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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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 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

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

Questions?

Matthew.ashton@knowsley.gov.uk

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.