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Part of: Domestic Abuse

Related to: Children Exposed to Domestic Abuse Domestic Abuse Characteristics, New Way Service Families Profile, Domestic Abuse Offenders, Recording and Understanding Domestic Abuse ,  People with Multiple Needs, Socio-economic Inequality, Ill Health and Disability, Mental Health and Illness, Safeguarding Children and Young People, Ethnicity, Sex and Gender, Sexual Orientation, Alcohol, Carers, Police Assessments, Youth Offending, Employment and Economic Activity, Homelessness, Night Time Economy, Safeguarding Adults, Self-Harm, Substance Misuse Suicide and Mortality of Undetermined Intent, Emotional Health and Wellbeing of Children and Young People

For information about the help that is available in Bath and North East Somerset see the Interpersonal Violence & Abuse Strategic Partnership Leaflet on Domestic Violence and Abuse Services.

Link to the NICE (National Institute for Health and Care Excellence) guidance on how health and social care services can respond effectively to the problem of domestic abuse. This guidance was published in February 2014.

Link to the Department for International Development (DFID) guidance on how to address violence against women and girls (VAWG) in health programming. VAWG includes physical, sexual, social and psychological harm, both actual and threatened. This guidance was published in July 2015.

Key Facts

  • 78% of Adult Safeguarding referrals, 94% of Southside’s Independent Domestic Violence Advice  and Support Workers Services, 96% of IRIS GP Programme referrals, 96% of MARAC cases and 77% of recorded crimes in Bath and North East Somerset involved women as victims of domestic abuse.
  • It is thought that in the UK 19% of male victims have told someone in authority compared to 44% of women.
  • According to MARAC records, of the 1,264 domestic abuse cases discussed over the 6 year period between the financial years 2010/11 and 2015/16 10% (122 cases) had a victim from a black or minority ethnic (BME) background.
  • Estimates suggest women who suffer from ill-health and disability in Bath and North East Somerset are almost twice as likely to experience domestic abuse as those who do not.
  • Of the 1,264 MARAC domestic abuse cases discussed in B&NES between the financial years 2010/11 and 2015/16 4% (55 cases) had a victim with a disability. 
  • Abused women are at least three times more likely to experience depression or anxiety disorders than other women.
  • Of the 134 clients of Southside's Independent Domestic Violence Advice Service (IDVA) whose data was used for research and monitoring purposes over the six month period between 1st April 2015 and 31st March 2016, 49% reported mental health issues.
  • Of the 55 referrals to the IRIS GP programme between July 2015 and March 2016 81% reported mental health issues, but only 18% of these said they had accessed a specialist mental health service.
  • Women with learning disabilities are twice as likely to experience domestic abuse than those without learning disabilities and they are also facing greater barriers to accessing services.
  • In 2014/15, 7 households were accepted as homeless due to issues of domestic abuse.

Identified risk levels 1

Many services who work with victims of domestic abuse use the CAADA (now called SafeLives) Risk Identification Checklist (RIC) to determine the risk level for different victims. The SafeLives Risk Identification Checklist (RIC) is a tool for practitioners who work with adult victims of domestic abuse to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC. 2

Those that score below 14 are considered to be of medium or low risk, and thus are often not entitled to the same level of support. The SafeLives Risk Identification Checklist (RIC) is the chief criteria used by organisations to identify risk levels of domestic abuse victims, but it is not the only one. 3

Southside, the Julian House Freedom Programme and Next Link use the SafeLives risk assessment to identify the level of risk, and the New Way Service categorise risk depending on whether any of the children in the family have been put on a Child Protection order, in which case the family is considered of high risk.

Southside - Between 1st April 2015 and 31st March 2016 the majority (76%) of Southside IDVA clients were at high-risk and were experiencing multiple forms of abuse. Conversely, the majority (73%) of Southside outreach clients were at lower risk of serious harm. 4

The profile of clients accessing each of the services was in line with the specialist nature of those services. 5

domestic_abuse_-_low_and_medium_risk_victims_april_13_-_march_14_-_infographic.

Figure 1: Risk levels identified for referrals to Southside, Next Link, Julian House Freedom Programme and New Way Service during April 2013-March 2014 6 7 8 9

The data collected in terms the of risk levels identified for the referrals to the four domestic abuse organisations, Southside, Next Link, Julian House Freedom Programme and the New Way Service was for the financial year April 2013 - March 2014.

When looking at both Southside’s IDVA  (Independent Domestic Violence Advisers) Service and its Specialist Support Services together, just over half (56%) of the 508 referrals have been identified as medium or low risk.  This is compares to 15% for the IDVA Service, as this now only works with medium and low risk victims who are self referrals. 10
 
In terms of Next Link, the vast majority (80%) of the women using their Safe House have been identified as high risk referrals, whereas most of the referrals to their Resettlement and Outreach Services have been identified as medium or low risk (80%).11
 
60% of the 139 women in the Julian House Freedom Programme have been categorised as medium or low risk, compared to the 27% who have been categorised as high risk.12
 
The majority of the couples referred to the New Way Service during this period have also been identified as medium or low risk, 70% of the 50 couples.13
domestic_abuse_-_low_and_medium_risk_police_incidents_may_13_-_april_14_-_infographic.
Figure 2: Risk levels identified by the police for domestic abuse incidents in B&NES (May 2013 - April 2014) 14
 
90% (1,327 incidents) of the 1,474 domestic abuse incidents recorded by the police in B&NES between May 2013 and April 2014 were categorised as low (58% 858 incidents) or medium (32% 469 incidents) risk, compared to the 10% (147 incidents) who were categorised as high risk. It is important to note that these figures refer to incidents that the police have carried out a Domestic Abuse risk assessment for, not people, therefore the same victim could have been counted more than once if they had been involved in more than one incident. 15
IRIS - Identification and Referral to Improve Safety Programme - is a GP-based domestic violence and abuse (DVA) training support and referral programme provided by Southside. It is a collaboration between primary care and third sector organisations specialising in DVA. Core areas of the programme are training and education, clinical enquiry, care pathways and an enhanced referral pathway to specialist domestic violence services. It is aimed at women who are experiencing DVA from a current partner, ex-partner or adult family member. IRIS also provides information and signposting for male victims and for perpetrators.16

The IRIS programme also uses the CAADA (now called SafeLives) Risk Identification Checklist (RIC) to determine the risk level of domestic abuse victims. Those that score 14 and above are considered high risk and those that score below 14 are considered to be of medium or low risk.

The average risk score given to referrals to the IRIS programme in B&NES between July 2015 and March 2016 was 12. 48% of referrals to IRIS were assessed as high risk using a combination of the Risk Identification Checklist and professional judgement.  17

For more information about referrals to the IRIS programme in B&NES see our briefing paper

Repeat clients

Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and Support Workers services. The data of 134 Southside IDVA clients was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. 18

12% of the 134 Southside IDVA clients were repeat clients, but the majority (88%) of clients had accessed the IDVA service only once  between 1st April 2015 and 31st March 2016.  11% of the 55 clients of the Support Workers service were repeat clients, but the majority (89%) of clients had accessed the Support Worker service only once between 1st April 2015 and 31st March 2016.  19

 
Gender
 
78% of Adult Safeguarding referrals, 94% of Southside clients (IDVA and Support Worker Services)*, 96% of IRIS GP Programme referrals**, 96% of MARAC cases*** and 77% of recorded crimes involved women as victims of domestic abuse. 20 21 22  23
Female victims: 

* Between 1st April 2015 and 31st March 2016 Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and support worker services.  The data of 134 IDVA clients during this period was used for research and monitoring purposes. Of these 134 IDVA clients, 92% were female. 24

** Out of the 90 referrals to the IRIS GP Programme between July 2015 and June 2016. 25

*** Out of the 268 MARAC cases in B&NES in 2015/1626

Though it is widely recognised that the majority of victims of domestic abuse are female, it is becoming increasingly acknowledged that the proportion of male victims is higher than previously thought. According to the 2015 Crime Survey for England and Wales 27% of women and 13% of men in the UK have experienced domestic abuse since the age of 16 (for every three victims of domestic abuse, two will be female, one will be male). This is the equivalent to an estimated 4.5 million female victims and 2.2 million male victims in the UK. 27 

It is believed that the key reason why recorded cases of male victims of domestic abuse across most agencies dealing with victims of domestic abuse do not reflect the true extent of the problem amongst men is that they are far less likely to report it. Thus, underreporting is an even greater issue amongst men, than it is amongst women. Analysis of the British Crime Survey 2010/11 shows in comparison to female victims of domestic abuse, men are three times more reluctant to tell the police. The British Crime Survey also indicates that only 19% of male victims have told someone in authority compared to 44% of women.28

 

Age

The age profile of the victims of domestic abuse crimes recorded by the police in Bath and North East Somerset between 2010-2012 is similar to that of offenders, but the numbers are more evenly distributed across the age ranges. As with offenders, the single age group that have been the victim of the greatest number of recorded domestic abuse crimes was the 22-27 year olds, making up 17.1% of the crimes, 313 incidents, and the victims of over half of the domestic abuse crimes recorded during this period were people 33 years old and under, 50.2% (918 incidents).

Age of victims of crimes-bar graph

Figure 3: Age of victims of domestic abuse crimes recorded by the police in Bath and North East Somerset (January 2010-December 2012) 29

The most striking thing about the ages of the 208 Adult Safeguarding referrals linked with domestic abuse for the period between March 2011 and March 2013 is that they represent a quite distinct demographic of victims of domestic abuse, compared to those recorded by the police. The Adult Safeguarding domestic abuse referrals 33 years old and under, only made up 11% of all the referrals, and only 3% of these referrals were aged between 22-27 years old.

The age group with the greatest number of Adult Safeguarding domestic abuse related referrals is that of 76 years and older, with 77 referrals making up 37% of domestic abuse related referrals. In fact 50% of the Adult Safeguarding domestic abuse related referrals are from those aged 64 years old and over. This older demographic is linked to the fact Adult Safeguarding referrals are connected with people with characterises that make them vulnerable which are often related to aging such as physical disabilities and dementia.

Adult safeguarding-age of victims-bar graph

Figure 4: Age of domestic abuse related referrals to Adult Safeguarding in Bath and North East Somerset (March 2011-2013) 30

Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and Support Workers services. The data of 134 of the Southside IDVA was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. 31

Of these 134 IDVA clients:

  • 2% were under 18 years old,
  • 14% were 18-20 years old,
  • 40% were 21-30 years old,
  • 19% were 31-40 year olds,
  • 19% were 41-50 years old,
  • 3% were 51-60 years old
  • and 3% were 61 years old and over. 32

Of the 55 clients of the Support Workers service:

  • 0% were under 18 years old,
  • 2% were 18-20 years old,
  • 29% were 21-30 years old,
  • 35% were 31-40 year olds,
  • 22% were 41-50 years old,
  • 5% were 51-60 years old
  • and 7% were 61 years old and over. 33

In terms of the age of the 151 women referred to the Julian House's Freedom Programme during in 2014:

  • the greatest proportion (25%) were aged 25-30 years (approx.38 referrals), followed by
  • 21% were aged 16-24 and 21% were aged 31-36 (approx.32 referrals in each), 
  • 3% were aged 55-72
  • None of these referrals were older than 72 years old. 34

 

Ethnicity 35

As with the ethnic profile of offenders, the vast majority of victims of domestic abuse crimes in Bath and North East Somerset between 2010-2012 were recorded as being White British by the police, making up 77% of the crimes, 1408 incidents. Similarly, just as with the offenders, White - Other is the next largest ethnic group in terms of the victims of domestic abuse crimes, with 83 incidents, making up 5% of the domestic abuse crimes recorded. Again, it should be noted though that no ethnicity was recorded for 14% of these domestic abuse crimes.

Only 5% (11 referrals) of the 208 Adult Safeguarding referrals linked to domestic abuse in Bath and North East Somerset were from an ethnic minority.

Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and Support Workers services. The data of 134 clients of the Southside IDVA Service was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. 36

88% of the 134 IDVA clients were white British or Irish, 12% were BME. 95% of the 55 clients of the Support Workers service were white British or Irish, 5% were BME. 37

All the 86 female referrals to the IRIS GP programme between July 2015 and June 2016 were white British. 38

According to MARAC records, of the 1,264 domestic abuse cases discussed over the 6 year period between the financial years 2010/11 and 2015/16 10% (122 cases) had a victim from a black or minority ethnic (BME) background.39

Of the 268 domestic abuse MARAC cases discussed in B&NES in 2015/16, 6% (15 cases) had a victim from a black or minority ethnic (BME) background, compared to 9% (20 cases) of the 230 cases in 2014/15.40

Sexual orientation 

4% of the 194 clients to Southside’s IDVA and Support Worker services between 1st April 2015- 31st March 2016 identified as lesbian, gay, bisexual or transgender (LGBT). 41

The data of 134 of these Southside IDVA clients was used for research and monitoring purposes. 5% of clients that engaged with the service identified as gay or bisexual, but no clients identified as lesbian or transgender. Government statistics estimate that between 7-10% of the UK population is LGBT. 42

The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. Every client who engaged with the Support Worker service identified as heterosexual. 43

Southside caseworkers have been reviewing the primary referral routes into the service and considering the barriers LGBT clients may face when accessing support. 44

According to MARAC records, of the 1,264 domestic abuse cases discussed over the 6 year period between the financial years 2010/11 and 2015/16 only 0.5% (6 cases) had a victim who identified themselves as being lesbian, gay,  bisexual or transgender.45

All the 86 female referrals to the IRIS GP programme between July 2015 and June 2016 identified themselves as heterosexual.46

Relationship to perpetrator 

Over the six month period between 1st April 2015 and 30th September 2015 the Southside Independent Domestic Violence Advice Service (IDVA) had a case load of 219 clients. 47 The data of 70 of these IDVA clients during this period was used for research and monitoring purposes. Of these 70 IDVA clients, 61% were ex-intimate partners with their primary perpetrator, while 36% were still intimate partners with their primary perpetrator, 80% did not live with their primary perpetrator, and 19% were living together. Of the 70 IDVA clients, 70% had attempted to leave the perpetrator in the 12 months prior to intake, an average of 2.6 times. 48

Ill health and disability 49

Estimates generated by the Home Office tool suggest women who suffer from Ill Health and Disability in Bath and North East Somerset are almost twice as likely to experience domestic abuse as those who do not. 50

Multi-country studies by the World Health Organisation (WHO) revealed that:51

  • Abused women were twice as likely as non-abused women to report poor health and physical and mental health problems including ‘functional disorders’ or ‘stress-related conditions’, even if the violence occurred years before.
  • Women who have experienced physical or sexual abuse from their partners are almost twice as likely to experience depression.
  • Intimate partner violence (IPV) is linked with unintended pregnancies, with women who have experienced IPV being more than twice as likely to have an abortion.
  • IPV is also linked to sexually transmitted infections, including HIV - directly through forced sexual intercourse or indirectly as women are less able to negotiate condom use with their partner.
  • Women who experience IPV are 16% more likely to have a low birth-weight baby.
  • Violence during pregnancy has also been associated with: miscarriage; late entry into prenatal care; stillbirth; premature labour and birth; and foetal injury

Mental health

It is now well accepted that abuse (both in childhood and in adult life) is often the main factor in the development of depression, anxiety and other mental health disorders, and may lead to sleep disturbances, Self-Harm, suicide and attempted suicide, eating disorders and Substance Misuse.

Mental Health and Illness statistics outlined by Women’s Aid: 52

  • Abused women are at least three times more likely to experience depression or anxiety disorders than other women.
  • One-third of all female suicide attempts and half of those by Black and ethnic minority women can be attributed to past or current experiences of domestic violence.
  • Women who use mental health services are much more likely to have experienced domestic violence than women in the general population.
  • 70% of women psychiatric in-patients and 80% of those in secure settings have histories of physical or sexual abuse.
  • Children who live with domestic violence are at increased risk of behavioural problems and emotional trauma, and mental health difficulties in adult life.
  • An audit in Greenwich found that 60% of mental health service users had experienced domestic violence.
  • Another survey of women using mental health services in Leeds found that half of them had experienced domestic violence and a further quarter had suffered sexual abuse.

Click here to see a briefing paper on Mental Health and Domestic Abuse

Ill health and disability amongst domestic abuse victims in Bath and North East Somerset

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP)  is a significant provider of mental health services across Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire.53 

At the moment of the 1250 clients of Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) services, 178 have been identified as having a risk from others. This includes a wide range of circumstances where a service user is vulnerable from others, including domestic abuse. This means that 14% of their service uses at the moment have been identified as having a risk from others, including domestic abuse. 54

As of November 2013, this financial year 2013/14, AWP have made 7 domestic abuse related referrals to MARAC and have had 35 service users who have been subject to MARAC (either as a victim or perpetrator) in B&NES. 55

The number of referrals from AWP services in Bath and North East Somerset to MARAC are the highest pro rata out of all the areas in the Trust. 56 

Adult Safeguarding and the services it co-ordinates are responsible for adults that are considered vulnerable and eligible for social care. Therefore, by their very nature domestic abuse related referrals to Adult Safeguarding are going to all have some sort of issue that makes them more vulnerable, most of which tend to be health related. Safeguarding considers adults to be vulnerable if they are affected by one of the following: physical and/or sensory impairments, learning disabilities, mental health issues, substance misuse issues, frailty due to old age, end of life care needs or long term or short term conditions that means they are unable to look after themselves.

adult safeguarding-ill health and disability-pie chart

Figure 5: Health vulnerability issues of the domestic abuse referrals to Adult Safeguarding in Bath and North East Somerset (March 2011-2013) 57

The main health and vulnerability issue affecting the referrals to Adult Safeguarding linked with domestic abuse in Bath and North East Somerset between March 2011 and March 2013 is that of physical disabilities, 58.2% of referrals (121). Though this of course will cover a wide range physical impairments of varying severity.

Learning disabilities are recorded as affecting the second largest proportion of domestic abuse related Adult Safeguarding referrals, with 36 referrals making up 17.3% of these referrals. It is also important to note that mental health issues (excluding dementia) with 13% (27) make up a significant proportion of these referrals.

40 referrals, 19% of the 208 referrals to Adult Safeguarding linked with domestic abuse for the period between March 2011 and March 2013 were investigated by the Avon and Wiltshire Mental Health Partnership NHS Trust. This provides further indication that a significant proportion of victims of domestic abuse are also experiencing mental health issues.

Southside -  Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and Support Workers services. The data of 134 Southside IDVA clients was used for research and monitoring purposes.  The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. 58

20% of the 134 Southside IDVA clients were identified as having a disability and 49% were identified as having mental health issues, more than half of whom (55%) had accessed a specialist service to support these needs. 23% of the 134 Southside IDVA clients had threatened or attempted suicide and 22% had self-harmed. However, due to high proportions of “don’t know” responses, it is likely that the proportion of clients with ill health and disability needs is underrepresented. 59

18% of the 55 clients of the Support Workers service were identified as having a disability and 53% were identified as having mental health issues, 31% had accessed a specialist service to support these needs. 7% of the 55 clients of the Support Workers service had threatened or attempted suicide and 18% had self-harmed. 60

Multi-Agency Risk Assessment Conferences (MARAC) -According to MARAC records, of the 1,264 domestic abuse cases discussed over the 6 year period between the financial years 2010/11 and 2015/16 4% (55 cases) had a victim with a disability. 61

Of the 268 domestic abuse MARAC cases discussed in B&NES in 2015/16, 5% (14 cases) had a victim with a disability, compared to 7% (15 cases) of the 230 cases in 2014/15.62

The proportions of MARAC cases that had a victim with a disability are lower than figures for the proportion of the Bath and North East Somerset population as a whole that have a limiting long term health condition or disability. The 2011 Census data which relies on self-referral indicates that 7% of the population of Bath and North East Somerset have a health condition or disability that they consider limits their day to day activities a lot, and 9% that limits them a little (16% in total).63

IRIS - Identification and Referral to Improve Safety Programme - Health data was recorded for the 55 referrals to the IRIS GP programme between July 2015 and March 2016 with regards to mental health issues, substance misuse, disabilities and visits to the GP:64

 

Service provision for women with learning disabilities who have experienced domestic abuse in Bath and North East Somerset and Bristol 65

In 2014 a Masters Student at the University of Bath did a dissertation which evaluated the quality of the protection and support for women with learning disabilities who experience domestic abuse in B&NES and Bristol.  The dissertation involved a literature review of studies linked to learning disabilities and disabilities and an assessment of the policy and guidance currently in place to protect women with learning disabilities from domestic abuse. A localised study was also conducted which involved interviews with employees in ten domestic abuse and learning disabilities services.

The key findings of the dissertation were:

  • The government definition of domestic abuse does not encompass the lived experience of people with learning disabilities because it assumes that domestic abuse relates to only partners, ex-partners and family members. But people with learning disabilities may be abused by a person who doesn’t belong to the family due to living in residential or supported living.

Women with learning disabilities who experience domestic abuse:

  • Women with disabilities are twice as likely to experience domestic abuse than non-disabled women and they are also facing greater barriers to accessing services.
  • The risk of a person with learning disabilities experiencing domestic abuse is likely to be increased by an enhanced negative self-concept, a reduced support network and a potential past history of abuse.
  • It has also been ascertained that women with learning disabilities may be doubly disadvantaged due to having a disability and being a woman.
  • If both partners have learning disabilities there are often misunderstandings around appropriate behaviour within the relationship.
  • The dissertation suggests speaking face-to-face to women with learning disabilities who have experienced domestic abuse to understand their needs.

Domestic abuse and learning disabilities services:

  • Training needs to be improved for learning disability support providers in identifying domestic abuse.

  • Learning disability support providers are calling for a statutory requirement for learning disabilities services to provide sexuality and relationship training to service users. This would enable those people to live in self-determination and to protect themselves.
  • It is recommended that the provision of support post abuse for women with learning disabilities is improved as there are concerns over the extent of repeated domestic abuse.
  • The dissertation also highlights the need for better communication between domestic abuse and learning disability services. However, the dissertation does point out that there is a willingness on both sides to collaborate more with each other. Therefore, it suggested deploying link workers to lean on the expertise of the other service, and thereby possibly improving the service for women with learning disabilities.

Department for International Development guidance on how to address violence against women and girls in health programming  66

In July 2015 the Department for International Development (DFID) published guidance on how to address violence against women and girls (VAWG) in health programming. VAWG includes physical, sexual, social and psychological harm, both actual and threatened.

This guidance aims to support HMG advisors and programme managers to consider VAWG in all health programming and policy dialogue. It focuses on the following types of violence: domestic violence including intimate partner violence (IPV) and violence against children, sexual violence, institutional violence in health services (e.g. forced sterilisation, abortion) and female genital cutting/mutilation (FGC/M).

The negative impact of VAWG on women’s and girls’ health outcomes 67

The DFID guidance states that -

Violence against women and girls across their lifespan (e.g. FGC/M, intimate partner violence, acid attacks, rape, denial of resources) contributes disproportionately to poor health outcomes. Those experiencing violence encounter more health problems and incur significantly higher health care costs than those who have not experienced violence. Survivors visit health facilities more frequently (when they have access) without necessarily revealing the root cause of their health problem, yet the violence they experience is significant in shaping their mental and physical health and social well-being.

The role played by health programmes in addressing VAWG 68

In many contexts, health services are the first port of call for women who have experienced VAWG. Health services present a unique opportunity to identify and start to address the violence that women and girls suffer at home. Health care settings and confidential patient/provider relationships can provide women and girls with safe environments where they can confidentially disclose their experiences and receive a supportive response.

The principal categories of health programmes outlined in the DFID guidance used to prevent or address VAWG are:

  • Primary prevention - Any programmes, interventions or strategies aimed at stopping violence before it occurs.
  • Secondary prevention - Any strategy aimed at minimising the harm that occurs once a violent event is taking place and immediate post-violence intervention aimed at preventing re-victimisation.
  • Tertiary prevention - All efforts aimed at treating and rehabilitating victims and perpetrators and facilitating their re-adaptation to society. Contrary to secondary prevention activities, which are usually in the short-term after the event, tertiary prevention activities are usually long-term.
  • Health promotion - is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

Evidence suggests that the most significant contribution that the health system can make is through improved secondary and tertiary prevention. This is through the integration of a response to VAWG into health services in order to facilitate easier access to essential treatment, care and support. The integration of a response to VAWG is particularly important for sexual and reproductive health (SRH) and HIV services as well as Maternal Newborn and Child Health (MNCH) services, as violence can lead to adverse sexual and reproductive health outcomes.

Although there is little evidence that health interventions can improve primary prevention, health facilities can model good practice by ensuring zero tolerance of violence, by establishing an environment that is safe for women and girls to use, or to be employed in, and by promoting awareness about VAWG (rights, impact etc.) through health promotion work. HIV and Sexual Reproductive Health (SRH) services provide a unique opportunity to reach men in health facilities.

The challenges of addressing VAWG through health programmes 69

The DFID guidance identified a number of challenges to addressing VAWG through health policy and programmes. These included:

The high levels and significant impacts of violence - place a significant burden on sector capacity and resources.

Insufficient training, a high turnover of trained staff and a lack of inclusion of training in VAWG response the health services. 

Difficulties in addressing the needs of marginalised and vulnerable populations (including older women beyond reproductive age and women and girls with disabilities). Those who are vulnerable or marginalised often suffer higher levels of violence and are often in most need of health services, while having the poorest access to those services. They face specific legal, social and economic barriers accessing services as well as significant discrimination within services. For example, women with disabilities who have experienced intimate partner or sexual violence report not being taken seriously within services because of a general denial of their sexuality and sexual and reproductive health needs.

Weak evidence about what works - While evidence is fairly robust on the relationship between VAWG and negative health outcomes, little is known about what works when implemented and integrated into primary health care in low-resource settings. The problem is exacerbated by under-reporting – by marginalised groups in particular – and by the fact that service user cases are often recorded according to exit diagnosis (e.g. injuries, antepartum bleeding, post-abortion care, STIs) yet a user’s experience of, and the negative impact of, violence are not captured. 

Weak management of health systems - Weak health systems, competing priorities and limited budgets all combine to weaken appropriate responses to VAWG. For example, VAWG health services as part of the Sexual Reproductive Health/Maternal Child Health services often competes with other areas such as family planning, safe facility delivery and child immunisations, which have a proven high return/impact that is easily measured on money invested. There can also be problems of poor leadership and lack of commitment to addressing VAWG. For example, there may be a lack of clear institutional policies on violence, a lack of coordination among various actors and departments involved in planning integrated services or developing a multi-sectoral response, and a lack of commitment by health administrators.

Lack of application of minimum standards - Minimum standards exist for the health sector to respond to partner and sexual violence against women. However, due to the sensitive nature of VAWG, cultural constraints and negative attitudes and the fact that health professionals (providers, managers and policy makers) are not routinely trained on the health sector response to GBV, there is limited understanding and expertise among VAWG actors to offer clear and concise guidance for health workers, particularly in emergency contexts. This could be further confounded in situations where several forms of abuse co-exist – such as sexual violence and FGC/M – and where children are concerned.

The weak legal and policy environment - Even in settings where comprehensive laws and policies addressing VAWG exist and are aligned, there are challenges in their implementation, due to lack of technical and financial resources, poor coordination, culturally ingrained attitudes and weak prioritisation of violence issues. 

Principles to guide health programming related to VAWG  70

The DFID guidance outlines the following key principles for health programmes related to VAWG:

Context specific - Interventions aimed at preventing and responding to violence in health settings should be based on rigorous analysis of the specific context and tailored to the forms of violence that girls and women experience (including type of violence, populations experiencing violence, risks that exist, and the environment), possible entry points and the resources available to support health facilities, staff and service users to tackle VAWG.

Woman and girl-centred and ‘do no harm’ approach - Programmes supporting women and girls at risk and VAWG survivors must be designed to promote their health and, at the very least, provide: first line support when women disclose, identification and care for survivors, clinical care and psychological support, training for health care providers on IPV and sexual violence and integrate VAWG provision into policies and programmes. They should also minimise risks to survivors. Basic ethics regarding confidentiality, informed consent, appropriate treatment of children/legal minors, safety and security, and upholding the rights, dignity and choice of survivors must be a minimum standard in all interventions. It is also critical that risk factors to survivors seeking services are identified and mitigated (such as perpetrators coming to services with survivors).

Promoting empowerment and accountability - Evidence shows that interventions to address VAWG are most effective when they prioritise women’s needs and rights, are accountable to them, and include their empowerment and rights as both means and ends in themselves Women and girls involved in the prevention and response to VAWG (individually or via community structures) can be well-placed (both in terms of relationships as well as experience and understanding of this work) to inform programme design, collect data and monitor the uptake (and experience) of health services, patterns of VAWG at the community level, and many other intended outcomes of VAWG programming.

Inclusive - Intervention programmes need to reach and address the needs of the most vulnerable women and girls: the poorest, marginalised and stigmatised including in rural areas.

Holistic and multi-sectoral - While the health sector has a key role to play in addressing VAWG, it cannot do everything. For efficiency and effectiveness, responses must play to the sector’s strengths and establish referral mechanisms to other sectors where appropriate (legal services; police; economic support).

Evidence-based or innovative - Given the limited evidence base there is space for innovation and for ensuring that interventions are accompanied by robust monitoring and processes for evidence collection and analysis.

For more information see the Department for International Development guidance on how to address violence against women and girls in health programming. 

 

Substance misuse 71

Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and support worker services. The data of 134 Southside IDVA clients was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. [fn] SafeLives (2016) SafeLives Insights service report Southside 12 months to April 2016

8% of the 134 Southside IDVA clients disclosed drug misuse, less than a third of which (27%) had accessed a specialist drug service to support with these needs. 10% of the 134 Southside IDVA clients disclosed alcohol misuse, over half of which (54%) had accessed a specialist alcohol misuse service. 72

5% of the 55 clients of the Support Workers service disclosed drug misuse, less than a third of which (33%) had accessed a specialist drug service to support with these needs. 13% of the 55 clients of the Support Workers service disclosed alcohol misuse, 43% had accessed a specialist alcohol misuse service. [fn] SafeLives (2016) SafeLives Insights service report Southside 12 months to April 2016

In relation to substance misuse by the 151 women referred to the Julian House's Freedom Programme during 2014,  16% were identified as having alcohol misuse issues (approx.24 referrals), 13% issues with drug use (approx.20 referrals) and 5% were identified as having both (approx. 8 referrals). 73

Of the 55 referrals to the Identification and Referral to Improve Safety Programme (IRIS) between July 2015 and March 2016, 18% reported alcohol issues and 10% recorded issues with drug use. 74

Economic status and deprivation 75

According to Home office estimates a greater proportion of unemployed women are estimated to be a victims of domestic abuse in Bath and North East Somerset annually compared to employed women with 9% estimated to experience domestic abuse in contrast to 5% of employed women.

Studies by the Health Foundation in 2011 demonstrated that survivors of abuse would most like to receive support from doctors above any other professional. 76

Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and Support Workers services. The data of 134 Southside IDVA clients was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. 77

58% of the 134 Southside IDVA clients were not in paid employment, education or training and 36% were in paid employment.  44% of the 55 clients of the Support Workers service were not in paid employment, education or training and 49% were in paid employment. 78

 

Housing issues and homelessness 

Homesearch is the council's service for applying for social housing.  In 2014/15 the number of advice and prevention Homesearch cases where ‘violent breakdown of relationship with partner’ is recorded as the main reason for contact was 114, in 2013/14 the figure was 109. 79 

The Council's housing team provide support for people experiencing housing difficulties. In 2014/15 approximately 20 households that had been in contact with the Council's housing team about housing difficulties had their priority increased by the council's housing panel due to issues of domestic abuse, this was similar to 2013/14.  80

Of the households that went to the Council's housing team for help in 2014/15, 7 were accepted as homeless due to issues of domestic abuse, these included 2 children and 2 households that had complex needs. In 2013/14, 13  households were accepted as homeless due to issues of domestic abuse, these included 16 children and 1 household that had complex needs. In 2012/13, 9 households were accepted as homeless due to issues of domestic abuse and these included 19 children.  81

In September 2015 the Developing Health and Independence charity knew of 41 women domestic abuse victims with substance misuse and housing issues issues (i.e. they are homeless or insecurely housed). 82 

 

Sources of referral 83

Adult Safeguarding - Unsurprisingly a considerable proportion of the sources of information about the alleged abuse related to the referrals to Adult Safeguarding linked with domestic abuse for the 1 year and 7 months period between March 2011 and March 2013 were from the social care sector, 34.6%. With the social workers and care managers being the category that provided abuse information for the greatest number of referrals, 26, making up 12.5% of all the domestic abuse related referrals. Furthermore, as you would expect with nature of Adult Safeguarding referrals, the health care sector was responsible for providing abuse information for the second largest proportion of these referrals, 21.6%. Primary and Community Health Staff, which includes GPs making up the single greatest proportion of these, 12% of all the 208 referrals (25).

The police also provided abuse information for a significant proportion of the domestic abuse related Adult Safeguarding referrals, 21 referrals, making up 10.1%.  It is worth noting that the proportion of referrals where the alleged victim of the domestic abuse was the one to alert Adult Safeguarding of this abuse is actually very small, 2.4%, 5 referrals. 

New Way Service - The vast majority of the 103 families/couples that were working with the New Way Service in the period 2013 - March 2015 were referred to them by a Social Worker (82%). Childrens Centres referred the second largest number of families/couples with 6%. 84

Southside - Between 1st April 2015 and 31st March 2016 37% of Southside IDVA clients were referred through the police, 17% through health services, 13% children’s services and 19% were self-referrals. During the same period the main referral pathway for Southside support worker clients was through health services (42%). Southside have an Iris worker who has worked to build strong links with health services in the local area. Clients also accessed the support worker services through self-referrals (36%) and referrals from the police (15%). 85

Bath Next Link - The makeup of the sources of referral of the 37 women who stayed at Next Link's safe house in Bath between April 2011-March 2012 were fairly evenly distributed between the various agencies. The greatest proportion of referrals came from other safe houses, with 16% of referrals, but this was closely followed by Next Link's crises services and other voluntary sector organisations, both with 14% (though the latter evidently covers more than one agency). A significant proportion of the women were self-referrals, 12% and referred by the police, and Southside IDVA service, both with 11%.  It is important to note though that no referrals came from MARAC and that healthcare providers are not even included as possible referral sources.

bath next link source of referrals to the safe house pie chart

Figure 7: Source of referral of the women at the Next Link's safe house in Bath (April 2011 - March 2012) 86

In terms of the 45 women supported by Next Link's resettlement services in Bath and North East during the same period, the makeup of referrals is quite different with 45% of referrals being self-referrals, and unsurprisingly a considerable proportion of the referrals 30% came from Next Link's safe house. Again a significant proportion, 13% came from the police, but unlike the safe house no referrals had come from Southside's IDVA service.  It is worth noting that unlike the safe house, Next Link's resettlement service did receive some referrals from MARAC, 6%.

Multi-Agency Risk Assessment Conferences (MARAC) - Between 2010/11 and 2015/16 by far the greatest number of referrals to MARAC were from the police, 802 out of the 1,264 referrals, 63.4%.87

In 2015/16 there were 151 referrals from the police, 56.4% of referrals, an increase compared to 2014/15 when there were 129 referrals, 56.1% of referrals.  This is a decrease compared to 2010/11 when there were 165 referrals from the police, 79.3% of referrals.88

The fact that all other 13 referring agency categories only accounted for 36.6% of referrals, suggests that there is a problem of under referring from other agencies that needs to be addressed. The comparatively low numbers of referrals to MARAC from other agencies may be in all, or some cases, down to a lack of awareness of MARAC and the referral process, a failure of reporting suspicions of the existence of domestic abuse in general, or the fact that the domestic abuse some of the agencies come in contact with is of a lower level and thus does not fulfil the MARAC referral criteria requirements.89

After the police the highest number of referrals to MARAC between 2010/11 and 2015/16 came from the Independent Domestic Violence Advocacy Service (IDVA), which is provided by the Southside Family Project, with a total of 177 referrals, 14% of all referrals between 2010/11-2015/16.90

In 2015/16 there were 38 referrals from the IDVA service, 14.2% of referrals, similar to in 2014/15 when there were 35 referrals, 15% of referrals.  This is a significant increase compared to 2010/11 when there were 8 referrals from the IDVA service, 3.8% of referrals.91

Figure 8: Sources of referrals to MARAC (2010/11-2015/16)92

Julian House's Freedom Programme - In 2014, 28 different agencies made referrals to the Bath Freedom Programme, however 22% of the 151 women had referred themselves to the programme. At the time of their referral, 14% of the women who had self-referred were not involved with any other agencies and so had no other support for them or their children in coping with and addressing the domestic abuse. 93

The main sources of the 151 referrals to the Freedom Programme during 2014 were: 94

  • Self referrals - 22%
  • Southside - 19%
  • Health visitor - 7%
  • Bath and North East Somerset Council social care - 8%
  • Next Link - 6%

 

Contact with multiple services 

Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and Support Workers services. The data of 134 Southside IDVA clients was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes.95

65% of the 134 Southside IDVA clients had reported the abuse to the police in the year before engaging with the IDVA service. 40% of the 134 IDVA clients had visited their GP in the 12 months prior to intake. 19% of the IDVA clients had attended A&E as a result of the abuse. However, the high proportions of “don’t know” responses mean that clients’ service use might be underreported. 96

84% of the 55 clients of the Support Workers service had reported the abuse to the police in the year before engaging with the Support Workers service. 67% of the 55 clients of the Support Workers service had visited their GP in the 12 months prior to intake. 9% of the clients Support Workers service had attended A&E as a result of the abuse. However, the high proportions of “don’t know” responses mean that clients’ service use might be underreported. 97

The 55 referrals to the Identification and Referral to Improve Safety Programme (IRIS) between July 2015 and March 2016 were offered support from the following agencies:98

  • Housing agencies (i.e. Refuge, Curo, Knightstone, Local authority)
  • Citizens Advice Bureau (CAB)
  • Specialist domestic abuse services (Freedom programme, Next Link)
  • Adult safeguarding
  • Child safeguarding
  • Counselling and Life Coaching  Services at Southside
  • Theraplay Services for children from Southside

Support and interventions

Southside - Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and support worker services. The data of 134 Southside IDVA clients was used for research and monitoring purposes. The data of 55 clients of the Support Workers service were also used for research and monitoring purposes.  99

Of those IDVA clients that left the service during this period, the exit forms of 96 of these were analysed.  Of these 96 IDVA clients, 95% of them had been supported with safety planning, 81% with Marac, 73% with the police and 59% with housing. 100

Of the clients of the Support Workers service that left the service during this period, the exit forms of 31 of these were analysed.  Of these 31 clients, 90% of them had been supported with safety planning, 77% with health and well-being, 45% with children, 39% with financial benefits, 29% with Marac, and 23% with the police. 101

Outcomes

Southside - Between 1st April 2015 and 31st March 2016, Southside supported 194 victims of domestic abuse through their Independent Domestic Violence Advisers (IDVA) and support worker services. The data of 134 Southside IDVA clients was used for research and monitoring purposes.The data of 55 clients of the Support Workers service were also used for research and monitoring purposes. 102

Of those IDVA clients that left the service during this period, the exit forms of 96 of these were analysed.  Of these 96 IDVA clients 44% reported that the abuse had stopped. Caseworkers reported a reduction in risk for 71% of these 96 IDVA clients, and the clients themselves concurred. The vast majority reported that they felt safer (77%); their quality of life had improved (75%) and they had increased confidence to access support in future (90%). 103

Of the clients of the Support Workers service that left the service during this period, the exit forms of 31 of these were analysed.  Of these 31 clients, the overwhelming majority of clients reported that they felt safer at case closure (91%) and that their quality of life had improved (86%). All clients said they felt confident to access support in future. 104

What does the community say?

What Factors Influence Disclosure or Non-Disclosure of Domestic Abuse? 105

The research report - What Factors Influence Disclosure or Non-Disclosure of Domestic Abuse? is based on a survey carried out in 2014 by SEEDS Bath (Survivors empowering & educating domestic abuse services). It focused on the factors that had influenced women experiencing domestic abuse to disclose or not to disclose what had befallen them to other parties.

This small-scale survey was designed by four members of SEEDS Bath, who had experienced domestic abuse themselves, and it was distributed through the Bath Mums website. Owing to the fact that just a very small number of women (18) filled in the survey, the results cannot be said to be representative of women who have experienced domestic abuse. However, they may provide some indication of possible reasons female domestic abuse victims choose to disclose or not disclose their experiences of abuse. The isolation of women who experience domestic abuse could be one reason for the low number of respondents.

Make up of respondents:

  • 44% (8 women) were 36-45 years old
  • 55% (10 women) had been more than ten years in a relationship with their abuser
  • 72% (13 women) had children
  • 39% (7 women) had witnessed domestic abuse in early childhood
  • 72% (13 women) had identified at some point in their relationship that they were in an unhealthy relationship
  • 67% (12 women) had considered confiding in someone about their experience of domestic abuse

Reasons for disclosing - The survey results indicate that there are many different reasons women chose to disclose, and that it that it is often due to a combination of factors.

The main reasons given by the respondents were, emotional trauma, children's safety & wellbeing, their own safety & wellbeing, wanting to get out of the situation, wanting a different life, and fear.

Reasons for not disclosing - The survey results indicate that there are a wide range of reasons women choose not to disclose:

Interestingly, worries respondents had about the well-fare of their children, was also one of the main factors the respondents gave for not disclosing. Many respondents stated that they had not disclosed due to fear of the possible resulting violent response from their abuser against them and their children. Some of the other reasons given by the respondents for not disclosing were: lack of confidence, concerns over the impact it would have on their relationships with friends, feeling too ashamed, thinking that they would not be believed, fear of reprisals, and lack of knowledge of the help available.  

The first person respondents spoke to regarding their relationship concerns - Friends were the people the greatest number of respondents spoke to first, followed by family members and then the police. GPs, health care workers and domestic abuse services were also identified as respondent’s first point of contact. 

Identification of the relationship as abusive - While 72% (13 women) of the women answering the survey had recognised at some point during their relationship that it was unhealthy, only 35% (6 women) identified their relationship as abusive when disclosing.

Recommended improvements – The report recommends that service providers make sure that their key staff have continuing professional education and training to meet the needs of victim, and to have adequate understanding of the complexities and challenges facing victims.

The report also advises that work place practices should enable disclosure by victims of domestic abuse through routine inquiries and that professionals like the police should prioritise the safety and the individual needs of the victims. It is suggested that this will not only help to ensure that the victims get several opportunities to disclose, but also the courage to do so.  

Domestic Abuse in the LGBT community 106

In March 2016, the Diversity Trust and Next Link published a research report on “Improving access to domestic abuse services across Avon and Somerset”, which explores the experience of LGBT victims of domestic abuse and their thoughts and ideas of how access to specialist services can be improved.

National estimates suggest that around 25% of LGBT people suffer violent or threatening relationships with partners, which is about the same rate as abuse against heterosexual women. This rate is not however reflected in the take-up rate of specialist services or incidents reported to police.

The report comprises a programme of activity including; focus groups, review of service providers’ policies and services, DVA staff awareness training, a campaign to increase reporting and referrals and national literature review.

The report lists a series of recommendations to local commissioners and domestic abuse service providers, the key ones being:

  • Commissioning of an IDVA/ISVA with a specialist remit to support LGBT survivors
  • Encourage organisations to nominate an LGBT champion
  • Increase monitoring/recording of gender identity and sexuality within services
  • Encourage promotion of domestic abuse services in LGBT scene venues
  • Develop an online digital domestic abuse resource for LGBT
  • To commission further research into LGBT domestic abuse, particularly experiences of Trans women and men, non-binary, gay and bisexual men.

Click for the report materials

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