1. Domestic Abuse and Sexual Violence Dr Shamim Rose Forensic Medical Examiner & Shelly Stoops, Criminologist Operational Manager Safe Place Merseyside Liverpool Community Health Trust

2. Domestic Violence/Abuse

3. Terminology Domestic violence or domestic abuse? Interpersonal violence Intimate partner violence Victim or Survivor?

4. What is domestic violence/abuse? Physical violence/abuse Sexual Violence/abuse Psychological abuse Financial abuse

5. Domestic violence and abuse: new definition The cross-government definition of domestic violence and abuse is: Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to: psychological physical sexual financial emotional Controlling behaviour Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. Home Office 2014 (This is not a legal definition)

6. Physical Effects On average, in the UK, two women a week are killed by a violent partner or ex-partner This constitutes nearly 40% of all female homicide victims 70% of incidents of domestic violence result in injury, (compared with 50% of incidents of acquaintance violence, 48% of stranger violence and 29% of mugging)

7. Sexual A U.S. study found that women who experienced intimate partner abuse were more likely to have a gynecological problem than were non-abused women These problems include chronic pelvic pain, vaginal bleeding or discharge, vaginal infection, painful menstruation, sexual dysfunction, fibroids, pelvic inflammatory disease, painful intercourse, urinary tract infection and infertility Sexual abuse, especially rape, can cause physical and mental trauma. In addition to damage to the urethra, vagina and anus, abuse can result in sexually transmitted infections, including HIV/AIDS Women who have been sexually abused are much more likely than non abused women to have had their partner stop them from using family planning and have a partner refuse to use a condom to prevent infection.

8. Psychological/Mental Health The World Health Organisation estimate that up to 60% of women in the UK mental health service population have been sexually abused in their lifetimes and 20% of victims of sexual violence will use health services in the first year, but by the second year, 50% are ‘heavily embedded’ in the health system. Women who have suffered domestic violence have approximately twice the level of usage of general medical services and between 3 and 8 times the level of usage of mental health services 70% of women psychiatric inpatients and 80% of those in secure settings have histories of physical or sexual abuse One study showed that the average rate of depression amongst battered women was 48%, the rate of suicidality was 18% and post traumatic stress disorder (PTSD) was 64%

9. Financial Withholding money Squandering family cash Not allowing to work/school/study Forcing into prostitution (Sexual Exploitation) Homelessness

10. Timeline of domestic violence in the UK 1767 British Common Law allows for a man to chastise his wife with a stick no greater in width than the length from the last joint to the end of the thumb (the rule of thumb). 1880 In England, the law is changed to allow a wife who had been habitually beaten by her husband to the point of "endangering her life" to separate from him, but cannot divorce him. 1895 The Married Women's Property Act (in England) makes conviction for assault sufficient grounds for divorce. 1964 Refuge House, the first battered women’s shelter in the world, opens in London. 1989 “Post- Traumatic Stress Syndrome” is applied to battered women by several experts on victims of trauma. Home office Circular to Chief Constables in 1990 The circular urged the police to develop explicit force policies on domestic violence, and to establish dedicated units with specially trained officers 1991 Marital rape outlawed in the UK 1993 Violence against women is included as a human rights violation by the United Nations at its International Conference on Human Rights in Vienna. The Protection from Harassment Act 1997 In January 1999, the Royal College of General Practitioners distributed new guidelines to all GPs in the UK on how to deal with and recognise patients who are victims of domestic violence.Royal College of General Practitioners 2004 ACPO guidance for all police forces Domestic Violence Crime and Victims Act 2004 to make common assault an arrestable offence

11. Domestic violence is- ‘ the largest cause of morbidity worldwide in women aged 19-44, greater than war, cancer or motor vehicle accidents’ (Home Office, 2007)

12. Appropriate referrals First port of call for any domestic abuse client should be the Safeguarding teamFirst port of call for any domestic abuse client should be the Safeguarding team They can instigate formal MARAC procedures if neededThey can instigate formal MARAC procedures if needed You can call Women’s Aid helpline 24 hours a day for access to refugeYou can call Women’s Aid helpline 24 hours a day for access to refuge

13. Where to go for Help SAFE Place for Sexual Violence 24 hours 0151 295 3550 0808 2000 247 Free phone 24 hr National Domestic Violence Helpline South Liverpool DV Services 0151 494 2222 (also have lots of bi-lingual staff) Worst Kept Secret-Liverpool IDVA Service 0800 028 3398 RASA-Liverpool ISVA Liverpool - 0151 707 4313