‘right to ask’. If records show that you may be at risk of domestic abuse, the police will consider disclosing the information. A disclosure can be made if it is legal, proportionate and necessary to do so.

If you are concerned about a friend or family member, you can apply for a disclosure on behalf of someone you know. More info here

Get a court order to protect you or your child

If you’re a victim of domestic abuse you can apply for a court order or injunction to protect yourself or your child from:

• your current or previous partner

• a family member

• someone you currently or previously lived with

This is called a non-molestation or occupation order.

Get a non-molestation or occupation order if you’ve been the victim of domestic abuse.

Safe Spaces

Safe Spaces are safe, confidential rooms where victims can take some time to reflect, access information on specialist support services or call friends or family.

Helplines

If you want to access support over the phone, you can call:

National Domestic Abuse Helpline – 0808 2000 247 (run by Refuge)(Please note wait times can be over an hour)
Aanchal Women’s Aid 0800 0124 924 (available English, Hindi, Punjabi, Urdu, Gujarati, Tamil, Bengali)
The Men’s Advice Line, for male domestic abuse survivors – 0808 801 0327 (run by Respect)
The Mix, free information and support for under 25s in the UK – 0808 808 4994
National LGBT+ Domestic Abuse Helpline – 0800 999 5428 (run by Galop)
Samaritans (24/7 service) – 116 123
Rights of Women advice lines, there are a range of services available

Locations specific, free, confidential support and advice is available to victims and their concerned family members or friends, 24 hours a day

Help for staff members experiencing Domestic Abuse

Domestic abuse impacts all aspects of an individuals life, including their work, and healthcare professionals in particular face unique barriers around seeking help. All NHS staff working in the UK should have support available to them at work. In 2023 NHS England joined the Employers Initiative on Domestic Abuse pledging to change workplace cultures around DA. Key recommendations are that NHS employers should have:

• a domestic abuse policy for staff as well as patients

• a trained designated point of contact for DA

Further guidance

• BMA report (2024) Domestic abuse in the health profession report

• Employers’ initiative on domestic abuse

• NHS Employers (2022) Supporting NHS staff with domestic violence and abuse (for organisations developing DA policy)

• A guide to meaningful survivor engagement - Women’s Aid

• White Ribbon Resources

Domestic abuse resources for clinical staff

• For Doctors

  • IRISi interventions provides specialist domestic violence and abuse training for General Practices and sexual health clinicians

  • Medical Women’s International Association’s Interactive Violence Manual

  • BMA Board of Science (2024) Domestic Abuse report

  • RCGP Safeguarding Toolkit

  • RCGP guidance on documenting DA in the electronic clinical record (2021)

• For Nurses

  • RCN Domestic abuse assessment tools and guidance (members only)

  • Guidance for nurses and midwives to support those affected by domestic abuse

  • Marac toolkit for health visitors, school nurses and community midwives

• General Resources and clinical guidance

  • Safe Lives resources for professionals

  • Cancer and domestic abuse: a toolkit for professionals

  • Guidelines for clinical management of non-fatal strangulation in acute and emergency care services

Liberating Motherhood

This is a page about motherhood, feminism, the intersection of the two, and how heterosexual relationships help drive women’s oppression. Eye-opening content from Zawn Villines on the tools abusive men use (household chore inequity features strongly!) and how to protect yourself.

Women should not have to sacrifice everything so that men don’t have to make a single change—but that’s what motherhood demands in a patriarchal society. This is not just a page for mothers, because mothers’ issues aren’t just for mothers, just as feminism isn’t just for women and anti-racism isn’t just for racial minorities.

Decoding Coercive control with Dr Emma Katz

Dr Emma Katz is a world expert on the impacts of coercive control on children and mothers and writes on survivor experiences, highlighting tactics used by perpetrators, and speaks about post separation abuse.

Shadows of Control

Shadows of control names what is usually hidden. It puts words around experiences many of us were told didn’t count and creates a place where survivors of domestic abuse feel less alone, and where those who want to understand can learn.

Still Not Safe: Dr Dalgarno on Post-Separation Abuse

Dr Elizabeth Delgarno writes about post-separation abuse and inequalities - particularly in the family courts, women and children's health and human rights, domestic violence, trauma and coercive control.

Was it even abuse?

Emma Rose Byham, author of ‘Was it even abuse’ blogs as ‘The Personal Growth Project’ documenting her journey as a survivor and therapist following covert abuse.

I wrote most of the points below several years ago, fresh from returning from the UK after a hearing at The Supreme Courts in London under the Hague Convention- my daughters had been abducted by my ex-husband while visiting the UK on a court ordered access visit. I hadn’t seen them for 3 months at that stage and had spoken to them only once.

It was meant as a quick guide to those who had experienced domestic violence and were starting their journey, to help but also give a realistic expectation. I posted it in an online group for female doctors specifically in that situation.

My story began in the UK almost 20 years ago, well before terms like “coercive control” “emotional abuse” “love bombing” or even “gas lighting” were banded about…. I have no excuse for my naivety going into the relationship…I was in my 30’s, had previous relationships and certainly not an over protected background. If you had asked me back then I would have told you domestic violence happened to lower socioeconomic classes or those pushed into marriages because of religious beliefs…that it was mainly a physical phenomenon and the women needed to leave.

It was not until I was sitting in a court psychologist waiting room reading a leaflet about coercive control and emotional abuse that I realized I was the “frog in boiling water “and the insidious nature of how it happened. I was now in Australia and wish I had known then what I know now.

My ex was extreme, I knew he was capable of some terrible behavior before I requested a divorce, I had spoken to counsellors as I was worried about his reaction. Nothing prepared me for what was to follow. Accusations by him of the worst possible imaginable, even being woken in the night and taken to police cells for questioning. Losing over night access to my small children for over a year. All the time having to continue the role as sole financial provider and losing role of main carer for our girls.

I feel very blessed to have my daughters with me in Australia, I have not heard anything from my ex since that abduction…I have never stopped my daughters access to communicate with him.

This is my advice

1. Prepare to lose financially- in lawyer fees, pension, property and investments….no matter what your situation you are likely to be worse off. Sorry.

2. You will eventually feel better…. find yourself again….no longer be bullied/compromised etc …essentially get your life back.

3. Your kids will benefit because you are happy

4. Don’t sweat the trivia/little stuff…. don’t respond to everything via your solicitor…use apps etc but keep official communication to a minimum as it will cost a fortune (your solicitor is not your friend and will charge for every email/phone call listened to read or sent)

5. Go in strong! Wish I had given as good as I had got but thought being reasonable would go in my favor…be rationale but strong. Hats off to wonderful parents who keep it civil and child focused. You can’t co-parent or negotiate with a narcissist.

6. Don’t believe/trust the system will “do the right thing” Sadly a lot of onus put on parental rights and kids having access even to abusive parents. Court orders are all very well but mean very little as enforcing them means going back to court.

7. Social services are not going to be concerned with minor issues…. may seem huge to you as a caring parent but unless extreme they won’t act. Don’t get drawn into story telling to authorities, keep it concise/child focused- that’s all they care about.

8. Less is more….initially they are up for a fight/want to maintain control…so want lots of access to kids and often tied to finances too. The reality of caring for kids is often a shock ( as not actually done it alone before)….they really don’t want it. So instead of putting up a huge fight for time initially it may be more beneficial to let them have that time an realize what it means… I know it can be hard if they are a neglectful parent but may bear fruit in the long run when they give up the fight…..

9.Diary/Log- keep a diary and record of all events, abuse, emails texts etc- keep it child focused- record kids reactions etc you may be asked to re-call later and is much easier if you have a record

10.Be financially savvy…maybe a whole other blog!

Sources of Help and Advice