1. Recognizing and Responding to Domestic Violence A presentation by Merseyside Domestic Violence Service Ltd.

2. The cost of domestic violence The annual cost of DV in England and Wales is estimated at £16 billion The annual cost to the Criminal Justice System is £1.2 billion The annual cost of Physical health care treatment resulting from domestic violence is £1.7 billion The annual cost to Social Services is £0.28 billion The annual cost of civil legal services due to domestic violence is £0.38 billion The Home Office estimates the Cost of Domestic Homicide at over 1 million pounds per death. Women’s Aid (2014) and

3. Reproductive - unintended pregnancies, induced abortions, increased risk of miscarriage Sexual - gynaecological problems, STI's, HIV. 1.5 times more likely to have an STI, twice as likely to have an abortion, Mental - increased risk of suicide, substance abuse, twice as likely to suffer depression and alcohol abuse, emotionally withdrawn, isolation, Physical - Homicide, 42% suffer substantial injury, permanent disability. headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor overall health. HUMAN COST OF DOMESTIC VIOLENCE

4. Violence against women has serious consequences for their physical health 70% of incidents of DV result in injury 46% of women sustain a minor physical injury, 20% a moderate physical injury, and 6% severe injuries (Walby & Allen, 2004) What are the most common types of injury? 4 Physical Health

5. Most common types of injury Ruptured tympanic membrane (ear drum) Rectal/perineal injury Genital bruising/contusion Facial abrasion/contusion Neck abrasion/contusion Abdominal laceration/penetration Orbital/nasal/zygomatic (cheekbone) fracture Damage to lips Dental damage Head abrasion/contusion Thorax abrasion/contusion Facial laceration Upper extremity abrasion/contusion (breast area) Injuries caused by perpetrator Cuts, bruises, and black eyes to miscarriage, bone injuries, spleen and liver trauma, partial loss of hearing or vision, and scars from cigarette burns or knife wounds. Bite marks, welts from a weapon Breast Injuries, chest and abdomen are more common in victims of dv multiple old and current injuries Defensive injuries These injuries are to the parts of the body used by the woman to fend off an attack: The small finger side of the forearm or the palms when used to block blows to the head and chest The bottoms of the feet when used to kick away an assailant The back, legs, buttocks, and back of the head when the woman is crouched on the floor Injuries inconsistent with the explanation given: The injury type or severity does not fit with the reported cause. The mechanism of injury reported would not produce the signs of injury found on physical examination. Injuries in various stages of healing: Signs of both recent and old injuries may represent a history of ongoing abuse. Delay in seeking medical attention for injuries may indicate either the victim's reluctance to involve doctors or his or her inability to leave home to seek needed care.

6. THIS IS AN EXAMPLE OF FINGER BRUISING

7. AN EXAMPLE OF A BITE MARK CAUSED BY A PERPETRATOR OF DOMESTIC VIOLENCE

8. AN EXAMPLE OF DOMESTIC VIOLENCE INVOLVING A KICK CAUSING AN IMPRINT OF THE SOLE OF THE PERPETRATORS SHOE

9. Creating an Environment Where Victims of Domestic Violence are Able to Disclose Information clearly displayed in waiting areas, i.e. posters, leaflets including information on helplines, groups, dv organisations, safety planning, disclosure. Training for all staff including receptionists Monitoring of patients who have a pattern of failing to attend appointments Clear policies and procedures for staff who may be asking questions Ensure staff wellbeing; ensure they have opportunities for self disclosure Staff training to recognise indicators of domestic violence Multiple abusers - Be aware that patients may attend with family members, friends, or the perpetrator – they too could be colluding with the abuse WHY IS IT IMPORTANT TO CREATE A SAFE ENVIRONMENT?..

10. Recognising and Responding to domestic violence Expectations of the child protection system X) Dad must leave the family home immediately Y) There must be no contact Z) Must report to Police Consequences of these expectations for the mother and children; X) He will kill me if I leave him, he will not leave Y) If he is unable to contact me by phone he will turn up unannounced at the house Z) Perpetrator is not convicted It is rare that professionals responses to domestic violence are directed toward the perpetrator It is common that women become the primary source of preventing further incidents of domestic violence

11. FAILIURE TO PROTECT YOU NEED TO TELL HIM TO LEAVE THE FAMILY HOME YOU NEED TO LEAVE HIM YOU ARE ALLOWING THE ABUSE TO CONTINUE YOU LACK MOTIVATION TO ENGAGE YOU LACK INSIGHT INTO DOMESTIC VIOLENCE YOU ARE PRIOROTISING HIM OVER YOUR CHILDREN ONE MORE POLICE CALL OUT AND THE CHILDREN WILL BE REMOVED YOU ARE TO HAVE NO CONTACT WITH HIM

12. The risks associated with leaving Leaving an abusive relationship can result in women being murdered It is important that whenever we have the opportunity to offer support and respite for women and children that we do so without forcing the issue of leaving permanently

13. How we can support you Training Development and implementation of policies and procedures Identifying referral pathways Risk assessments and initial assessments Working directly with female victims/survivors and male perpetrators of domestic violence

14. We now look forward to some questions? Thank you for your time