Policy blog

I kept hoping someone would ask…

Anyone who’s worked with victims of domestic abuse knows the stories. The GP who told her the problems with her boyfriend were just post-natal depression. The A&E nurse who treated the injury, without asking how she’d got it. The housing officer who raised a repair for the smashed door without stopping to think why it was broken.  

The shocking truth is this: we could stop domestic abuse far earlier than we do. There are too many missed opportunities where frontline workers don’t stop, think, and ask about domestic abuse when they’re worried about a family.

In new figures we’ve published today, SafeLives reveals that 85% of victims were in touch with public services in the year before they finally got effective help – and on average they were in touch with five services. That’s five lots of professionals who could have helped them earlier – but didn’t. And it means that victims are living with abuse for nearly 3 years before they get the right help.

Lots of victims won’t call the police about the abuse they suffer – so we have to find other ways to reach them, and get them help that makes them safe. And victims shouldn’t have to wait until there’s a crisis and the police are called before they get help.

No-one is suggesting that professionals are deliberately ignoring domestic abuse. Many are doing a great job under real pressure. They may not know how to start the conversation, what to look out for or what to do if a victim or child tells them what’s going on at home.

Around the country, some great projects are showing the way. Iris, which started in GP surgeries in Bristol and London and is now spreading nationwide, trains GPs to spot abuse, and links them up with specialists who can help victims. Many hospitals are now hosting Idvas – specialist domestic violence workers – in their A&E and maternity departments, and early evidence is that they are seeing a more vulnerable client group.

So today, SafeLives is calling on all professionals to look out for domestic abuse. Whether you’re a homelessness worker, GP, nurse or social worker – look out for the signs, and if you’re worried, ask the question. Then act. We’ve got a great sheet of top tips here to help you know what to do.

And we’re saying to everyone that wants to end domestic abuse: we have to find families where there is abuse more quickly. And we have to get them the right help - help that stops the abuse.

Too often, failed requests for support are seen as a normal part of a victim’s journey. But that isn’t good enough.  

Local partners like the police and councils should make it their mission to cut the average time that victims and children live with abuse. And, working with specialist domestic abuse services, they should get out into their communities and make sure every professional knows what to do, and who can help.

So that every GP surgery, every housing appointment, every social work visit, every Citizens Advice drop-in, every pre-natal scan, every parents’ evening – all of these are chances to spot domestic violence, and get victims help faster.

You often hear the well-meaning slogan - domestic abuse is everyone’s business. Here at SafeLives, we’d propose a modification: stopping domestic abuse is everyone’s business.

A taster for Wednesday….

On Wednesday we are holding our annual national conference with the theme of ‘Getting Right First Time.’ We will be looking at different ways to respond sooner to victims, children and perpetrators. Our keynote speaker in the morning with be Dr Eamon McCrory from UCL who will talk about the impact of domestic abuse on the brain development of young children. In case you want a bit more information about this – and the wider impact on the health of adults.  See this TED talk from Dr Nadine Burke Harris with some amazingly powerful messages.

Ok, maybe more than a taster….this talk has had 320,000 views already.

Piecing together the evidence - 2

This content originally appeared on Diana Barran's blog in February 2015 and reflected her views at the time. Caada is the previous name of SafeLives.

Last month I noted the evidence from some recent DHRs which showed the high percentage of women murdered by their partners who were still in a relationship. This was reconfirmed by the evidence from the Femicide Census published last week which reflects the tireless work of Karen Ingala Smith on this subject.

In the Femicide Census data, which spans almost 700 murders from 2009-2013, 58% of women were still in a relationship with the person who killed them. Over half had been in the relationship for over 5 years.

So this is where the gap lies – services for women who can’t or don’t leave for whatever reason and for older women. Our data across all types of practitioners- not just IDVAs – shows that about 80% of clients who engage are separated or separating.

Where is the exception to this? IDVAs working in hospitals where half their clients are still in the relationship.

So location matters. And so do the choices we offer women to ‘stay’ safely.

Catching up on some reading…

This content originally appeared on Diana Barran's blog in January 2015 and reflected her views at the time. Caada is the previous name of SafeLives. 

 Like most of us, I tend to carry around a pile of articles and research findings to read.

Today I caught up on the findings from the Provide conference held in Bristol before Christmas. This programme is led by Prof Gene Feder and includes both pilot trials followed by randomised control trials.

Of particular interest I think are the findings of the PATH (psychological advocacy towards healing) trial. In PATH, women are offered not only conventional advocacy such as given by an IDVA, but also the advocate delivers some psychological therapy. This helps bridge the gap between women experiencing much higher levels of mental illness than the average, but also the reality that even those who do disclose mental health issues are unlikely to get an effective intervention from mental health services. For more information go to http://www.bristol.ac.uk/social-community-medicine/projects/provide/evid...

The study showed firstly that PATH filled a gap and secondly that the intervention gave enduring benefit for over a year.

We are keen to make the links between practical advocacy and longer term ‘recovery’ support. This looks like a promising example. Please let us know if you have emerging good ideas in your area.

Inspired by the Reith lectures

This content originally appeared on Diana Barran's blog in January 2015 and reflected her views at the time. Caada is the previous name of SafeLives.

One doesn’t immediately expect that the distinguished thoughts of a Reith lecturer would have immediate relevance to our work to address domestic abuse – but this year’s lecturer, Atul Gawande, who spoke so eloquently about different issues affecting the future of healthcare, mentioned three points that felt highly relevant. You can listen to the lectures which are brilliant at http://www.bbc.co.uk/programmes/b00729d9

His second lecture talks about systems – how medicine is moving from the ‘magic bullet’ of penicillin to complex systems involving many practitioners, technology and inter-related problems. You will see the link with making a proper safety plan for a victim and children – it involves the resources of several agencies, clear communication and attention to detail as every case is different and the risk of getting it wrong is high. He suggests (I hope I do his lecture justice) that not only do the really complex aspects of a surgical procedure need to be done well, but also all the mundane but vital (literally) elements such as hand washing by nursing staff. To ensure consistency of practice he recommends….using a checklist. Does this sound familiar? And just like the CAADA-DASH risk checklist which was not/is not uniformly popular, nor was his checklist for medical staff. While many practitioners did not welcome the new medical checklist, nearly all of them said that they would want the procedure to be followed in exactly this way if they were undergoing an operation. Why didn’t we think to ask that about the risk checklist?! Of course any sensible person would want to have all those elements covered by an IDVA or police officer before a safety plan was made. The types of abuse suffered, the additional vulnerabilities and needs of a victim or particular risks associated with a perpetrator need to be identified if they are present. You can read more about his thoughts on this at http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=2&oref=slogi...

Secondly, in a later talk, he comes back to the idea of how we implement systems. He talks about developing standards, writing guidance, and last of all when there is still a lack of consistent quality, he notes that there are sanctions for individuals who do not ‘follow the guidelines’. Again, this sounds all too familiar. In fact, we have done our fair share of guideline writing… Rather he argues, we should reward good practice and encourage those who are doing it right. A message for those responsible for driving culture change following the HMIC inspection?

Finally, and most importantly, he argues eloquently that the medical profession needs to listen to the patient. Radical. The same is true as we develop our response to domestic abuse – ensuring that lived experience is at the heart of what we do. For the group of victims, family members, survivors and thrivers who are helping us to shape our thinking at CAADA, I can only say, ‘Thank you – your input is vital – literally’.