Policy blog

Cry for Health

Today, we publish our research ‘A Cry for Health’ – a rallying cry to every hospital in England and Wales to have specialist domestic abuse support onsite.

This is a recommendation after years of research. Women and children living with abuse have been waiting for much much longer.

Domestic abuse is a public health epidemic and health must be part of the solution. We must meet victims where they are.  We know four of five victims do not call the police. We have to go to them: where they feel supported, where they feel safe and free from stigma.

We must have Independent Domestic Violence Advisors (Idvas) in hospitals across the country.

Our research shows very starkly that domestic abuse victims in hospital experience multiple vulnerabilities. The levels of physical and sexual abuse as well as coercive and controlling behaviour are frankly shocking. Two thirds of victims in hospital disclose serious mental health issues, including half with PTSD and nearly half have self-harmed or attempted suicide. We also found that half of the victims who disclose in hospital are still with their partner.

By failing to ask the question in hospital – they are being discharged back into the arms of the perpetrator who put them there. Only to inevitably return weeks later. This cycle of abuse could be stopped - if we have had specialist professionals to ask the question and provide support, right then, right there.

And of course many of these victims have children – children who are growing up in households that are filled with fear. Everything we know about the development of children’s brains tells us that these are exactly the children who need our help. And their mothers are just women who understandably do not want to call the police. It only takes each of us to think for just one second how hard that must be, and how long we might all wait before calling the police on a family member. On the father of our children. We mustn’t wait until victims call the police because they are scared for their lives. We must find ways to ask them first.  And Idvas in hospitals could help us do just that.

More broadly, our research shows that this is also an issue for staff working in hospitals. Our best estimate is that over 50,000 NHS employees (44,000 women and 6,000 men) are victims of domestic abuse. We need help in hospitals for staff as well as patients. With domestic abuse – there is no ‘us’ and ‘them’. Only us.

Sometimes our enthusiasm and passion for the cause can blur our judgement about what is possible. But I cannot think of another time where I have felt more personally excited about the potential for change. We have absolute focus that this is a common sense vision that can be achieved. There is nothing simple about addressing domestic abuse, but improving support in hospitals for victims at their most vulnerable seems like a pretty good step in the right direction.

And we think it will cost just £100,000 per hospital to unlock the capacity of the clinical staff and for specialist domestic abuse professionals to be onsite. When we know that domestic abuse costs the NHS £1.76 billion – that is put into perspective. 

There is a book by Roddy Doyle, The Woman Who Walked Into Doors, and I would like to just include a short extract from Paula – the heroine of the story who represents so many thousands of heroines up and down the country.

In this extract, Paula is in A&E after another assault from her husband Charlo. She puts it better than I can.

Someone once told me that we never remember pain.  Once it’s gone, it’s gone.  A nurse.  She told me just before the doctor put my arm back in its socket.  She was being nice.  She’d seen me before.
I fell down the stairs again, I told her.  Sorry.
No questions asked. What about the burns on my hand? The missing hair?  The teeth?  I waited to be asked.  Ask me.  Ask me.  I’d tell her.  I’d tell them everything….Ask me about it.
In the hospital.
Please ask me.
In the clinic.
Ask me, ask me, ask me….
I would get worked up waiting.  I believed it was a matter of luck.  Maybe this time.  A nurse would look at me and know.  A doctor would look past his nose. He’d ask the question. He’d ask the right question and I’d answer and it would be over.  One question.  One question.  I’d answer.

I’d tell them everything if they asked.”

For more information on our research, see our A Cry For Health section and join the conversation on Twitter at #CryForHealth




Disrupting the silence

This week it is our staff conference - a time for us to get together and plan for the year ahead. It is crucial for us to always think about we can put the voice of victims and survivors at the heart of everything we do. Our Chief Executive, Diana, reflects on the power of people speaking out.

I was struck last week by the courage of several victims of gender-based violence to speak out publicly, and just how important it is that everyone hears their voices – not just those of us who work in the sector. Whether it is the extraordinary letter from the victim of rape at Stanford to Brock Turner, the rapist, or the emotional words from Barry Steenkamp about his murdered daughter – they all put in stark relief the impact of gender-based violence and how we must never ever lose sight of this. 

And the wonderful Rachel Williams, who spoke so powerfully on Radio London last week about her experiences. Brave survivors of rape and sexual abuse have spoken out publicly via the Clear Lines Festival, led by Winnie Li and Nina Burrowes.  A blog post from the Womanity Foundation highlighted the work of GlobalGirl Media, which is bringing women’s experiences to life through video. Increasingly, social media too is giving us all a glimpse of this reality. 

Lots of good and important stuff is happening out there and we are listening hard. At SafeLives, we describe ourselves as expert-led. We must remind ourselves that the real experts are those who have lived it, experienced it, and know first-hand the fear and trauma of abuse and assault. And that is why is the victims, survivors, and their friends and family that truly lead our work –  helping us understand how we can work together to make things better.

People think abuse happens behind ‘closed doors’, well -  not if these women have anything to do with it. These voices couldn't be further from the victim-blaming, judgemental narratives that we read every day. 

I applaud their courage and hope that the world starts listening to these and many many others. As the Womanity Foundation's blog put it, we all need to ‘disrupt the silence’.

I love my job - and here's why

This morning I was standing at the bus stop literally hopping from foot to foot I was so impatient to get to work. And not because I've got pending deadlines or urgent meetings.

It's not very cool or British to say you love your job or your organisation. We're all supposed to dread Monday, live in desperate hope of Friday and/or wine, and be secretly resentful of all our colleagues. I don't. I'm not. I love my job. We're a geographically spread and very busy team. We rarely get to spend time together and when we do it's often crammed with decisions we need to make. Yesterday we took time to look ahead to next financial year and the excitement in the room bowled me over.

This is a talented, committed team. They know about domestic abuse, and the absolute horror it causes, but they also know they can do something about it. Something that works. Something that changes lives. I'm bursting with pride to be a part of that. I'll put it down to my Middle Eastern blood, summertime, anything you like, but I know I'm not alone in how I feel about going to work. And that's awesome.

Mental health support must be part of the response to domestic abuse

Charities, campaigners and a small but growing number of MPs have done a brilliant job over the last fifteen years in raising awareness of mental health: tackling the myths, encouraging people to talk, and reducing the stigma. We know now that anyone can experience mental health problems, or have a friend or family who is struggling. That one in four stat has stuck.

Mental Health Awareness Week is a considerable campaign that illustrates this progress and moves it along further. Just one look at Twitter shows you thousands of people are sharing content, insight and stories. They are talking to one another. All with the hashtag #MHA2016.

We could learn a lot from these campaigns in the domestic abuse sector. How do we reduce stigma and tackle stereotypes? How do we encourage people to be comfortable talking to one another? To know what to do if you're worried about a friend or family member? How do we lift the lid on another painful, difficult and very personal subject?

We could also do a great deal more to highlight the interrelated issues of mental health and domestic abuse. The teams behind Mental Health Awareness Week decided this year to have a particular focus on relationships, something we greatly welcome.

Despite evidence indicating a direct relationship between experiences of domestic abuse and heightened rates of depression, trauma and self-harm, signs of domestic abuse are often missed when providing mental health support. Mirroring this, mental health issues may not be acknowledged and effectively addressed when a person discloses domestic abuse to a service or support worker.

Our data has found that 16% of those living with serious abuse have considered or attempted suicide as a result of abuse. There is an urgent need to acknowledge abuse and mental health as interrelated issues, and enable people to access to support they require. People don't live their lives in siloes, and it's therefore crucial that we break down the silos in our responses to different problems people might face in their lives.

Domestic abuse comprises any incident or pattern of controlling, coercive, threatening or violent behaviour - whether it be physical, psychological, sexual, financial or emotional. This causes significant psychological consequences, including anxiety, depression, suicidal behaviour, low self-esteem, inability to trust others, flashbacks, sleep disturbances and emotional detachment. Abuse within an intimate or familiar relationship also leaves victims particularly susceptible to post traumatic stress disorder (PTSD).

The collective evidence of the impact abuse has on mental health means we now know that as many as 60% of psychiatric in-patients are experiencing (or have experienced) domestic abuse. However, due to real or perceived barriers such time pressure, lack of training and limited resources, professionals and frontline staff are not always able to spot, assess and address abuse. Not only does this inadequately address the needs of patients in a holistic way, but an exclusive focus on a patient's mental health can make the abuser, and their impact, invisible, or even lead to blame for a situation being wrongly assigned to the victim. This hides abuse under multiple layers of misunderstanding or incomplete understanding, and makes patients - people - more vulnerable to domestic abuse.

Training of frontline professionals needs to be high quality and consistent. Yesterday, the Home Secretary addressed over 100,000 police officers about the need for them to keep improving their response to abuse and vulnerability. That must include the ability to recognise mental health issues when attending incidents of abuse, and understanding that when they go to a scene where someone is in a high state of distress, abuse may be a factor. Healthcare professionals must recognise both physical and psychological experiences of control, coercion and abuse when dealing with patients, and links must be forged between health specialists and domestic abuse specialists.

An effective approach to mental health and domestic abuse must address the often complex needs of those suffering abuse. We cannot respond to one issue a person is facing effectively without recognising, acknowledging and dealing with others - if we want to see people well, happy and safe. 

Time and money continue to be tight. However, to provide wraparound support for people that actually responds to the complex nature of people's situations is not only the right response, it is the most rational. The public health sector must be part of the solution to domestic abuse; it cannot be a police or judicial response only. Many people feel more comfortable disclosing in a health setting; later this year, we will be publishing research to show the impact of including health in the response to domestic abuse.

Providing a holistic response, that is as tailored as people are complex, we greatly increase the chances of them becoming safe, and crucially - staying safe.

Follow Diana Barran on Twitter: www.twitter.com/dianabarran

The power of 'humble data'

I was recently interested to read this blog by Joe Ferns. Joe is a Director at the Big Lottery Fund, which supports a number of SafeLives' projects - including our Insights service. He was reflecting on how the organisation evaluates the impact of the grants it gives. A number of the points Joe made really resonated with the experience we have had at SafeLives over the past few years, as we have tried to capture, aggregate, understand and use more data about the work of the many small specialist domestic abuse services around the country through our Insights service.

Joe talks about having sense of purpose, being clear why you are keeping the data.  We were clear that we wanted the voice and experience of the victim to be captured systematically and then analysed and shared with those who needed to hear it, everyone from the frontline practitioner, the manager of the service, commissioners, funders and policy makers. We aim never to ask for a practitioner to record any data that they would not normally keep for the purposes of good case management. Our Insights dataset has information on over 50,000 adult victims, children and young people collected by about 50 different domestic abuse services. 

And it has been the humble data - the data about who accesses services, where they access them, how long they have to wait before getting help and what their needs are - that have proved to be powerful and actionable.

A few examples…

  • Domestic abuse has a terrible impact on the mental health of both the victim and their children.  But our data showed major variations in levels of disclosure of mental health problems – from under 10% to over 60%.  The obvious question is why. What emerged is that the setting of the service and confidence of the practitioner are key to eliciting a disclosure.  Domestic abuse practitioners based in hospitals saw twice the level of disclosure than their colleagues in community settings.  Local services are using this information to negotiate co-location in A&E or with the local mental health team.  The result?  Big increases in disclosures and a better response for victims.
  • We can see the lack of provision for older women, many of whom live with abuse for over 20 years before they get help. This is a simple message for funders to hear and respond to in their grant making. Other messages about inequality of access that have relevance to funders, commissioners and policy makers are crystal clear in relation to barriers for B&ME victims to the criminal justice system, for working women to refuge provision and for LGBT communities. You can read more about these findings in our latest publication, All Welcome.

None of this is to say that outcome data isn’t important. Of course it is. The joy of the humble stuff – especially when it is aggregated - is that the evidence is solid, the messages self-evident and the resulting action benefits those who we are aiming to support in a way that no charity analysing its work on its own could reasonably do. And crucially, it can often be achieved without a big price tag attached.

We'd like to dedicate this blog to the extraordinary work of the services using Insights across the UK. Your rigour and dedication means we can learn more than ever before about the challenges victims face and the difference your interventions make.

This post was first published on 26 April 2016 on the Big Lottery Fund's blog.