Domestic abuse in London – a whole health approach
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.
‘We Only Do Bones Here’ maps the domestic abuse response within health settings in the capital and makes recommendations for the most effective means of securing a whole-health response which truly meets the needs of all victims and survivors.
Only one in five people experiencing abuse ever calls the police but victims will be accessing every hospital, GP surgery and mental health setting every day, while children and their parents will be being supported every day in Child and Adolescent Mental Health Services (CAMHS), health visiting services and by school nurses.
We are calling 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.
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
This report builds on the findings of the Pathfinder Project, a partnership between Standing Together, AVA, Imkaan, IRISi and SafeLives, which was a three-year fixed-term pilot funded by the Department for Health and Social Care (DHSC) which sought to embed a ‘whole-health’ approach to domestic abuse in eight sites across England.
In this report, we focus specifically on the capital’s provision of health-based domestic abuse services, combining the experience of survivors who accessed healthcare services through a dedicated survey with observations from frontline specialist services and other stakeholders who engaged in two roundtables held in December 2020 and January 2021.
Key findings in the report:
- Domestic abuse has a devastating effect on the health and wellbeing of victims and families, and costs society £66 billion per year – of which more than £2 billion is borne by health services.
- We estimate that 241,000 women and 120,000 men experienced domestic abuse in the past year in London, on the basis of Crime Survey of England and Wales estimates that 7.3 per cent of women aged 16-64 and 3.6 per cent of men in the same age bracket experienced domestic abuse between March 2019 and March 2020.
- 425,480 children and young people in London will have experienced domestic abuse by the time they are an adult.
- We estimate there are around 45,750 female survivors of domestic abuse working for the NHS just in London.
- We estimate around 88,000 Londoners received medical attention following partner abuse in the last 12 months.
- The estimated health service costs of domestic abuse in London equals £433 million per year.
- One in ten offences recorded by the Metropolitan Police involves domestic abuse.
- Only one in five people experiencing abuse ever calls the police but victims will be accessing every hospital, GP surgery and mental health setting every day, while children and their parents will be being supported every day in Child and Adolescent Mental Health Services (CAMHS), health visiting services and by school nurses.
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, Havering
We are incredibly grateful to the members of the Whole Health London Advisory Group for their insight. We are particularly indebted to our ‘by and for’ specialist sector partners: Forward UK, Galop, Southall Black Sisters and Stay Safe East – we know how much pressure your services have come under in the last year and are therefore doubly grateful for the time you found to give to this project.
Thank you, too, to the survivors who shared their experiences with us – we hope this report makes a difference.
Survivors say London’s healthcare providers are missing opportunities to get life-saving support to victims of domestic abuse. We are calling for all candidates in the upcoming mayoral and local assembly elections to sign our pledge and help us fight for a ‘whole-health’ approach to the domestic abuse response in London.
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 vital services.
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:
- 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
To learn more about this project please contact Verona Blackford, Public Affairs and Policy Officer, firstname.lastname@example.org
Thank you to our advisory group members who have helped us to shape the project:
Jess Asato, Head of Public Affairs and Policy, SafeLives
Medina Johnson, CEO, IRISi
Donna Covey CBE, Director, AVA
Guddy Burnet, CEO, Standing Together
Miranda Pio, Programme Manager for Pathfinder, Standing Together
Nicola Douglas, Children and Health Team Leader, Standing Together
Fiona Dwyer, CEO, Solace
Niki Scordi, CEO, Advance
Rachel Nicholas, Head of Service, Victim Support
Prof. Gene Feder, Professor of Primary Care, Bristol Medical School, University of Bristol
Prof Louise Howard, Professor of Women’s Mental Health, KCL
Jessica Southgate, CEO, Agenda
Laurelle Brown, Programme Manager, London Violence Reduction Unit
Karolina Bober, VAWG Strategy and Commissioning Manager, Islington Council
Jain Lemom, Senior Policy and Commissioning Manager for VAWG, MOPAC
Dr Liz Henderson, GP and Deputy Medical Director, IRISi Clinical Lead in Southwark, NHSEI
Aiswarya Kurup, Project Manager, NHSEI London Region Safeguarding Team
Leni Morris, CEO, Galop
Dr Jasna Magić, National LGBT+ Domestic Abuse Project Manager, Galop
Peter Kelley, Service Lead, Galop
Michele Lawrence, Head of Safeguarding, Public Health England
Ruth Bashall, CEO, Stay Safe East