Joint strategic needs assessment

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Domestic and Sexual Violence and Abuse (2014)

Topic titleDomestic and Sexual Violence and Abuse
Topic ownerDSV Strategy Group
Topic reviewerDara Coppel/Liz Pierce and Jane Lewis
Topic endorsed byDSV Strategy Group
Current versionFebruary 2014
Replaces version2011
Linked JSNA topicsSexual health, child health and wellbeing, maternal health, avoidable injury, mental health and wellbeing, prostitution, homelessness and substance misuse
Insight Document ID66206

Introduction

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Domestic violence and abuse (DVA) is defined by the Home Office ( 2013) as

'Any incident or pattern of incidents of controlling, coercive or 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. This can encompass, but is not limited to, the following types of abuse: psychological, physical, sexual, financial and emotional.

This definition includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.’ (Home Office 2013)

Sexual violence (SV) is defined by the World Health Organisation ( 2010) as

‘Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic or otherwise directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work, This definition includes rape, defined as physically forced or otherwise coerced penetration of the vulva or anus, using a penis, other body parts or an object’.

Domestic and sexual violence and abuse are complex areas to tackle due to the hidden nature of offending and victimisation. Over a third (36%) of people report some experience of domestic violence and abuse, sexual victimisation or stalking in their lifetime and 89% of people who suffer 4 or more assaults in their lifetime are women (Walby and Allen 2004).

This needs assessment will use the term ‘Domestic and Sexual Violence and Abuse’ abbreviated to DSVA.

Gender-based violence and abuse both reflects and reinforces inequities between men and women and compromises the health, dignity, security and autonomy of its victims. It encompasses a wide range of human rights violations, including sexual abuse of children, rape, domestic abuse, sexual assault and harassment, trafficking of women and girls and several harmful traditional practices.  New forms of domestic abuse are emerging due to the new technology such as cyber stalking, using mobile phones, social networks, computers and geo-location tracking.

 

Key issues and gaps

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The impact of domestic violence and abuse

  • Violence and abuse is experienced by many people at some point in their lives – at least 1 in 4 children and young people experience some form of abuse and 1 in 4 women experience domestic abuse at some time in their lives.
  • Reported levels of violence and abuse remain high in Nottingham.
  • Violence and abuse is estimated to cost the economy in England and Wales in 2008 £5.7 billion based on public services and loss of economic activity due to injury. It also estimated that the human and emotional costs of DV could be estimated at an additional £9.9 billion (Walby, 2009)
  • Violence and abuse have ongoing impacts and costs for health, education, criminal justice, social care, housing, civil law and the voluntary sector.
  • The lifelong impacts of violence and abuse on children can lead to multiple poor outcomes in educational and economic performance, increased anti-social behaviour and risk taking, the inability to bond during parenthood, and poorer health outcomes in the short and long term. (UNICEF 2006)
  • The task of addressing domestic and sexual violence has risen up the political agenda, both nationally and locally. Recognising the growing consequences of violence for health care services and its detrimental effect on scarce health care resources for Nottingham is vital.

The Public Health Outcomes Framework ( PHOF), 2013-2016, includes the following relevant indicators

• domestic abuse

• violent crime ( including sexual violence)

• statutory homelessness

• self-reported wellbeing

• mortality rate from preventable causes

Other relevant outcomes

• Low birth weight

• Child development

• Child poverty

• Pupil absence

• Hospital admissions for avoidable injuries for under 18s

• Self harm admissions

• Infant mortality

• Suicide rate

• Social connectedness

• Reoffending rates

• Completion of drug treatment

• Alcohol related admissions to hospital

Indicators from the NHS Outcomes Framework relevant to Domestic Violence and Abuse 2013-2016

• Potential Years of Life Lost from causes considered amenable to health care

• Reducing deaths in babies and young children

• Patient experience of NHS care ( including mental health A&E, primary care and maternity services)

• Recovery from injury

This needs analysis considers the health needs of victims/survivors and their children.

Domestic violence and abuse is also relevant to the following public health priorities and JSNA sections: sexual health, child health and wellbeing, maternal health, avoidable injury, mental health and wellbeing, prostitution, homelessness and substance misuse.

Unmet and emerging needs

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There is emerging awareness of the following needs which can be described as organised forms of abuse ( including by families, communities, or groups of individuals)

  • So called ‘Honour Based Violence’, forced marriage, female genital mutilation, partner abuse in intimate teen relationships, sexual exploitation, trafficking, and girls and women affected by gangs
  • There are on-going unmet needs for some groups or individuals, including those with a disability or impairment, people from LGBT communities, male survivors, BMER groups.
  • Survivors affected by a combination of substance misuse, mental health and DSVA have particular needs which are complex and have been highlighted through the Stella Project.

A systematic approach

As domestic violence and abuse is a cross cutting issue it would benefit from a whole system approach. This would include

  • An early intervention model that includes primary, secondary and tertiary prevention (WHO 2002)
  • Improving understanding of current need. As DSVA is underreported our key objective is to increase reporting, however there is a gap in understanding the true local extent of DSVA
  • A better understanding of how to reduce repeat victimisation through identification and appropriate support and empowerment of survivors and children.
  • A greater focus on the reduction of the number of perpetrators and the amount of abuse they perpetrate.
  • A recognition of the difference in approach required for emerging, enduring and serial perpetrators and survivors.

Recognition of the specialist expertise that has developed in the voluntary sector in Nottingham that should be allowed to inform and influence public sector partners.

Recommendations for consideration for commissioners

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  • An agreed domestic violence and abuse strategy and action plan across Nottingham
  • Identify recurrent funding for the specialist response to DSVA
  • Take a joint commissioning approach
  • Identify a DSVA Champion as part of the partnership
  • Strengthen the DSVA voluntary sector to respond to need and improve the response to DSVA by public services
  • Develop and publish a DSVA Charter outlining what response a citizen can expect from local services.
  • Build capacity in existing services to meet the gaps identified
  • Maintain a partnership approach to DSVA in Nottingham

1. Who's at risk and why?

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The Duluth Power and Control model ( DAIP 2013) (Figure 1) describes how domestic and sexual violence and abuse are caused by the abusers belief in the benefits of behaviour which exerts power and control over their partner, ex partner, children or other family members.

Figure 1: The Duluth Power and Control Model

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The risk factors for violence and abuse are complex and multi-factorial. Individual violence and abuse also takes place in the context of a wider eco-system of individual, personal relationships, community and societal factors (DH 2008 and 2012, WHO 2002).

Individual factors

  • Gender is a significant risk factor as women are more likely than men to experience interpersonal violence, especially sexual violence, and to experience severe and/or repeated incidences of violence and abuse
  • Being young is a key factor in both experiencing and perpetrating violence and abuse.  54% of rapes of women and 75% of rapes of men occur before the age of 18 (Tjaden and Thoennes, 2000). Children experiencing sexual abuse are more likely to be part of a family experiencing physical violence.
  • Domestic abuse is more likely to begin or escalate during pregnancy. More than 30% of cases of abuse start during pregnancy. (Mezey 1997)
  • Disabled women are twice as likely to experience domestic violence and abuse than non-disabled women (Walby and Allen, 2004).
  • Some forms of violence and abuse against women are more likely to be experienced by particular sub groups of the population e.g. Black and Minority Ethnic and Refugee (BMER) women are more likely to experience female genital mutilation (FGM) and forced marriage and so called honour based violence. ( Dorkennoo et al 2007)
  • Previous abuse or violence is associated with an increased risk of experiencing and/or perpetrating further violence and abuse. (Walby and Allen 2004)
  • Excess alcohol consumption increases the risk of all forms violence and abuse, increasing both the risk of perpetrating and of experiencing violence and abuse.  Many women have an alcohol problem as a result of abuse, where alcohol is used as a coping mechanism. (Walby and Allen 2004)
  • Some women are introduced to substances by their abusive partners as a way of increasing control over them (Swan et al, 2000).
  • Those with mental health problems are more likely to have experienced violence and abuse than to perpetrate violence. For those who have experienced violence or abuse there are serious consequences on mental health – abused women and men are more likely to suffer from a range of mental health problems including depression and anxiety (Silverman et al, 1996).  Between 50% and 60% of women mental health service users have experienced domestic violence (DoH, 2003).
  • Experiences of domestic and sexual violence and abuse, mental ill-health and substance use are frequently interlinked. Domestic violence and other abuse is the most common cause of depression and other mental health difficulties in women, and results in self-harm and suicide rates among survivors which are at least four times higher than the general female population. Overall, women who have experienced at least one form of gender-based violence and abuse are at least three times more likely to be substance dependent than women who have not been affected by gender-based violence or abuse.(Rees et al in AVA 2013)

Personal Relationships

  • Multiple Adverse Childhood Events can increase the risk of repeated violence and abuse. Groups at greater risk can include ‘Looked-After Children’, those on Child Protection Registers, Young Offenders, those excluded from school, Teenage Parents and those with Physical or Learning Disability (DH, 2008)
  • In relationships where there is domestic violence and abuse, children witness about three-quarters of the abusive incidents.
  • 70% of children living in UK refuges have been abused by their father (Bowker,Arbitell and McFerron 1998)

 Societal Factors

  • There is higher than average reporting of domestic violence and abuse in areas of greater socio-economic deprivation.
  • Groups that face higher levels of discrimination experience more violence – including BME groups (specific communities are more likely to be subject to forced marriage, honour based violence and female genital mutilation), LGBT, those with disabilities, the young and the old. Girls and women disproportionately experience higher levels of sexual and domestic abuse. Violence and abuse can act to reinforce discrimination and social exclusion.

Community Factors

  • Youth violence and gang membership is associated with harsh physical punishment or abuse at home; lack of parental support and guidance; lack of educational or work opportunities; having peers in gangs.
  • Acceptability of violence and abuse within our communities and culture, for example, smacking and abusive forms of child punishment.

Protective and resilience factors for violence and abuse include exposure to positive values and expectations, belonging to community youth groups or participating in positive activities.

2. The level of need in the population

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Establishing a comprehensive picture of the extent of domestic and sexual violence remains a challenge. Domestic violence and abuse is often (although not always) a hidden crime and it is estimated that only 40% of offences are reported to the police. Similarly, sexual violence is also underreported with only an estimated 11% of rapes actually reported. Consequently, Nottingham depends on the British Crime Survey (BCS) in order to supplement local incident data when assessing the true level of need in the population.

National Prevalence of Domestic Violence and Abuse

Nationally, the majority of domestic violence and abuse  is perpetrated by men against women but it is important to acknowledge that men are also affected by domestic and sexual violence. Research suggests that approximately 50% of male victims were also perpetrators of abuse. According to the British Crime Survey at least 10% of women and 2.5% of men will suffer from domestic violence and abuse in a given year and 1 in 3 women will be subject to repeat incidents, compared to 1 in 10 male victims. Based on the BCS it is estimated that in Nottingham in any given 12 month period there are:

  • 12,900 female survivors (4,300 of whom will be suffering repeat victimisation).
  • 3,200 male survivors (300 of whom will be suffering repeat victimisation).

Local Prevalence of Domestic Violence and Abuse 

Various organisations collect information that provide a picture of the extent of domestic abuse in Nottingham, however Police data is the source most consistently collected at a City level. Nottingham Police receive on average 12,000 domestic violence and abuse related calls annually of which 2500 are recorded as crimes. 39% of all recorded violence in the city is DVA. 84% of victims of incidents recorded as crimes are women, 16% are men. (CDP data)

The majority of domestic violence and abuse is committed by a current or ex-partner. Local data shows that male victims are more likely than women to experience violence perpetrated by other family members. (31% of domestic violence and abuse against males is committed by a family member compared to 17% for females).

Since summer 2012 the Domestic Abuse Referral Team (DART) has been supporting a multiagency response to DVA affecting families that include children or vulnerable adults. This information will support the understanding of the current situation in Nottingham for these groups. The first year of the DART system in Nottingham has included cases involving 3010 victims and 4236 children, 3000 of whom are under 10 years of age.

Domestic violence and abuse are not limited to certain areas or communities as it affects all walks of life. There are, however, communities and groups of people who will be more at risk and disproportionately affected. For example, areas of high deprivation see a concentration of risk factors. Analysis for the Safe From Harm Strategic Commissioning Review identified that Nottingham has over 20% of households in the most deprived 10% of areas nationally but that these represent 40% of calls to the police for domestic incidents.  Figure 1 shows the distribution of reporting of domestic violence calls to the Police across the City and highlights ‘hotspots’. As can be seen, Aspley continues to be the ward demonstrating the highest number of calls and this has continued in 2012. It is important to note, however, that some communities are not reporting domestic violence and abuse in accordance to the level expected based on socio-demographic factors. In order to highlight these ‘cold spots’, local victim postcode data and known risk factors have been used in order to produce a risk map (Figure 2). Comparison of Figures 1 and 2 (below) highlights that levels of reporting in places such as St. Anns and Clifton are not consistent with the levels of DVA estimated in those areas. 

Figure 2: DVA Hotspots (Calls to the Police) (2011/12)

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Figure 3: DVA Risk Map (2011/12)

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It is important to note that not all calls to the Police can be recorded as a crime. Of the 12,000 domestic violence and abuse related calls to the police in 2012/13, 8,000 were recorded as domestic violence incidents and 2600 were recorded as crimes. It is estimated that 6,000 people reported domestic violence and abuse in Nottingham out of an estimated 12,700 female and 3,000 male survivors based on the British Crime Survey.  This means that up to almost 40% of all cases are being reported to the police, which is in keeping with national research. 60% of domestic violence and abuse cases are NOT reported to the Police. Walby (2009) does however describe that the proportion of those experiencing domestic violence and abuse who are willing to use public services is increasing.

There is a requirement for midwifery services to use routine inquiry to identify domestic violence and abuse. At present reports on the number of women reporting abuse as a result of this are not available.

Public Health Outcomes Framework The measure of  domestic abuse in the Public Health outcomes Framework is defined as the ‘rate of domestic abuse incidents recorded by the police per 1000 population’ This is reported at national and local level on the Public Health Outcomes Tool, but at present there is reported to be a data quality issue with this measure which makes benchmarking problematic. The reported level for Nottingham and Nottinghamshire is particularly low, and may reflect variation in the understanding of the indicator.

National Prevalence of Sexual Violence

The British Crime Survey (BCS) highlights that 0.5% of women will suffer serious sexual assault and 0.3% will experience rape within a 12 month period (compared to 0.2% of men who were subject to any form of sexual assault). Based on these reported rates of incidence, it is estimated that in Nottingham in any given 12 month period there are ;

  • 637 female victims of serious sexual assault; of whom, 382 were female victims of rape
  • 254 male victims of any form of sexual assault.

Sexual assault includes offences ranging from indecent exposure to rape. In half of incidents identified by the Crime Survey for England and Wales (CSEW) (ONS 2013) and offences recorded by the police the violence resulted in no physical injury to the victim. However, the 2011/12 CSEW shows that there were 2.1 million violent incidents in England and Wales with 3% of adults victimised. The number of violent incidents has halved from its peak in 1995 when the survey estimated over 4.2 million violent incidents. While the survey suggests little significant change in the incidence of rape over the last few years, the number of rapes reported to the police has risen from about 6,600 in 1997 to 16,000 in 2011/12

The 2011/12 CSEW found that young women were much more likely to be victims of sexual assault in the last year and NSPCC research indicates that around 21% of girls and 11% of boys experience some form of childhood sexual abuse.

Each adult rape is estimated to cost over £76,000 in its emotional and physical impact on the victim, lost economic output due to convalescence, early treatment costs to the health service and costs incurred in the criminal justice system. The overall cost to society of sexual offences in 2003/04 was estimated at £8.5 billion ( Dubourg et al 2005).

Local Prevalence of Sexual Violence

The Topaz Centre is the Nottingham/ Nottinghamshire Sexual Assault Referral Centre (SARC) and a recent Health Needs Assessment included the number of recorded sexual offences in the last 18 months, which showed an increase.

Number of sexual offences

Time period

No. of crimes

1 Oct 2011 – 31 March 2012

425

1 April 2012 – 30 Sept 2012

462

1 Oct 2012 – 31 March 2013

546

Total

1433

In the 12 months between April 2012 and March 2013 the vast majority of referrals received by the Topaz Centre, 93%, were female and 64% of referrals were made by the police to the SARC

The recorded crime figures from Nottinghamshire Police from September 2011 to September 2012 show a rise in serious sexual offences of over 15%. This may include an increase in the number of historic offences reported, as victims may be more confident in coming forward and reporting historic offences due to the recent high profile media stories.

Costs of DVA

DVA is estimated to cost the NHS £1.7 billion per year (Walby, 2009), as well as costing other public services £2.1 billion. AVA have extrapolated these figures based on local population to give the following  estimates of costs of DVA to local areas

Nottingham City:

Total cost to core public services and lost economic output £38 million

This includes £11.4m physical and mental healthcare costs, £8.3m criminal justice, £ 1.9m social services, £1.3 m housing and refuges, £2.5m civil legal, £12.6 m lost economic output. AVA also estimate the ‘human and emotional costs’ ( as defined by Walby 2009) to the city to be £65.4m.

These estimates are based on 2009 estimates of population size and do not take account of the city’s young age structure and deprivation, both of which would be expected to increase these estimates.

The following diagram from the Audit Commission (2011) outlines the typical cost of one case of domestic violence and abuse over one year. This is a total of £20,000.

Figure 4: The Cost of one case of domestic violence over one year, Audit Commission (2011)

 

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3. Current services and assets in relation to need

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Current Services in Nottingham are described below along the national structure of ‘prevention’ ‘provision’, ‘protection’ 

 

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Specialist Services Sensitive to Equality and Diversity (Protected characteristics)

Age

  • The 2013 definition of DVA includes young people from the age of 16.
  • The helpline, outreach services, rape crisis, Topaz and two refuges are accessible to this younger age group. However services need to develop sensitive and accessible services for this group. ( see pilot for girls affected by gangs)
  • No services have an upper age limit, however refuges may not meet older women’s needs, and alternatives eg Sanctuary may be more appropriate.

Black Minority Ethnic and Refugee (BMER)

A number of specialist services exist covering a number of groups, including BMER women who are most at risk of Forced Marriage, Honour Based Violence and Female Genital Mutilation.

  • Black Minority Ethnic and Refugee (BMER) Refuge
  • Outreach project (includes BMER)
  • Female Genital Mutilation Referral Path for Midwives
  • No recourse to public funds Protocol for Nottingham City Council
  • Police domestic abuse support unit include staff trained to manage Honour Based Violence.  

Faith and religion

All services are accessible to all faith groups. Some services have developed particular expertise, such as Umuada and Zola Refuges.

Lesbian, Gay, Bisexual Services (LGB)

Nottingham has no specialist services for these groups; however work is being done to ensure resources are available to this community.

  • The Helpline supports women in same sex relationships and will refer to Broken Rainbow for information, counselling and signposting where required.
  • Women's Aid refuges and DVA floating support services will support lesbian, bisexual and transgender women
  • Victim Support aim to provide services for all men who experience domestic violence and abuse including gay and bisexual men.
  • The Health Shop provide a LGBT Drop-In Service for domestic and sexual violence.
  • Equation publishes an information card for LGBT communities and provides information on their website.
  • Equation has a male IDVA who will support men in same sex relationships at high risk.

Marriage and Civil Partnerships

All services are equally accessible to survivors regardless of marital status.

Pregnancy and Maternity

Pregnancy is identified as a time of increased risk for DVA. Specialist support within Health Visiting and Midwifery services is available.

Services for Transgender Survivors

For those survivors who have transitioned into their adopted gender, appropriate services will be accessible.

For survivors who are in transition a more individual approach will be required.

The Helpline will be the first point of access to services.

Services for Women

Nottingham has a range of services specifically designed for women survivors. In terms of reporting, everyone is encouraged to phone the help line. Refuges are the key provision which are women-only.

Services for Men

Nottingham has a range of services specifically designed for male survivors. In terms of reporting, everyone is encouraged to phone the help line and although run by Women’s Aid it is for anyone with concerns about domestic violence and abuse. Essentially males can access the same services except Women’s Aid and the refuges.

  • Equation ‘Male Victims Good Practice Guide’ includes a directory of resources and a screening tool (to make sure that they are genuine victims as 50% of male victims are also perpetrators)
  • Victim Support lead in Nottingham in supporting men who have experienced domestic violence and abuse and use the Equation screening tool
  • Equation training programme for substance misuse agencies on direct enquiry about domestic violence and abuse with service users and this includes training on the screening tool
  • A Male Independent Domestic Violence Advisor is available to support high risk cases at the MARAC.
  • Sanctuary scheme is available to men and women.
  • Equation has published an information card for men to highlight services and support available.

Services for Disabled Survivors (including enduring mental health problems)

There are no specialist services for these groups although work is being done to ensure resources are available to this community.

  • Women's Aid refuges undertook a Disability Discrimination Act access audit when it first came in and developed action plans to improve access and service.
  • The Sanctuary Scheme is particularly helpful for disabled survivors or survivors with disabled children or dependants and for elders.
  • Equation have developed some guidance on disability and promotes training on this topic, it also publicises national and local support on the website and produces accessible materials for visually impaired women. A streamed BSL signed video will be available online to highlight local services.
  • Nottingham Mencap  host the ‘Smile Stop Hate Crime’ initiative that also raise awareness of safety and the risk of ‘mate crime’ for people with a learning disability. The Learning Disability personal health file has been updated to include information about keeping safe, that includes safe relationships at home and in personal relationships.
  • The Stella Project was a national pilot funded by the Department of Health through AVA (Against Violence and Abuse). Nottingham was one of three pilot areas for  developing good practice on mental health, substance misuse and domestic/sexual violence and abuse. This has led to the production of e learning and a toolkit.
  • Two of the three refuges in Nottingham City have wheelchair access.
  • There is a textphone service to access the 24hr Freephone helpline.
  • Independent Living Support services ( Womens Aid and Shine) are accessible.
  • Topaz (SARC) is accessible.

Services for substance misusers

  • There are no targeted services for substance misusing survivors. All services should be accessible to stable users. Refuges may not be appropriate for chaotic users. 

Assets

The independent specialist domestic and sexual violence sector - Womens Aid, Rape Crisis and Equation ( formerly Nottinghamshire Domestic Violence Forum)-  has developed since the 1970s in Nottingham. Whilst this voluntary sector is funded through local statutory sector commissioning, it has also brought funding into the sector in Nottingham through other sources. All of these agencies play a role in the wider DSVA partnership. General support is given to the sector from wider civil society including Trade Unions, faith-based organisations and broader women’s organisations such as the Women’s Institute and Soroptimists.

The Women’s Resource Centre (2011) outlines the benefits of the women’s voluntary and community sector through a ‘social return on investment analysis’ (SROI) based on a New Economics Foundation and Office for Civil Society cost benefit equation. The report identified the specific value of the sector. The report identified that agencies supporting women also supported their families and wider society. The cost benefit analysis found that for every £1 investment there is a return between £5 and £11.

4. Projected service use and outcomes in 3-5 years and 5-10 years

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Reporting of domestic violence and abuse remains high and service demand looks set to remain high, especially in light of the fact that only 40% of cases are being reported.

DVA incidents reported to the police (2002/03 to 2011/12)

Year

2002/
03

2003/4

2004/5

2005/6

2006/7

2007/8

2008/9

2009/10

2010/11

2011/12

Total

4,587

5,481

6,632

8,349

11,270

12,835

12,917

11,890

11,327

11,906

There are between 600 – 700 DVA crimes and incidents recorded by the Police per month in Nottingham. About 100 of these are assessed as being high risk cases and the rest are medium or standard risk. 40 of these high risk cases are referred to the MARAC each month and the remainder are managed by the DASU or the Beat Manager for their area. In 2012/13 the establishment of the Domestic Abuse Medium Risk Panel for Repeat Victims will deal with up to 30 medium risk cases per month. Consequently, agencies dealing with these cases are doing so at full capacity. Additionally, a number of other factors are likely to increase service demand:

  • Based on projected increases in Nottingham’s population, it is estimated that demand for services will increase by 3% over the next 5 years and 6% over the next 10 years.
  •  By 2020 BMER population increased to 29% with a possible increase in gender abuse particularly relevant to BMER population such as HBV, FM, FGM
  • Women under 25 are more vulnerable to domestic abuse. Currently 32% of population is 18 – 29 years of age and this is set to increase.
  • Nottingham continues to have high levels of deprivation which is a common risk factor
  • Women with an average income below £10,000 are more likely to live with domestic abuse and the economic growth is likely to remain a challenge  over the medium term
  • Improved screening within various settings is likely to increase the identification of domestic violence and abuse and subsequently increase need for support.
  • The changes to welfare including, Legal Aid, Child Benefit, Housing Benefit cap, Universal Credit, Under occupancy rules-‘Bedroom Tax’ and the Disability Living Allowance will have an impact on survivors and children in Nottingham but the extent of this has not been fully assessed.

There are also changes to provision of services regionally that could have an impact on Nottingham services. For example, according to the National Database ‘UK refuges on line’, the East Midlands is 6th out of 9 regions for refuge provision. In the last year refuge places around the region have reduced as below.

In 1975 The Government Select Committee on violence in marriage recommended 1 refuge place per 10,000 population. This became the BVPI for number of refuge places per head of population in 2005. This BVPI was stood down by the present government, but the Government recommendation has not been changed.

The region has lost a total of 77 specialist bed spaces in the last 2 years, Local Authorities refer to other areas and survivors themselves move around the region for their own safety.

A reduction in bed spaces and an increase in the length of time survivors spend in refuge will mean that less women and children are able to access an emergency place of safety.

Regionally survivors will depend on Sanctuary Schemes, civil law, generic homeless accommodation to provide safe accommodation. This will inevitably lead to women and children being at greater risk and to increased pressures on homeless provision

Area

Population

BVPI for refuge places against population (see below)

Reduction in number of refuge places in the last 2 years

Current places per 100,000 pop.

Nottingham

308,735

31

42 places to 31

 

10.04

Nottinghamshire

401,321

40

30 places to 15

 

3.74

Derby

250,568

25

47 places to 25

 

9.98

Leicester

331,606

33

40 places to 11

 

3.32

Lincolnshire

332,163

33

retained 19 places 

 

5.72

There is no up to date information on Derbyshire and Leicestershire.

 

5. Evidence of what works

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The UK Government policy on domestic violence and abuse is included in the overall strategy called Ending violence against women and girls and coordination is the responsibility of the Home Office, reflecting the broad partnership nature of this issue.

NICE guidance PH50 was published in February 2014. The guidance includes recommendations for the response by health and social care services to domestic violence and abuse. Prevention in educational settings was beyond the scope of the review. The guidelines were described as "a wake up call to the NHS"  and include recommendations for trained practitioners to be able to identify and enquire about abuse, and refer into a specialist pathway for support.  The guidance identifies particular groups who may have difficulty accessing services or have particular needs, for example lesbian, gay, bisexual and transgender people, those who abuse alcohol and substances, and those with mental health problems. NICE provide a range of background evidence, including one paper which describes Nottingham City as an area of good practice (Hanman 2013). The guidelines also recommend a shared needs assessment and commissioning approach, similar to the local recommendations of the ‘Safe From Harm Strategic Commissioning Review (Nottingham City Council 2014).

The Audit Commission (2011) identified that local areas, such as Nottingham, take similar approaches to successfully address domestic abuse. These include;

  • A multi-agency approach
  • A victim centred approach
  • Organising funding and understand value for money
  • Recognising and address diversity and equality

Commissioning services for women and children who experience violence or abuse : Department of Health This guidance, published in 2011 is designed to support health commissioners – in particular those commissioning primary care, mental health services, maternity care and sexual health services – to improve the commissioning of services for women and children who are victims of violence or abuse. This guidance provides suggested outcome measures, case examples (including service specifications to download)

Preventing intimate partner and sexual violence against women: Taking action and generating evidence published by the World Health Organisation, 2010, summarises the evidence base for primary prevention strategies. It describes how these can be tailored to the needs, capacities and resources of particular settings. It also emphasizes the importance of integrating evaluation into all prevention activities in order to expand current knowledge of what work.

The Stella project (AVA, 2013) identified a range of evidence based good practice in the form of the toolkit Stella toolkit-Complicated Matters relevant to supporting survivors with mental health problems and substance misuse issues.

Professional guidance for health visitors and school nurses on DVA published by the Department of Health in 2013 summarises evidence based practice for key health professionals.

Pregnancy is recognised as a time of increased risk and prevalence for domestic violence and abuse. Evidence from the Bristol area (Baird et al 2011) has influenced the introduction of routine enquiry in Nottingham and Nottinghamshire by midwifery services. This supports the NICE antenatal guidelines (NICE 2008) and the local safeguarding guidance (Nottingham and Nottinghamshire Safeguarding Children Boards, 2011) by enabling earlier identification of women experiencing domestic violence or abuse during pregnancy.

Toolkit for frontline staff on children, young people and domestic violence published by DH in 2009 provides specific information about children, domestic violence and abuse and related issues including principles for commissioning services.

The evidence base for the IRIS (Identification and Referral to Improve Safety) model in primary care is increasing and has demonstrated the effect of training and support on GPs’ readiness to enquire about domestic abuse. All learning is collected together here IRIS Publications  NICE guidance published 2014 supports this approach.

In Nottingham City, the ‘Safe From Harm Strategic Commissioning Review’  included a detailed literature review to assess the evidence base for a range of primary, secondary and tertiary prevention approaches and benchmarked local practice against that. The review reported to the Health and Wellbeing Board in January 2014.

Equation keep an updated web based Library with a range of policies, reports and good practice guidelines.

6. User views

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At a national level there have been reports into the views of survivors of DSVA and their experience of services.

Standing Together against Domestic Violence in July 2012 published Turning Points , a report on survivors’ views of services in Hammersmith and Fulham, which contains learning which is relevant to partnership approaches in Nottingham.

Womens’ National Commission ‘Women’s Voices to Government’ published A bitter pill to swallow  in 2010 in response to the Violence against Women and Girls Strategy ,to feed back from Focus Groups on the health aspects of domestic abuse..

In 2009 the NSPCC published partner exploitation and violence in young people's intimate relationships outlining young people’s experience of domestic and sexual violence and abuse in their own relationships and their attempts to seek help.

There have been a number of sources of published service users’ views locally.

Stella Project

As part of the Stella Project for survivors with mental health and substance use, focus groups were undertaken, and the results reported by Holly and Scalabrino (2012) Treat me like a Human Being-Survivor consultation This included the voices of survivors from Nottinghamshire who were part of the Stella project.

NHS Nottingham City, 2009

A snapshot investigation was undertaken in November 2009 through NHS Nottingham City to explore the attitudes to domestic violence and abuse enquiry and disclosure held by both health service staff and domestic violence and abuse survivors in Nottingham.  Some recommendations from the snapshot include:

Survivors:

  • Domestic violence and abuse is often obvious, even if the survivor denies it when asked. Staff need to ask for and act on disclosures when they see signs.
  • Disclosure and leaving are dangerous and difficult.
  • If women are at risk of serious harm or being killed, override requests to not act or to keep the disclosure confidential
  • Information needs to be distributed where women are likely to visit, but attention needs to be paid to doing this safely.

Health Professionals:

  • All health staff should have the same in-house domestic violence and abuse training. A substantial block of training is required.
  • Following training, domestic violence and abuse should be asked about through clinical enquiry.  GPs and practice nurses should be encouraged to be centrally involved in responding to domestic violence and abuse.
  • Further work is needed to determine what data is collected by different staff groups across key partners.
  • When translation services are required in domestic violence and abuse situations, Language Line Services should always be used and female interpreters always provided.
  • The current statutory/community/ voluntary sector domestic violence and abuse services should be strenuously supported, including added support to Refuges, Shine and the Women's Aid 24 Hour Helpline at week-ends, so that out of hours access is improved.

Nottingham City Council Adult Services, 2010

In addition, Adult Services has more recently undertaken some focus groups and interviews with women from a range of BMER communities regarding the development of a specialist refuge with self contained units in a larger project for a range of different BMER groups. The findings were as follows

  • Staff with knowledge and skills on a range of BMER related issues is essential these include Forced Marriage, Honour Based Violence and Female Genital Mutilation.
  • Staff with knowledge and skills on a range of BMER related practical issues such as immigration and no recourse to public funds are crucial
  • Staff for children are important to enable children from a range of cultures with different languages to communicate and support each other as they may have experienced very high risk abuse.

Victim Support: 2012:

The Listening and Learning Report was commissioned by the Victims Commissioner for the arrival of the Police and Crime Commissioner. The report seeks to represent the views of victims and service providers in Nottinghamshire.

  • Victims wanted to be supported by people who have empathy, knowledge and understanding of their needs and situation.
  • Overwhelmingly victims wanted services to respond to them as individuals rather than assuming their needs and vulnerability.
  • Additionally, it was clear that some vulnerable groups are less likely to access any services and are more likely to experience harassment and discrimination.
  • Commissioning to provide an overarching service delivery framework where the victim is at the heart of the services being provided for them both by the police, criminal justice agencies and by support service providers.
  • Victims overwhelmingly wanted their safety and wellbeing to be the primary focus.
  • consider longer-term funding when commissioning support services in line with the five year policing plan, to allow support providers to develop both their own service and their co-operation within the inter-agency landscape of service provision.
  • Victims were consistently clear about the value of independent support in helping them cope with the emotional, practical and financial impacts of being a victim of crime:
  • The listening ear that support agencies offered was repeatedly and overwhelmingly cited as a lifeline. Having independent support while engaging with the police, and in particular giving a documented statement, was important.
  • Young victims of sexual assault, for example, recover more swiftly when provided with specific support. Research also calls for serious youth violence to be recognised as a child protection issue, so that the vulnerabilities of both young victims and young perpetrators are recognised and supported.
  • Stakeholders commented on the need for a more co-ordinated approach to victims with the sharing of information, risk assessments and information on vulnerable victims being important to the quality and assessment of service needs and provision by the right agency.
  • A greater involvement by health organisations, particularly mental health services, in assessing and meeting vulnerable victim and perpetrator needs was identified, to provide a rounded support solution.
  • Overwhelmingly, female victims were positive about the voluntary sector provision, the understanding, empathy, support and help received. Similar comments were also made about many police officers: “They contacted me to build the case and were very good, followed up and were supportive.
  • Gaps identified concerned specialist areas, for example support for children, and identification and support for those suffering honour based violence. And there needs to be more acknowledgment that there are male victims of domestic abuse so that male victims are signposted accordingly.
  • There remains a constant need to maintain training of police officers and other local organisations, particularly around identifying domestic abuse and first response and knowledge of support agencies that victims can be referred onto.

Victims of Sexual violence

  • Stakeholders reported 4-6 month waiting lists for counselling for adults who had experienced abuse as children. There was also debate among stakeholders about what was needed, and that some victims identify counselling as a need when quality support maybe more appropriate which was evidenced through the consultation: “Counselling was not productive as they wouldn’t talk about anything to-do with the court case.”
  • Throughout, victims spoke of the value placed on independent support they had received. Victims commented that they did not feel they could have had closure without it, and many said they could not have imagined how they would have managed without the support.
  • Few cases of rape and around half of sexual assault are reported. There are evident difficulties for victims in bringing themselves to report these crimes.
  • It is essential that the service sexual violence victims receive is needs focused, depending on age and in some cases ability to understand.
  • There are no organisations set up to specifically support lesbian, gay, bisexual and transgender (LGBT) victims, although a local LGBT switchboard operates and there are some self-help groups operating in the city.

There are a number of on-going service user consultations at present to inform local partners, including by Women’s Aid Integrated Services.

7. Equality impact assessments

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The CDP’s Domestic Violence Strategy was subject to a full equality impact assessment during 2008/09.  The assessment found that domestic violence and abuse affect all women equally but that some communities experience additional barriers to accessing services for example, language, literacy, culture, economic status and racism and homophobia. 

Men and women’s experience of domestic violence is not equivalent and it is important to understand the differences in experience and barriers to ensure that services are developed appropriately. Domestic violence and abuse affecting women is a volume crime and the cost benefit for reducing it is becoming more apparent. Men’s domestic violence is not a volume crime and services have consequently not been developed. Agencies and Commissioners are seeking innovative responses to this issue to ensure that male victims are able to access help and support.

The strategy was not found to have any significant negative impacts on diverse communities and where any potential for exclusion or negative impact was identified, measures have been put in place to address these.

Negative impacts and how they are currently being addressed are as follows:

  • Poor access, information and outreach to disabled communities. To be addressed by influencing key agencies to improve accessibility, provide access to text phones and BSL interpreters, promoting services to disability communities and establishing text-phone facility at Women’s Aid Integrated Services.
  • Poor demographic recording by Police. To be addressed by the Police improving their recording.
  • The  BMER refuge was not commissioned to be accessible. To be addressed by the City Council undertaking an access audit and support the landlord with an action plan.
  • Disability communities may not be aware of the numbers of survivors and the impact. To be addressed by awareness raising within the Adult Safeguarding Board and the disability communities, as well as ensuring services are as accessible as possible
  • Concerns around survivors with mental health needs. Yet to be addressed. 
  • Need to ensure vulnerable adults who are victims and survivors are able to access the support they need. To be addressed by providing briefings to Adult Services as part of Safeguarding Adults training and setting MARAC targets for vulnerable adults.
  • Faith and DV Toolkit is under promoted to structured faith communities. To be addressed by working with key stakeholders to identify how to move this forwards as there are presently insufficient resources to tackle this important work.

8. Unmet needs and service gaps

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The Safe from Harm Strategic Commissioning Review has been led by Nottingham City Council in 2013 in close consultation with partners and identified  the following

  • The current pathways of specialist DSVA services-the review found that the work that specialist services does supports public sector roles across the partnership ( this will be further investigated in Phase 2 of the review).
  • Benchmarking Nottingham’s services against national best practice- this identified that Nottingham has the range of services expected but that they are working to capacity and that additional emphasis on primary prevention would be helpful.
  • Whether there was an overlap in the families affected by DSVA and Anti Social Behaviour. This found that there was not a particular link.
  • Characteristics of high risk cases represented at MARAC ( Multi agency risk assessment conferences)-this illustrated the range of vulnerabilities and complexities of need
  • The range of services commissioned has developed over time and would benefit from a more strategic approach.

Nottingham has undertaken 3 Domestic Homicide Reviews ( DHR’s) which will be published by March 2014. The learning from the DHR’s will be combined with the learning from Serious Case Reviews to inform best practice.

Through discussion with local specialists in the DSVA sector the following specific gaps in service provision have been identified. These have not been prioritised at present; however they should be considered going forward.

Prevention

  • domestic violence and abuse awareness training that includes work with survivors and children where the  perpetrators are still either living at home or in contact for staff with a significant role in working with families living with domestic violence and abuse such as social care, mental health, substance misuse and other relevant front-line workers.
  • Establishing regular “healthy relationship” programmes in the community such as the Freedom Programme (12 weeks) for survivors who wish to develop an awareness about domestic violence and abuse and how to stay safe.
  • An on-going commitment to resourcing awareness raising campaigns such as the White Ribbon Campaign with all communities, particularly at men and boys.
  • Awareness raising to encourage reporting within vulnerable and hard to reach communities

Provision

  • Full time Children’s workers in refuge and family hostels
  • Children’s Outreach services
  • Therapeutic support for children and young people affected by DSVA
  • Safe Contact Centre for children and their non abusing parents
  • Extend Women’s Safety Services for Probation IDAP programmes
  • Extension of the programme at the YOT developed by Equation for ‘emerging’ perpetrators, who may have lived with domestic abuse as children and young people.

Partnership

  • Development of new community and court mandated perpetrator provision

(including for women and Lesbian /Gay/ Bi men and women where appropriate)

Encourage sexual violence reporting across Nottingham.

9. Recommendations for consideration by commissioners

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  • An agreed domestic violence and abuse strategy and action plan across Nottingham
  • Identify recurrent funding for the specialist response to DSVA
  • Take a joint commissioning approach.
  • Identify a DSVA Champion as part of the partnership
  • Strengthen the DSVA voluntary sector to respond to need and improve the response to DSVA by public services
  • Develop and publish a DSVA Charter outlining what response a citizen can expect from local services.
  • Build capacity in existing services to meet the gaps identified
  • Maintain a partnership approach to DSVA in Nottingham

10. Recommendations for needs assessment work

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The CDP has commissioned an updated DSVA needs assessment to be published in 2014.

Key contacts

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Jane Lewis, Jane.lewis@nottinghamcity.gov.uk , Domestic violence and sexual violence lead, Nottingham Crime and Drugs Partnership

Liz Pierce,  liz.pierce@nottinghamcity.gov.uk  Public Health Manager, Nottingham City Council

Louise Noon, Louise.Noon@nottinghamcity.nhs.uk , Public Health Manager, Nottingham City Council

James Rhodes, James.Rhodes@nottinghamcity.gov.uk, Policy, Performance and Insight Manager, Nottingham Crime and Drugs Partnership

Rasool Gore, Rasool.gore@nottinghamcity.gov.uk Lead Commissioning Manager, Nottingham City Council

Deborah Hooton, Deborah.Hooton@nottinghamcity.nhs.uk   Head of Joint Commissioning for Children and Families, Nottingham City Clinical Commissioning Group

Ellen Martin, ellen.martin1@nhs.net, Lead Commissioner, East Midlands Health and Justice Commissioning, NHS England

Anne Partington anne.partington@nottinghamcity.gov.uk Acting Head of Safeguarding, Nottingham City Council

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