Domestic Abuse Workshop Ann Jackson RMN Royal College of Nursing Advance Nurse Practitioner conference December 2011

2 Definition “Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality” Source: Home Office (2004)

3 Some statistics  Affects over 350,000 England & Wales  Half a million older people  80:20% women, male  30% begins in pregnancy  2 women are killed every week

3 million women experience violence in a year  Domestic violence  Rape and sexual violence  Sexual harassment  Female genital mutilation  Forced marriage  Crimes in the name of ‘honour’ or HBC  Trafficking  Sexual exploitation

Health  Past experiences of abuse and violence – anxiety, depression, insomnia, self-harm/self-injury, eating disorders, relationship difficulties, other psychiatric diagnoses (‘schizophrenia’ ‘borderline personality disorder’)  Longstanding illness or disability  24% suffer from anxiety or depression – key risks – bereavement; loss of role; poverty; physical ill-health; alcohol abuse Source: Women at the Crossroads, Mental Health Foundation (2003) at the Crossroads, Mental Health Foundation (2003) : Women at the Crossroads, Mental Health Foundation (2003)

Inequalities…violence against women  2005 domestic violence prime cause of miscarriage or still- birth  % experienced domestic violence, sexual assault or stalking  Two women killed every week by current or former partner  2005 HO physical and emotional cost of rape to be £61,440 per incident  40% homeless women stated domestic violence as cause Source: Uncovering women’s inequality in the UK: statistics, Women’s Resource Centre (2007)

7 The cost of domestic violence Cost of domestic violence on society is £23 billion:  Services: criminal justice system  Health care  Social services  Housing  Civil legal  Economic output losses  Human and emotional costs Source: Women & Equality Unit 2004

Consequences  Depression x 4  Suicidal thoughts and behaviours x 3.5  PTSD x 4  Public health issues  Chronic pain  Pelvic pain and disease  Gynaecological symptoms  Sexual problems Source: Sane Responses (2008) GLDVP

Key women’s mental health policy DH (2003)Mainstreaming Gender and Women's Mental Health in conjunction with the consultation document in 2002 into the mainstream, this is singularly the most comprehensive policy relating to addressing the mental health inequalities of women, including those who offend. NIMHE/CSIP (2006) Women at Risk - The review of mental health of women in custody DH (2003) Personality Disorder: no longer a diagnosis of exclusion DH (2006) Supporting Women into the Mainstream – Commissioning women-only community day services DH (2006) Tackling the Health and Mental Health Effects of Domestic and Sexual Violence and Abuse DH (2008) Refocusing the Care Programme Approach – Policy and positive practice guidance NMHDU (2010) Working towards women’s well-being: unfinished business

What Women Say In addition to being safe, women want services that: Promote empowerment, choice & self- determination Place importance on the underlying causes & context of women’s distress Address issues relating to roles as mothers & need for work & accommodation Value women’s strengths & abilities & potential for recovery

Specific groups of women Women who have experienced violence & abuse Women from black & ethnic communities Women who are mothers and carers Women offenders with mental ill health Women who self-harm Women receiving diagnosis BPD Women with dual diagnosis Women with peri-natal mental ill health Women with eating disorders Women who are homeless Women who are refugees, asylum seekers Women who are sex workers Women who are travellers

Safe and Sane 2011 – Southall Black Sisters SBS domestic violence and mental health project – holistic, advice & advocacy, group support, counselling & psychotherapy Recognised as good practice model – high success rates for BME women – reduction in medication, self-harm and suicidal behaviours Completely adapted for complex, multiple inequality of BME women 14

DH Taskforce on the Health Aspects of Violence against Women and Girls 2010  Early identification of victims; Improving access and quality for victims; raise profile of VWAG – frontline staff, commissioners, partner agencies  Training & development; embedding improvement  Four sub-groups: domestic violence; sexual violence against women; child sexual abuse and harmful traditional practices (FGM, forced marriage and honour-based violence) and human trafficking  See also still we rise for evidence from women survivors

Pre and Post coalition 21 recommendations, implementation urged – ‘national disgrace’  Prevention and awareness  Making the NHS a ‘safe space’ to be heard and helped  Using information well and safely  Right services, with the right people, in the right place at the right time Recommendation 8: well-being policies for staff who are victims...

Coalition 4 year strategy “The Government’s commitment to tackling VAWG is clear. Violence will not be accepted and we will not stop until it has been eradicated. Government departments will continue to lead by example and we will encourage all spheres of society to be part of a wider movement to take action.” March 2011

‘Exemplar’ service DVA and health Identification and Referral to Improve Safety (IRIS) is a general practice based DVA training, support and referral programme for primary care staff and provides care pathways for all adult patients living with abuse and their children. IRIS is centred in partnership between primary care and specialist third sector agencies to deliver essential services and close the historical gap between the two sectors. Ultimately IRIS improves the quality of care for patients experiencing DVA and fulfils the moral, legal and economic case for addressing DVA in general practice.

19 “The best things were…”  Safety  Respect  A non-judgemental attitude, being believed  Mutual help and support from others  Time to talk and be heard  Attitude and approach of the workers  Rebuilding the capacity to hope Source: Abrahams (2007)