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Domestic abuse in London – a whole health approach

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Domestic abuse has a profound impact on our physical and mental health. It is vital that health services are an active part of the solution to give victims the help they so urgently need.

A whole health approach will help transform the health response to victims and perpetrators of domestic abuse across the capital. By drawing on best practice from specialist DA services, the project will launch a new survey to find out about survivors’ experiences in the health sector and organise a series of roundtables with health and domestic abuse stakeholders to drive change

We know only one in five victims calls the police – but many more access health services. Whether a GP’s surgery, a maternity unit, or a mental health services, health providers are well placed to spot the signs of domestic abuse and provide immediate support and information.

London is already a leader in its provision of health-based specialist domestic abuse services. The Capital has made some progress in this area, with a number of health based Idvas across the Capital as well as the Violence Reduction Unit has just awarded £1m in funding to expand IRISi from 10 to 17 boroughs.

There remains a gap in provision of specialists within mental health settings, but in 2018 Barnet, Enfield, Haringey Mental Health Trust piloted a mental health Idva during which time referrals to specialist services increased by 660% in just one year. SafeLives is proud to have AVA as part of the advisory group who pioneered the pan-London Community Group programme in 2009 which aimed to improve psychosocial outcomes for the whole family by running concurrent support groups for mothers and children. It has now been rolled out in England and Scotland offering a wider portfolio of services, policy work and training to keep survivors safe in London and beyond.  

In the last three years a coalition of domestic abuse specialist organisations came together funded by DCMS and the DHSC to deliver the Pathfinder Project. Over the three years, it engaged nine CCGs and 18 NHS Trusts across England to implement wide-ranging and sustainable interventions in eight local area. It built the case for a Whole Health Approach by doing the following:

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  • Working with health stakeholders across these eight sites to identify and share good practice
  • Turning guidance into practice and providing interventions where a gap in provision was identified
  • Embedding local health and domestic abuse governance structures linking the parts of each local health economy to each other and to their local specialist domestic abuse services to promote a coordinated community response to survivors and perpetrators of domestic abuse
  • Sharing learning and guiding national dissemination of good practice to inform future policy work and data collection[1]

Domestic abuse in London – the statistics

  • We estimate c77,500 Londoners received medical attention following domestic abuse in the last 12 months 
  • Domestic abuse offences rose by 63% between 2011-2018 (MOPAC)
  • Killings linked to domestic abuse trebled in the last year (2018-19), from nine to 29 (Metropolitan Police)
  • Just 6% of London’s MARAC (multi-agency risk assessment conferences) referrals are from health partners.
  • COVID-19 has brought particular challenges to providing services for survivors in the capital. At the peak of lockdown during the COVID-19 pandemic the Met Police were arresting 100 people a day for domestic abuse related incidences.
  • From June 2019- June 2020 10,000 cases were heard at Marac in London according to SafeLives’ dataset

Health and domestic abuse

  • In the year before getting effective help, nearly a quarter (23%) of victims at high risk of serious harm or murder, and one in ten victims at medium risk, went to accident and emergency departments because of their injuries. In the most extreme cases, victims reported that they attended A & E 15 times.
  • Hospital Idvas were more likely to reach these groups of victims compared to local services. This included victims who disclosed high levels of complex or multiple needs related to mental health, drugs and alcohol, aged 55 or over, victims who do not have children living with them, victims from high income households and victims who remain in a relationship with their abuser.
  • The Home Office estimates that every year domestic abuse costs the healthcare system over £2.3 billion.To implement a hospital based Idva in each hospital would cost £15.7 million.
  • SafeLives is partnered with IRISi which is a social enterprise established to promote and improve the healthcare response to gender based violence.  The work that IRISi has achieved in the health space are examples of what can be possible if authorities adopt a whole health response to domestic abuse. Particularly powerful examples are projects like Pathfinder and their innovative work with pharmacies.

To learn more about this project please contact Ella Harvey, Public Affairs and Communications Officer, ella.harvey@safelives.org.uk