Practice blog

'Early intervention is going to save lives' - domestic abuse support in hospitals

Mandie Burston was the Royal College of Nursing's Nurse of the Year in 2015, and is a passionate advocate for domestic abuse awareness in Health settings.

With no bias or boundary domestic abuse continues to infiltrate every sector of life, where no one is immune. It can begin at any time in life, it is rarely a one off event, and it is devastating and destructive to those directly and indirectly affected.

As many prepare for the upcoming festive period, all those involved in domestic abuse take 16 days of activism, raising awareness with public promotions, social media updates, conferences, TV and radio campaigns, with the single aspiration: that that the person suffering hears the messages of hope, and reaches out on to the road of recovery.

On the 28th November, Her Royal Highness the Duchess of Cornwall visited a programme embedded into University Hospital of North Midlands Accident & Emergency department, showcasing an award-winning project which helps those who are attending A&E and affected by abuse. ARCH, a local charity, with over 30 years’ experience have improved education & awareness for staff, who in turn, now recognise & respond promptly, initiating early interventions.  

Domestic abuse is often hidden by shame, guilt, and confusion. It is known as the most unreported crime and continues to affect 1:3 women, 1:6 men, 1:5 children. Those affected can be silenced through fear, crippled by depression and mental health complexities; they may have addictions which began as coping strategies or forced behaviour by a perpetrator. The only commonality of those abused is a failure by professionals to recognise and respond early.

In Health, we see those affected by depression, addiction, with bumps and bruises, unexplained injuries, vague symptoms, but do we ask why? Do we enquire about the safety of the person; do we ask if they are being abused? Do we fully understand the dynamics of a perpetrator-victim relationship and conduct ourselves accordingly ensuring the safety of those affected?

Early intervention is going to save lives. Sadly time and time again the headlines tell of a tragic story of a lost life, despite countless attendances to an A&E department, despite several GP appointments, despite various professional agencies' involvement, no one asked the question 'Are you safe?' On average a women dies at the hands of her perpetrator every 2.5 days. This does not include the deaths of those associated to addiction and health associated disease process.

Simple solutions are often the best solutions and with current NHS resources being stretched to the limit, by fostering a partnership with an Idva service, the human, emotional and financial cost of abuse can be met head on.

The role of an Idva is a light at the end of a very dark frightening tunnel to someone who is living with abuse. An Idva understands, advises on safety, will never say “just leave”.  An Idva becomes a helping hand in the hell of abuse. Those who work as Idvas do so silently, discretely, with empathy and understanding, with knowledge and compassion. With time and resources, Idvas can turn lives around into something worth living, in a world without fear.

For more information and resources, visit our 16 Days homepage

'I want to let them know they're not on their own' – training tomorrow's GPs on domestic abuse

Recent research found that the current level of domestic abuse training given to future GPs is inadequate. As part of the 16 Days of Action against gender based violence, we’re calling for domestic abuse training to be provided to all medical professionals. SafeLives Communications Officer Ruth spoke to Briony – a trainer at SafeLives who recently spent two days training medical students at King’s College London.

Hi Briony, can you tell me a bit about how this training at King’s came about, and what sort of topics you covered?

The training was part of a much wider area of their syllabus which is quite new – around improving access to healthcare for vulnerable patients.

They were second year medical students so most of them were quite a bit younger than the learners I usually train, and all of them are working towards being GPs. Most of it was around the basics: definitions, getting them to think about their ideas around what domestic abuse is, then looking at the Home Office definition, which structures a lot of the responses in the UK. We talked about that question of ‘why doesn’t she just leave?’ exploring the reasons why a person who is experiencing domestic abuse can’t – or shouldn’t have to – leave. We also looked at how abusive relationships develop, and the fact that they start in the way most relationships start. We looked at how a person might develop control over another person and how they sustain that, the different tactics they might use. So really trying to move the focus away from physical violence, towards the different forms of emotional and psychological abuse they might see in their practice.

We then talked about the health impacts of domestic abuse; so the long term effects in terms of physical health, but also in terms of mental health, and the various ways that these might present in patients they see. So we talked about the dynamics of domestic abuse, and how that might impact on what a person tells us, or how they choose to engage at different points depending on what’s going on.

What were you hoping for them to get out of the training?

The main message I wanted them to go away with was ‘you ask about all these other things that have an impact on people’s health, and we know from global research that domestic abuse has a significant effect on health. So why would you not ask about that?’ They need to be comfortable talking about this.

I also wanted to let them know that they’re not on their own – there are places for them to refer to. We know that the mental health impact on GPs can be really high, so as well as helping GPs to give the best response to patients who are experiencing domestic abuse, it’s about reducing the impact on them too. Letting them know that if they come across this, they can feel empowered to take action and refer it on – but they don’t have to deal with it by themselves.

What do you think the difference is between training GPs before they are qualified, compared to later on?

At this point in their training they haven’t seen many patients, so they’re still deciding what their own style of consulting is going to look like – so to train them now, and make this part of their practice, is so much easier than talking to established GPs who are already carrying so much with them.

There’s definitely a role for continued professional development (CPD), and medical practitioners – like many other professionals – do have to have that. It is important because resources change, pathways change, best practice is updated.

But I think it’s such a great opportunity to be able to train them early on, because as students they haven’t got the load of carrying cases and patients, targets, all the things we know that health professionals are dealing with. So to get them at this point where they still have the luxury of some time to think and reflect on ‘what sort of GP do I want to be?’ is really valuable. And, they’re still learning, so they see the training as something for them to take on board and assimilate – rather than something they have to do in order to tick a box. Getting GPs together in a practice for two hours to do training can be incredibly difficult – and it can feel like it’s putting pressure on an already strained service.

The other good thing about making it a part of their training is that it professionalises this issue. It makes domestic abuse awareness another part of their job, rather than a sort of add-on.

Did any interesting discussions come up in the training room? Did they have any preconceptions about domestic abuse?

It’s interesting, I think I actually had some preconceptions, because of the experience I’ve had training established medical professionals. I went in expecting these medical students to have the same ingrained ideas about what domestic abuse looks like… but actually, they’re 19 years old and they got it. I asked them what domestic abuse means and they talked about it not just being physical abuse, how it can be emotional and financial… clearly they’d already absorbed a lot of those messages which I think is a good sign of how things are changing in society. They had some of the same concerns as their older colleagues around ‘what can I do?’, so we gave them some very clear pathways.

Why do you think it’s so important for health professionals to have training on domestic abuse?

Well in research, patients who were survivors said that they were more likely to tell a medical professional – particularly their GP – than the police or someone else. So, on that basis it’s essential that health professionals have this knowledge. This was only a couple of hours of training, but I think it’s enough to plant the seed and get people thinking about domestic abuse as a health issue. It’s not a ‘women’s issue’, it’s not a voluntary sector issue – and it’s not just a criminal justice issue either: four out of five victims never tell the police.

If we know that people are using the health service because of the impact of the abuse they’re experiencing, and we know that people feel more comfortable disclosing abuse to health professionals than anyone else, then it doesn’t make sense for us to not be training them. We’ve got all these expert professionals – Idvas, young people’s workers, outreach workers – who are all doing an amazing job, but we’re not training a key group of people who could be referring to them.


Please would you consider making a donation of £25, or a regular gift of £10 a month, or whatever you can afford to help us call for specialist domestic abuse teams in every hospital in the country? You can donate online here or by texting STOP16 followed by the amount you want to give to 70070. Thank you.

Kathryn Hinchliff on the impact of Service Managers training and Leading Lights accreditation

Kathryn Hinchliff is Leading Lights Programme Lead at SafeLives. Here she talks to Senior Communications Officer, Natalie Mantle about our Service Managers training and Leading Lights accreditation, and the opportunities they can open.


Hi Kathryn, can you tell us a bit about your role/your background?

Kathryn Hinchcliff

I have worked in the domestic abuse sector for 14 years now, with half of that time at SafeLives on the Leading Lights team. Before I came to SafeLives I worked as an Idva/Outreach service manager in Rotherham and have also worked in Norfolk managing a county wide Idva service. I started out in this sector as a data-monitoring worker in Norfolk, collecting and analysing information from the police, health services, housing and DA services to inform practice across Norfolk. I think this slightly geeky background has stood me in good stead for my role as Leading Lights Programme Lead. I also worked for a short time in a refuge and this experience has really helped me as we have developed leading lights to meet the needs of all specialist domestic abuse services and not just Idva.

Can you tell me about the Service Managers training course and why it’s so important?

We developed the service manager’s training for three reasons. Firstly, we found that service managers were often working in isolation. We felt this group would really benefit from some peer support, and a nationally recognised qualification to back up the important work that they do. Managers were also struggling to fully embed standards across the organisation, and finally, frontline staff attending our accredited courses were leaning new approaches and sharing resources, but were finding it hard to implement in their teams as their managers did not always understand the approach.

The course covers effective support and supervision for staff, case management best practice, the importance of good governance and improving the multi-agency response. It also looks at how services can be commissioning ready and better evidence the impact they have. Feedback from the course repeatedly emphasises the benefits of the tools and resources provided, the impact on practice and the opportunities for peer support.

What opportunities can Service Managers training open up?

The course is an essential first step to achieving Leading Lights but many managers and senior staff choose to do the training for their own professional development – to learn from their peers and review their practice.

The service manager’s training is now a nationally recognised level 4 award and the only course of its kind in the UK.  Many learners have fedback how helpful it has been for their own personal development. The course encourages and teaches reflective practice and really helps managers to critique their services and identify opportunities to improve. One of the assignments involves auditing files using the SafeLives recommended audit tool – learners have fed back during the training that this has been eye opening for them and has helped them to identify potentially concerning gaps in practice as well as helping them see the really good practice and celebrate that with their teams. One learner reflected that the course really increased their confidence in their management style and was instrumental in giving them the confidence to apply for and get a promotion. 

If anyone is thinking about taking the Service Managers course but isn’t sure, what words of wisdom would you offer them?

One of the reasons I love training on the service manager’s course is because it is so rare that service managers give themselves time for professional development and have the time to properly reflect on their practice. It is fantastic to see the changes they have implemented from block 1 to block 2 and then see how embedded these are once they are assessed for leading lights. The course is intensive and managers can struggle to see how they will fit in the assignments and for some it may be a long time since they did any formal learning. So I would say if this is something that is stopping you then please do get in touch as we can support learners in many ways to complete the course and get back into learning. Over 300 service managers have now been trained – if they can do it so can you.

Leading Lights is coming up for its 10th birthday and we now have more than 50 accredited services. How do you think it’s changed over the years? What difference do you think accreditation makes to services?

Leading Lights has developed a lot over the 10 years with a big review taking place 4 years ago to ensure the accreditation is suitable for all specialist domestic abuse services and not just Idva. We now have a flexible model that has been developed in consultation with community based services. Our 50th service to be accredited was Bedfordshire Families First - Horizon project who run group work programmes for victims of domestic abuse. They are the first such programme to receive the accreditation and it was great to see the excellent practice they have put in place to ensure their clients are supported safely. Accreditation is a great way for services to celebrate their success with the teams, it provides a quality mark that is recognised by commissioners and most importantly it improves practice at every level of an organisation so that victims of domestic abuse are getting a better, safer service.

"The course was transformative – it was the first time I had attended a management training that was geared specifically towards this sector, and as a result I took so much more away from it than any previous course I have completed. The training cemented my existing knowledge and, at the same time, introduced me to areas of strategic management and governance that hadn’t previously been as ‘on my radar’ as they could have been."

Zoe Jackson, Aurora New Dawn


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Domestic abuse can happen to anyone: even those who are helping others

Melani Morgan is the SafeLives lead on DA Matters, a change programme for Police.

Yesterday I read the tragic news that Leanne McKie's husband has been charged with her murder. Leanne was a detective. Her husband is also a police officer. My thoughts immediately went to their children, her family and friends and her colleagues. 

It also took me back to my own lived experience of domestic abuse as a serving police officer. I was reminded how impossible it seemed to tell my colleagues what was happening to me at home. Shame and fear of judgement stopped me. I excelled at work to prove to myself and maybe others, that a police officer can be being abused at home , survive it and still be capable of doing a good job helping others.

After leaving my abuser and having made myself safe I vowed to ask my colleagues if they were being harmed at home, every time, if I saw any signs of coercion, control or violence. 

We don't know yet about Leanne McKie’s life before her murder and whether she suffered abuse at the hands of her murderer, but if she did let’s try and stop it happening again. Let’s all try to ask our police colleagues how they are when we notice something odd or worrying. Let's all give reassurance and offers of help to escape abuse if needed. Let’s all enquire when a Police colleague appears to show signs that they may be an abuser. Police officers do a tough, relentless and sometimes thankless job. Let’s ensure we give them as much support as possible, especially when they suffer the worldwide epidemic that is domestic abuse.

If you are experiencing abuse from a partner or ex-partner, or are worried about someone else, support is available.


Interview: reflections on the role of the Youth Idva

Linzi is a Youth Idva, working in South Wales. Communications Officer Ruth caught up with her while she was attending our Expert course in Responding to Young People, to talk about why specialist support for young people is so vital.

Young people are navigating an increasingly challenging and rapidly changing world. Our young people's practitioner training can help you to understand the dynamics of abuse as experienced by young people, including CSE, gang culture and technology.

Ruth: Could you tell me a bit about your role, and how you came into it?

Linzi: Firstly I was working in youth support work, working with young people who were witnessing domestic abuse. Then we got some funding from Children in Need for me to become a Youth Idva, so now I work with 11-18 year olds who are victims in their own relationships – or victims at home from their siblings. So I provide support for them, to help with their emotional wellbeing and safety.

And why do you think it’s important to have specialist youth Idvas?

I think in our organisation we’ve got really strong adult Idva support – the Idvas are all great, but the approach needs to be different with young people. The tools we had were very adult focussed, and we were just missing such a big trick with young people coming into the service. We were getting young people referred to us and then being put into adult groups, and it just wasn’t appropriate for them to be in those settings. As a result they just weren’t moving on properly, they weren’t getting the support they should have been getting really.

Can you think of an example of a time when the specialist support you provided made a difference to a young person experiencing abuse?

There’s one client that jumps out at me; she was referred by her social worker who said ‘there’s some domestic abuse here’. So I went to see her at school and this girl was adamant that there wasn’t any domestic abuse in her relationship. I think perhaps an adult Idva would have gone out there, done a risk assessment and left – because she just wasn’t giving much away at all. But in the youth Idva role we can give more time, to sit down and just explore different avenues other than the abuse itself.

So twelve months down the line, this young person has made the disclosure, she’s got a restraining order against the guy. In that short space of time she’s recognised that it was an abusive relationship and acted on it, and I think it takes a Youth Idva to put that extra time in to explore all the things going on for a young person. Her mum had thrown her out so she was living with the perpetrator and relying on him for everything, so it was a lot to unpick and the Youth Idva role allows you to give that proper support.

Adult services quite often operate a sort of ‘three strikes and you’re out’ rule with missing appointments, whereas I’m lucky that I don’t have that – she could turn me down ten times but as long as she sends me a text saying ‘yeah I’ll see you again’ then I’ll see her when she’s ready. It allows us to be a lot more flexible.

So you’ve been on the SafeLives Expert training this week, looking specifically at responding to young people. Do you think the training will make a difference to the support you offer to your clients?

Oh massively. I think it’s so important to be able to link in with other practitioners from across the UK and pick up their tools, but also it’s good to learn about things like gang culture – which isn’t something we’ve really had to deal with yet in the South Wales valleys – it’s good to take that back with me so that if it does come up I’ll be prepared for it. It is always a reactive job, trying to keep up with whatever trend comes next especially in terms of technology, so it’s important to make sure we’re all on the same level.

Do you think having a qualification will make a difference to the way you feel about your work?

Yeah I think it will, for myself but also for other people. I think for other agencies it does carry a lot more weight. I think for schools as well if you’re going in and you can say you’ve got a qualification schools are much happier to let you in!

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