Practice blog

Sexual violence in GBT relationships

Luke Martin is a consultant primarily focusing on working with male and LGBT victims of domestic abuse. Luke worked as an Independent Domestic and Sexual Violence Advisor (Idsva) for eight years. He has also worked extensively for and with Respect, including on the national helpline for male victims of abuse, The Men’s Advice Line. Luke currently trains on SafeLives’ Idva accreditation course, DA Matters (a change programme for police responders) and Respect’s ‘Working with Male Victims’ training programme. Luke has consulted for organisations such as SurvivorsUK, the national male rape and sexual violence service and worked on campaigns such as the Home Office’s ‘This is Abuse’ campaign. 

Figures from the Men’s Advice Line show that men in same sex relationships are more likely to disclose experiences of sexual violence and abuse within intimate relationships. It is unclear as to whether this is because men in same sex relationships are more likely to experience sexual abuse, or because they feel more comfortable talking about it.

To some extent we see men in same sex relationships experiencing sexual abuse in a similar way to that experienced by heterosexual women. Men might experience unwanted touching, sexual assault or rape within their intimate relationships. What we might also see is more experimental or risky behaviour. Whilst working as an Idva and Isva I supported men whose partners encouraged them to access a sex scene that they did not feel comfortable with. This may have been sex at saunas, chemsex parties or encouraging or initiating threesomes or group sex. As with much abusive behaviour, victims often engaged with the request to appease the perpetrator and manage the risk of harm to themselves.  

Gay and bisexual victims might be encouraged to use party drugs, or may have chosen to use substances of their own volition. This may have also formed part of a grooming process that we might see with an older perpetrator and often younger, more vulnerable victim. Drugs such as ketamine, G (GHB), mephedrone and crystal meth are being used, inducing a euphoria and reducing inhibitions to such an extent that the user might have little idea who they are having sex with, let alone if it were safe. Perpetrators might introduce the use of these substances in the intimacy of their own homes, on a one on one basis with their partner then might encourage the victim to access these substances for free through chemsex parties.

Of concern is that when substances are used, a sexual assault or rape may take place and the victim not know. Substance use might also stop victims feeling able to disclose sexual assault or rape; there are many societal myths and victim blaming attitudes associated with victims being under the influence of drink or drugs. This is only compounded when the assailant was an intimate partner as it doesn’t fit the ‘image’ of who perpetrates sexual offences.

Historically HIV status has been used as a form of abuse, including disclosing someone’s HIV status. In 2017 the case of R v Rowe saw a young man purposely infecting other gay men with HIV, some of whom identified as being in a relationship with Rowe. However, with the increase in access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) we are progressing in managing the transmission of HIV – although we might see withholding medication as a form of abuse.

We might see the use of experiential power in same sex relationships. This might be more prevalent in first relationships but could be used at any point. Experiential power is the use of experience to dictate how something should be. Somebody who has been out as a gay or bisexual man has more involvement within the LGBT scene or a wider network of LGBT friends, and might use that experience to set the rules of the relationship. When we explore this in the context of sexual abuse this might include introducing third parties in to the relationship, encouraging unprotected sex  or introducing sexual practices that the victim might not feel comfortable with.

Across the board our education system is failing young people in teaching them what healthy relationships look like. For those areas that are doing this well, it predominantly focuses on heterosexual relationships. Young LGBT people, as with all young people, are increasingly looking to porn to educate themselves on what their relationships should look like, and we know that this is not healthy. Gay porn often shows sex taking place between several people, modelled on a dominant and subservient relationship which impacts on young G, B and T people’s experiences of healthy sexual relationships.

As well as education on healthy and unhealthy relationships, it is vital that we increase routine questioning around domestic and sexual abuse. More and more sexual health clinics are carrying out routine questioning as are many health departments. However, professionals can feel ill-equipped in dealing with these kinds of disclosures. It is at this point that additional training might be required. Local authorities as well as local domestic and sexual abuse services might offer training in upskilling workers to support such disclosures.

Visit our Spotlight homepage for blogs, podcasts, interviews and more.

If you're a man experiencing domestic abuse, you can call the Men's Advice Line on 0808 081 0327.

Galop run the national helpline for LGBT+ people experiencing domestic abuse: 0800 999 5428

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A week in the life of a specialist LGBT Idva

Birmingham LGBT is an award winning charity delivering services to the LGBT community in Birmingham. The organisation has grown significantly since its inception and in January 2013, Birmingham LGBT opened the first LGBT Health and Wellbeing centre in England and Wales. The centre is fully accessible and runs a number of services including sexual health, wellbeing, older people's services and a specialist LGBT Idva service.

The LGBT Idva service has been running for several years now and helps to support anyone who identifies as lesbian, gay, bisexual or transgender who is experiencing abuse from intimate partners, ex partners or family members. They also offer support around forced marriage and 'honour'-based violence. 

Sajida Bandali is a senior LGBT Idva at Birmingham LGBT.

Monday

No time for Monday blues. As I enter the office I receive a call from one of my new clients who is distressed. She identifies as a trans woman and has just fled to the UK. She fled from her country of origin facing persecution from her family and community. Her crime? Not being born female. Her punishment? Violence in the name of honour.

My client made an asylum application and has been housed by G4S. Last night she experienced a transphobic hate crime from a fellow housemate. She is utterly disappointed as although she can finally be free to live as a trans woman in the UK, she has experienced abuse in the first week of her stay. She had been yearning to finally be addressed as her preferred pronoun; she. To finally openly dress the way she wants, without fear of harassment and abuse. Sadly, high numbers of transgender people still experience hate crime, despite increases in public awareness and legal advancement in LGBT rights.

I make arrangements to transfer my client into alternative accommodation and liaise with the police to report the hate crime. I also book an appointment for her to receive support from my colleague who is a Trans outreach worker.

I then check for any new referrals that have come in over the weekend and spend the rest of the day completing case work.

Tuesday

This morning I am out of the office promoting our service at a health event. 

As I arrive back at the office, my client is waiting at reception for his appointment. He’s an elderly gay man whose much younger male partner is financially and physically abusive.

My client is vulnerable with a number of health problems. He has very little means to support himself, as his state pension is used by his partner to fund a drugs habit. My client was part of the generation where being in a relationship with another man was a criminal offence. He is very sceptical of services and is apprehensive about reporting incidents of abuse to the police due to past homophobia.

Barriers can deter all victims of domestic and sexual abuse from seeking help. For LGBT victims, there are additional barriers. The Birmingham LGBT Centre is therefore a safe space for him to make disclosures and receive support. He is very isolated which adds to his dependency on his relationship. In his eyes, endurance is better than isolation. After thorough safety planning today, I discuss community groups for older LGBT people, to reduce his isolation. 

Wednesday

Our midweek client is being seen at a GP surgery to preserve anonymity. The client is a young woman who belongs to a prominent family in a tight knit religious community. The closet remains tightly shut on her lesbian identity, for she fears shaming her community.

Hiding her sexuality has been difficult and it is having a detrimental effect on her mental health. She has been signed off work due to poor mental health after being ‘outed’ by her line manager. Sadly, she recently took an overdose.

Her siblings were each taken abroad and forced into marriage. Consequently, we are concerned she may also be at risk of forced marriage and 'honour'-based violence. After safety planning, we arrange safe housing for this client and her partner. Now that she is also engaging with mental health services, we are hoping her road to recovery is in hand.

Wednesday ends with an unexpected international call from a former client. We learn that he resumed the relationship with his abusive partner and has moved abroad. We reiterate safety planning and provide details of getting support abroad.

Thursday

Today we have our weekly nurse-led sexual health clinic. The clinic offers services such as confidential testing and treatment for STI’s, HIV rapid testing and advice and support.

One of the workers has informed us that a client has disclosed domestic abuse. He reveals he left his unhappy heterosexual marriage and came out as a gay man. He was ostracised because of his sexual orientation and was prevented from seeing his children. Due to feeling isolated, he became heavily involved in the ‘chemsex’ scene. Participants at chemsex parties use drugs such as Mkat, crystal meth, mephedrone and GHB during sexual encounters. This can be risky as sometimes protection is not used and  injecting equipment and paraphernalia may be shared during intravenous drug use. It is also concerning as people in coercive relationships may be pressured or threatened into participating.

The client disclosed that he contracted HIV during this time in his life and has struggled to manage his condition due to poor mental health and chaotic relationships with men. After safety planning and offering the relevant support, he is referred to our specialist chemsex worker and local drugs service. Due to the client’s financial circumstances, the rest of the day is spent applying for the very few remaining financial grants.

Friday

It’s the end of the week, but still very busy. I am helping out on reception and the Centre is bustling! Many LGBT people are estranged from their family of origin, or have to hide their identity from them. Therefore, the LGBT community is their family. Today we have a clinic on for people who identify as transgender, a social group for LGBT asylum seekers and a yoga class.

One of our Idvas is at the Crown Court today supporting a young client for a GBH trial. This is his first same sex relationship. His partner would frequently make him question his sexual identity and reinforced that no one would believe him if he reported the abuse, and that he would experience homophobia through the court process. 

Leading up to the trial, we have worked with him to understand the dynamics of power and control using an LGBT adapted version of the Duluth power and control wheel. After a lot of reassurance and confidence building, he has decided to give evidence today. 

The close of play brings in a vulnerable woman cradling a crying baby. She has disclosed abuse from her female partner and requires respite. It is a race against the clock but we manage to contact relevant services and find her safe accommodation. We book her a taxi reassured that she can be safe over the weekend.

The Idva cape is then hung up, awaiting duty for the week to come.

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A night with Police Scotland

Lucy McDonald is SafeLives’ Training Development Officer for Scotland.  In November, as part of the 16 Days of Action campaign, Lucy accompanied Police Scotland on a night shift to see first-hand their response to domestic abuse. 

On a cold November night, when I would usually be enjoying the comforts of home, I found myself in the back of a police van, along with fellow domestic abuse specialists from ASSIST and Hemat Gryffe. As part of Police Scotland’s 16 Days of Action to end violence against women and girls campaign, we were invited by Detective Superintendent Gordon McCreadie, Police Scotland’s national lead on domestic abuse, to do a night shift to give us an insight into how the police respond to domestic abuse. 

First stop was a tour of the Contact, Command and Control Centre in Glasgow, one of several such centres in Scotland which takes 101 and 999 calls made to police. Led by a white-ribbon wearing Chief Inspector host, we were taken firstly to the Service Centre where the calls come in.  A bustling room, we immediately got a sense of the sheer scale of the task at hand. It was 7pm, a quick check on a screen told us that since midnight there had been almost 3750 101 calls, 800+ 999 calls and almost 200 other emergency calls. We asked, of course, about domestic abuse calls and were told that in a 24 hour period the previous weekend, there had been 187 calls and that on an average day they received 161.

Under the old regional systems, prior to the formation of a virtualised Service Centre, there were a finite number of telephone lines into each individual Service Centre. This meant that a single incident, such as a road traffic accident on one of Scotland’s busy motorways might attract dozens of calls from the public tying up the limited phone lines whilst other parts of the country were quiet and had capacity. So, if you were a victim of domestic abuse needing urgent assistance at the same time, there was a chance your call might not get through because of the peak in demand.  Now, with the National Virtual Service Centre approach there is much greater capacity to handle calls from across Scotland so callers are more likely to get the right response first time. We found out that almost all 999 calls are answered in less than 10 seconds, most far quicker, and the majority of non-emergency 101 calls were being answered within 40 seconds.

A night with Police Scotland

We were quickly directed over to a Service Advisor who was taking a call from a woman reporting domestic abuse. The sophisticated system showed immediately that the woman had called earlier in the night, but the emerging picture was now becoming concerning and the handler upgraded the call to a Priority 1, which meant a response team would be dispatched immediately. In the Area Control Room next door, we were shown the process of dispatch, watching in awe as a police officer skilfully worked her way around a complex system using electronic mapping to identify the closest, most appropriate officers in one sub-division to multiple jobs based on location and competing priority levels. 

Now 9pm, it was time to see things on the ground so we piled back into the van for the short drive over to one of the police hubs in Paisley, just in time for the start of a new shift. We got a briefing from the Inspector overseeing the shift, who explained their approach to domestic incidents and their determination to keep the quality of response high at all times.  He admitted this was challenging at times, mentioning a home nearby where there had been 128 police call outs. 128. A chronic cycle of a woman being subjected to ongoing physical violence and coercive control, periods of separation and reconciliation, amongst other criminality and alcohol abuse. The challenge, he said, was to ensure that his team never became desensitised to the risk of harm to that woman.

Back out in the van, as we took to the streets and admired the pretty Christmas lights in the town centre, my mind kept returning to the woman who had called the police 128 times. Was she looking forward to Christmas? Was she full of hope, or full of fear and despair? I could guess the answer. 

As the night got colder and the streets got icier we listened to the airwaves, which were unexpectedly quiet. There was some activity about a possible missing person, but that died down. We wondered if everyone was at home, keeping cosy. 

And then a report came in. It turned out to be the 129th call of the woman I’d been wondering about. Her ex-partner had been released from custody earlier in the week and she thought she’d heard someone rattle her letter box. As we turned the van and started to make our way to the address the Inspector told us they’d had a similar call from her earlier in the week and it had turned out to be neighbours.  A woman on high alert, I thought, waiting for the next incident. I pondered the kind of response she would get tonight from the cops who’d been dispatched - were they thinking ‘here we go again…’? When we reached her street, the answer was obvious. The patrol car was already there and the officers were making their way into her house. We waited anxiously in the van across the street. Then we heard an update and request on the radio – there was no sign of her ex-partner in the building but could a check be made of street CCTV footage from the last hour to assure the officers on movements in the area? Fortunately this came back negative. Twenty minutes later the cops emerged having offered reassurance to the woman that they have become so familiar with, the woman living in a heightened state of anxiety and coping the only way she can.

Shortly after this, we called it a night after what had been an insightful experience with fellow police and domestic abuse colleagues. And as I drove back to the warmth and comfort of my home, I reflected on the events of the night. I was aware that domestic abuse accounted for at least 20% of police business (over 58,000 incidents recorded in 2016/17), but seeing the stark reality of call volume first-hand really hits home the scale of the problem.

I already knew that victims of domestic abuse will be subjected to physical and emotional abuse for years before getting the right support. Indeed, in Whole Lives we found that people experiencing the highest levels of domestic abuse in Scotland will wait an average of four years before accessing or being directed to the right form of expert intervention. What I saw first-hand that night was Police Scotland doing the best they can to respond and reassure, make the appropriate referrals, apprehend perpetrators when they can. They did what they could to support the woman who called them so regularly, and there was much I didn’t know about her circumstances: was she in engaged with local domestic abuse services, did she have an Idaa1 supporting her, had she been referred to Marac2, or was her partner at MATAC3

In the last decade we’ve seen major changes in the response towards victims of domestic abuse and how perpetrators are managed, by Police Scotland and other key organisations. We continue to see changes and progression, such as the anticipated Domestic Abuse (Scotland) Bill which will create new offences around coercive and controlling behaviour. However, alongside these improved processes and systems, the most effective response requires partnerships between both statutory and voluntary services, and an approach that combines belief and validation for the victims’ experience alongside practical and tailored intervention led by the victim and tailored to their needs and risk. This also means being creative about what we can offer to everyone experiencing domestic abuse, regardless of who they are, their circumstances and whether or not they have been able to leave the relationship.  

And we need this in a way that is consistent across every part of Scotland. Granted, there are great examples of this in locations across Scotland, but at the moment it very much depends on where you live, what is available to you there and which services are working together. That is what needs to change, and only through positive collaboration can we make this happen, only together can we improve the wellbeing and safety of families experiencing domestic abuse across the country, reduce the volume of those experiencing domestic abuse and the time it’s taking them to receive effective intervention. 

Thank you Police Scotland for inviting us into your world.

 

About Lucy McDonald

With a background in psychology, Lucy began supporting children affected by domestic abuse, before moving into refuge and then settling into domestic abuse advocacy. She began working with SafeLives in 2006, supporting the development and delivery of numerous training and accreditation activities across the UK including Idva, Marac and Leading Lights. Most recently she has been heavily involved in implementing the Idaa training programme, as well as programmes for Crown Office and Procurator Fiscal ServicePolice ScotlandNHS Health Scotland, the Caledonian System and a variety of teams and services across Scotland. Her expertise is in safe and effective responses to domestic abuse including risk identification, multi-agency collaboration and whole-family safety planning.


1Independent Domestic Abuse Advocate

2Multi Agency Risk Assessment Conference

3Multi Agency Tasking and Coordinating

Interview: Joy Leighton from Victim Support reflects on the importance of Service Managers training and Leading Lights accreditation

Joy Leighton is a Senior Operations Officer at Victim Support. Here she talks to Senior Communications Officer, Natalie Mantle, about the impact of SafeLives Service Manager training and Leading Lights accreditation.  

 

Hi Joy, can you tell us a little about your role and your background?

Joy Leighton

I joined Victim Support way back in 1998 as a volunteer to support victims of crime. This support ranged from victims of criminal damage to homicide. I enjoyed the specialist training and when an opening came for a deputy co-ordinator at my local branch, I leapt at the chance to change career paths. After this I survived two internal restructures, firstly as a branch manager and then I set up and ran the local victim's hub for Hertfordshire before being made redundant in May 2011 due to the inception of the regional hub in Essex. However, proving you can never keep a good woman down(!) I re-joined Victim Support in October 2011 as Manager of Luton Idva Service.

You've since gone on to complete the SafeLives Service Managers training. What was your motivation to do this?

Having completed the Idva and Sexual Violence training with SafeLives, this coupled with an ever increasing Idva service and the pilot of a KIDVA service, I heard about the Leading Lights programme and always keen to improve and develop what I deemed to be an already strong Idva service, I decided to take the plunge and take the first step to achieving the accreditation. 

Since completing the Service Managers training, you've gone on to gain Leading Lights accreditation. Can you tell me a little bit about that process?

The process was a little slow to begin with - as a national charity, Victim Support had several managers who had gone through the managers training from various geographical areas (Herts, Beds, Manchester, London) and as far as I'm aware we were the first national organisation to go for it. After a little toing and froing (due to Victim Support gaining additional services) I decided to bite the bullet and go for it. I used my action plan from the Service Managers training as a basis to identify where any shortfalls were. I quickly put Leading Lights on the team meeting agenda and scheduled in Leading Lights meetings to review processes and work through the action plan, liaising with various departments within Victim Support to look at policies to ensure we met the criteria needed. I utilised Kathryn, SafeLives Leading Lights trainer when needed (she is very approachable!) to give me guidance and advice. Part way through the process I booked in a date for the Leading Lights assessment day to give the team something to aim for. The day itself was 'pain free'. Kathryn and her colleague were personable, which helped put the team at ease, while they carried out the case file audit and interviews with staff. Then it was just waiting for the Leading Lights panel to sit in order to find out our fate. A few weeks later we found out all the hard work had paid off when we got the good news we had passed!

What's the biggest imapct you think completing the Service Managers training, and gaining Leading Lights accreditation, has had on you and your service?

For me personally, I think it has been a great sense of achievement and pride. With the support of a hard working team, I think it helped me turn a good service into an excellent one. The team are now reassured that the service runs to 'best practice'. Post Leading Lights, the team still comment on how much more effectively and efficiently they now work. I think it is good to be able to demostrate to both current and future commissioners that the service is Leading Lights accredited and what this means for them. In July 2016 we were successful in winning back the Bedfordshire Idva service and are currently in the process of beginning Leading Lights again!

If anyone is considering signing up for Service Managers training, but isn't sure, what words of advice would you offer them?

Have a plan and don't reinvent the wheel! Utilise services that have already been through it whether that is internally to your organisation or externally. Get the team on board, be inclusive, wherever possible, utilise their knowledge and expertise around service delivery to get their views on what will work. Put Leading Lights on team meeting agendas to keep them informed. Trial processes to find out what works well for your team. Be brave and set a date so you have a goal to work towards. Good luck :) 

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Let’s fix the DVA-shaped hole in the training for medics once and for all

Medina Johnson is the Chief Executive of IRISi, and Gene Feder is a Professor of Primary Care at Bristol University Medical School. They provided this blog for us as part of our 16 Days campaign around the Health response to domestic abuse.

Not a seasonal carol but all together now:

There’s a hole in our training dear tutors, dear tutors,

There’s a hole in our training, dear tutors, a hole.

With what shall we fix it trainee medics, trainee medics?

With what shall we fix it, trainee medics, with what?

(and here’s the bit that doesn’t scan!)

With training, a simple care pathway and direct referral to a specialist advocate,

With training, a simple care pathway and direct referral to a specialist advocate,

With that!

Ever get the feeling we’ve been here before?

For years our medical school curricula have chosen to exclude training on DVA (domestic violence and abuse) and for years health care professionals have been missing thousands of patients with experience of DVA.  This is not a statement of blame but one of fact. None of us, whatever the discussion or wherever we work, want to begin a conversation with someone if, through our lack of skills, training, experience and onward support, we can’t deal with where it will lead us and may leave our conversation partner feeling worse than they did before the conversation had started. This is a dilemma we hear regularly from health care professionals who have a suspicion, a clinical inkling, that they are seeing patients who they are concerned are experiencing current DVA or the effects of historic DVA, don’t know how to ask them about this, don’t know what to do with what they are told and don’t know what to offer next.

Our first call to action is to invite all medical, dental, nursing, midwifery, physiotherapy and occupational therapy courses to review their curricula and ensure that teaching on DVA is integrated into epidemiology, history taking, diagnosis and treatment of patients. In a recent study of UK medical schools, of the 25 that responded, 21 had some teaching of DVA in the curriculum, but 11 had two hours or less in the five year course.

Our second call to action is to commissioners within Clinical Commissioning Groups, Public Health teams, Health Boards, Local Authorities, Police and Crime Commissions and wider. Why wouldn’t you want to fund a local programme of training, where clinicians are taught to ask, respond, refer and record, coupled with a clear referral pathway?

Standalone DVA training for health staff, which does not have a robust evidence base, doesn’t work. The IRIS model does. We know that sounds a bit simplistic, but the whole reason we developed the IRIS model is because training on its own generally doesn't shift what clinicians do. The reason IRIS is successful is because training is tightly integrated with a referral pathway and ongoing support to practices. Each locally commissioned programme is delivered by a strong partnership between a local clinical lead and a specialist advocate educator usually based in specialist, third sector VAWG organisation.

In the seven years since IRIS became a commissionable model, over 800 general practices in England and Wales have become IRIS DV Aware Practices and over 8,000 women have been referred to their local IRIS AE.  We estimate that over a further 29,000 women will have had a discussion about DVA with their primary health care clinician, will have received signposting information and will know that there is support available if they need it and when the time is right for them.

The IRIS model has now extended to sexual health services and we are working on projects exploring this approach in pharmacy and dentistry.

For more information, please email us: info@irisi.org or see www.irisi.org

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