Domestic abuse

Introduction

What is domestic violence?

The Government defines domestic violence as "any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults (those aged 16 upwards) who are or have been intimate partners or family members, regardless of gender or sexuality." (Home Office, 2012)

Why is domestic violence a public health issue?

Whilst both men and women may perpetrate or experience domestic violence and abuse, it is more commonly inflicted on women by men. Women are also more likely to experience repeated and severe forms of violence, including sexual violence and are also more likely to have sustained psychological or emotional impact or result in injury or death.

Women who experience domestic violence present more frequently to health services. They are admitted to hospital more often than their non-abused counterparts and are issued with more prescriptions. There is evidence of a linear relationship between severity of domestic violence and the use of health services (Povey  D. et al, 2009, cited in Smith et al, 2011).

A high proportion of women attending A&E, primary care, family planning, reproductive and sexual health settings are likely to have experienced domestic violence and abuse at some point  (Alhabib, S. et al, 2010).

People who have experienced domestic violence can have chronic health problems including: gynaecological disorders, chronic pain, neurological symptoms, gastro-intestinal disorders, and self-reported heart disease. (Feder et al, 2011) The most prevalent effect is on mental health, including post-traumatic stress disorder, depression, anxiety, suicidal thoughts, and substance misuse (Coid, J et al, 2003).

In relationships where there is domestic violence, children witness about three-quarters of the abusive incidents. About half the children in these families have themselves been badly hit or beaten (Royal College of Psychiatrists, 2012).

These children have an increased risk of developing acute and long term physical and emotional health problems (Felitti VJ, Andrea RF, Nordenberg et al, 2002). Many will be traumatised by what they witness, whether it is the violence itself or the emotional and physical effects the behaviour has on someone in the household.

Impact of domestic violence on the wider determinants of health

Homelessness research carried out by the homeless charity, Shelter; found that domestic violence is "the single most quoted reason for becoming homeless". The study found that 40% of all homeless women stated domestic violence as a contributor to their homelessness (Cramer H and Carter M, 2002).

Loss of income or work The British Crime Survey showed that more than one fifth of women (21%) who were employed and who had suffered domestic violence took time off work as a result of the worst incident (British Crime survey, 2009/10).

Feelings of isolation can also occur having left a violent relationship since victims might have had to move to a new area away from friends and family. Building new social networks and pursuing new work or educational opportunities whilst recovering from the effects of a violent relationship can be very hard especially where the victim has experienced mental health issues.

Figure 1. Wider determinants of health and risk factors associated with domestic abuse

Wider determinants and risk factors with domestic abuse

Poverty and financial hardship

Risk factors for becoming a victim of domestic violence

The following have been identified by the World Health Organisation (WHO) (Harvey A et al, 2007) and the National Institute of Health and Clinical Excellence (National Institute for Health and Care Excellence, 2013) as risk factors for becoming a victim of domestic violence It is important to note that the potential to become a victim of domestic violence increases where a combination of risk factors occurs for an individual.

Facts, figures and trends

The main and most reliable indicator of domestic abuse in Bracknell Forest is incidents reported to Thames Valley Police. These can be broken down into recorded crime (where a crime has been committed e.g. assault) and non-recordable crime (where a crime has not taken place but the incident has been reported to police).

Data below shows domestic abuse incidents using the Domestic Qualifier. This is used for all offences where the Domestic Abuse Flag has been selected against an offence if it is identified that the offence is domestic related. The national definition is applied for all domestic abuse offences where the offender and victim are aged 16 and over and where there is a valid relationship between the two.

Figure 2 shows that Bracknell Forest currently has the highest rate of domestic abuse incidents (recorded crime) in Berkshire at 4.89 per 1000 population. This is similar to the Thames Valley average of 4.72.

Figure 2. Domestic Abuse, recorded crime compared by Local Authority

Source: Thames Valley Crime Recording Systems (CEDAR - offences recorded to 29 April 2014; Niche - offences recorded from 29 April 2014)*

Figure 3 shows that again Bracknell Forest has the highest rate of domestic abuse incidents (non recorded crime) in Berkshire at 13.28 per 1000 population. This is similar to the Thames Valley average 13.95.

Figure 3. Domestic Abuse -non- recorded crime compared by Local Authority 

Source: Thames Valley Crime Recording Systems (CEDAR - offences recorded to 29 April 2014; Niche - offences recorded from 29 April 2014)*

* Following the introduction of Niche RMS for recording crime, 225 crimes (0.19%) have yet to be assigned to local authority areas. This will impact on the 2014/15 figures provided above.

What are the unmet needs/ service gaps?

Training for General Practice in identifying and recording domestic abuse.  The Royal College of General Practitioners published a range of resources targetted at general practice to help develop DVA policy.

National and local strategies (current best practices)

1. In 2010 the government launched a new cross government strategy ‘call to end violence against women and girls’ (Department of Heath, 2010) The strategy emphasises four distinct themes:

  • prevention of violence against women and girls by challenging the attitudes and behaviours which foster it and intervening as early as possible
  • provision of adequate levels of support where violence does occur
  • action to reduce the risk to victims and ensure that perpetrators are brought to justice
  • partnership work to obtain the best outcome for victims and their families

2. In 2012 the first National Public Health Outcomes Framework for England was published which has four domains. The first domain ‘improving the wider determinants of health’ includes domestic abuse.  (Further guidance is yet to be published regarding how this will be measured).

3. The recent Mandate from the government to the NHS Commissioning Board cites the broader role of the NHS in society is to work in partnership to contribute to reducing violence, in particular by improving the way the NHS shares information about violent assaults with partners and supports victims of crime. 

4. National Institute of Clinical Excellence (2014)  Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively.

5. Domestic Violence and Abuse: Health Visiting and School Nursing Programmes- professional guidance for health visitors and school nurses.

6. Responding to domestic abuse: guidance for general practices

8. A structured education programme for primary care focusing on identification and referral to improve safety for people experiencing domestic violence. (Devine A. et al, 2013)

Local delivery in Bracknell Forest

Domestic abuse is a key priority in the Community Safety Plan for Bracknell Forest for 2013-14. A clear multi- agency action plan has been developed working with partners from across the directorates in the council, police, health and the voluntary sector. Bracknell Forest Community Safety Plan 2011-14.

A summary of two projects in the plan are summarised below.

  • Locally the Domestic Abuse Service Co-ordination (DASC) is being trialled in Bracknell Forest and is currently being scientifically evaluated by Cambridge University. It aims to provide enhanced support to standard and medium risk cases of domestic abuse and their children, along with enhanced management and supervision of offenders.
  • The Domestic Abuse Perpetrator Service (DAPS) is a local 1-to-1 perpetrator service. The service works with parents of children on child protection plans. The study has recently received positive evaluation.

Recommendations for consideration by other key organisations

Develop a framework to address domestic violence taking a life course approach to include primary prevention, better identification and evidence- based support services for victims.

  • Ensure multi- agency domestic violence prevention programmes are identified in UA JHWS (Joint Health and Well being Strategies) to include evidenced based programmes e.g. parenting, Family Nurse Partnerships, Drug and alcohol harm reduction initiatives.
  • Consider training for General Practice in identifying, recording domestic abuse and signposting to appropriate services. 
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