Report: A Cry for Health
National domestic abuse charity, SafeLives, calls on every hospital in England and Wales to have specialist domestic abuse support onsite. Health providers must be part of the long-term solution to tackle domestic abuse.
The findings of SafeLives' research published today, which provides evidence from over 4,000 victims supported in hospital and community settings, show that we are missing opportunities to identify victims of domestic abuse – particularly the most vulnerable – and that locating a team of Independent Domestic Violence Advisors (Idvas) within a hospital is a key way to address this.
SafeLives is calling for hospital-based Idvas to be integrated as part of a whole-system approach to support which include community based specialist domestic abuse services, mental health and health services. The charity believes that this provides a way of reaching the 4 out of 5 victims who never contact the police as well as providing an opportunity to save money through earlier identification.
An investment of just £100,000 per major hospital nationally would provide support for 15,000 additional victims of abuse and magnify the impact of our existing health services in this area.
Diana Barran, Chief Executive of SafeLives says: “This research reinforces what survivors, Idvas and health professionals have been telling us for years: that we need a whole-sector, public health response to what is a public health epidemic. We already know that Idvas are a lifeline for victims of domestic abuse, and this research shows that hospitals are a place where they can make a real difference to some of the most vulnerable victims."
Sara, 42, survivor of domestic abuse (name changed): “My health suffered hugely due to the abuse – one day I collapsed while shopping. I was taken to hospital and I met an Idva there. And suddenly I could talk to someone who understood. The Idva had the patience, the understanding. She knew what I was trying to say even when I couldn't get the words out. I trusted her, and she started to put me and my family back together again…If I hadn't met that Idva I hate to think what might have happened – someone might have been killed.”
Key findings of the research:
1)Health and domestic abuse are inextricably linked.
Domestic abuse has a profound and long-term impact on our physical and mental health. And victims who seek medical assistance are more likely to have mental health difficulties, substance misuse issues and additional vulnerabilities.
- Our research found that almost 60% of victims identified in hospital had mental health concerns (compared with 35% of victims who engaged with a community service)
- Just under half (49%) of victims identified in hospitals had post-traumatic stress disorder (PTSD) compared to 6% of community victims
- One in six (16%) had been to A&E for an overdose in the last six months, compared to 3% of community victims
We need to address mental health issues as well as the domestic abuse that victims are suffering. Unless we do this, our current efforts to reduce one or the other will be seriously undermined.
Domestic abuse isn't just about the injuries we can see: the hidden harm to victims and children is even greater.
2) We are missing opportunities to support victims and reduce the impact on their health and wellbeing.
This issue cannot and should not be dealt with by the police alone. The British Crime Survey found that four out of five victims do not call the police. Health professionals are ideally placed to identify victims; our research found that 56% of hospital victims had accessed A&E in the year before getting help. These missed opportunities to intervene are especially important for victims who are not in contact with other agencies.
Our research showed clearly, that without the provision of specialist support to respond to a disclosure of domestic abuse, clinical staff are unlikely to ask about it.
"There is no point asking the question if we’re not going to do something about it. It’s like opening a nasty cut and not doing anything about it”
“We found people we were identifying through A&E were not known by other services”
Currently, victims go to hospital, visit their doctor, talk to their midwife. And yet all too often, we are not asking the question.
In about half of cases, victims are being discharged back into the arms of the perpetrator who put them there.
3) Domestic abuse already puts enormous strain on our NHS. With a small investment, we can unlock the potential in our health service and make victims safer, faster.
Domestic abuse costs £1.73 billion to the NHS already. Our doctors and nurses already do an incredibly tough job. We cannot expect them to find the time and space to ask the question, in the right environment that supports a victim to disclose, without specialist services to refer onto. We must have clear referral pathways to specialist domestic abuse provision with the training and focus to reassure victims and support them in their long journey to being safe and well.
"We do leave a lot of work to them [Idvas]... They do so much more with patients than we could ever dream of doing because of time. Their role is so important. I don’t know what we would do without them”
Our research has found that it would only cost £15.7m for every NHS acute provider to have a robust Idva service. That is £100,000 per hospital. It would provide help for 15,000 additional victims a year.
- National policy-makers need to prioritise domestic abuse as a health issue, incentivising hospitals with a seven-day a week Idva service, alongside increased support for children of victims, and to ensure NICE guidelines – that every person presenting with indicators of abuse must be asked – are followed consistently.
- Commissioners should have a strategy to address domestic abuse in a range of health settings including hospitals, GP surgeries and mental health services. This needs to include Idva services in hospitals and beyond, they must ensure this provision is sustainable and effectively supported, and they must fund services in a way that provides victims with long-term support in and outside of hospital. Victims need ongoing support from other services once they have exited the Idva service.
- Hospital Idva services and hospitals should embed the Idva service within the hospital, ensuring that it is visible across departments and that there are clear referral pathways for staff. Ensure that NICE guidelines are being followed consistently, and involve the Idva in delivering domestic abuse training to all hospital staff.
- Non hospital-based Idva services should seek funding to extend your existing service into hospitals, and ensure that referral routes are established and known to health professionals across departments.
Read the report, 'A Cry for Health'
For more information – Head of Communications Penny East at SafeLives: email@example.com, 07818 593 562
For a copy of the full evaluation report, please email firstname.lastname@example.org
Available for interview:
- Diana Barran (Chief Executive of SafeLives)
Notes to editors
SafeLives: a national charity dedicated to ending domestic abuse. It combines support for local services with hard data to find out what works. Then it does everything it can to make sure families everywhere benefit. SafeLives' new strategy addresses the needs of the whole family, taking a whole-picture approach to vulnerability.
Cry for Health (Themis): In November 2012, Themis was launched as the first research project of its kind in the UK. It set out to explore the impact of co-locating Idva services in hospitals. We wanted to develop the evidence base to highlight the benefits of stronger links between the health sector and domestic abuse services through innovative models.
The research was carried out across four geographical areas, examining five English hospitals that had adopted the approach of locating specialist domestic abuse services within their A&E and Maternity units. The project reached a total of 692 hospital victims and 3,544 community victims in the three years we were collecting data.