Policy blog

Early intervention is key to reducing domestic abuse

This blog is an extract from Diana's article for the Journal of Family Health, Vol 26, No 1.  Click here to read the piece in full.

Setting up a national charity was never part of the plan. I was a hedge fund manager, interested in social issues, with a head for numbers. It seemed like a logical step for me to join the team at New Philanthropy Capital (NPC), a charity that ensures funding and fundraising is as effective as possible in creating long-term social change. I took on a large piece of research at NPC: looking at our national response to domestic abuse. The results were stark - it was a problem that ran through so many other issues such as mental health, substance misuse, child poverty – and abuse at home was often a common factor. And yet it was the hardest issue to raise money for. It was a hidden problem affecting thousands of families, yet its many isolated victims were suffering in silence.

Establishing SafeLives

SafeLives (then known as Caada) was conceived and set up almost 11 years ago, on my kitchen table. I wanted to approach domestic abuse with evidence underpinning the forefront. The funding that was available back then was largely being spent on refuges – a crucial part of the response to domestic abuse – but one that was only helping a small minority of victims. It seemed that we were missing valuable opportunities to intervene earlier and with more effective methods, to get people safe. Surely our starting point should be to try and keep women safe in their own homes?

It was also clear that that the response to domestic abuse was very siloed, with little joint work between the police, children’s services and health practitioners and the specialist charities working supporting women. This limited the impact of their eorts, all too often leaving practitioners feeling defeated and victims in unsafe situations. I asked myself: ‘What would I want for my best friend? How could we increase her choices?’

Responding to risk – the first decade

We began by establishing the following:

Creating the role of an Idva (independent domestic violence advisor).
This single practitioner provides one point of contact for victims to navigate the various services and steps to being free from abuse. We created the first formal qualification to reduce the postcode lottery of services for victims and give practitioners the skills and confidence that they needed.

Getting local services talking to one another and sharing information.
There are many services a victim may come into contact with in their pathway to safety, many within the health sector. To make interventions more effective, professionals need to view the whole picture. In response, we set up Maracs (multi-agency risk assessment conference) for agencies to come together to work through the issues. These include mental health workers, substance misuse workers, social workers, housing offcers, probation staff and many more. There are now 270 Maracs in England and Wales who supported over 80,000 cases last year, involving over 100,000 children.

We established a risk identification tool called Dash.
This helps professionals quickly understand the situation and be more con!dent in their response ensuring that resources followed risk. 

We started collecting national and regional data and evidence to inform policy and practice.
There are so many brilliant charities and services across the UK, working tirelessly to help and their insight wasn’t being utilised. We collect data from these services and feed it into the national narrative.

We also felt that it was important to have a risk-led response, prioritising those 100,000 victims who are suffering serious harm or even murder, and their children. This means every high-risk victim should be assigned a dedicated domestic violence professional (an Idva) supporting them to live in safety. And it means frontline services must work together to protect them and their family.

The future

And now we look forward to the next 10 years. A lot has been achieved, with the invaluable support from numerous local services and agencies. No one organisation can tackle domestic abuse in isolation; partnerships will make a better future possible. Our aim for the next decade is about getting it right first time for every member of the family where there is domestic abuse. Our research shows that victims disclose abuse on average five times before they get an adequate response and on average, live with abuse for almost three years – with many suffering for a far longer time. We want to address the gaps in services for those living with medium-risk abuse, for those who are still in relationships with the perpetrator, for those with complex needs (substance misuse and mental health) and ensuring we have an effective response for children and young people.

We are testing a new initiative to challenge perpetrators to stop their abusive behaviour. Over the past 10 years, we have done a better job of keeping a current partner safe, but little to prevent abusive men from repeating their behaviour with a new partner. If we are ever to reduce the number of victims, we must reduce the number of perpetrators: getting to the root of the problem.

Early intervention hubs

We are also going to pilot some early intervention hubs, which will look at all safeguarding risks across a whole family – breaking down the silos that exist today. We hope that these will give us the opportunity to intervene as early as possible to address not just domestic abuse, but wider safeguarding issues for adults and children. We believe that health professionals have an important role to play in these, both in terms of the links they can make between, for example, mother and child, and also between substance use and mental health problems. This will be crucial in developing better safety plans for vulnerable families.

We all have points of contact with the NHS, whether it be a nurse, a GP, a midwife - the public trusts health care professionals. Victims have poorer health than the average person, be that physical health or mental health
complications. They tell us that they want to disclose, but they don’t know where to turn. We believe there is great opportunity for the health sector to help fill this gap and identify those victims who might not want to contact the police. In recognition of this close relationship between the victim and the health sector, we want all health workers to be trained to spot the signs of abuse. Health care professionals need to make sure they make the link between the risk to the adult and the risk to the child, and that they act upon it. And children need to receive specialist domestic violence support, tailored to their needs and linked to the help their parents are getting.

Early intervention on the frontline

We also want to advocate for Idvas to be placed in all hospitals and maternity units, not just some. We are carrying out a comprehensive study on the impact of hospital-based Idvas and the profile of the victims that
they support. We look forward to this being published and working with policy makers and frontline staff to create a more coherent, joined up response to get victims the help they deserve and need to be safe.

We know resources are stretched, time and money are tight. Early intervention – with victims, children and perpetrators – is key to reducing domestic abuse: from a human perspective and an economic one. This is where our focus lies for the next 10 years – making sure we respond to each member of the family in a coordinated way. Health care professionals and health practitioners working on the frontline will be crucial in making this happen.

Change in legislation recognises control is at the centre of domestic abuse

From 29 December, 'controlling or coercive behaviour in an intimate or family relationship' will become illegal. It does not need to be physically violent; it does not even need to be physically threatening, but it is abuse. From now, you can be tried in a criminal court and face up to five years in prison if found guilty of it.

When I talk to people about this new legislation, I get a mixed reaction. How can we legislate for something that is so 'personal'? How will we manage given that the police and courts are struggling to deal with domestic abuse already? As one person put it - "we still can't deal with black eyes and broken bones properly - what difference will this make"?

I do understand the scepticism. Despite the rise in identified cases reported on by HMIC two weeks ago, domestic abuse continues to be under-reported, poorly understood and hidden. How is more legislation going to change that?

The law is a reflection of a society's morals, our sense of right and wrong; our right to be able to live a life free from fear of another. Make no mistake, being in a controlling and coercive relationship snatches this right away. It is terrifying; its impact on the victim and their children is both profound and long-term.

We work with friends and families of victims who have been murdered. They are not survivors - it is too late for them. Abuse can happen to anyone and these courageous friends and relations are from all walks of their life; each story is unique and heart-breaking. When you talk to them, the common thread is the immense control the perpetrator exerted over the victim. Their stories ended in the most unimaginable horror. These relationships began with the victim becoming isolated, checked up on, chased, manipulated, humiliated, followed, harassed, stalked - controlled and coerced. 

If you have an abusive partner or family member, simply living your life is a problem. Trying to make everyday decisions independently becomes an excuse for further abuse. Perpetrators want control over their victim and when they feel their grip loosen, their behaviour often gets worse. We see time and time again, whether it be financial, emotional, physical or sexual abuse - control is at the centre. That is why we recognise the value of this legislation. It illustrates the serious nature of control and coercion and empowers the police to act on it, early.

So often, victims only get proper help when it's too late. We want them to get support before they have to move home, move town, move their children to a new school, go to hospital; before they are injured, before they are killed.

SafeLives advocates for early intervention. If this legislation helps police officers recognise and take abuse seriously from the outset it will have made a powerful difference. Of course, we must be cautious about the implementation of this new law. We must work hard to train those people charged with identifying coercive control - not just the police but also health professionals, housing officers, teachers, social workers. We must work out how to support frontline professionals to use this legislation to make meaningful improvements to current support and provision.

This new law also speaks to the victims of domestic abuse up and down the country. It sends a message about the experience they're having. And that is why we must do what we can to promote it and raise awareness.

Domestic abuse campaigns and adverts often depict terrible scenes: pictures of women covered in bruises and men with their fists in the air. And this absolutely happens, and is a huge and abhorrent problem; indeed 100,000 people a year live are at risk of being murdered or seriously injured by a partner/ex-partner. However, not every victim of abuse will recognise this scene. We must raise awareness that where there is coercion and control, whether a relationship is violent or not, it is still abuse. For people whose decisions, choices, lives are not wholly theirs anymore - whose relationship has become a source of fear: it has never been acceptable, it has always been dangerous, and now it is illegal.

HMIC's report is encouraging, but there is still work to be done

Last year, the police in England and Wales received 900,000 calls about domestic abuse. That’s 100 an hour.

One in three of all recorded assaults are domestic abuse-related.

And these are the reported incidents. We all know there are a huge number of victims who remain hidden.

I founded SafeLives ten years ago; yet I am still not used to reading statistics like this. They remain stubbornly and depressingly static.

However, the report published today by Her Majesty’s Inspectorate of Constabulary (HMIC) about the police response to domestic abuse is encouraging. HMIC found a 31% increase in the number of domestic abuse crimes being recorded across England and Wales in the last year – a marked shift in the response. By showing themselves to be increasingly committed to recording crimes properly, the police not only help to inform our understanding of the problem – they also reinforce the fact that domestic abuse is a crime and must be treated as such.

Attitudes have also improved, with frontline officers moving towards being more supportive and sympathetic to victims. Of course, this personal response is dependent on the area, dependent on the individual. Improvements are been found in forces where they have conducted extensive training – something we hope will be rolled out to every police force.

We welcome this progress. However, to better support victims, we must deal with the root of the problem: the perpetrator. It is clear that the police are still failing to challenge abusive behaviour. Victims must be supported, they must be made safe. But to deal with the problem sustainably, we must have fewer perpetrators.

Our data shows 55% of victims have experienced some form of abuse previously and that many perpetrators do it time and time again. The report reflects the national narrative – support the victim and get them away from the perpetrator. This is clearly the most immediate priority, but if we continue to fail to challenge perpetrators – we will never see a reduction in the number of victims. Today less than 1% of perpetrators get any specialist intervention to change their behaviour and prevent them from moving on to future abuse victims. A quarter (24%) of known perpetrators are thought to be repeat offenders; the cycle of abuse can only stop when we make perpetrators stop. We need the police to be at the forefront of this challenge.

The victim becomes safe, and yet the perpetrator is free to find another partner, another potential victim. We at SafeLives want to work with the police to see an increase in the number of perpetrators being prosecuted, the number of perpetrators being challenged to change.

This is not an either/or situation – holding the perpetrator accountable should happen in addition to, and never at the expense of, keeping a victim safe.

Perpetrators are the cause of domestic abuse. Without dealing with the root of the problem, we will continue to see more victims harmed, injured and murdered. We look forward to working with the police to make this happen. Holding perpetrators to account is a challenge, and not without its controversies, but we must be brave and face it head on. 


Why we need everyone on board to stop domestic abuse

How would you respond if someone told you “I’m being abused”?

It’s a question that we should all reflect on – because as Citizens Advice’s new research shows, those who experience domestic abuse are much more likely to tell a friend or family member than anyone else. And even for those of us who work in the domestic abuse sector, it isn’t always an easy question to answer.

But we do all need to have that answer ready – because for the 1 in 4 women and 1 in 6 men who experience domestic abuse at some point, it could be life-saving.

That’s why SafeLives welcomes Citizens Advice’s campaign to get people to talk about abuse. We know from our research that professionals in most cases will miss five opportunities to spot domestic abuse before the victim eventually gets the specialist help they need to stop it. This is a huge gap in the identification of abuse – one which we and other domestic abuse charities work hard to fill by helping organisations improve their response. But friends and family can help to bridge it as well, by knowing what constitutes abuse and having the confidence to talk about it.

Even in an ideal world where professionals got it right every time, there would still be room for friends and family to play their part – there are many victims of domestic abuse who simply aren’t visible to services. In situations like this, we need to think outside the box and engage whoever we can to spot the abuse and help stop it.

This is especially true when it comes to particular groups, such as BAME and older people, who are often in abusive relationships for longer and are less likely to be in contact with services. From research we know that the length of abuse is 50% greater for BAME victims at risk of serious injury or murder – compared with white British or Irish victims – and a quarter of victims aged over 60 have been in an abusive relationship for more than two decades.

These are frightening statistics which need to change. It is vital that we equip people with the knowledge of what to do and who to ask for help if they suspect someone is living with abuse, be it a neighbour, a friend or a relative. Anything which builds public understanding of domestic abuse, such as this online tool, is helpful in this regard.

Furthermore, by giving people the confidence and tools to spot abuse and do something about it in their personal interactions, we improve the odds that they will be able to transfer this awareness into their professional lives. For every person who Citizens Advice’s campaign reaches, it scores a double victory: one when they notice their friend acting oddly around her partner, another when they ask to see the domestic abuse policy at the hospital where they work.

The truth is, even though domestic abuse has been receiving more and more media coverage in recent months, there is still not enough public awareness of how we can intervene as individuals. Many of us would be paralysed with uncertainty about what we could do if a friend told us that she was being subjected to violence at home. Citizens Advice’s campaign to change that is therefore a welcome and timely addition to the fight against domestic abuse, one which we fully support.

On ‘healthy’ relationships

In a few weeks, I’m speaking at a conference on how we can better identify and support victims of domestic violence. Aimed at a range of professionals, the event explores, amongst other things, the new Nice quality standard for domestic violence, due to be published in February 2016. It’s vitally important that we bridge the gap between specialist domestic abuse professionals and health workers who come into contact with family members experiencing abuse, but perhaps aren’t sure how to respond.

Our Themis research highlights the central role that health professionals can play in identifying and referring victims of domestic abuse. Not only are these victims often hidden from other public services, like the police, they’re also more frequently from ‘hard to reach’ groups – those who are pregnant, the elderly, and people with complex needs such as mental health issues or substance misuse.

We also know that victims of domestic abuse use local health services much more than others. If you’re a health professional - whether you work in A&E, private practice or elsewhere - it’s almost certain that some of your patients are experiencing domestic abuse. That’s a daunting idea to come to terms with – that the biggest danger to your patient’s wellbeing could actually be someone at home. When confronted with the reality of abuse, it can be difficult to know what to do, especially when resources are stretched.

Empowering health professionals

For this reason, rather than creating new demands on services, we need to deal with the unspoken issue that's already there – by empowering health professionals to ‘ask the question’ and creating clear referral routes to specialist domestic abuse services to help them/you act quickly and easily.

With this in mind, SafeLives offers a simple checklist which can help all health professionals to feel more confident at identifying and referring domestic abuse. What’s more, we’ve recently collaborated with Bristol University on the Responds project to produce free training resources for clinicians. We also provide our own top tips sheets and videos to help you get to grips with the risk assessment process.

I hope the most important message health professionals attending the event take away is that they’re not on their own. There’s a whole network of domestic abuse experts out there, ready to support them, and events like this provide the ideal opportunity to start making those links.

Identifying and supporting victims of domestic violence and improving the effectiveness of Maracs takes place on Monday 16 November at the Hallam Conference Centre in London. To get 20% off, quote the code hcuk20safe when booking.