Practice blog

10 Key Practice Points for Supporting Clients with Learning Disabilities

Collette Eaton-Harris is a Knowledge Hub Advisor for SafeLives. In this blog she talks to specialist practitioners about how domestic abuse workers can make their services more accessible to people with learning disabilities. She shares 10 tips that focus on making sure the client's needs are being met, and that all applicable risks are being considered.

For the audio version of this blog, please scroll to the bottom of this page. 

Studies have shown that disabled women are twice as likely to experience domestic abuse, sexual assault and rape as non-disabled women. Disabled men are also more likely to experience intimate partner violence. 

Despite this, domestic abuse services may find that they rarely receive referrals for this client group. I spoke to practitioners Clare Light, a Learning Disabilities Primary Care Liaison Nurse in Somerset and Julie Reeves, a domestic abuse worker for Splitz in North Devon who has previously supported adults with learning disabilities in a residential setting, to find out what domestic abuse workers can do to make themselves more accessible to clients with learning disabilities.

Here are 10 practical tips:

1. Make links with Learning Disability services

It is important for domestic abuse workers to proactively reach out to their local learning disabilities services which may be co-located in a health setting or a social care setting, or may be situated within a learning disabilities specific centre. Learning disabilities teams may not know about your services or how to refer to you or to the Marac; our figures show that only 7% of referrals into a domestic abuse service were received from health services, and 0% were referred through adult safeguarding.

By making links you can help them better identify people at risk, but also seek their guidance on how best to support clients with learning disabilities on your case load. 

2. Appreciate individual needs and abilities

The individual needs and abilities of people with learning disabilities will vary hugely and so it is important to understand how to best support each client. Treating people as individuals is standard, good practice for domestic abuse workers, but clients with learning disabilities may have very specific communication needs that are not immediately apparent. As Clare Light explained; “One of our service users did not understand negatives and so would find it difficult to answer questions accurately depending on how they were phrased. This was only apparent once a speech and language therapist had assessed the client”. This has clear implications for domestic abuse practices such as conducting a Dash assessment, so it’s important to liaise with professionals who have insight into the client’s understanding of the spoken word.

3. Communication is key

Because communication needs can vary, traditional ways of contacting clients e.g. by telephone or by letter may not be appropriate and could lead to clients missing out on a service. Check with the referrer and with the learning disabilities team how best to contact and communicate with the client. Some people with learning disabilities will be more familiar with the use of symbols in communication and this is something that the learning disabilities team should be able to support you with. Some clients may benefit from you using repetition.

4. Include people your client knows and trusts

Clare also emphasised the importance of meeting with the client along with someone that they know and trust as this will help the client feel comfortable. Clients with learning disabilities may be particularly lacking in confidence and assertiveness. This can lead to people-pleasing which may mean that they answer your questions in the way they think is ‘right’ rather than realistic.  They might minimise what is happening if they are worried that they will be in trouble or they may say yes to questions thinking that this is what you want to hear. Someone they know and trust can help manage this by preparing them for the meeting and supporting them during it. The supporter may also have important information relating to the client’s risks and needs that can feed into your assessment.  Domestic abuse workers should always consider who would be a safe and appropriate person to support the client at meetings; for a number of reasons it may be that family members or friends are less suitable than a professional who has a good relationship with the client. 

5. Adjust your timeframes

Whilst best practice is to complete the Dash at the first opportunity, we also need to adapt our approach when the needs of the client requires a different approach. Clients with learning disabilities may not have the capacity to focus for the length of time you need to complete the Dash in one appointment. They may need to take breaks to help with focus if they become easily distracted. They may also find it difficult to retain a lot of complex information so plan to be more flexible in your approach, allowing yourself to be guided by the client and those that know them best. Always gauge the client’s understanding and help them recall by asking questions, summarising regularly and taking breaks when needed.

6. Use simple examples to convey complex ideas

Coercive control is nuanced and multifaceted and whilst some behaviours are simple to identify as abusive, others are less so. This can be a challenge for someone who finds abstract concepts difficult to process. Work with the learning disabilities team to develop simple relationship ‘rules’ that the client will be able apply in order to recognise abuse. There are some good films that can support you with this; for example, this film by Bristol City Council and Misfits and this film by the Tizard Centre, University of Kent.  

7. Abuse may be familiarised

People with learning disabilities may have experienced poly victimisation; repeat experience of being abused throughout their lifetime. Disabled clients are more likely to be experiencing abuse from an adult family member and are more at risk of honour based violence. Our figures also show that one in five report abuse from multiple perpetrators. This means that for some clients with learning disabilities, the domestic abuse they experience may feel familiar and acceptable. They may not name what is happening as wrong. Clare explained that for some, their abuser is also their ‘rescuer’; the person who they perceive to have helped them leave an abusive family setting or who they feel protects them from abuse from other people. This may mean that they feel a sense of gratitude towards the perpetrator. Challenging the perception that the abuser is being kind and loving can be very difficult. Clare emphasises that this can lead to some clients being very reluctant to consent to a referral to a domestic abuse service. Domestic abuse workers could consider ways of making this prospect less daunting. For example, if your local learning disability service runs a day centre, you could arrange to drop in regularly to meet with potential clients more informally or jointly facilitate healthy relationship workshops for people with learning disabilities.

8. Stay risk focussed

It’s important not to assume that people with learning disabilities will be receiving lots of support and will therefore have better protection from an abusive partner. Not all people with learning disabilities will need, want or have formal support services. They may be living independently or they may have family support instead. Our data suggests that disabled people are more likely than non-disabled people to be living with the perpetrator.

Even if the client is living in a residential setting, this does not necessarily mean constant supervision or that they are not able to come and go from their accommodation autonomously. Our data shows that although disabled clients have a higher rate of complex needs and continue to experience a higher level of abuse at case closure compared to non-disabled clients; only 9% have engagement from adult social care.

Additionally, the person who is abusing them may themselves be a  service user with learning disabilities, restricting the client’s ability to access support when avoiding contact from the perpetrator. Professionals supporting the client may not be familiar with domestic abuse risk assessment or safety planning, so make sure you clearly communicate your concerns and ideas for improving safety.

9. Reconsider traditional safety plan options

Clare emphasised that some of the options domestic abuse workers are used to providing would be too complex or overwhelming for many of those with learning disabilities. For example, applying for a court order or being encouraged to report breaches may not be good options for some clients.

Clare also explained that despite the abuse, the client may feel a strong affection for the perpetrator and may become distressed if separated from them. This, coupled with change often being particularly frightening for people with learning disabilities, means that refuge may not be a viable option. 

10. Be aware of ‘Mate crime’

Mate crime is the term given to forms of hate crime in which the perpetrator(s) exploit and abuse a person with learning disabilities by presenting themselves as a friend. Perpetrators manipulate and groom to gain access to the person’s home, benefits or in order to sexually exploit. Some cases have resulted in homicide. Whilst there may not be a relationship for such crimes to be deemed domestic abuse; there are obvious overlaps, particularly as the victim may believe that the perpetrator is their boyfriend or girlfriend.

Clients with learning disabilities will have the same desire and need for relationships. Julie Reeves explained that there can be a strong desire to feel accepted and to have what is perceived to be ‘normal’ experiences of relationships and sex. This, she highlights, puts people with learning disabilities at risk of being targeted and exploited by those who want to take advantage. Clients may acquiesce to requests for sexual acts because they think that they need to do this to maintain the relationship. When safety planning, domestic abuse workers should consider all the people the client is at risk from.

Collette Eaton-Harris, Knowledge Hub Advisor.

With thanks to Clare Light, Learning Disabilities Primary Care Liaison Nurse, Somerset Partnership and Julie Reeves, Splitz North Devon.

Keep an eye on our Spotlights page for all the latest podcasts, blogs and other content in our series on disabled people and domestic abuse.

Helping Women with Learning Disabilities Express Their Views

Lois Cameron is a director at Talking Mats®. Lois developed the organisation in partnership with fellow director, Joan Murphy. Talking Mats is a social enterprise whose vision is to improve the lives of people with communication difficulties by increasing their capacity to communicate effectively about things that matter to them. 

Here, Lois writes about their successful communication tool which can help identify people with learning disabilities who are experiencing domestic abuse.

Scroll to the end of this blog for the audio version.

At the recent Spotlight On Violence Against Women and Learning Disabilities conference organised by NHS Health Scotland there was a great desire to address the increased risk that women with learning disabilities face. They are particularly vulnerable to abuse of all kinds: financial, physical, emotional and sexual. The conference was attended by a diverse range of people including: third sector organisations offering specialist support, accident and emergency staff, dental practitioners, advocacy groups and learning disability nurses. 

One of the common themes that emerged from the different practitioners was the need for more information and for that information to be accessible. It was recognised that women who need help often do not know where to get it. Even when they are in contact with services, staff do not always pick up on the signs that all is not well, and do not know how best to support the women in order to help them say what is worrying them. 

The incidents of communication difficulties  are extremely common with people with learning disabilities. These impact both the understanding of information as well as the ability to formulate sentences and articulate a view. Communication difficulties are exacerbated if the content discussed is emotional and challenging.   

The conference made me reflect on a collaborative project called Keeping Safe that I have been working on for the past six years. In conjunction with other partners, we have been developing a visual tool for people with a learning disability to think about their lives and raise issues of concern. The project has been funded by the Scottish Government.  

We use a visual method of communication developed at the University of Stirling called Talking Mats®. Evaluation of the project demonstrated that people with a learning disability are able to use the Talking Mats Keeping Safe resource to raise concerns. Staff reported that they have often learned new things about the people they were working with.1

There are lots of reasons why I think this resource works and enables people with a learning disability to understand, reflect and express their views. Here are some of them:

  • The use of colour pictures is engaging and the images help explain the topics and reduce the cognitive load for the person with a learning disability. This in turn lessens acquiescence. When people find language difficult and they are asked a question, they will often just agree rather than admit they don’t know what you are asking. Using images can therefore contribute to aiding understanding and thus help to have a more effective conversation. 
  • The images give people a way of expressing themselves without too much emphasis on verbal communication. They can express a view simply by placing an image on the mat. Taking away the pressure to formulate sentences allows the person to talk if they want to and the quality of information in the conversation is often enhanced.
  • The conversation is mediated through the placing cards on the mat. This takes away the pressure of eye contact which can be difficult for some, particularly those with autism. It also means that people can take as long as they want to respond and that it is easier for the silence to be held. Often when there is silence people fill the silence with more chat and if someone has a different way of processing language, this can add to their difficulties. 
  • The Keeping Safe Talking Mat creates a listening space to ask, “How is your life going for you?” That may sound like a very broad question but it was divided into 3 different topics : your well-being, your relationships and thoughts and feelings. The structure and associated images helped people reflect on the different facets of their lives. It also gave staff a fresh perspective giving a greater understanding of what was going on for an individual.
  •  The resource is holistic and allows people to comment on the small things in their lives as well as the bigger and potentially more difficult things. Indeed, building people’s capacity to comment on small concerns is critical to helping them raise bigger concerns. The visual images and the structure of the resource gives permission for both parties to talk about more difficult topics. 

Reflecting on the Spotlight On Violence conference, I realised how crucial it is for services to work together. We need to understand that if we are to address what seems like an intractable issue then there has to be a genuine appreciation of the skills different services bring to the table.

For me, at the heart of this, lies accessible and adapted communication. We must strive to get communication right for a group of women who by their life experiences are likely to be disempowered and vulnerable. How we communicate, and how we adapt our own verbal and non-verbal language to enable others to communicate effectively, is critical to developing quality and effective services and ensuring safer lives. 

Keep an eye on our Spotlights page for all the latest podcasts, blogs and other content in our series on disabled people and domestic abuse.

1. Keeping Safe: How's it going?

A week in the life of the UK's only specialist Deaf Idva Service

For an audio version of each entry, scroll down to the bottom of each section or visit our Soundcloud page.

In this blog, the DeafHope team share with us the complex work that their highly experienced team carry out weekly. 

DeafHope is currently the only specialist domestic abuse service for Deaf women and girls in the UK. They were established in 2010 in response to deaf women and girls who struggle to access mainstream services, increasing the likelihood of staying with or returning to their abuser. The team have recently noted an increasing number of referrals for complex cases linked to immigration and forced marriage. DeafHope also deliver healthy relationship workshops to young Deaf people aged 11-21 to increase their understanding of domestic abuse and forced marriage.  

DeafHope are a full Deaf team, employing 7 qualified Deaf Idvas who cover pan-London boroughs, Kent, and Surrey and one hearing coordinator. They use interpreters in their office each day to interpret phone calls. 
 

Monday

As Service Manager I check with our Coordinator the weekly work plan of the rest of the team. One of our Idvas does not work Mondays, and another team member is unwell. This leaves us low on Idva support in one of our areas so I’m hoping we do not receive any crisis referrals from that location this week. After a relatively quiet September, we have had a high number of referrals this month. I review the two referrals that came in Friday to ensure they are being assessed and allocated to a worker.  

Idva V was due to support a client in court for a five-day hearing, but texts me to report the court has failed to book sufficient interpreters to cover the full week and so the case has to be adjourned for 4 weeks. Her client is understandably very distressed at the delay and the Idva remains with her all day to liaise with her legal team and to offer emotional support.  

Idva M had planned to visit two clients today. One client went into crisis over the weekend and was supported by our 24-hour crisis SMS line. Unfortunately, she is suffering from the stress of the weekend and so cancels today's appointment. The Idva sees her second client who has recently relocated with her children. There are a number of issues for the Idva to address on the client’s safety plan and a number of calls to make. Idva M has her own interpreter with her to help her manage these.

Idva S spends the morning with a family who have relocated from refuge. This client has a complex case and has needed a lot of support, but we can now hand over to DeafHope Outreach and the Children and Families Worker. The family have been moved 4 times in one year, involving changes of school and nursery and also a couple of spells in emergency hostel rooms when temporary accommodation proved to be unfit and unsafe for the children. As a result, the oldest child’s behaviour has deteriorated and become difficult for mum to cope with. The client has already been rushed to hospital a few times with stress and exhaustion.

At 2pm we receive a phone call from another domestic abuse service wanting to refer a Deaf client. A referral form is sent and if we receive it back before 5pm it can be processed that day. I was due to carry out a worker’s appraisal but this has needed to be postponed due to other clients contacting us needing support.

Tuesday

I'm in the office early to check any overnight referrals. We have had permission from Head Office to install and use WhatsApp within the team. This is a welcome decision as it means we can more easily contact each other when out of the office and it’s quicker and more reliable than SMS messages from our work phones. We have been trying to get newer work phones that are more versatile and quicker for SMS, Skype and Facetime. We cannot effectively buddy workers with work phones, so often have to rely on our personal phones for this, but we never use personal phones for client work.

Idva V is meeting with Friday’s new referral in South West London and will report back. Idva C usually visit clients in refuges or in the community on Tuesdays, but today is supporting a client in court. She meets the client early to go through last minute preparations for giving evidence and stays in court to support her. Interpreters are provided and she has her own interpreter which enables her to monitor any misunderstandings or errors by the court interpreters. The police later contact her with a sentencing update and she is able to relay this to her client.

Idva M has a very early start of 6.30 am to travel to a client in London. Her client is due to give evidence against her ex-partner. Unfortunately, no interpreter is booked by the Witness Care Unit, despite emails to them to ensure they made adequate arrangements. This means the client is unable to ask questions. Sadly, this is not an isolated case and we have now started mapping how many court cases are cancelled or adjourned due to failure to book interpreters so we can tackle the issue with the CPS. Two hours later they are in court for the judge’s decision. Special measures are in force and two interpreters are present, one for her and one for her ex-partner. However, neither interpreter had introduced themselves or checked the client’s preferred signing style (which can vary considerably) and the client struggles to understand the interpreter in court, impacting on her evidence and responses to questions.

Because both interpreters are working individually there is no co-working as is usually the case, and this can lead to errors. It was clear that the client would have benefitted from a Deaf relay interpreter, and the court interpreter is not of sufficient quality to effectively interpret for her. Sadly, the defendant was found not guilty. The quality of court interpreters can be a big issue for Deaf people and this is a common problem we see. We can never know in advance which interpreters have been booked and whether they will meet the client’s needs for a Deaf relay or Deaf intermediary interpreter.

Late morning, I receive a text from the client who had been in crisis over the weekend and cancelled her meeting yesterday. Children's Social Services have come to interview her over concerns raised by her son’s school and the police, who were called out over the weekend. The client is panicking as the social worker has not bought an interpreter and is trying to go through a foster care agreement by communicating in writing; a second language for the client. I log onto Skype to talk with her, but our office interpreter is on her lunch break. While we are waiting I am able to talk to the social worker via messaging on Skype and relay this to the client.

Once the interpreter returns we try to continue the conversation but the client’s microphone is not working. When we update the social worker it is agreed we will have a meeting tomorrow with the client’s DeafHope Idva, Children and families’ worker and an interpreter. This means an SOS call to our interpreting agency to find a suitable interpreter in time.

Wednesday

Idva M attends the joint meeting that was planned yesterday. We have been trying for some time to get a round-table meeting for this client to bring in the relevant services, and so this was a welcomed though very heavy meeting. Finally, we now have a plan of action for this client and her children. We wait to hear from Children's Social Care if they will cover some of the costs of the interpreter used.

I’m again in the office to check any new referrals and to ensure the team have updated the files of new clients they’ve already met with. I'm due to meet with two new fundraisers, one corporate and one trust, to brief them on what we do and the areas in which we need funding. In the afternoon I continue training with the new Outreach worker and the Children and Families worker.

During training I have to leave to meet a new referral client who came to the office for assessment. This is an oral client so we communicate by speech and lip-reading and do not need to use an interpreter. We are able to complete the Dash and a safety plan. We register her mobile to SMS 999 in case her ex-partner turns up at her house. The client has not eaten for two days and has no money for food for the next six days and so after we finish our meeting I take her to a local supermarket and buy her essential food for a few days.

Idva C is meeting with a client who has been married for 20 years and is finding it difficult to leave her abuser. A refuge is not suitable for this client and placing her in one would most likely result in her returning to her husband. We have spent time with her, meeting regularly, building her confidence and self-esteem and moving towards some level of independence. Today the Idva takes her to college for her to enrol on a course to learn new skills which is a huge step forward. She was extremely overweight and unhappy about this, but with our support she has lost an incredible 11 stone! Her health has meant it has not been easy for her to leave, but we are now approaching the point where she is ready to move forward with our support. This client has needed long term support and their case highlights the vulnerability of some Deaf clients and the need to work at their pace or risk them disengaging. It also highlights the need to constantly review and manage risk. This client will be referred to our Outreach workers once she has left her relationship and support will continue until she is fully able to live independently.

Thursday

Today Idva M and I are delivering week four of our survivor workshop with five Deaf women with very different backgrounds, cultures and experiences.  This week we were covering the impact of experiencing domestic abuse on children. An emotional subject, but we also manage to have some laughs when sharing parenting experiences.  After the workshop, I return to the office and catch up with this week’s new referrals and to write up yesterday’s assessment for handing over.

This has been a relatively quiet day for the Idva team so an ideal time to update client notes, touch base with other clients and also start preparing the weekly updates.

 

Friday 

I'm covering the office today but with two Idvas on leave or TOIL, I’m hoping that there will be no crisis calls. Unfortunately, we get two calls today. One is an agency referral for a young client in North Kent who is assessed as medium risk. I have a chance to check the referral before allocating to our Young DeafHope Idva who works with under 25 year olds. The other is a self-referral from the Midlands; outside our funding area. However, we set up a Skype call and using this system through BSL I am able to make an assessment and identify what the client needs. She is experiencing continued abuse and harassment from her ex-partner and his family. I follow up with an email confirmation of action and advice.  

Idva S returns to the office after meeting with a new client. This client has been referred to Marac but the agency who referred the client is not responding to telephone calls and the Marac Coordinator is on leave today so we’re unsure when the case will be heard. Idva S is also having problems because her Access to Work budget for the month, which she uses for interpreters, is at a limit. This means she has to be selective about what meetings she can arrange. Fortunately, the office interpreter is funded by me so today she can use her for phone calls.

Before we close for the week we check all new our referrals are safe and know how to contact the crisis number over the weekend if needed. One of the challenges of being a specialist service covering a wide geographical area is the amount of travelling we need to do to meet with clients. Skype and Facetime can be really useful not only to communicate with clients quickly when they need it, but also for me to keep check on the emotional well-being of the team. The group Whatsapp system has also been really helpful this week, being able to send one message instead of 12 messages to each individual in the team!    

Keep an eye on our Spotlights Homepage for all the latest podcasts, blogs and other content in our series on disabled victims

Making the Marac process work for disabled people

For an audio version of this blog, please scroll to the bottom of this page or click through to our Soundcloud page.

Jennifer Daw is a Research Analyst for SafeLives. In this blog she looks at what current Marac data tells us about how many disabled people are accessing support services. She writes about 'hidden impairments' and SafeLives' recommendations for the inclusion of disabled people at Marac. 

Last year saw the 20th anniversary of the first disability-focused anti-discrimination law (Disability Discrimination Act 1995) (DDA) in the UK which was a major turning point for disabled people. Today, the DDA is no longer in force and has been replaced by the Equality Act 2010 which aims to make disability laws clearer and protect disabled people better.

In my former employment, I worked on a number of equality and diversity projects which made me aware of the difficulties disabled people face in education, training and employment. There is another area where people with impairments are particularly at risk – that is domestic abuse. There is a large gap in research on the issue of domestic violence and disability but from the information available we know that:

  • Disabled women are twice as likely to be victims of domestic violence as non-disabled women;
  • Disabled women are twice as likely to be assaulted or raped as non-disabled women
  • Both men and women with a limiting illness or impairments are more likely to experience intimate partner violence.
  • Disabled women are likely to have to endure abuse for longer because appropriate support is not available.

In our current release of UK Marac data (July 2015 – June 2016),  4% of high risk cases referred to Marac involved a disabled victim – far short of the SafeLives recommendation of 16% or higher, and surprising considering what the statistics tell us about the volume of disabled people suffering abuse. 

There may be a number of reasons why disabled people are not being identified at Marac.  One explanation could be the issue of ‘hidden impairments’.  A ‘hidden impairment’ means that a person’s injury or condition is not noticeable or visible.  The list of medical conditions that may be regarded as hidden impairments is extensive and can include people with epilepsy, diabetes, cancer, heart, liver or kidney problems and mental health issues.  Many people, including the victims themselves, may not realise someone would be protected under the Equality Act as having an impairment (and can be recorded as such) if a condition is long term and has a considerable negative effect on their lives.   

Saima Afzal MBE, an Independent Equality, Human Rights and Safeguarding Adviser states[1]:

“Those with 'hidden impairments' are often discriminated against because the general public and/or practitioners can’t see the impairment and as such assumptions can be made…or there is a stigma attached to Mental Health that prevents those suffering from coming forward”                       

As Saima highlights, if a condition is not evident, problems or difficulties may not be identified and needs not met.  One area of hidden impairments - mental health conditions – has a complex relationship with domestic violence.  Professor Louise Howard from the Institute of Psychiatry notes[2]:

"Domestic violence can often lead to victims developing mental health problems and people with mental health problems are more likely to experience domestic violence"

Research has shown higher rates of mental health issues with women who have experienced domestic violence compared to those who have not.[3] The SafeLives national Insights dataset shows just over a third (34%) of clients reported they have had a problem with mental health issues in the last 12 months. In the interim findings of the SafeLives Themis project nearly a quarter (23%) of non-hospital Idva clients disclosed mental health issues compared to nearly half (47%) of hospital Idva clients.

For this marginalised group, acts of domestic violence can be linked to their impairment. For example, a perpetrator of abuse can withhold or intentionally refuse to assist with care needs. As the abuser can often be the person relied upon for care there is an increased opportunity to use power and control.  Dr Jackie Barron from Women's Aid explains:[4]

"We've heard cases where a woman's wheelchair was removed just as she was about to sit down, or a hearing aid thrown to the other side of the room leaving the victim unable to communicate"

It can also be harder for disabled women to get away from an abuser as it means leaving a home that has been adapted to meet their needs, or residential care. Refuges, already coping with cuts in funding, are not always accessible or able to meet certain needs. Saima Afzal MBE[5] highlights that “self-blaming, low self-esteem stops victims of abuse from coming forward, therefore an impairment, visible or non-visible will only further exacerbate the situation”.

The Research, Evaluation and Analysis team at SafeLives are keen to ensure the number of disabled victims at Marac is documented accurately, to ensure that they are being identified and supported by the Marac process. Low referrals of disabled victims could be a sign that local services are difficult to access, or there is a lack of awareness for agencies working with this group and their increased vulnerability to domestic abuse and the Marac process.

As Saima Afzal MBE emphasises[6]:

“Statutory agencies and those that work in the Domestic Abuse and safeguarding arena need to capture the diverse needs of victims…if a need isn't visible we [statutory bodies and practitioners] may be unwittingly not accounting for it.  We also need to monitor disabled peoples needs more explicitly…if someone is struggling to communicate is that because of their ethnicity, language, confidence or communication barriers, or is because of an impairment? Until we unpick those barriers and identify them we won’t know the true extent of the reasons for under reporting”

Useful resources

See the SafeLives guidance for identifying and recording disabled victims at Mara and our Spotlight page on disabled people experiencing domestic abuse

 

[1] Afzal, S. (Personal communication, 4th December 2015)

[5] Afzal, S. (Personal communication, 4th December 2015)

[6] Afzal, S. (Personal communication, 4th December 2015)

[Image below: the hand of a person making notes during a meeting]

What Domestic Homicide Reviews tell us about the abuse of older people

With thanks to Standing Together for providing this blog post. Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse.

At Standing Together, we believe that all services and communities have a key role to play in eradicating domestic abuse and addressing it as early as possible. To do this we must identify domestic abuse in all its forms and – most importantly – everyone who is affected by it. 

This is especially urgent for older victims of domestic abuse. Too often assumptions about age can mean that, when older people are injured, depressed or display other potential signs of domestic abuse, the cause is assumed to be poor health or other social care needs. 

Earlier this year, Standing Together chaired a review of 32 domestic homicide reviews (DHR). We wanted to explore the circumstances that led to these deaths to identify patterns, address gaps in the system and help prevent similar tragedies from happening in the future. The findings were startling: over a quarter of those murdered by their current or intimate partner were aged 58 or above. This often surprises people who assume that domestic abuse poses a more serious threat to younger victims. There is a common assumption that older couples must be happy or they would not have remained in the relationship for so long. Sadly these DHRs found that, like the wider public, professionals can also fail to consider domestic abuse because of the victim’s age.

In some circumstances there was an age difference between the perpetrator and the victim which caused professionals around them to consider it more of a carer relationship, rather than an intimate relationship. In other situations the reviews found the victim’s age influenced her view of what help was available. As is common with all who are abused by their former or intimate partners, older women who were killed did not define their relationship as one that featured ‘domestic violence’.

As guidance from the Association of Directors of Adult Social Services (Adass) shows, there are a huge number of reasons why older women may not disclose domestic abuse: embarrassment, lack of awareness about services and options, and feelings of isolation – to name just a few. Older survivors may also have less experience of ‘self-help’ models or disclosing personal circumstances to a stranger.

In many of the domestic homicides our review looked at, the victim and the perpetrators were considered to be carers for one another. Six cases involved an ex/current partner who also was the carer of the victim. Yet, carers’ assessments were not completed despite research suggesting that the potential for violence in these relationships tends to be greater when the carer is a partner or close relative, and where the carer is trying to support a relative with a substance misuse issue. 

For professionals in the domestic abuse sector, the coordinated community response is not just a theory. It builds the strategic and operational structures which hold us all to account for the work we are (or are not) doing. There are vital lessons to be learned from the work of  groups like Solace Women’s Aid or housing providers like Gentoo to reach out and support older women. The Older People’s Commissioner for Wales has also launched a campaign on domestic abuse that is well worth a look. 

The review emphasised to us why it’s so important for professionals to think creatively when working with older victims. For example, have you considered your Marac referrals for older women?  What links can you make with your adult safeguarding board, and how can you ensure that there is adequate training for domestic abuse? What lessons can you learn from the domestic homicide reviews in your area which have involved older people? 

We have to grapple with the detail if we’re ever going to make a difference. Standing Together means working together. 

Find out more

Throughout July and August, we're focusing on domestic abuse as it affects older people. Listen to our new podcast, catch up with our webinars and more on the Spotlight webpage.