A PARTNERSHIP WITH HEALTH

1
A PARTNERSHIP WITH HEALTH

• CHRISTINE MANN
• MA.RGN.CMB.RHV.BAC (Accred)
• NATIONAL DOMESTIC ABUSE
• CO ORDINATOR,
• DEPT. of HEALTH
• christine.mann_at_dh.gsi.gov.uk

2
TODAYS FOCUS DOMESTIC ABUSE
Physical, Sexual, Psychological, Financial,
Emotional

• Any incident of threatening behaviour, violence
  or abuse, between adults who are or have been
  intimate partners or family members, regardless
  of gender or sexuality . Home Office.
• Includes forced marriage, so called honour
  crimes and female genital mutilation.
• No gender symmetry (BSC,2004)

3
CRIME and DISORDER COSTS

• Bed days related to crime and disorder cost the
  NHS between 1.1 and 2.3 billion per year
• Mental ill health and physical injuries from
  domestic violence cost the NHS around 1.4
  billion per year(Walby,2004)
• Employment costs One in four women with lifetime
  prevalence of abuse (BCS,1996)
• NHS largest NHS largest female employer in Europe
  
• Productivity
• Absenteeism
• Liability

4
TACKLING VIOLENT CRIME PROGRAMME

• Domestic abuse forms up to 25 of all violent
  crime
• Major public health issue- negatively impacting
  on victims and their communities.
• Linked to substance abuse, family breakdown
  truanting, delinquency, educational attainment,
  economic viability homelessness, rise in SDTs,
  teenage pregnancy (Mann,2001)
• Leading cause of illness/injury in women
  19-44years
• (WHO,2002)
• Murder (BCS,1996)

5
CROSS GOVERNMENT INTER MINISTERIAL GROUP

• Increasing safe accommodation choices for women
  and children
• Developing early and effective health
  intervention
• Improving the interface between criminal and
  civil law
• Ensuring police and CPS respond appropriately
• Promoting education and awareness training
• National Delivery Plan

6
HEALTH - PARTNERSHIP WITH PREGNANT SERVICE USERS

• Specifically pregnant women-high risk
• Increased risk of miscarriage, low birth weight,
  foetal injury and foetal death.(Mezey et al,1997)
• Confidential Enquiry into Maternal and Child
  Health (2000/2002)- key risk in 14 of maternal
  deaths
• Maternity Standard (Childrens NSF 2004) linked
  to health inequalities for vulnerable women.
• Maternity Matters (2007)
• All pregnant women to be provided with an safe
  environment to encourage disclosure of domestic
  abuse.
• Services in place by 2009

7
PARTNERSHIP with CHILDREN

• Domestic abuse is a primary indicator of child
  protection needs. (Stark.B,and Flitcraft,A, 1988)
• Sexual abuse- NSPCC study-gender asymmetry
• 21 of young women
• 11 of young men -report sexual abuse
• (Cawson,2000)
• May create a spiral of disadvantage for life
  (Montgomery et al,1997)
• Adoption and Children Act (2002)-significant
  harm
• Childrens NSF (2004)
• Every Child Matters(2004)
• Co ordinated service planning,commissioning,delive
  ry

8
PARTNERSHIP WITH MENTAL HEALTH USERS

• Over 50 of women who are in contact with mental
  health services have a history of domestic abuse
  (DoH 2002)
• 25 of suicides - result of domestic
  abuse(Flitcraft,A.1996)
• Mainstreaming Womens Mental Health (2003)-all
  Mental Health Trusts with a domestic abuse lead?

9
DEPT of HEALTH CONTRTIBUTION

• National Domestic Abuse Co ordinator
• Extensive research programme tackling the health
  and mental health effects of of domestic and
  sexual violence-public health context victims
  ,survivors and perpetrators .
• Responding to Abuse A Handbook for Health
  Professionals (Jan.2006) training manual
• Prevalence Study and DVD FGM.
• Contribution to Forced Marriage
• guidelines to be launched in June (Foreign
  and
• Commonwealth Office)

10
MINIMISE RISKS

• Training (BJGP,2006) and guidance.
• Raising the issue with all pregnant women and
  providing information irrespective of response
  provides informed choices.
• Documentation protective and preventive-Specialis
  t DV Courts civil proceedings.
• Referral pathways
• Data collection/audit- Electronic Patient Record.
  
• Workplace policies (CAADA,2005)
• Effective partnerships MARACS,Sanctuary Schemes
  Cocooning.

11
SHARING INFORMATION

• NO barrier to sharing anonymised data
  /information.
• S.115 (C_at_D ACT,1998) gives health power to share
• where courts request
• significant risk to an individual if
  withheld
• (Laming, Bichard, Soham)
• Safe Information Sharing Protocols
• Domestic Violence Crime and Victims Act
  (2004)-homicide reviews-minimise likelihood

12
A PRIMARY CARE STRATEGY

• Organisationally embedded at Board levelpowerful
  message-overarching .
• Competent well trained staffrecognising their
  potential role in crime reduction .
• Proactive not reactive-a service user led
  response.
• Service delivery empowering and enabling safer
  choices for both service users and staff
• Need for work place policies (NHS Employers.
  Org).
• All HR Depts to implement policies.
• Senior representation on CDRP

13
LOCAL/REGIONAL SUPPORT

• Use LAA s- effective local solutions to local
  circumstances.
• Domestic abuse cross cutting issue / use costs
  to build business case
• Strategic Health Authorities
• Government Office Regional DV Co ordinators
• L.A. DV co ordinators/IDV advocates.
• Regional Public Health network

14
NHS CONTRIBUTION

• 80 of women in a violent relationship had sought
  help from the health service at least once
  (Adams, S. 2000)
• Perpetrators also seek help from the NHS
  (Hester_at_Westmarland,2006)-appropriate response.
• Safe effective intervention may enable a victim
  to become a survivor.
• DELIVERED THRO EFFICIENT PARTNERSHIPS-ALL
  PARTNERS ROUND THE TABLE

15
CHALLENGING THE CULTURE

• 31 of girls think it acceptable to be hit
• 16 regularly hit by boyfriends
• 33 experience violence at home(NSPCC,2005)
• Young men reflect a similar if not greater
  acceptance of violence. (37-75)
• Our future tomorrows parents----their children?

16
WHERE DO WE GO FROM HERE?

• Early and effective interventions(Farrington_at_oid,2
  003)
• Training and improved risk assessment
• Ensuring that the welfare of the child is
  genuinely paramount-recognise the continuum
• Education from an early age coupled
• with appropriate support for vulnerable
• Powerful social and institutional messages that
  produce change in practice and service provision.
• Significant change in culture _at_genuine commitment
  to partnership working.