Domestic Violence and the role of Multi Agency Risk Assessment Conferences (MARACs)

Domestic violence accounts for 16% of all violent crime and is defined as 'any incident of threatening behaviour, violence or abuse between adults who are or have been in a relationship together, or between family members, regardless of gender or sexuality.'

The Adoption and Children Act 2002 includes in the definition of harm to children any 'harm suffered by seeing or hearing ill treatment of others, especially in the home.'

The Victim Initial Risk Indicator Form is completed by police at the scene of domestic violence incidents and allows victims to be categorized as 'standard,' 'medium,' 'high' and 'very high' risk. MARACs aim to focus help those victims at high and very high risk by facilitating information sharing between key agencies and initiating the most appropriate intervention.

Information sharing; MARAC and a doctor's duty of confidentiality

The coordinator for health professionals on MARAC may seek information that is urgently required from the GP or may be contacted directly by a GP that discovers a patient is at risk. A prompt response may be essential to prevent very serious harm.

A consent-based approach to the sharing of all sensitive patient information is the preferred practice, but may not always be possible or desirable.

Doctors have conflicting duties to respect maintaining confidentiality and sharing data they judge to be in the patient's best interests. This must be assessed carefully at the outset, taking into account professional guidance, contractual obligations and the relevant legislation eg the Data Protection Act, the Human Rights Act and the common law on confidentiality and negligence.

It may be permissible to disclose the minimum data necessary to serve a legal purpose to a person who is legally permitted to carry out that purpose and who shares a similar duty of confidentiality to the doctor;

where there is a risk of death or serious mental or physical harm to an individual
where the safety of a child is at stake - the best interests of the child are always paramount
where seeking consent may increase the danger to an individual
where seeking consent may impede the prevention, investigation or prosecution of a criminal offence
where it is overwhelmingly and substantially in the public interest

A proportionate disclosure to MARAC in high risk cases, without the consent of the patient, whether victim or perpetrator, would probably be permissible.

However, if there is any doubt in a particular case then a legal opinion is essential before disclosure, unless the consequent delay is likely to result in serious harm.

For a fuller article on Domestic Violence and the role of MARAC click here

CED 5/2/07