4 Domestic Violence Definition “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:psychologicalphysicalsexualfinancialEmotional(Home Office, March 2013)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.This definition, which is not a legal definition, includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.It occurs regardless of a persons Economic or social statusCultural or ethnic heritageSexual OrientationGenderReligious BeliefsAge
5 Domestic Abuse – the Impact on Health & Well-being
6 Domestic Abuse & Sexual Health Abused women are three times more likely to experience gynaecological problems than non-abused women, with a dose-response relationship and the risk increases when experiencing both physical and sexual abuse. These include;recurrent urinary tract infectionsabnormal vaginal bleedingDyspaeruniachronic pelvic pain.(Professor Gene Feder - Professor of Primary Care Research & Development)The most consistent and largest physical health difference between abused an non-abused women is in the experience of gynaecological problems, STI’s, vaginal bleeding and infection, genital irritation, chronic pelvic pain and urinary tract infections. It is important to remember that the majority of sexual assaults and rapes are carried out by a known perpetrators.In combined 1998 and 2000 British Crime Survey sweeps, 67% of rapes against women were committed by current or ex-partners or ‘dates’.
7 Domestic Abuse & Pregnancy More than 30% of domestic abuse cases first start during pregnancy.40-60% of women experiencing domestic abuse are abused during pregnancy.More than 14% of maternal deaths occur in women who have told their health professional they are in an abusive relationship.(CEMACH Report ‘Saving Mothers’ Lives - Reviewing maternal deaths to make motherhood safer ’, December 2007)Women suffering domestic abuse during pregnancy are more likely to experience, miscarriage, maternal death, premature birth, babies with low birth-weight/stillbirth/injury/death(‘Responding to Domestic Abuse’, DH, 2005).In 1998 the DH recognised that maternal and child morbidity and mortality in relation to domestic abuse had in the past often been overlooked. Domestic abuse also affects the quality of relationship a woman is able to form with her child/ren. Mothers may be unable to bond successfully with their babies and may be more likely to suffer with post-natal depression. We know that low birth weight has a knock on effects on the health of the individual throughout his/her lifetime.
8 Domestic Abuse & Mental Distress Between 50% and 60% of women mental health service users have experienced DA and up to 20% will be experiencing current abuseDA is the most prevalent cause of depression and other mental health difficultiesBetween 35% and 73% of abused women experience depression or anxiety disorders. This is at least three times greater than the general populationDA commonly results in self-harm and attempted suicide and a third of all female suicide attempts can be attributed to current or past experience of DA.The figures for minority ethnic women are even higher. For example, 50% of women of Asian origin who have attempted suicide or self-harm are DA survivors.70% of female psychiatric in-patients and 80% of those in secure settings have histories of physical and or sexual abuse(Adapted from Women’s Aid Guidance for mental health professionals, J Barron 2005)Perpetrators often use survivors mental health issues to their own advantage by;Controlling, selling or withholdingHiding or moving objectsLiaising with professionals involved in the care of their partnerTelling the survivor that they cannot cope without them, that they are mad and no one will believe them.
9 DA & Substance MisuseAlcohol misuse is linked to domestic abuse in a number of ways;Survivors may use alcohol as a mechanism for coping with abusePerpetrators may use alcohol as an excuse for being abusive or violent and physical incidents of abuse maybe more likely to occur once alcohol has been consumed.Alcohol misuse among domestic violence perpetrators may be up to seven times higher than in the general population(National Alcohol Harm Reduction Strategy, 2004).Those experiencing domestic abuse are as much as fifteen times more likely to misuse alcohol and nine times more likely to misuse drugs than women generally(Maryland Department of Health, 2001).Reviews of research indicate that rates of alcohol abuse among perpetrators of domestic violence may be two to seven times higher than for the general population (Logan et al, 2001).Research also suggests that alcohol may be used not only as a post-offence excuse but also in the build up to abuse.Even where a perpetrator has an alcohol dependency they still retain the choice to seek help.The increase in alcohol and drug use is usually as a coping mechanism and usually comes after the DVA has started rather than before it, i.e. the substance use is a result of the DVA not to be used as an excuse for it starting (we know that perpetrators do this and sometimes professionals collude with this).
10 Domestic Abuse & Physical Health Women injured by domestic violence as opposed to other means are 13 times more likely to be injured in the breast, chest and abdomen.Domestic abuse/violence is one of the most common causes of injury in women.The long term physical affects of domestic abuse on health include chronic pain (headaches, back pain), increased minor infections, neurological symptoms (fainting & dizziness), chronic IBS, raised blood pressure and coronary artery disease.(Professor Gene Feder)The cost of physical injury to the health service is staggering given the likelihood that victims of domestic abuse will make repeated visits or the GP surgery or A&E for treatment. By just treating the symptoms of abuse we are simply maintaining the current human and economic cost of domestic abuse and stretching a health service which already has huge financial and staff resource issues.
11 The true cost of domestic abuse… More than 1 in 4 women and around 1 in 6 men have experienced domestic abuse since the age of 16. (Home Office, ‘Homicide, Firearm Offences & Intimate Violence 2008/09’, January 2010)Women are more likely than men to experience longer periods of partner abuse, repeat victimisation and injury or emotional effects as a result of the abuse. (Home Office, ‘Homicide, Firearm Offences & Intimate Violence 2008/09’, January 2010)On average 2 women per week are killed in England & Wales by their partners or ex-partners (Crime in England and Wales 2006/07 Report)DVA costing health £1.7 billion per year (Walby S. The cost of domestic violence: Update Lancaster. Lancaster University: 2009). It should be recognised that these costs are calculated from known cases of domestic abuse. Many cases of domestic abuse continue to remain hidden so these figures will be an underestimation of the true cost.
12 Domestic Abuse in Surrey In the 51 weeks to 25th March 2013 Surrey Police received 12,567 reports of a domestic incidents or crimes. That is 246 reports every week. (Surrey Police, 2013)In the specialist domestic abuse outreach services in Surrey dealt 3,127 new service users.
13 Surrey StatisticsSince 2000 there have been 58 known attempted or actual DA related killings in SurreyNumber of murders: 26Number of attempted murders: 29Number of manslaughters: 3(Surrey Police, April’13)
14 Links between DA & Safeguarding In 2005, Section 120 of the Adoption and Children Act 2002 came into force, which extends the legal definition of harming children to include harm suffered by seeing or hearing ill treatment of others, especially in the home. This includes domestic abuse.
15 Impact of Domestic Abuse & Children Womb – 1 Year Old - Premature Birth, Still Birth, Unborn baby maybe the target of an attack, Miscarriage, Low Birth Weight, Poor antenatal & postnatal care, Affected by a mother’s diet, alcohol, and drug consumption2 – 13 years - Poor health, Difficulties sleeping & settling, Excessive screaming or crying, Frozen Awareness, Slow emotional development, They may present with challenging behaviours, They may be withdrawn, Nightmares & disrupted sleep patterns, Bedwetting & eating disorders, Physical problems such as headaches, stomach cramps, asthma or skin complaints, Suicidal feelings and self harmTeenagers - Alcohol & drug misuse, Early sexual activity and/or pregnancy, Self Harm, Suicidal Thoughts/Attempts, Homelessness, Criminal Activity, Abusive behaviours within their own Intimate relationships, Medical issues - stress-related issues such as IBS, skin complaints, gynaecological issues etc.Highlight the fact that many children & young people are referred to CAMHS however these referrals are not accepted as the issue is situational not mental health. We need to find alternative care pathways for both adults and children affected by domestic abuse if we are to provide appropriate care, reduce harm and save resources
16 Working Together (Working Together 2013) Early help is more effective in promoting the welfare of children than reacting later. Early help means providing support as soon as a problem emerges, at any point in a child’s life.Professionals should, in particular, be alert to the potential need for early help for a child who:is disabled and has specific additional needs;has special educational needs;is a young carer;is showing signs of engaging in anti-social or criminal behaviour;is in a family circumstance presenting challenges for the child, such as substance abuse, adult mental health, domestic violence; and/oris showing early signs of abuse and/or neglect.(Working Together 2013)Highlight links between domestic abuse – substance misuse, anti-social behaviour, becoming a young carer, referrals (possibly inappropriate) to CAMHS
17 Munro Reports“Domestic violence is a significant issue linked to child protection, and its prevalence may be varied in different localities. Services need to be developed to reflect this:There are 120,000 victims in any year who are at high risk of being killed or seriously injured as a result of domestic abuse (1)69% of high risk victims have children (2)”CAADA (2010) Saving Lives, Saving MoneyHowarth etc al (2009), Safety in Numbers: A Multisite Evaluation of Independent Domestic Violence Advisor Services
18 Serious Case Reviews (SCR) A study of 130 SCR’s published between 1 January 2008 and 12 September 2011 involving a child aged under one year found that.domestic abuse was a factor in at least 60 of these casessubstance misuse was a factor in at least 46 of these casesparental mental health was a factor in at least 34 of these cases.one or more of the above was a factor in 94 cases(‘An analysis of serious case reviews concerning children under one’, NSPCC, December 2011)Domestic abuse has been a factor in all three Serious Case Reviews in Surrey since September 2011(Surrey Safeguarding Children Board, 2013)
19 Why we need to work together? Domestic abuse & violence has a long lasting and often devastating impact on the health & wellbeing of survivors, their children & families.Health care services, particularly primary care, can be a survivor’s first or only point of contact with professionals.Abused women identify doctors as the professional from whom they would most like to seek supportDomestic abuse is a significant and sometimes fatal safeguarding issue90% of all female patients experiencing DA consult their GP over a five year period (Wisner et al, 1999)Women report wanting health services and professionals to have a duty to identify and respond to violence against women and girls (A bitter pill to swallow: Report from WNC focus groups, Women’s National Commission; 2010)They report wanting to be asked and expecting an appropriate response (Feder GS et al ‘Women exposed to intimate partner violence: expectations and experiences when they encounter health care professionals’, 2006)All patients want... (Page, B ‘Making the most of the patient survey. Ipsos-MORI; 2004)
20 Why now?Royal College of GPs has made tackling domestic abuse a ‘clinical priority’Department of Health recommends that all health professionals play a role in tackling domestic abuse & violenceIRIS Project findingsNICE review & consultationHealth & Well-Being Board PrioritiesWHO Guidelines on Responding to intimate partner violence and sexual violence against womenDomestic violence and abuse – identification and prevention NICE is developing public health programme guidance on ‘Domestic violence and abuse: how social care, health services and those they work with can identify, prevent and reduce domestic violence and abuse’. The consultation period runs from 2nd August – 27th September Surrey Health & Well-Being Board have identified Emotional Well-Being & Mental Health as a priority – DA has a significant impact upon both!
21 Surrey Against Domestic Abuse Domestic abuse is a key priority for agencies, partnership Boards and Groups:Structure:Community and Public Safety BoardDomestic Abuse Development GroupLocal DA ForaSpecialist Task and Finish GroupsDomestic Abuse Strategy for SurreyTransforming Public Services agendaHealth & Well Being BoardDA has the highest profile it has ever had in Surrey.Currently there are 5 Domestic Homicide Reviews across Surrey following tragic DA related deathsFull programme of DA CommsDA week 14th OctoberJan/Feb campaignDA websiteDA training free to all delegatesStrategy sign off and action planningSSAB SCR/DHR event November 2013DA event Feb 2013 with SMEFConference or event 21 March 2013
24 Surrey DA Services Outreach Services Children’s Services Refuges 24 hr HelplineCounsellingGroup workVolunteering ServicesLegal Advice Drop-inSpecialist Domestic Violence CourtsSanctuary SchemeAwareness RaisingService providers and commissioners should take a much more strategic approach towards volunteering, with a clear vision of how volunteers will help meet organisational objectives and benefit patients and the local community.The Department of Health, NHS Commissioning Board, Public Health England and other national bodies need to articulate and measure the value of volunteering and support local organisations to work with volunteers effectively.Providers of all kinds should focus on volunteering as a means of improving quality rather than cutting costs, and should resource volunteer management appropriately.Volunteering in health and care: Securing a sustainable future (Naylor, C et al, March, 2013)
25 How we work with service users Outreachface-to-face, phone, or text.Specialist advice, advocacy, information & support.Crisis intervention & long term work delivered on a needs-led basis.Empowerment & recovery crucial to prevent repeat victimisation & maximising safety & well-being.Benefits, Children & child contact, Debt, Divorce & separation, Housing, Injunctions, criminal law, referral to other agencies and much more!
26 Thank you for listening… Barbara French DA Strategy Manager barbara Thank you for listening… Barbara French DA Strategy Manager