1. Public Health Approach to addressing Domestic Abuse in Knowsley Matthew Ashton Director of Public Health Knowsley MBC

2. Overview Background Process Key findings Political scrutiny Scrutiny Recommendations Key messages

3. Background Domestic abuse is a significant public health issue, having a major impact upon those directly affected and their families. Locally, it had been raised as a issue at the Safeguarding Children’s Board and through the wider Knowsley Partnership. Previous needs assessments (and consequently services) developed from a Community Safety perspective. Need for new needs assessment from health perspective

4. In Knowsley 1 in 3 females smoke 1 In 3 females suffer from domestic abuse 1 in 8 females have Cardiovascular Disease (CVD) – Heart disease and strokes 1 in 9 females drink alcohol at increasing & high risk levels 1 in 15 females have coronary heart disease (CHD) (source: Life style survey 2012) www.apho.org.uk /diseaseprevalen cemodels www.apho.org.uk /diseaseprevalen cemodels - modelled estimates http://www.apho.org.uk/resource/ item.aspx?RID=11 1120 http://www.apho.org.uk/resource/ item.aspx?RID=11 1120 – modelled estimates (source: Crime Survey for England & Wales 2012) (source: QOF April 11 – March 12) 1 in 61 people have Cancer

5. Population impact? Domestic abuse incidents (N =3409) Domestic abuse crimes (N = 489) Sanction detentions (N = 318) Court cases (N = 288) Successful convictions (N = 204)

6. Aims of Needs Assessment The aims of the needs assessment were; To assess the levels of domestic abuse, and health and wellbeing needs of those affected in Knowsley To identify the causes and drivers of domestic abuse To explore the links between domestic abuse and other risk taking behaviours To investigate the extent to which current service provision is addressing the needs

7. Process Conduct Literature / evidence review Data intelligence collation and analysis (incl. service mapping and intelligence) Stakeholder engagement Scrutiny review

8. Overview of trend Domestic abuse Offences/crimes Knowsley Domestic Abuse Service Referrals Housing issues / homelessness presentations Incidents (police) A & E - Home Assaults National Survey prevalence

9. Financial Impact in Knowsley £56m human and emotional £11m housing, civil, legal employment and other costs. £3.8m physical and mental health care costs. £2.4m criminal justice costs. £452,000 social care costs. Calculated using estimates from (Järvinen et al, 2008) for domestic violence. Total annual cost to Knowsley economy estimated as £73 million.

10. Health and Wellbeing Needs – Victims and their children Victims Short term Physical health (minor – severe) Sexual health Eating disorders / self harm Fear and safety concerns (safety primary concern) Short and long term Mental health and wellbeing (depression, suicide, self harm, confidence, self esteem) Substance misuse (particularly alcohol) Housing Employment & Poverty Difficulties with relationships (intimacy, trust) Isolation Children and Young people Mental health and wellbeing Behavioural and emotional problems Links with substance misuse Child Maltreatment and Child abuse – identifying and dealing with it Education / housing Unsettled childhoods Long term impacts affecting life chances Links with crime, gangs and violence.

11. Political Scrutiny Scrutiny review by elected members on the draft needs assessment to; – Inform, sense check and develop recommendations Three evidence sessions, involving expert witnesses, plus visits to MARAC and NICE stakeholder session

12. Identified needs / issues Data / intelligence issues Strategic approach – systems Primary prevention Support for victims Support for affected children Dealing with perpetrator needs

13. Scrutiny recommendations That the strategic approach to domestic abuse be reviewed That data and intelligence issues in relation to domestic abuse be resolved Seek all opportunities to break the cycle of domestic abuse through a greater focus on prevention That support for victim survivors is reviewed That support for affected children is reviewed That the way perpetrators are dealt with is reviewed

14. Key messages Domestic Abuse is a significant public health issue in Knowsley Applying a public health approach to the needs assessment important Involving members through scrutiny of draft needs assessment was integral to raising profile, gaining ownership and development of recommendations. It raised issues for local authority and health commissioners, wider public sector and providers about referral processes and support services Addressing mental health problems, alcohol issues and healthy relationships potentially could significantly impact on domestic abuse levels. Current focus on dealing with consequences rather than prevention

15. Communication Strategy Methods Posters Postcards Beermats Bus / Taxis Media Releases Facebook Twitter Community Messaging One Stop Shops GP Practices

16. Questions? Matthew.ashton@knowsley.gov.uk

17. Recommendation 1 That the strategic approach to domestic abuse be reviewed by: Considering the strategic governance arrangements for domestic abuse; The council and its partners considering joint commissioning arrangements for domestic abuse specific services to enable a more flexible use of resources; Services focussing on addressing the behaviour of perpetrators as well as resolving the needs of the victim survivor; and, Standards/expectations being developed in the response times to resolve domestic abuse incidents completely.

18. Recommendation 2 That data and intelligence issues in relation to domestic abuse be resolved through: Undertaking further work to improve the recording of domestic abuse across partner agencies and exploring other sources of insight (particularly for teenage intimate partner violence and child on parent abuse); and, Exploring opportunities for the streamlining of referral forms from various agencies to ensure a consistent approach and improving referral processes particularly from the Vulnerable Persons Unit (VPU).

19. Recommendation 3 by: Developing a systematic approach to the primary prevention of domestic abuse; Considering the inclusion of evidence based programmes on violence and domestic abuse within the school curriculum and ensuring that their effectiveness is assessed; Investigating further the content of parenting programmes and exploring the introduction of a specific module on domestic abuse; and, Developing work with Her Majesty’s Prison Service that explores the use of more domestic abuse programmes/modules on programmes for prisoners where domestic abuse isn’t necessarily their trigger offence.

20. Recommendation 4 That support for victim survivors is reviewed by: Considering the threshold level and pathways for low-medium risk victim survivors; and, Delivering training on domestic abuse awareness and how to support those affected to all front line responders including the police.

21. Recommendation 5 That support for affected children is reviewed by: Evaluating the effectiveness of programmes to identify and support the needs of children affected by domestic abuse and show they make a difference; Reviewing the support for children affected by domestic abuse that fall below the threshold for wellbeing support and identify whether their needs are being adequately addressed; Collecting insight from children and young people on the impact of domestic abuse and using this information to inform commissioning decisions; and Testing the feasibility of rolling out Operation Encompass across Merseyside, through police colleagues given that some of Knowsley’s school age children may attend schools across local authority boundaries.

22. Recommendation 6 That the way perpetrators are dealt with is reviewed by: Assessing the long term effectiveness of existing perpetrator programmes; Exploring the reasons why there are disproportionately higher levels of cracked and ineffective domestic abuse trials in Knowsley; Exploring the greater use of sanctions for perpetrators who do not attend or complete community perpetrator programmes; Considering the use of civil action against perpetrators of domestic abuse where criminal convictions are not possible; and, Considering the broader use of Integrated Offender Management (IOM) for domestic abuse offenders to allow for a more intensive intervention to reduce the risk of reoffending and the risk of harm.