Public Health Approach to addressing Domestic Abuse in Knowsley
Matthew AshtonDirector of Public Health
Knowsley MBC
Overview• Background
• Process
• Key findings
• Political scrutiny
• Scrutiny Recommendations
• Key messages
Background• Domestic abuse is a significant public health issue, having a
major impact upon those directly affected and their families.
• Locally, it had been raised as a issue at the Safeguarding Children’s Board and through the wider Knowsley Partnership.
• Previous needs assessments (and consequently services) developed from a Community Safety perspective.
• Need for new needs assessment from health perspective
In Knowsley1 in 3 females smoke
1 In 3 females suffer from domestic abuse
1 in 8 females have Cardiovascular Disease (CVD) – Heart disease and strokes
1 in 9 females drink alcohol at increasing & high risk levels
1 in 15 females have coronary heart disease (CHD)
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1 in 61 people have Cancer
Population impact?Domestic abuse incidents (N =3409)
Domestic abuse crimes (N = 489)
Sanction detentions (N = 318)
Court cases (N = 288)
Successful convictions (N = 204)
Aims of Needs AssessmentThe 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
Process
• Conduct Literature / evidence review
• Data intelligence collation and analysis (incl. service mapping and intelligence)
• Stakeholder engagement
• Scrutiny review
Overview of trendDomestic abuse Offences/crimesKnowsley Domestic Abuse Service ReferralsHousing issues / homelessness presentations
Incidents (police)A & E - Home AssaultsNational Survey prevalence
Financial Impact in Knowsley£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.
• 76%Human and Emotional Costs
• 15%Housing, Civil and Legal Employment Costs
• 5%Physical and Mental Healthcare costs
• 3%Criminal Justice Costs
• 0.6%Social Care Costs
Calculated using estimates from (Järvinen et al, 2008) for domestic violence. Total annual cost to Knowsley economy estimated as £73 million.
Health and Wellbeing Needs – Victims and their children
VictimsShort term• Physical health (minor – severe)• Sexual health• Eating disorders / self harm• Fear and safety concerns (safety primary
concern)
Short and long term• Mental health and wellbeing (depression,
suicide, self harm, confidence, self esteem)
• Substance misuse (particularly alcohol)
• Housing• Employment & Poverty• Difficulties with relationships (intimacy,
trust)
• Isolation
Children and Young people• Mental health and wellbeing• Behavioural and emotional
problems• Links with substance misuse • Child Maltreatment and Child abuse
– identifying and dealing with it• Education / housing• Unsettled childhoods
• Long term impacts affecting life chances
• Links with crime, gangs and violence.
Political Scrutiny
• Scrutiny review by elected members on the draft needs assessment to;– Inform, sense check and develop
recommendations
• Three evidence sessions, involving expert witnesses, plus visits to MARAC and NICE stakeholder session
Identified needs / issues
Data / intelligence
issues
Strategic approach –
systems
Primary prevention
Support for victims
Support for affected children
Dealing with perpetrator
needs
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 recommendations.
• 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 levels.
• Current focus on dealing with consequences rather than prevention
Communication StrategyMethods
PostersPostcardsBeermatsBus / TaxisMedia ReleasesFacebookTwitterCommunity MessagingOne Stop ShopsGP Practices
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 by: • 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 addressed;
• 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.
Recommended
