KEY CHALLENGES IN ADDRESSING DOMESTIC ABUSE 10th November 2015 Nasheima Sheikh - Assistant Chief Executive

What is Domestic Abuse?

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over, who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse: Psychological, Physical, Sexual, Financial, Emotional Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish or frighten their victim Home Office 2013

DOMESTIC ABUSE – THE FACTS  1 woman murdered every 3 days  1 in 4 women will experience DA at some point during their lifetime  DA accounts for almost a fifth to a quarter of all reported violent crime … .…. what happens to the ones who don’t report? 20/80 … 25/75 …

DOMESTIC ABUSE – THE FACTS  A gendered crime – most victims are women  Changing demography introduces new challenges – new issues, languages, culture, additional barriers …  Cost of DA is high - £143 for every household in Birmingham; £3 billion to public services  A high human cost : estimated 21-30,000 DA victims per year in Birmingham & others are affected

Impact of domestic abuse Repeated short-term impact on physical health including bruises, burns, broken bones, sexually transmitted diseases Physical and sensory impairments Loss of confidence and low self esteem leading to long term social difficulties and poor mental health, anxiety, depression, panic attacks alcohol and substance misuse as a way of coping Physical and emotional harm to a child or dependent adult in the household Preventing children and adults reaching their full potential Negative impact on work and possible loss of independent income Serious injury or death

What challenges do you face in addressing domestic abuse?

Domestic abuse is different – why?  HOME can be the least safe place for women  DA encompasses many behaviours – many are not crimes  DA is everywhere and nowhere  Involves relationships and emotions  Involves children, relatives, Carers, PA’s …  DA is complex and may not end – even with conviction  Women approach, on average, between 5-12 agencies (BME is 12-18) before they get a supportive response

Making the links between adult safeguarding and domestic abuse …it is clear that a significant proportion of people who need safeguarding support do so because they are experiencing domestic abuse. Despite the clear overlap between work to support people experiencing domestic abuse and safeguarding adults work, the two have developed as separate professional fields. Clear strategic and practice links need to be made between the approaches Adult safeguarding and domestic abuse – a guide to support practitioners and managers

What is Coercive Control?

IMAGINE ….. Imagine … always having to ask permission to see your family and friends Imagine … someone taking the battery out of your wheelchair so you cannot move Imagine … not having any control over what and when you eat Imagine … being threatened with going into an institution if you tell anyone Imagine … being threatened with withdrawl of assistance if you do not comply with sexual demands Imagine … never being able to speak to anyone because your abuser is always there Imagine … being a prisoner in your own home ….

IMAGINE ….. Imagine … the person who is supposed to love you is making fun of you to your friends Imagine … being too scared to tell anyone what is going on Imagine … telling someone, only for it to be relayed back to your abuser Imagine … being afraid to sleep at night Imagine … that you believe it when your partner tells you it is your fault. That if only you could hear, see, didn’t need support, didn’t need medication, were a better parent, lover, dressed better, kept your mouth shut, kept in shape … somehow things could get better …. Imagine … that the most dangerous thing you can do is leave …

It is the degree of control that is the greatest predictor of future risk, not the degree of violence … Professor Evan Stark – July 2015

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Impact of control …  Pattern of coercive control & intimate terror distorts a victim’s perceptions  Increased isolation, powerlessness and dependency  Increases victim’s fear of statutory intervention  Restricts victim’s freedom to make decisions – could appear unco- operative  Could have their lives micro-managed  If they seek support – this could increase risk to them … Abusers often deliberately emphasise and reinforce dependency as a way of maintaining control and will often use forms of abuse that exploit, or contribute to, the victim’s impairment

…so how do you identify domestic abuse?

Care Act 2014: Domestic Violence listed for the first time within the circumstances that constitute abuse and neglect

DISABLED WOMEN, WHAT WE KNOW…  Women who have disabilities are at significant and higher risk of domestic abuse (Rich 2014)  More than 50% of disabled women have experienced domestic abuse during their lives (Magowan, 2003)  A study done by Baylor University shows that disabled women can stay in dangerous conditions significantly longer than non-disabled women – 11.3 years as compared to 7.1 years. (Holly A. Devines, Barrier Free Living Domestic Violence Program)  Kinds of abuse tactics used are wide ranging and often focus on the disability

DISABLED WOMEN, WHAT WE KNOW…  Largest study of disabled women’s experience of domestic abuse in the UK found that: Disabled women are twice as likely to experience gender- based violence than non-disabled women, likely to experience abuse over a longer period of time and suffer more severe injuries as a result and are less likely to seek help and often the help is not appropriate Being disabled made the abuse worse and severely limited their capacity to escape and the abuse featured high level degrading emotional abuse and often extreme sexual violence (‘Making the links: domestic violence and disabled women’, Professor Gill Hague, Violence Against Women Research Group, Bristol University UK)  Women with learning disabilities are less likely to know that services exist and have fewer resources in terms of money, social or emotional support  Feature of abuse for women with learning disabilities – lack of clarity about what is acceptable in a relationship (play fighting) (Kent University 2014)

OLDER WOMEN, WHAT WE KNOW…  Domestic abuse is often confused with elder abuse – victim is portrayed as vulnerable and in need of medical and social care and the perpetrator is also old and often excused of responsibility. More than 50% of abuse experienced by older women is domestic abuse (O’Keefe, Madelaine et al 2007)  Older women are seen as not typical domestic abuse victims and may face particular barriers to seeking support: May be carers of abusive partners May also have physical and emotional health difficulties May be dependant on the abuser for daily care May be experiencing abuse from a son May fear the consequences of intervention – court, being placed in a nursing home, losing their decision making rights Leaving a home of a lifetime Responses of family members and adult children

WOMEN WITH MENTAL HEALTH ISSUES, WHAT WE KNOW…  Domestic violence is the most prevalent cause of depression and other mental health difficulties for women  The impact of torture has been found to have psychological parallels with the impact of torture and the imprisonment of hostages  Domestic violence is a factor in at least 1 in 4 suicide attempts made by women  70% of psychiatric in patients have a history of abuse  Responses of professionals; experiences of abuse blamed on mental health issue  Fear of institutionalisation

Mental Capacity Assessing capacity can be particularly challenging in domestic abuse situations where the person lives with and/or is cared for by the perpetrator and is perceived to be making decisions which put or keep themselves in danger Skilled assessment and intervention is required to judge whether decisions thought to be “unwise” in this situation are truly free and informed decisions, as a result of coercion and control or made in fear of retribution. Remember that women are most at risk of serious harm or homicide when they leave an abusive relationship Creating a relationship within which a victim of abuse feels safe to discuss the detail of the coercion they face can take time. The Care Act 2014 mandates the use of advocates for anyone who has difficulty making decisions about how their health and care needs should be met

CASE STUDY – MIRIAM Miriam* is a woman with multiple disabilities who has: Several children, one of whom requires constant care Suffered severe physical, emotional and financial abuse from her husband of 28 years, His control extended over the children, who were constantly fearful He moved out of their home, taking most of their possessions, the contents of their bank account as well as continuing to claim benefits due to the family. He tried to sell the house and had post diverted to his new address His actions left Miriam and the children at risk of severe poverty and homelessness. The level of abuse was considered by Police to leave Miriam at high risk.

CASE STUDY – MIRIAM Our workers supported Miriam with: Safety measures (injunction and safety planning), Donations of food, and toiletries We helped with getting her finances sorted, ensuring she claimed benefits and that they came to her Negotiated with her bank and obtained a grant from a local charity Helped to get legal measures put in place to prevent the sale of her house without her permission. We supported with getting the care needs of her eldest son assessed, and assessment of the educational and mental health needs of her other children. Miriam herself benefited from emotional support, building up her confidence and lessening her isolation. She is looking forward to rebuilding her life.

Case Study – Jenny* Jenny sought our support but was incoherent and extremely fearful, describing incidents of sexual, mental and physical abuse. She described hearing voices and hallucinating. She told us she had been diagnosed as schizophrenic but hadn’t taken her medication for 8 months as she believed she was suffering from anxiety. Adult services were contacted and duty day staff were called in. Two Community Psychiatric Nurses became involved – Jenny was known to them and they had been concerned for her welfare as she had missed appointments. Women’s Aid facilitated with Jenny to get Adult Services & CPN to put a tailored support package in place to ensure her mental health needs were met and the domestic abuse was addressed.

Challenges …  Domestic abuse is often not the presenting issue  There maybe complex & multiple issues  Nature of coercive control leaves women finding it difficult to engage … chaotic … unpredictable … unco-operative..  Nature of coercive control means that abusers are skilled manipulators  Pressure on services leaves professionals struggling to engage with women, and to sustain engagement … increasing the barriers faced by women ….

BARRIERS  Not believing her experience  Not seeing her on her own  Focus on symptom not cause  Wanting to rescue  Assuming a lack of capacity to make decisions  Not seeing carer as capable of abuse  Assuming she will want to leave / stay  Lack of accessible accommodation  Access to specialist equipment  Movement of care packages  Offered accommodation in an institution  Make excuses for perpetrators  Not asking the question

How do we meet challenges?  Safe enquiry – safe, confidential environment & direct questions  Listen, believe, validate  Offer information, choices and access to specialist services  Risk assess and safety plan with the service user  Use your professional judgement  Do not collude with the perpetrator  Multi agency working – safely and appropriately  Think Safeguarding Remember that domestic abuse is a pattern of controlling behaviour not one off incidents Ask yourself: is my intervention going to further abuse / disempower her or put her in danger?

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