Public Health Approach to
addressing Domestic Abuse in
Knowsley
Matthew Ashton
Director 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
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
2012)
(source: QOF April 11 –
March 12)
1 in 8 females have Cardiovascular Disease (CVD) – Heart disease and strokes
www.apho.org.uk
/diseaseprevalen
cemodels modelled
estimates
1 In 3 females suffer from domestic abuse
http://www.apho
.org.uk/resource/
item.aspx?RID=11
(source: Life style
1120 – modelled
survey 2012)
estimates
1 in 3 females smoke
(source: Life style
survey 2012)
In Knowsley
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 trend
Domestic abuse Offences/crimes
Knowsley Domestic Abuse Service
Referrals
Housing issues / homelessness
presentations
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
Criminal
Justice Costs
Social Care
Costs
• 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
million.
Health and Wellbeing Needs – Victims and their
children
Victims
Short 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 Strategy
Methods
Posters
Postcards
Beermats
Bus / Taxis
Media Releases
Facebook
Twitter
Community Messaging
One Stop Shops
GP 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.