Practice blog

Making the Marac process work for disabled people

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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 Today, the DDA is no longer in force and has been replaced by the Equality Act 2010 which aims to make disability laws clearer and protect disabled people better.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.

Older people and domestic abuse - completing the jigsaw

How can we help older people living with domestic abuse? Join the conversation – Twitter Q&A with Age UK 1-2pm on Wednesday 31 August. 

Richard Powley is Head of Safeguarding at Age UK. In this thoughtful blog post he takes a look at what can be done to improve the help and support offered to older people experiencing domestic abuse.

A few weeks ago I was able to do my civic duty by taking part in jury service and, as I first went into the jury waiting room, it became clear that it had been set up for people who would be doing a lot of waiting around. As well as the usual piles of out of date magazines there were tables dotted all around with jigsaw boxes sitting on them. 

As a jury we couldn’t speak about the trial when we were in the waiting area. But the jigsaws let us talk to each other, without talking about the case, and they became the subject of intense discussion and competition.

Inevitably, as we came closer to the end of one 2,000 piece behemoth (a Venetian lagoon if you want to know) we began to realise, to our great dismay, that there were some crucial pieces missing. 

Looking into the issue of domestic abuse and older people this week, that image of gaps in a jigsaw came back to me. Some of the necessary legislative and operational pieces are in place to empower and protect older victims of domestic abuse, but they are just not joining up to create a coherent whole. The outcomes of this are much, much more serious than an incomplete picture of a picturesque lagoon. They can, in fact, be devastating. 

There is no doubt that a more coherent approach is needed. Domestic abuse does not go away with age, and its damaging impact certainly doesn’t lessen. For older people domestic abuse is a hidden issue with hidden victims, and it is not clear that the current law and practice is applied consistently or that it is able to respond effectively to the needs of older people.

So let’s look at a few of the missing pieces in a bit more detail:
 

Piece #1: Recognition
There is evidence from criminal cases, Domestic Homicide and Serious Case Reviews that domestic abuse issues for older people often go unrecognised, which means that protective or supportive measures that may have reduced the risks of harm are not put in place. 

The Domestic Homicide Review for Mrs Y, a 79-year-old woman killed by her husband found that she was not considered to be a potential victim of abuse, due in part to her age. Had the potential signs of domestic abuse been recognised and explored, then it may have been prevented. (Sunderland City Council)

Older people may also be particularly affected by what may be perceived as ‘low level’ individual incidents which can, as part of a longstanding pattern of cumulative abusive behaviour, have consequences that can equal or surpass any individual incident. 
 

Piece #2: Understanding
Specific risk factors for older people, including the development of health needs, retirement from work (resulting in increased contact), stress associated with caring roles and social or geographical isolation may place them at increased risk from domestic abuse. As we age our ability to recover from both mental and physical abuse can be adversely affected, and the impact of domestic abuse can be particularly profound for those who may be reliant on a partner to provide care and financial support.

Additionally, for some older people, there will be factors that may make them less likely to disclose domestic abuse. These include concerns about sharing information considered to be private, and embarrassment and shame about a situation of domestic abuse. Long term undermining of an individual’s self-esteem over many years could intensify these feelings.
 

Piece #3 Joined up approaches
For older people psychological, financial, physical and sexual abuse may trigger adult safeguarding rather than criminal justice and/or protective domestic abuse processes. It is important that the possibility of domestic abuse is fully considered in adult safeguarding enquiries involving intimate partners or family members. Issues of coercion, pressure and mental capacity also need to be carefully considered. Person centred approaches and the appropriate sharing of information and expertise across safeguarding partnerships will help this to happen. 

Consistent inclusion of older people’s needs and insights as part of local Multi-Agency Risk Assessment Conferences and Multi-Agency Public Protection Arrangements could also help to identify and reduce serious risks that may affect older people. 
 

Piece #4 Developing the law
The broadening of the cross-Government definition of domestic violence and abuse is very welcome, as is the new offence of controlling or coercive behaviour in an intimate or family relationship (Serious Crime Act 2015).  

However the Serious Crime Act states that these behaviours will be deemed to have had a “serious effect” where the victim either fears that violence will be used against them on “at least two occasions”, OR they have been caused “serious alarm or distress”. This means that controlling or coercive behaviour may not be caught in situations where the abusive behaviour is hidden (e.g. hidden financial abuse) or where, because of cognitive impairment, an individual does not fully appreciate the nature of the behaviour and experience serious alarm or distress. It may help protect those in such circumstances if this were changed to include serious alarm, distress or detriment. (CPS: Controlling or Coercive Behaviour in an Intimate or Family Relationship)

Putting these pieces in place, alongside approaches informed by the experiences and insights of older people, would be a significant step forwards in preventing harm. I warmly welcome the focus of organisations such as Safe Lives on this issue, the more we talk about it, the greater the chance of real progress. 

 

Find out more

Throughout July and August, we're focusing on domestic abuse as it affects older people. Join our free webinars, listen to our new podcast and more on the Spotlights webpage.

5 challenges older victims of domestic abuse face – and what you can do to help

Monsura Mahmud is a Domestic Abuse Prevention Adviser for the Silver Project, a specialist service for women aged 55 and over affected by domestic and sexual abuse. The project is run by Leading Lights-accredited Solace Women’s Aid and provides one-to-one support, as well as training professionals who come into contact with older victims.

The person sitting in front of you has taken the hardest step of all: they’ve told someone about the abuse they’re experiencing. Now they need your help to become safe.

In my last post, I looked at some of the reasons older victims can find it difficult to seek help. But what happens once they’ve found your service? These barriers don’t simply go away. If your client is over 60, the chances are they’ve been living with the abuse for a long time – maybe even decades. This might be the first time they’ve ever reached out for help.

At the Silver Project, we see this scenario all the time, but we also know that because of a range of factors linked to age – health, mobility, financial security and isolation to name a few – keeping your client engaged can make offering support even more challenging.

1. Health and mobility issues are affecting the victim’s ability to access services

It can take longer for older victims to get the right support because they can’t get out as easily, don’t have anywhere safe to go or don’t have access to a mobile phone. This may be exacerbated by the fact the perpetrator is also their carer.

How can I help?

  • Be flexible in where and how you provide support – hold drop-in and outreach sessions at places older women feel comfortable or can access more easily, like health centres, GP surgeries and day/community centres
  • Meet face-to-face wherever possible and ensure any communication meets their needs – for example, using minicom, videophone or interpreting services for hard of hearing or deaf service users
  • Visit clients in their own homes, where safe to do so, and arrange joint visits with other professionals if their presence is reassuring for your client
  • Be aware of refuges that can accommodate carers

Stepping into a large organisation can be very overwhelming when you’ve already been through so much. Just taking the time to explain the service and what they do made a huge difference.

2. The victim has limited eligibility for housing, legal or financial support

Older victims might require specially adapted homes to help them live independently. This can limit the options available to them, particularly in areas like London where there is a lack of housing and a long waiting list for adapted properties.

If they have savings or a home of their own it could mean they are not eligible for legal aid. Others may face financial hardship as leaving the perpetrator can require costly care options.

How can I help?

  • Know the housing associations which operate in your area – some offer the option to register directly without going through the local authority
  • Be aware of local solicitors/legal services that offer pro bono support. Ask whether they can visit clients at home or in a safe location.
  • Ensure staff are trained on the needs of older people, including pensions and benefits available to them
  • Remember that all older people and carers have the right to request a Community Care Assessment. This can be a good way to work jointly with social services.

Getting Legal Aid was difficult, but I couldn’t give up and had to stay positive. The Silver Project gave me the extra support I needed.

3. The victim is reluctant to leave or has complex needs which make it difficult to do so

Older victims typically live with abuse for many years before getting help. This could mean that it will take them longer to deal with the trauma or leave the abusive situation at all.

They may have complex needs such as dementia or use alcohol as a coping mechanism. This can mean that you’ll need to work with clients on a longer term basis and steps to safety, such as re-housing, legal advice and access to care, may take longer.

How can I help?

  • Respect your client’s autonomy and their right to make decisions in their own life. They will leave when they are ready.
  • Help your client plan for their future safety. What have they tried in the past to keep themselves safe and is it working? Do they have a place to go if they need to escape?
  • Feelings of isolation significantly affect older people’s quality of life. Explore options like befriending services, local activities and day/community centres to help address this.
  • Give clients as much relevant information and assistance as possible, without overwhelming them, to help them make informed choices about their future. Where possible, give options in writing.

It's always good to see a familiar face. You can build a rapport and don’t have to keep repeating your story again and again.

4. The perpetrator is elderly or has health issues of their own

We often see cases where the perpetrator has dementia or memory loss, or conditions which are known to make them violent. The perpetrator may be viewed as vulnerable and not capable of serious harm. A criminal justice response may be seen as inappropriate, and could result in an inadequate or unsuitable response by professionals.

How can I help?

  • Where possible and safe, look for support services for the ‘vulnerable’ perpetrator as this may be the only way to ensure the victim’s safety
  • Recognise that your client may want to maintain the relationship and help the abuser. You must always support any decision they make.

In my experience, the best way to engage is to listen carefully and give all the support and resources you can.

5. The abuser is the victim’s adult child or grandchild

We find that victims in these cases are even less likely to report the abuse to the authorities. This is often because they still love their child and want them to get help. They may worry about being alone or even blame themselves for the abuse because of how the child was raised.

The perpetrator may also have complex needs, such as mental ill-health or problematic alcohol or substance use. However, unless they are a risk to the community, you may find that services are reluctant to intervene.

How can I help?

  • For the reasons outlined above, the options for clients in these situations can be limited. However, wherever possible, explore alternative solutions with your client – for example, we found that women were happier if a neighbour reported the abuse to the police, so we worked with them to agree a code word with a trusted neighbour.
  • Speak to other local domestic abuse services to find out about their experiences of this type of abuse. What worked for them?
  • Link in with specialists such as drug and alcohol services, housing and social care. If the person causing the harm is under 18, find out if there is a Young People’s Violence Advisor (Ypva) working locally.

You were always ready and willing to help, no matter what. You gave your time to listen – always.

Whatever challenges your clients face, it’s essential that you build strong partnerships with the services your client is already using. We work closely with local Age UK groups, as well as adult social care, care homes and sheltered accommodation, health services, the police and the fire service. Share information whenever appropriate, and visit the client together if it makes them feel more comfortable. By working together, you’ll achieve far greater outcomes and, ultimately, help more older victims to become sustainably safe.

Find out more

Throughout July and August, we're focusing on domestic abuse as it affects older people. Join our free webinars, listen to our new podcast and more on the Spotlight webpage.

It's our right to be safe at any age. How can we make it easier for older victims to get help?

Monsura Mahmud is a Domestic Abuse Prevention Adviser for the Silver Project, a specialist service for women aged 55 and over affected by domestic and sexual abuse. The project is run by Leading Lights-accredited Solace Women’s Aid and provides one-to-one support, as well as training professionals who come into contact with older victims.

In many ways, the impact of living with domestic abuse is the same for all victims – regardless of age. Everyone worries about not being believed, or having to live with the stigma of abuse. They worry about what will happen to them financially, if the abuse will get worse or what might happen to the perpetrator if they do speak out.

But for older victims, this fear can be exacerbated by a number of other factors. As professionals, being aware of these barriers allows us to better understand their fears and, as a result, take a more flexible and creative approach to support.

Older victims might not recognise what’s happening as abuse

It goes without saying that there is no ‘typical’ victim of abuse. But it’s normally younger women or families who are portrayed in leaflets, posters and campaigns. This is matched by a wider lack of services and resources which take into account the unique needs of older victims.

“I’m not sure whether I knew I was experiencing abuse. It’s sometimes difficult to distinguish… it’s a very large word. There is financial, mental, verbal, economic and so much more. Some is invisible to the eye. Some has happened and some is still going on. It’s not always physical.”

They may be reluctant to talk about it

Generational attitudes towards relationships mean some older victims might accept the abuse as “the way it’s always been”. Older women may be from a time where it was not socially acceptable to talk about problems in their relationships; where women’s roles were confined to the home and divorce or separation were taboo.

This reluctance to talk about abuse can be exacerbated by victim-blaming among some professionals, which can be even more prevalent when a victim has lived with the abuse for a very long time. Too often, professionals make excuses for the abuser instead (“It can’t be that bad if she’s stayed with him that long”).

They don’t know about the help that’s available….

Services open and close so frequently, and the support that’s out there varies from one area to the next. If older people don’t have access to the internet or the skills to use modern technology, how will they know where to get help?

…Or have been let down in the past

If the abuse has been going on for a number of years, it’s likely that victims will have attempted to get help in the past. But if at every turn they fail to get the support they need, many may simply give up.

It took some time for me to access support. I started out by searching on the internet and I called several numbers. I was very isolated. It took a lot of persistence but eventually I found the Silver Project.

They may have health or mobility needs

Older women are statistically more likely than younger women to have health problems, reduced mobility or other disabilities which means their situation makes them more vulnerable to harm. This could also mean a loss of ability to communicate clearly if they’ve suffered a stroke, heart attack, have hearing loss or have experienced other chronic disorders. It could also mean they’re more isolated – both physically and socially.

Too often, professionals don’t consider domestic violence as an issue for older victims, and therefore don’t ask about it. They may assume that injuries, confusion, depression etc are the results of age-related conditions.

Another common barrier among those victims with health or mobility needs is that the perpetrator of the abuse is also their carer. This can lead them to become further isolated from friends, family and support. This is especially the case for victims who have depended on the perpetrator for much of their lives. They may also make threats to put the victim into a care home if they tell anyone about the abuse.

Family and friends aren’t supportive

Some adult children will be supportive of their parent and encourage them to leave or seek help. But others can create barriers by expecting women to stay, continuing to assume the carer role to an elderly father. The responsibility they place on themselves to be the carer of the abusive partner or child can also be too much.

They think it’s too late

We know that older victims are much more likely to live with abuse for prolonged periods of time. The thought of having to give up the home they’ve lived in for many years, leaving behind pets and treasured possessions, can be too much. After a lifetime of contributing to the family business, homes or other assets, many fear they will be left with nothing. And, too often, life can get in the way – the death of family or friends, birth of grandchildren, retirement, moving house – and victims can feel the time isn’t right to seek help.

Most of our lives have been settled, we would hope – working, raising a family, and so on… There is more emotion involved as you have a long history. There is just so much more at stake.

Find out more

In her next blog, Monsura examines some of the additional risk factors facing older victims and offers tips on how professionals can best support them.

Throughout July and August, we're focusing on domestic abuse as it affects older people. Join our free webinars, listen to our new podcast and more on the Spotlight webpage.