New SafeLives survey finds healthcare services are missing opportunities to support domestic abuse victims

31st March 2021

Survivors say London’s healthcare providers are missing opportunities to get life-saving support to victims of domestic abuse, a new study suggests.

In a survey for the ‘We Only Do Bones Here’ report by SafeLives, a UK-wide domestic abuse charity, survivors of domestic abuse detail missed opportunities to enquire about and support victims. One survivor told researchers: “when I went to A&E the doctor told me we only do bones here, not that ‘relationship mental health stuff’. But didn’t offer to refer me to somewhere that did.” - Survivor, Southwark

Yet the health impacts of domestic abuse are clear:

  • 98 per cent of respondents to SafeLives’ survey said the abuse had affected their mental health
  • over three-quarters (76 per cent) of survivors reported having suicidal thoughts due to the abuse
  • and over three-quarters of survivors answering the survey (86 per cent) said they suffered physical health issues as a result of the harm;

Another survivor in Barking and Dagenham told the charity: “My GP told me a few months ago that he didn’t know if there were services in the Borough for domestic abuse and that he would call me the next day. He didn’t call for a month.” - Survivor, Barking and Dagenham

In response, SafeLives calls for a ‘whole health’ approach to create better provision for survivors in all health settings, across all London boroughs. This strategy will mean over-stretched healthcare professionals will receive the support they need to adequately help victims, and victims won’t face a postcode lottery when it comes to accessing services.

A mapping exercise in the report found that five London Acute Trusts did not have hospital-based provision, while only three out of ten Mental Health Trusts had co-located specialist domestic abuse workers. The flagship IRIS programme has recently received funding to expand its service to 16 out of 32 boroughs, but an investment of around £2.5 million would be required to ensure it reached all GP surgeries.

The report recommends building on existing good practice across London. Specialist domestic abuse professionals can be located in health settings such as A&Es, GP surgeries and in mental health services, and have been shown to help healthcare professionals better understand when someone might be a victim of domestic abuse. Once someone has disclosed, those domestic abuse staff can then support victims to get to safety, in some cases saving their lives.

But while London has recently expanded services, through welcome funding from the Mayor’s Office for Policing and Crime (MOPAC) and the Violence Reduction Unit, gaps remain across many of London’s boroughs.

SafeLives is also asking mayoral and London Assembly candidates to sign a pledge to ensure that domestic abuse provision in healthcare settings is increased to help victims and survivors get safe. This has become even more urgent as a result of the increase in domestic abuse during the Covid pandemic. By the end of September 2020, the Met had seen an 8.5 per cent rise in domestic abuse incidents compared to the previous year.

The report identifies that migrant victims of domestic abuse experienced particular problems in accessing health services and recommends that migrant survivors should be considered as exceptions to the current NHS charging regime. Disabled survivors also said that their needs were not met, with one saying that said the lack of support, and of adjustments for their disabilities made them feel “like a ghost” in the system. LGBT+ survivors told practitioners of experiences in which healthcare professionals have written off abuse in same-sex relationships as a “catfight” or with problematic phrases including, “boys will be boys.”

SafeLives estimates that 241,000 women and 120,000 men experienced domestic abuse in the past year in London. 425,480 children and young people in London will have experienced domestic abuse by the time they are an adult.

CEO of SafeLives, Suzanne Jacob OBE said: “Only one in five victims of domestic abuse calls the police, but many more will be speaking to their GP or seeking medical help at A&E. That’s why it’s crucial for healthcare services to respond quickly and effectively to patients who may show signs of abuse. With the London elections just over a month away, we are calling on political candidates to recognise the urgent need for increased domestic abuse services in healthcare settings and the potential they have to save lives.”

Welcoming the report, the designate Domestic Abuse Commissioner Nicole Jacobs, said: “Health settings are trusted environments, used by everyone. Because of this, they are places that we can reach those from every background and walk of life subjected to domestic abuse, especially those who may not feel confident seeking help from other professionals. That is why it is critical to ensure awareness about domestic abuse is embedded into the safeguarding policy and practices of all health settings.”

Medina Johnson, CEO of IRISi, said: “This important report showcases the vital role health-based domestic abuse advocates can play in upskilling healthcare professionals and supporting survivors to get safe and well. I hope it leads to a greater recognition of the need for a sustainably-funded, integrated health approach to survivors in the capital.”

Key Findings

“I had so many medical and mental health issues because of the abuse. It was all documented but never was I asked or signposted. Only when I fled I told my GP, his reply was ‘Why didn’t you just leave?’ (Survivor)

  • 76% reported that health professionals did not ask if ‘everything is ok at home’ when they had been unaware or unsure if they were experiencing abuse
  • 35% of respondents suggested that health professionals did not understand the dynamics of domestic abuse
  • 24% felt professionals were “uninterested”, showing no curiosity around symptoms, sometimes prescribing medication or diagnosing a survivor with a personality disorder after limited contact.
  • 18% felt they were not believed or perceived as “crazy”

Other concerns from victims and survivors included; being unable to see a female doctor to whom they may feel more confident disclosing sexual abuse, a cold or impersonal manner from doctors, and staff being unable to quickly signpost to the appropriate support.

”The treatment approach from the start was 'What is wrong with you?' rather than ‘What has happened to you and how can we help?’” (Survivor)

A ‘whole health’ approach

Domestic Abuse is a public health emergency and demands a ‘whole health’ approach so that professionals in all health settings recognise domestic violence and abuse as part of their core business and they all share a responsibility to provide an appropriate and effective response.

SafeLives recommends London’s policy-makers and commissioners collaborate on a five year plan to increase health-based provision across the capital, including data collection and outcome monitoring. This would aim to build understanding and awareness of domestic abuse into the infrastructure of health services across the capital from hospitals to GP surgeries.

The Whole Health London project is funded by the City Bridge Trust, the funding arm of The City of London Corporation’s charity, Bridge House Estates, and is supported by an Advisory Group, which includes representatives from specialist frontline domestic abuse organisations, academics and commissioners in London.

Notes to Editors

R, a survivor of domestic abuse whose case study is included in the report is available for comment, though identity protection will be required.

Jessica Asato, Head of Public Affairs and Policy and one of the authors of the report is also available for media requests.

Medina Johnson, CEO of IRISi which provides the IRIS Advocate Educator intervention for domestic abuse survivors in 16 London boroughs is also available for interview.

Please contact: Connie Simpson on 07394 560 467 / connie.simpson@safelives.org.uk

Read the report: ‘We Only Do Bones Here’ – Why London needs a whole-health approach to domestic abuse.