Transcript Pre and Post coalition - Royal College of Nursing

Domestic Abuse Workshop
Ann Jackson RMN
Royal College of Nursing Advance Nurse
Practitioner conference December 2011
[email protected]
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)
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Some statistics
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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
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3 million women experience violence in a year
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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 stillbirth
 2005 45% 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)
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
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Consequences
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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 & selfdetermination
• 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
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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
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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.
“The best things were…”
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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)
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