27th September 2019
Emma Retter, Research Analyst at SafeLives, looks at how the collection of data can provide the vital support survivors need.
The UK definition of domestic abuse is “any incident or pattern of incidents of controlling, coercive, 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. The abuse can encompass, but is not limited to psychological, physical, sexual, financial, emotional.” It includes coercive control, which 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.
Each year an estimated 2 million adults in England and Wales experience some form of domestic abuse – 1.3 million female victims/survivors and 695,000 male victims/survivors. These figures are likely to be an underestimate, because all types of domestic violence and abuse are under reported in health and social research, to the police and to other services.
Data collection, therefore, is not simply a numbers game when it comes to domestic abuse. When it is collected by health staff in a consistent, effective and clear way, it creates a story. This story becomes a narrative that informs us about a community and can provide answers to what support is needed for the survivors of domestic abuse in that community. Without data, we have little evidence to show the excellent work being done in many areas of health for survivors. We also have little evidence to make a case for the extra work, extra funding and extra services that are needed for those survivors that are falling through the gaps in support. And as we know, health services have a key role in finding these gaps. This blog will look at why the collection of data can provide the vital support survivors need and give a few examples of what the most effective data is to collect within a health setting.
Health Data and ‘Hidden’ Victims
Survivors of domestic abuse do not always telephone the police for help. The latest Crime Survey for England and Wales, released in November 2018, informed us that only around one in six survivors told the police about the abuse they were suffering. We know that the police refer two thirds of all survivors to Marac. So how do we find and provide support to the other survivors out there? How do we understand their story and the specific support that they need? And how do we know if there are services there to support them?
SafeLives have produced a series of Spotlights which brings together insight from survivors, practitioners, academics and other experts, alongside our own data and focuses on these groups of victims who may be 'hidden' from services or face additional barriers to accessing support. The first spotlight focuses on older people and domestic abuse. SafeLives found that older victims experience abuse for twice as long before seeking help as those aged under 61 and nearly half have a disability. It was also found that older clients are hugely underrepresented among domestic abuse services. If a patient discloses domestic abuse to a health setting, simply capturing their age can make all the difference to the local and national picture. It is usually younger women and children who are shown in campaigns around domestic abuse. Older people can sometimes be forgotten about. But, if your health practice captures the age of a survivor of abuse and begin to see a pattern emerging of domestic abuse in an older generation, this can lead to the older survivors having more targeted specific support. Domestic abuse workers, such as a Health Independent Domestic Violence Advisor (Idva) in the hospital, or an Iris Advocate Educator in the GP, can use this data to ensure their service is fully accessible to older victims. If there is no domestic abuse worker in the health setting, this information can be incredibly important to show that support within a health setting can reach these older survivors of domestic abuse. Commissioners can use this data to come to an informed decision about where money and funding should be placed.
SafeLives Cry for Health report gave a wealth of evidence to show that health settings are able to reach a different profile of people than community-based services. As one Senior hospital Idva stated:
“I think we are meeting people who are hidden from society”
Health services are key to capturing individuals who are sometimes cut off from society. When these individuals access a health service and are asked about domestic abuse, a disclosure and referral to the right support can be life changing. However, the picture that can be drawn from understanding a little more about each patient who discloses abuse can be life changing for a community. A few examples of the eight spotlights include: Disabled people, Young People, ‘Honour’ based violence and forced marriage and LGBT+.
What Data to Collect?
There is no universal best way to collect data. What is important is that data is collected is confidential. Any notes made regarding the abuse must not be accessible anyone outside of the patients health care as this can put an individual at serious risk of harm.
How a health setting collects data will change with the health setting, the area and the systems that are in place in the service. However, there are a few key questions that can really make a difference to the provision of domestic abuse support to an individual and in a community:
Information as to where the patient has been referred to and action taken by health professionals is important to record for the patient’s safety. If a referral to a multi-agency setting or a specialist service is made, it is important that the health setting has confirmation that the referral has been accepted. Making a note of who you are referring patient’s to also highlights links between specialist services and health settings. This can lead to joined up working between health settings and specialist services which can further the support and safety of patients and staff alike.
The gender, age, sexual orientation and ethnicity of a patient is important to capture. These demographics can have an impact on how a patient feels regarding access to support and the specific support they need. A male survivor of domestic abuse may have very different needs to a female survivor. A 16-year-old survivor may have very different needs to a 45-year-old survivor. A Black or ‘Minority Ethnic’ (BME) survivor of abuse may have different needs to that of a non BME survivor. It is important all survivors of abuse receive the support specific to them. Without knowing the demographics of survivors of abuse, we are unable to provide the right support. By collecting this demographic data and piecing together who the clients are that are approaching health for support, the right support at the right time can be put in place for all survivors of abuse.
The presence of children in the household or soon to be in the household is important, not only to ensure that children can receive support but for safeguarding purposes.
Relationship to Perpetrator
Does the patient live with the perpetrator? Is the perpetrator the patient’s carer? Are there multiple perpetrators? These questions are important for the safety of the survivor. It is also important in relation to the support given. A patient facing violence from their son or daughter may need very different support to someone being stalked by their ex-partner.
Is there a risk of Forced Marriage or ‘Honour’ Based Violence?
In order for the specific support that survivors need in relation to forced marriage and ‘honour’ based violence, it is vital that this information is collected.
Pathfinder Good Practice
Practice in terms of data collection around domestic abuse has differed in all of the Pathfinder sites. No two sites or teams have been the same! We thought we’d use one example here of a Safeguarding team at one of the sites.
The safeguarding team currently uses a simple excel spreadsheet to track the demographics of patients who are victims of abuse, which departments the patients are being referred from, notes on the disclosure by the patient and finally, the actions of the hospital. This simple excel spreadsheet not only shows the support the client needs and the actions of the staff, but it also allows the Safeguarding team to see where referrals are coming from and, more importantly, which departments are not referring domestic abuse and so may need some more training!
We all know and understand how busy health professionals are. However, recording a few simple details on an excel spreadsheet each time a disclosure relating to domestic abuse takes place can really make the difference to patients in health settings and may lead to lives being saved.
 Home Office (2019), The economic and social cost of domestic abuse
 Domestic abuse: findings from the Crime Survey for England and Wales - Appendix tables, Appendix Table 25: Why the victim did not tell the police about the partner abuse experienced in the last year, year ending March 2018 CSEW1, November 2018 https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/datasets/domesticabusefindingsfromthecrimesurveyforenglandandwalesappendixtables
 Latest Marac National Dataset, 12 months 01/04/2018 to 31/03/2019, SafeLives, http://www.safelives.org.uk/practice-support/resources-marac-meetings/latest-marac-data
 SafeLives, A Cry for Health, Why we must invest in domestic abuse services in hospitals, November 2016 http://www.safelives.org.uk/sites/default/files/resources/SAFJ4993_Themis_report_WEBcorrect.pdf