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“A life barely half lived”: Domestic abuse practitioners’ experiences of supporting survivors of psychological abuse

Gemma Halliwell is a Research Fellow at the University of Bristol within the Domestic Violence and Abuse Research Group (DVAHG). She is a SafeLives Research Associate and Pioneer.

Domestic abuse is experienced by 1 in 3 women and 1 in 6 men in their lifetime. Yet, these figures are based on reports of physical or sexual violence and there are no consistent estimates about the number of people who have experienced non-physical forms of abuse.

Psychological abuse[1] is hard to define, it overlaps with many other forms of abuse and is inconsistently measured – this means that we are nowhere close to uncovering its true prevalence or impact. Addressing the lack of research in this area, we asked practitioners working in domestic abuse services to share with us their experience of supporting survivors as part of our wider study about ‘Psychological Violence’, commissioned by the Oak Foundation. They told us that psychological abuse is common, often exists in the absence of physical violence but can be misidentified or overlooked. Many felt that psychological abuse is as harmful, if not more harmful than physical violence. Often practitioners quoted survivors saying that they would rather “get a smack in the mouth” than suffer psychological abuse as it is the “worst kind” of abuse. This reflects wider research which has shown an association between psychological abuse and lifelong health issues, particularly mental health concerns like PTSD, depression, anxiety and suicidal thoughts or behaviours. For practitioners, these impacts were often connected to the most common consequence of psychological abuse, significant damage to survivor’s confidence, self-esteem and identity. This had a radiating impact on every aspect of survivor’s lives, often preventing them from feeling like they could manage everyday activities like going to work, making decisions, building relationships with family and presented challenges with parenting. 

“In simple terms, an inability to function without guidance or instruction of another person. Defer decision making to others, including children. No pleasure in anything. No autonomy. A life barely half lived.” DVA Practitioner

Our research found that the biggest challenge to tackling psychological abuse is identifying it in the first place. Practitioners talked about how survivors often struggled to recognise psychological abuse as ‘domestic abuse’ because of the tactic’s perpetrators use to establish and maintain control. Designed to cause confusion, subtle slow and insidious acts of psychological abuse used by perpetrators were often interspersed with warmth and kindness. This caused survivors to doubt their own experiences, thinking they were “going mad” or to minimise the abuse – believing it was not severe enough to warrant help because they hadn’t been hit.

“The fact is victims of psychological violence often don't recognise that they are victims of abuse and therefore the barrier is them knowing they need to access support in the first place.” DVA Practitioner

This, in turn, played into wider social messages that practitioners felt normalised certain aspects of psychological abuse in the media as “romantic” and emphasised that domestic abuse is only synonymous with cuts and bruises. When we asked practitioners where the gaps are in providing support to survivors, they told us that above all we need to increase awareness of non-physical forms of abuse within society and across professional agencies. Lack of understanding about the patterns underpinning psychological abuse and the tactics used by perpetrators - particularly within the police, the courts and child protection services - had significant consequences for survivors. They highlighted how even with new legislation in the UK about coercive control, evidencing psychological abuse is problematic and places significant burden on survivors to prove what had happened. This often resulted in cases being withdrawn from court or civil orders not being granted.

 “Very poor court outcomes. A non-molestation order will only be granted when there is an act of violence or a threat of it, meaning there are no protective measures.” DA Practitioner

Within children’s services and child courts, they talked about how perpetrators could ‘charm’ professionals into being granted access to children which enabled the abuse to continue. Perpetrators of psychological abuse were rarely held accountable for their actions and could often fly below the radar of services.

“So many of the people I work with have to go through the ordeal of family court and hand over their children to an abuser, because a Judge has ruled that without a criminal conviction the perpetrator doesn’t pose a risk - demonstrating a clear lack of education around what [psychological] abuse actually is.” DVA Practitioner

Lack of training, a universal definition and standardised assessment tools meant that psychological abuse is rarely identified by wider agencies. Access to support for psychological abuse is also in short supply according to practitioners, particularly mental health and long-term care services. Practitioners told us that the shortage of resources across agencies had led to rising ‘risk-thresholds’ and prioritisation of physical forms of abuse, which often resulted in survivors not being able to access the support they needed.

As a society and in the delivery of frontline services, we have a responsibility to identify and respond to domestic abuse - whatever form it takes. For as long as the image of domestic abuse is synonymous with “a smack in the mouth”, we create barriers which inhibit the visibility of psychological abuse to both survivors and professionals. The outcome of this is that perpetrators of psychological abuse are often able to escape accountability and are not challenged to stop. There will always be a need for crisis care and interventions that address severe forms of physical abuse. But as research shows, underpinning almost every domestic homicide review is a continued and sustained pattern of psychological abuse – which has often been misidentified as ‘medium risk’, falling below the threshold for intervention. Our findings highlight the urgent need to increase both public and professional awareness of psychological abuse, for training of wider agencies, and for sustainable funding that increases long-term support options for survivors and their children.

[1] The wider research project focussed on Europe where the term Psychological Violence is commonplace. Findings showed that UK practitioners identified most strongly with the term psychological abuse.

SafeLives' research into psychological abuse

Jen Daw, Research Analyst at SafeLives, explains the key findings and process behind the 'Psychological Violence' report, just launched.

In 2018, the Oak Foundation funded SafeLives to conduct research around ‘Psychological Violence’.  This European wide research aimed to establish a clear and consistent definition of ‘Psychological Violence’ and amplify the voices of survivors. We also reviewed the legislative frameworks in place across Europe, assessing their ability to protect survivors and their children.  

The research took an ‘empowerment and participatory approach’ grounded in the lived experiences of survivors.  The mixed-methods project was co-produced by survivors and practitioners. Survivors led research design, assisted in development of data collection tools and conducted interviews and focus groups.  An independent expert panel fed into every stage of the process, ensuring that the research truly reflected and gave voice to the survivors.  We had an amazing response from survivors and practitioners to our surveys with 600+ survey responses from practitioners and over 400 from survivors.  Survivors gave their time to take part in interviews and focus groups and spoke freely and in depth about their experiences.  Many thanked us for an opportunity to contribute to this topic.  From this engagement, it became clear this was a topic survivors and practitioners wanted to talk about and get acknowledged.  When we analysed the data – it confirmed why. 

Survivors told us ‘psychological violence’ is extremely hard to recognise as abusive.  They described its creeping nature often using the ‘frog in water’ analogy.  At the beginning of the relationship survivors described their partners as ‘the ideal companion’.  Some talked of being ‘love-bombed’ and completely charmed with compliments and constant communication.   

Survivors discussed numerous acts of covert abuse.1 They described experiencing gendered criticisms, put-downs, insults about their appearance, parenting or cooking/housekeeping.  They also talked about the abuse being masked in normalised ideas of love and romance.  These hidden abuses also included psychological manipulation such as projecting blame, refusing to take accountability, ‘stonewalling’2, the ‘silent treatment’ and ‘gaslighting’3.    

“He made me feel like I was crazy. I apologised for things I hadn't even done just to try and keep the peace. I always felt guilty for everything and nothing at the same time. I was emotionally exhausted; I would cry all the time” (Survivor) 

Survivors described further tactics such as insults presented as a joke, presenting differently in public to private, using their social status to gain the upper hand or present the victim as unstable, and using a victim’s vulnerabilities such as mental health difficulties or immigration status. 

“I am a strong woman…I always thought I would leave a man who treated me badly. But it creeps up on you. They are very clever and manipulative” (Survivor) 

Many survivors described ‘walking on eggshells’ throughout the relationship to try and keep the peace. They also explained why they remained in the relationship after abusive incidents.  They communicated how partners used ‘dosing’.4  Over three-quarters (80%) of survivors said their partner promised to change saying they recognised their issues after an abusive incident or if they tried to end the relationship.  Some survivors said they saw this as a ‘return to hope’ that the person they knew at the beginning would return.  This could escalate to more intense psychological manipulation with 5 in 10 (49%) survivors saying their partner suggested they would take their own life if the relationship ended. 

He would threaten to harm himself or kill himself if I tried to end the relationship…he would call me "his angel" and tell me that he couldn't live without me or cope…so I felt that I couldn't leave him” (Survivor) 

Many survivors portrayed the difficulty of explaining what was happening to them with many noting they didn’t access support as “who would believe me” without any proof of physical harm.  A few noted how they ‘wish they’d been hit’ to have something tangible as evidence.   

“Many, many times I wished he would hit me, so that I could know for sure it really was abuse, so there would be proof, so that I had a clear reason to leave the marriage, and a clear reason to justify and explain it to others. He was so charming; no-one would ever believe me otherwise” (Survivor) 

Our findings highlight the urgent need to increase both public and professional awareness of psychological violence, for earlier identification, and to give any victim or survivor a supportive, understanding and appropriate response to this insidious and extremely harmful form of domestic violence and abuse.   

Read more about psychological abuse

Read the full report

 

The unintended consequences of the NHS’s Partnership with Amazon’s Alexa service

Aliya Bakheit is the Digital Strategy Analayst at SafeLives. In this blog she discusses why the new partnership with Amazon Alexa and the NHS may be detrimental for those living with domestic abuse.

Last week, we learnt that the UK government has announced a new partnership with Amazon Alexa and the NHS. The output of which will allow people who have access to Amazon’s voice-assisted technology to get expert health advice via the device. The technology will automatically search the official NHS website when UK users ask for health-related advice.

The idea is to support patients, especially the elderly, blind and those with accessibility issues to take more control over their healthcare and to ultimately reduce demand on our already overwhelmed NHS. Security experts have already warned about the lack of privacy surrounding the partnership, but Amazon is making it clear that it doesn't share information with third parties or build profiles on its customers. In a statement to the Times, the firm has said: "All data was encrypted and kept confidential. "Customers are in control of their voice history and can review or delete recordings."

While this initiative is certainly an innovative development in utilizing digital tools to address healthcare needs, here at SafeLives, we believe that further research is required to fully investigate the safety implications for people living with domestic violence in coercive and controlling relationships. And considering that one in five people will experience domestic violence in their lifetime, this is not an insignificant concern. This technology often has default settings that exposes the user’s search history, and this information could potentially be weaponised should a perpetrator obtain these transcripts - which are easily downloadable - putting the survivor at significant and increased risk as well as blocking potential routes for seeking support.

In this specific context also, this initiative could lead to more health-related questions being asked of Alexa (perhaps around pregnancy or birth control) which could be discovered by perpetrators. We know that a third of all domestic abuse begins in pregnancy, so this is a particularly risky time for survivors, and makes them ever more vulnerable to the abuse escalating should the perpetrator uncover the Alexa transcripts.

In order to understand these potential risks, gaps and opportunities presented by technology in the context of domestic violence and abuse, SafeLives, Snook and Chayn undertook a collaborative research project, 'Tech vs Abuse’, commissioned by Comic Relief in January 2017. This research was carried out over six months and gathered insights from over 200 survivors of domestic abuse (over 18 years old) and 350 practitioners who support them. There were concerns about the potential for further coercive control made possible by the ‘internet of things’ within people’s homes, such as the Amazon Alexa device. Overall, there was a sense that the perpetrator was always one step ahead. This resulted in a lasting fear of using technology, both by survivors and practitioners. They viewed technology as potentially dangerous, both during abusive relationships and recovery. Women chose, or were often advised, to remove all technology from their lives. This left them further socially isolated and with less control.

Making health information more accessible by all is generally to be welcomed, we know that GPs, nurses and other health professionals are really well placed to identify and respond to domestic abuse – there is no substitute for a trained, empathetic person who can ask the right questions at the right time. The research highlighted in our Cry for Health report, shows that nearly nine out of ten (86%) referrals to hospital Idvas came from hospital departments and we know that a high percentage of domestic abuse cases are first uncovered during a visit with a health care practitioner, midwife or community nurse practitioner in particular. There are obvious risks associated with obtaining your health advice online; however not being physically seen by someone who is trained to spot for signs of distress and abuse is a considerable one.

As part of the Government’s new Domestic Abuse Bill launched on Tuesday, it has been outlined that ‘from April 2020, NHS England are planning for Independent Domestic Violence Advisors (IDVAs) to be integral to every NHS Trust Domestic Violence and Abuse Action Plan, as part of the NHS Standard Contract.’ This is of course a great step in the right direction, however we believe that anything that prevents potential victims from being seen in person, such as this new partnership with Alexa, could be detrimental to them accessing services and support, ultimately delaying or even obstructing any support that could be provided with potentially unthinkable consequences for the victim and the wider family.

We believe that tech giants have a responsibility and duty to respond to the ever growing need to ensure that the internet is a safe place for all, but particularly for the women and girls who are most likely to be targeted in acts of digital violence that reflect the pattern of abuse experienced offline. The tech industry and the health sector must do more to understand how inextricably linked domestic abuse is with them – and technologies must not be developed without thinking through the unintended implications for those living with abuse, sadly far more than we ever realise.

For more information read the Tech vs Abuse report 

Domestic abuse and the family court

Toni Mayo is a social worker who has worked with children and families, and later specialised in family court social work for Cafcass, where she still practices and supervises other social workers. She has experience of training social workers in equality and diversity issues and in court work. Recently she has begun writing and delivering training for SafeLives.  

Domestic Abuse and the Family Court 

Many families who have experienced domestic abuse find themselves in family court. Some are subject to care proceedings, where children are removed from mothers who have been assessed as “unable to protect” their children from the domestic abuse they are experiencing themselves. A higher number of families are subject to proceedings under the child arrangements programme (CAP). Under this, the Court will determine where a child should live, and who they should spend time with, the new language of residence and contact.

Applications under the CAP can be for a variety of reasons - including a parent applying for their children to live with them, be returned from an abusive ex-partner, or attempting to place legal security around their existing arrangements. In some cases, however, a parent may be making an application after their partner has left due to domestic abuse, taking their children. They may have responded to this by either applying for their children to live with them instead, or to spend time with them.

The world of child arrangements proceedings is uncomfortable, if not frightening and harmful for survivors of domestic abuse. The adversarial nature of family court and the nature of domestic abuse means that survivors are almost certainly going to experience the following things:

  1. Gaslighting – by the perpetrator making false allegations, reiterated by their skilled legal representatives, if they have them.
     
  2. Bureaucracy – without the assistance of a solicitor, a service user will have to navigate the process themselves.
     
  3. Lack of empathy from professionals – Cafcass officers are highly skilled and experienced social workers. Often, they can identify a victim and a perpetrator of domestic abuse respectively and analyse any resulting complexities. Cafcass officers are not, however, allowed to determine issues of fact, only the Court can. If a Cafcass officer was considered partisan within a case, then it would disadvantage the victim/survivor, and certainly the children. Therefore, often survivors will find themselves feeling like they have not been believed.

When applications are made by abusive parents, what is the motivation? Are these applications a final and malicious attempt to control and abuse their ex-partner, who is attempting to extricate themselves from the relationship? That may be true in some cases, but in my experience, it is only the minority who are solely motivated by cynical objectives. I think it is a fair conclusion that most parents wish to know where their children are, and to spend time with them, even if at times their need to exercise control and dominate the other parent overrides this.

Many women feel forced to leave a violent partner due to Children and Young People’s Services (CYPS) intervention. They are given an ultimatum, either end the abusive relationship, or your children are removed. When they do leave, and they or the perpetrator make an application under the CAP, they find themselves needing to meet the means and merit thresholds or paying for solicitors as a result of the reforms to legal aid in 2012.

I am not seeking to argue that women should not leave violent relationships, or that CYPS should not be frank with victims about the likely consequences of remaining within them. But specialists understand the most dangerous period for victims is immediately after they leave. The factors above demonstrate that there is other potential harm as well, one that resonates greatly with victims of domestic abuse – the risk that their children may be removed by CYPS or the perpetrator.

Determining the best interest of the child

Sturge and Glaser1 wrote the definitive article regarding post-separation “contact” in cases of domestic abuse, which is still widely referenced in Cafcass. For contact to take place safely, there needs to be a welfare analysis undertaken which considers several factors: does the child want contact? Have they witnessed violence and/or are imitating violent behaviour? Are they afraid? Is the resident parent afraid or undermined? Does the perpetrator accept and regret their behaviour? Can the contact be safe? Will it maintain a positive relationship for the child with the adult or indeed repair a broken one, or at least contribute to a child’s identity?

Practice direction 12J has revised the assumption that children should always spend time with both parents. It clearly states that domestic abuse is harmful to children, who experience it directly – previously they were considered to have “witnessed” it. Domestic abuse now needs to be carefully considered in issues of contact. This is of course highly ambiguous, and I have seen the test of best interests applied differently by Cafcass officers, Local Authority social workers and the Judiciary. Although uneven, I do consider that this “best interests’ model” is likely to be more person centred and safer than the “forfeiture model”, which suggests that abusive parents relinquish their parental rights and responsibilities. Of course, safe contact is not always possible and, in these cases, it should not happen, but we should have clear evidence and arguments for why it is unsafe. The welfare checklist allows a holistic analysis of children’s needs when considering their best interests and contact.

Accountability and support to change

My time in private law proceedings has confirmed my long held social work values. All people are trying their best and the world is hard to live in. All human beings fall short, both as people and parents. Therefore, as Social Workers we should not judge adult behaviour, but focus on the impact on children. To support change means that we need to analyse the cause of the adult behaviour. Sometimes that is by removing the perpetrator from the children’s lives. More often it is by holding perpetrators to account for their behaviour and then supporting them to make changes. Sometimes survivors of domestic abuse, who are traumatised and impacted in terms of their parenting will also need support in this regard.

This work relies on a social work practice that demonstrates unconditional positive regard and empathy for all people, but also holds people accountable for the impact of their behaviour on others.

(1) Sturge and Glaser (2000) Contact and domestic violence – the experts’ court report In Family Law:  615

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Developing our multi-agency domestic abuse response

Jackie Milton qualified as a social worker over 20 years ago.  During her early career Jackie worked within adult mental health services but moved to children’s services after a period working in an early intervention team funded by the Children’s Fund which was part of the 1997 Labour Government’s War on Poverty strategy.

Jackie is currently employed by North Somerset as a Service Leader. Her passions centre around social justice and the empowerment of communities to become equal partners in services; encouraging positive change by raising expectations and recognising human rights. Throughout her career the lasting impact of trauma and adversity has been evident both in her work supporting adults, children and their families. 

Being chosen to be one of the pilot sites for SafeLives One Front Door project was a complete honour and as North Somerset were the only pilot site that didn’t already have an established MASH arrangement, we very much felt that we were bottom of the class. Whilst we had enthusiastic partners in both health and Avon and Somerset Police, we knew we had many challenges to overcome.

We started with the end goal in mind. SafeLives’ vision of a multi-agency response for everyone impacted by domestic abuse, is compelling and radical; something that every agency can identify with and buy in to. Having said that, you can’t eat an elephant in one go, so we have phased our programme to first establish a pathway for police notifications of domestic abuse where there are children involved.

We have had a few false starts, but we eventually got the right people in the same room together. We assembled a core team of professionals including drug and alcohol services, Idva, health, police, housing, CSC, Early Help, DOFA (Designated Officer For Allegations), HIF (High Impact Families/Troubled Families) and attended numerous events to spread the vision to GPs and the Designated Safeguarding in Education leads. Probation and mental health were keen to join but the low numbers of cases they were involved in meant that the resource implication for them wasn’t an effective use of their time. Due to this we are currently experimenting with virtual attendance and measuring its effectiveness. We are really excited that schools are playing an ever-increasing role.

We found that each agency had their own agenda and unspoken cultural views on what was needed to tackle domestic abuse (usually, it was another agency needing to do more and do it sooner).

As we did not have an established MASH arrangement, we found we had to create an entire process from scratch. This would not have happened if we didn’t have the support from our SafeLives project lead, Deidre Cartwright. Deidre met with the strategic leads and supported us to create a process (out of our ramblings) that would work for all the organisations involved and also fit into the One Front Door model.

The team started working together in October 2018. It started very simply, with a book of handwritten notes before progressing to a spreadsheet. We had endless debates about BRAG1 (blue, red, amber green) ratings – does a police red top trump a housing red? Can you BRAG if you’ve no previous knowledge of the person? What time should the information sharing meeting be held bearing in mind the health rep had to research every family member? Slowly, the team members started to take ownership of the project and came together to agree what tweaks were needed. 

The joint working quicklygave us great results, which gave everyone confidence in the new system and motivated them to persevere, which was especially helpful when the going got tough. 

Relationships between the agencies felt different. As a small local authority, we know everyone in the professional network but we each started appreciating the specific skills and knowledge of our partners and got a deeper understanding of each other’s service delivery requirements. There grew a collective responsibility for the children and families that had been discussed and even if an agency had no role within the safety planning they felt connected to the outcomes. The focus on domestic abuse has raised its profile locally. We became acutely aware (and slightly ashamed) of the fragmented, disjointed, linear way services are delivered and are hopeful that the One Front Door model could bring about effective change. Our conversations around domestic abuse have changed and our frustrations about a lack of response to the perpetrator have grown.  

Listening to the other pilot sites we began to realise that by not having an established MASH, starting with a blank canvas was actually quite liberating and gave us the blank canvas that we needed to create and implement key changes to our system.

Currently we are about to have our bespoke Liquid Logic system go live which talks to both early help and children’s social care systems and we are planning our next development phase. We are also arranging a social get together as we forgot to schedule some fun into our project planning.

The success of the pilot has emboldened us and we are about to trial an early intervention into family conflict which has been created by our collective desire to target potential perpetrators.  But the best news of all is that victims of domestic abuse in North Somerset are getting a holistic and timely offer of support.

(1) Brag ratings are widely used in our One Front Door Pilot

Read the One Front Door report.

For more information on One Front Door please contact OFD@safelives.org.uk

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