the public health approach to addressing domestic abuse

Public Health Approach to
addressing Domestic Abuse in
Matthew Ashton
Director of Public Health
Knowsley MBC
• Background
• Process
• Key findings
• Political scrutiny
• Scrutiny Recommendations
• Key messages
• Domestic abuse is a significant public health issue, having
a major impact upon those directly affected and their
• Locally, it had been raised as a issue at the Safeguarding
Children’s Board and through the wider Knowsley
• Previous needs assessments (and consequently services)
developed from a Community Safety perspective.
• Need for new needs assessment from health perspective
1 in 9 females drink alcohol at increasing & high risk levels
1 in 15 females have coronary heart disease (CHD)
1 in 61 people have Cancer
(source: Crime
Survey for
England & Wales
(source: QOF April 11 –
March 12)
1 in 8 females have Cardiovascular Disease (CVD) – Heart disease and strokes
cemodels modelled
1 In 3 females suffer from domestic abuse
(source: Life style
1120 – modelled
survey 2012)
1 in 3 females smoke
(source: Life style
survey 2012)
In Knowsley
Population impact?
Domestic abuse incidents (N
Domestic abuse
crimes (N = 489)
detentions (N =
Court cases
(N = 288)
(N = 204)
Aims of Needs Assessment
The aims of the needs assessment were;
• To assess the levels of domestic abuse, and health and
wellbeing needs of those affected in Knowsley
• To identify the causes and drivers of domestic abuse
• To explore the links between domestic abuse and other risk
taking behaviours
• To investigate the extent to which current service provision
is addressing the needs
• Conduct Literature / evidence review
• Data intelligence collation and analysis
(incl. service mapping and intelligence)
• Stakeholder engagement
• Scrutiny review
Overview of trend
Domestic abuse Offences/crimes
Knowsley Domestic Abuse Service
Housing issues / homelessness
Incidents (police)
A & E - Home Assaults
National Survey prevalence
Financial Impact in Knowsley
• 76%
Human and Emotional Costs
Housing, Civil and Legal
Employment Costs
Physical and Mental
Healthcare costs
Justice Costs
Social Care
• 15%
• 5%
• 3%
• 0.6%
£56m human and emotional
£11m housing, civil, legal
employment and other costs.
£3.8m physical and mental health
care costs.
£2.4m criminal justice costs.
£452,000 social care costs.
Calculated using estimates from (Järvinen et al, 2008) for domestic
violence. Total annual cost to Knowsley economy estimated as £73
Health and Wellbeing Needs – Victims and their
Short term
• Physical health (minor – severe)
• Sexual health
• Eating disorders / self harm
• Fear and safety concerns (safety primary
Short and long term
• Mental health and wellbeing
(depression, suicide, self harm, confidence, self
Substance misuse (particularly alcohol)
Employment & Poverty
Difficulties with relationships
(intimacy, trust)
Children and Young people
Mental health and wellbeing
Behavioural and emotional
Links with substance misuse
Child Maltreatment and Child
abuse – identifying and dealing
with it
Education / housing
Unsettled childhoods
Long term impacts affecting life
Links with crime, gangs and
Political Scrutiny
• Scrutiny review by elected members on the
draft needs assessment to;
– Inform, sense check and develop
• Three evidence sessions, involving expert
witnesses, plus visits to MARAC and NICE
stakeholder session
Identified needs / issues
Data /
approach –
Support for
Support for
Dealing with
Scrutiny recommendations
• That the strategic approach to domestic abuse be reviewed
• That data and intelligence issues in relation to domestic abuse
be resolved
• Seek all opportunities to break the cycle of domestic abuse
through a greater focus on prevention
• That support for victim survivors is reviewed
• That support for affected children is reviewed
• That the way perpetrators are dealt with is reviewed
Key messages
• Domestic Abuse is a significant public health issue in Knowsley
• Applying a public health approach to the needs assessment important
• Involving members through scrutiny of draft needs assessment was
integral to raising profile, gaining ownership and development of
• It raised issues for local authority and health commissioners, wider public
sector and providers about referral processes and support services
• Addressing mental health problems, alcohol issues and healthy
relationships potentially could significantly impact on domestic abuse
• Current focus on dealing with consequences rather than prevention
Communication Strategy
Bus / Taxis
Media Releases
Community Messaging
One Stop Shops
GP Practices
[email protected]
Recommendation 1
That the strategic approach to domestic abuse be reviewed by:
Considering the strategic governance arrangements for domestic abuse;
The council and its partners considering joint commissioning arrangements for
domestic abuse specific services to enable a more flexible use of resources;
Services focussing on addressing the behaviour of perpetrators as well as
resolving the needs of the victim survivor; and,
Standards/expectations being developed in the response times to resolve
domestic abuse incidents completely.
Recommendation 2
That data and intelligence issues in relation to domestic
abuse be resolved through:
• Undertaking further work to improve the recording of
domestic abuse across partner agencies and exploring
other sources of insight (particularly for teenage intimate
partner violence and child on parent abuse); and,
• Exploring opportunities for the streamlining of referral
forms from various agencies to ensure a consistent
approach and improving referral processes particularly
from the Vulnerable Persons Unit (VPU).
Recommendation 3
Developing a systematic approach to the primary prevention of domestic abuse;
Considering the inclusion of evidence based programmes on violence and
domestic abuse within the school curriculum and ensuring that their effectiveness
is assessed;
Investigating further the content of parenting programmes and exploring the
introduction of a specific module on domestic abuse; and,
Developing work with Her Majesty’s Prison Service that explores the use of more
domestic abuse programmes/modules on programmes for prisoners where
domestic abuse isn’t necessarily their trigger offence.
Recommendation 4
That support for victim survivors is reviewed by:
• Considering the threshold level and pathways for
low-medium risk victim survivors; and,
• Delivering training on domestic abuse awareness
and how to support those affected to all front
line responders including the police.
Recommendation 5
That support for affected children is reviewed by:
Evaluating the effectiveness of programmes to identify and support the needs of
children affected by domestic abuse and show they make a difference;
Reviewing the support for children affected by domestic abuse that fall below the
threshold for wellbeing support and identify whether their needs are being adequately
Collecting insight from children and young people on the impact of domestic abuse and
using this information to inform commissioning decisions; and
Testing the feasibility of rolling out Operation Encompass across Merseyside, through
police colleagues given that some of Knowsley’s school age children may attend schools
across local authority boundaries.
Recommendation 6
That the way perpetrators are dealt with is reviewed by:
Assessing the long term effectiveness of existing perpetrator programmes;
Exploring the reasons why there are disproportionately higher levels of cracked
and ineffective domestic abuse trials in Knowsley;
Exploring the greater use of sanctions for perpetrators who do not attend or
complete community perpetrator programmes;
Considering the use of civil action against perpetrators of domestic abuse where
criminal convictions are not possible; and,
Considering the broader use of Integrated Offender Management (IOM) for
domestic abuse offenders to allow for a more intensive intervention to reduce the
risk of reoffending and the risk of harm.

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