Safeguarding Vulnerable Adults
POLICY
NEC019
This policy is a North Essex Cluster policy.
NHS North Essex is a cluster of three primary care trusts working as a
single organisation on behalf of Mid Essex PCT, North East Essex PCT
and West Essex PCT
Version number: 1
Policy Owner:
Safeguarding Vulnerable Adults Lead
Date Approved: June 2012
Approved By: Internal Governance Group
Review Date: 30th April 2014
Target Audience:
All Commissioning staff
This is an update of the previous policy of Mid Essex
PCT/North East Essex PCT/West Essex PCT
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Equality Analysis
An equality impact assessment has
been undertaken and approved by HR.
There are no detrimental impacts of
this policy for those with protected
characteristics under the Equality Act
2010.
This document has been written as a North Essex cluster policy and replaces:
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North East Essex PCT - Safeguarding Adults Policy
Mid Essex PCT – Safeguarding Vulnerable Adults Policy
West Essex PCT – Safeguarding Vulnerable Adults Policy
This document should be read in conjunction with the following documents:
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Southend Essex and Thurrock Safeguarding Vulnerable Adults Guidelines
(2010)
Southend Essex and Thurrock Information Sharing Protocol
And also in conjunction with the following NHS West Essex documents until they are
replaced by a North Essex cluster policy:
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Data Protection Act Policy
Information Governance Policy
Integrated Governance Strategy
Incident reporting policy
Consent to Treatment Policy
Recruitment and Retention Policy
Records Management Policy
Domestic Abuse Policy
Whistleblowing Policy
Safeguarding Children and Families Guidelines & Policy
Building Partnerships and Staying Safe – Prevent Strategy (November 2011)
Professional Codes of Conduct
Aims
The NHS North Essex cluster is committed to:
 Ensuring that the welfare of adults is paramount at all times
 Maximising people’s choice, control and inclusion and protecting their human
rights
 Working in partnership with others in order to safeguarding vulnerable adults
 Ensuring safe and effective working practices are in place.
 Supporting staff within the organisation.
Introduction
NHS North Essex operates as a cluster of three Primary Care Trusts – North East
Essex, Mid Essex and West Essex. This policy sets out the roles and responsibilities
of all staff within the NHS North Essex cluster in working together with other
professionals and agencies in promoting adults welfare and safeguarding them from
abuse and neglect.
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This policy is intended to support staff working within the NHS North Essex cluster.
It does not replace, but is supplementary to the Southend, Essex, Thurrock (SET)
Safeguarding Adults Guidelines (2010) available at www.essexsab.org.
Scope
This policy applies to all staff (permanent, seconded or temporary and volunteers of
the NHS North Essex cluster as well as all people who work on behalf of the NHS
North Essex (including independent contractors).
Definitions
A vulnerable adult is defined as:
 any person aged 18 or over
 who is or may be in need of community care services by reason of mental, or
other disability age or illness
 and who is or maybe unable to take care of him or herself or unable to protect
him or herself against significant harm or serious exploitation
No Secrets (2000) – Department of Health
Therefore all adults who meet the above criteria may be defined as “vulnerable”.
Throughout this policy, the term “Vulnerable Adult” is used to refer to a service user
who falls within the above definition.
Definition of abuse
Definitions of the types of abuse and adult safeguarding principles are identified
within the Southend, Essex, Thurrock Safeguarding Adults Guidelines (2010) and
include:
Physical abuse - including hitting, slapping, pushing, kicking, misuse of medication,
restraint, or inappropriate sanctions;
Sexual abuse - including rape and sexual assault or sexual acts to which the adult
has not consented, could not consent to, or was pressured into consenting;
Psychological abuse including emotional abuse, threats of harm or
abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation,
coercion, harassment, verbal abuse, isolation or withdrawal from services or
supportive networks
Financial or material abuse - including theft, fraud, exploitation, pressure in
connection with Wills, property or inheritance or financial transactions, possessions
or benefits
Neglect and acts of omission - including ignoring medical or physical care needs,
failure to provide access to appropriate health, social care or educational services,
the withholding of essentials such as medication, adequate nutrition and heating
Discriminatory Abuse - including racist, sexist, that based on a person’s disability,
and other forms of harassment, slurs or similar treatment
Institutional Abuse - can include any of the above and poor or unsatisfactory
professional practice, or pervasive ill treatment or gross misconduct. It is abuse or
mistreatment by a regime as well as by individuals, within any setting where care is
provided.
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It is important that Trust staff are familiar with generally agreed definitions of types of
abuse so that appropriate decisions are made about whether information received
may constitute abuse.
Duty to Safeguard Vulnerable Adults
Everyone has the right to live their lives free from violence and abuse. This right is
underpinned by the duty on public agencies under the Human Rights Act (1998) to
intervene proportionately to protect the rights of citizens. These rights include
Article 2: ‘the Right to life’;
Article 3: ‘the Right to Freedom from torture’ (including humiliating and degrading
treatment);
Article 8: ‘the Right to family life’ (one that sustains the individual).
Responsibilities of the NHS North Essex Cluster
The NHS North Essex cluster has signed up and accepts the principles laid down
within the Essex Safeguarding Adults Board Guidelines. These include:
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To take action to identify and prevent abuse from happening.
Respond appropriately when abuse has or is suspected to have occurred.
Ensure that the agreed safeguarding adults procedures are followed at all
times, these are available at www.essexsab.org
Provide support, advice and resources to staff in responding to safeguarding
adult issues.
Inform staff of any local or national issues relating to safeguarding adults.
Ensure staff are aware of their responsibilities to attend training and to
support staff in accessing these events.
Ensure staff have access to appropriate training.
Ensure that the organisation has a dedicated staff member with an expertise
in safeguarding adults.
Ensure staff have access to appropriate consultation and supervision
regarding safeguarding adults.
Understand how diversity, beliefs and values of people who use services may
influence the identification, prevention and response to safeguarding
concerns.
Ensure that information is available for people that use services, family
members setting out what to do if they have a concern (e.g. ASK SAL
helpline).
Ensure that all employees who come in contact with vulnerable adults have a
CRB check in line with the requirements of the Independent Safeguarding
Authority Vetting and Barring Scheme.
Responsibilities of all staff
 Follow the safeguarding policies and procedures at all times, particularly if
concerns arise about the safety or welfare of a vulnerable adult.
 Participate in safeguarding adults training and maintain current working
knowledge.
 Be familiar with the SET Safeguarding Adults Guidelines.
 Discuss any concerns about the welfare of a vulnerable adult with their line
manager and complete a SETSAF1 to formally report concerns.
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Contribute to actions required including information sharing and attending
meetings.
Work collaboratively with other agencies to safeguarding and protect the
welfare of people who use services.
Remain alert at all times to the possibility of abuse.
Recognise the impact that diversity, beliefs and values of people who use
services can have.
In addition, Managers have the following responsibilities:
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To ensure that all their own staff members have adequate and appropriate
training for their roles and responsibilities within Adult Safeguarding in line
with the ESAB Training Strategy.
To provide support and advice (within their own competency) to all staff when
dealing with Adult Safeguarding issues and to provide support, advice and
resources to enable the Safeguarding Vulnerable Adults Lead to fulfil their
role.
To provide a safe environment in which to work and receive services,
without fear of reprisal in accordance with the Whistleblowing Policy.
To encourage an atmosphere of openness so that staff can approach them
with any concerns regarding Vulnerable Adults.
To ensure that safeguarding Vulnerable Adults becomes fully integrated into
NHS systems.
Common Law
There is a common law Duty of Confidence where a person has a right to expect
information given in confidence to be kept confidential by the person receiving the
information, i.e. doctor and patient, solicitor and client.
The Duty of Confidence is not absolute and disclosures can be justified if, when
looked at, the information is not of a confidential nature and can be accessed
elsewhere and if it is in the public interest to disclose the information (if a court
orders the disclosure). When deciding on disclosing information without consent of
the person the disclosure would have to be proportionate to the need to protect the
vulnerable adult. If there is doubt whether to disclose such information the person
wishing to share the information should obtain advice from their legal advisor.
Training
All staff should receive a basic Safeguarding Vulnerable Adults awareness training at
a level according to their role and as stated within the Essex Safeguarding Adults
Board Training Strategy. This should be refreshed as a minimum every two years.
Professional Leads
The named professional is responsible for Safeguarding Vulnerable Adults. They
will provide a contact point for other agencies and is responsible for linking in with
the wider network to share information.
Within the NHS North Essex cluster the professional leads for adult safeguarding
matters are the Safeguarding Vulnerable Adults team:
Assistant Director for Safeguarding Vulnerable Adults
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Safeguarding Vulnerable Adults Lead
Safeguarding Vulnerable Adults Nurse
Administrative Assistant for safeguarding Vulnerable Adults Team
Assistant Director Safeguarding Vulnerable Adults
Safeguarding Vulnerable Adults Lead
Safeguarding Vulnerable Adults Lead
Safeguarding Vulnerable Adults Nurse
Administrative Assistant for Safeguarding Vulnerable
Adults Team
How to Report Abuse
It is expected that all staff follow the SET Safeguarding Adults Guidelines (for full set
of procedures see www.essexsab.org).
1. If staff suspect a vulnerable person is being abused or is at risk of abuse, they
are expected to report concerns to a line manager (unless they suspect that
the line manager is implicated – in such circumstances the Whistleblowing
Policy should be followed.
2. If at any time staff feel the person needs urgent medical assistance, they have
a duty to call for an ambulance or arrange for a doctor to see the person at
the earliest opportunity.
3. If at the time staff have reason to believe the vulnerable person is in
immediate and serious risk of harm or that a crime has been committed the
police must be called.
4. A SET SAF 1 form (SEE APPENDIX ONE) must be completed where there
are allegations of abuse and sent to the relevant Social Care area. Guidance
notes are available on www.essexsab.org.
All service users need to be safe. Throughout the process the service user’s needs
remain paramount. This process is about protecting the adult and prevention of
abuse.
Allegation of abuse by a staff member
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Employees should be aware that abuse is a serious matter that can lead to a
criminal conviction. Where applicable the organisations disciplinary policy should be
implemented.
Capacity and Consent
One of the overriding principles in Safeguarding Vulnerable Adults is capacity and
consent. Whenever possible every effort must be made to obtain the consent of an
adult to report abuse taking into consideration the definitions of the Mental Capacity
Act (2005). However when there is a duty of care and the adult does not have the
capacity to protect him / herself the matter must be discussed with the Safeguarding
Vulnerable Adults Lead to determine how best to proceed.
Any patient affected by abuse, who has capacity, should be consulted as to whether
or not they wish action to be taken in relation to their own situation. However, their
response will be viewed in the context of the need for any intervention in order to
protect other service users and / or staff from harm or risk of harm. If the individual
does not wish to report the abuse a discussion must take place the Safeguarding
Vulnerable Adults Lead as to the appropriate course of action to safeguard other
service users and staff or in the public interest.
Choices and Risk
On occasions, vulnerable adults are left in situations, which leave them seriously at
risk of abuse. Sometimes attempts to justify this are made on the grounds of a
person’s right to make choices about their lifestyle, which may involve risk.
Decisions about risk at this level should never be taken by individual staff but
through a properly constituted professionals meeting and by involving risk
assessments.
Supporting Vulnerable Adults who fail to attend Appointments
It is recognised that vulnerable adults often experience difficulties accessing health
services. It is imperative services are readily available and easily accessible to
ensure inequality in health provision does not occur.
Failure to attend appointments may be an indication that the carers of the vulnerable
adult are failing to engage with health professionals and can be an indication they
are not meeting the health and welfare needs of the vulnerable adult.
Early signs of potential or actual disengagement with health services need to be
recognised and assessed as this may be a precursor or indication that the vulnerable
adult may be experiencing abuse.
Therefore it is vital that all providers of health services have robust systems in place
to monitor failure to attend appointments and processes to inform the referrer of the
non attendance.
Proactive measures that health service providers may wish to put in place to support
vulnerable adults to attend include:
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to ensure that they have up to date contact details for the vulnerable
adult, Next of Kin and other significant contacts
to check regularly that contact information is correct
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to ascertain the best way of contacting/communicating with the
vulnerable adult. E.g. if the vulnerable adult is unable to read,
contacting by telephone may be the most appropriate method
to ascertain the level of understanding of the vulnerable adult as a
learning disability or literacy, language or communication difficulty
needs to be recognised and addressed. Attempts should be made to
aid communication in a way that is appropriate to their needs.
to place a “flag” or “alert” on the vulnerable adult’s records to inform all
persons accessing the records of any specific needs of the vulnerable
adult
to identify ways to support the vulnerable adult to remember their
appointment
to ensure that the vulnerable adult knows how to make contact with the
service
If a vulnerable adult has failed or continues to fail to attend a scheduled appointment
the responsible professional should consider if the appointment is essential and if the
vulnerable adult’s health needs are being neglected.
All attempts should be made to contact the vulnerable adult and carer to ascertain
why the appointment was not attended and a rescheduled appointment should be
offered. Reasons for non attendance and actions taken should be documented in
the patient records.
Consideration should be given to contacting other professionals directly involved with
the vulnerable adult as they may be able to assist in identifying issues with non –
attendance or confirm any concerns.
Where difficulty is experienced in gaining access to the vulnerable adult and there is
cause for concern, further action should be taken – a SETSAF1 should be completed
or 999 in emergencies. Staff should follow the Southend, Essex and Thurrock
Safeguarding Adults Guidelines (2010).
Advice should be sought from the Safeguarding Vulnerable Adults Lead if there is
any doubt around what action to take.
Monitoring compliance with this policy
Compliance with this policy will be monitored by the Safeguarding Adults Team by
undertaking relevant audits such as the Essex Safeguarding Adults Board annual
audit with any recommendations shared and implemented across the North Essex
cluster and monitored through an appropriate action plan.
In addition the Safeguarding Adults Team will submit quarterly reports to the Clinical
Quality Review groups in each locality.
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SET SAF 1 – SAFEGUARDING ADULT CONCERN FORM
Service User reference/NHS No:
(Swift/PRN/NHS) (if known)
Date Form Completed:
1.Tell us if the concern is for a person or an Organisation:
(please complete as much of this as is known – if not known put N/K)
Name of person who you are concerned about:
Organisation:
Gender:
Home Address:
Telephone Number:
Age:
DOB:
Ethnic Origin and or Nationality:
Does the person have any Communication Needs:
Are they aware of this referral:
Yes
No
Have they agreed to this referral:
If not, why not:
Yes
No
Is the vulnerable adult in receipt of any social or health care services:
Yes
No
Not Known
Please give brief details:
2a. – Current Situation and Details of the Incident/Concern(s) being raised
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Does the person continue to be at risk of harm?
Yes
Are there other people who may be at risk of harm?
Yes
No
No
If the answer to either of the above is yes, please describe the risk that
remains and the names of any others potentially at risk:
(please only refer to identified risk that relates directly to the concern)
2b. Details of the concern(s) being raised
Time of incident/
Date:
Concern:
Location of Incident:
Brief factual details of the incident:
This should include a clear factual outline of the concern being raised with details of
times, dates, people and places where appropriate.
(please continue on separate sheet if required).
If injuries are present Please give a brief/accurate description:
Has a body chart been completed?
Yes
No
(If completed please attach to SET SAF 1 or forward as soon as possible.)
Details of any medical attention sought:
Doctor Informed?
Yes
No
Name of Doctor informed:
Date and time of information given:
Actions taken to date to safeguard the individual:
Are any other professionals aware in this alert?
(in particular please specify if the police are involved)?
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If police have been contacted Is there a crime incident number?
3. Relative/Name of Main Carer
Name:
Relationship to Person:
Is Relative/Carer aware of this referral?
Contact Address:
Yes
No
Telephone No:
Mobile No:
Email:
County:
Postcode:
4. Details of alleged perpetrator(s) involved if abuse is suspected
(please complete as much of this as is known)
Name:
Gender:
D.O.B.:
Address (if known):
Do they live with the vulnerable adult?:
Yes
No
If so, in what capacity e.g. spouse, fellow resident, carer:
Occupation/Position/Title:
Is this person known/related to the individual who is subject of this concern? –
If so please describe relationship
Are they aware of this alert?
Yes
No
5. Please provide details of the person raising the alert. (We cannot guarantee
your anonymity but will do all we can to keep your details confidential if you
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prefer)
Can your details be shared with third parties?
I would prefer to remain anonymous:
Yes
No
Please give your reasons for remaining anonymous:
Date:
Name:
Job Title and/or Relationship to person referred:
Organisation (if applicable):
Contact Address:
County:
Telephone No:
Postcode:
Mobile:
Email:
6. Details of person completing form (add only if different to box 5)
Name:
Date completed:
Address:
Telephone No:
Mobile:
Email:
* FOR HEALTH STAFF ONLY – HAVE YOU COMPLETED YOUR LOCAL
INCIDENT FORM PRIOR TO SENDING THIS FORM
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Completed forms should be sent to your relevant Local Authority:
Southend
By Email: accessteam@southend.gov.uk
By Fax to: 01702 534794
Making a referral/enquiry by telephone:
Access Team: 01702 215008
Essex
By Post to: Essex Social Care Direct, Essex House, 200 The Crescent,
Colchester, Essex, CO4 9YQ
By email:
Secure email only: essex.socialcare@essexcc.gcsx.gov.uk
Please note you can only send emails to the secure address if you are sending from a secure
email address
Non Secure email: Socialcaredirect@essex.gov.uk
By fax to: 0845 601 6230
Making a referral/enquiry by telephone: 0845 603 7630
Out of hours Referrals:
General Public - 0845 606 1212
Statutory Agencies – 0300 123 0778
Fax: 0300 123 0779
Thurrock
By Email: SafeguardingAdults@thurrock.gov.uk
By Fax to: 01375 652760
Making a referral/enquiry by telephone:
Community Solutions Team: 01375 652686
Out of hours: 01375 372468 (Fax 01375 397080)
Please tick which form of abuse you suspect:
Physical
Sexual
Emotional
Financial or Material
Neglect
Institutional
Not Determined
Discriminatory
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Completion by Investigating/Receiving Team
No further action
Case Management
Resolution
No further action
referral to other
SET SAF4
agency
completed
Key team referred to:
Tel No
Name:
Address:
Mobile:
E-mail:
Referrer updated
By Whom
If referrer not updated reasons why:
Signed:
Date:
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Proceed to
information gathering
SET SAF2
SET SAF RISK At all
stages there must be an
ongoing and documented
RISK MANAGEMENT PLAN.
APPENDIX 2
Safeguarding Vulnerable Adults Alert
Internal Process
Incident occurs/ Concerns raised
Complete Incident Form and send to the Integrated
Governance team immediately. Make telephone contact with
the Safeguarding Vulnerable Adults Lead and/or the Integrated
Governance team
Discussion takes place to determine whether this is a
safeguarding vulnerable adult issue - Immediately or by next
working day
Consider referral to Police (if appropriate)
YES
SET SAF 1 form to be completed
by nominated person.
(Refer to Safeguarding
Vulnerable Adults guidelines)
NO
Normal process will apply
Investigation commences
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Appendix 3
Strictly Private and Confidential
Safeguarding Adults - Patient Consent Form
The healthcare professional stated below, believes that you may be at risk
and is seeking your consent, in accordance with the Data Protection Act, to
make a referral to safeguarding Essex. (Professionals can still disclose
information under common law “Duty of Confidence” without your consent, if
other people are at risk)
If you agree to give your consent, some or all of the following information may
be shared -your personal details, information about your carers, your current
environment and details of the safeguarding adult concern. This may be
shared with a multi-agency group, which could include representatives from
National Health Service, Advocacy and any others as deemed necessary.
These people are qualified and will consider the information put forward and
make recommendations on how the care you receive might be extended to
support you further with any difficulties you may be experiencing. The
healthcare professionals involved are trained to protect your rights to privacy
and confidentiality and this will be respected at all times.
Patient Authorisation
I do / do not* give my consent for the below named health care professional
to share personal information, as described above, with Safeguarding Essex
for the purpose outlined above. Depending on the circumstances, information
will be shared and held by members of the multidisciplinary team, which could
include representatives from Essex Social Services, Advocacy and any others
as deemed necessary by the multi disciplinary team.
* please delete as
appropriate
I can confirm that the health care professional (HCP) has explained
1. The nature of their concern.
2. Who will have access to the information.
3. That I may withdraw my consent at any time.
4. That I can contact Safeguarding Essex about the referral.
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Patient details
Name
Address
DOB
Patient’s signature…………………………………Date ………………..
Healthcare Profession details
Name
Job title
Contact
details
Signed: ………………………………………………Date
………………………
NB. This form needs to be retained in the Patients record.
+ Copy for Patient (if not detrimental)
+ Copy for Safeguarding Adult Lead
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Appendix 4
Strictly Private and Confidential
Safeguarding Adults – Statement from Health Care Professional (HCP)
(This section should not be provided to the patient)
Notes to the health care professional
This form should only be used in conjunction with the Safeguarding Adults
Policy. There is common Law ‘Duty of Confidence’, where a person has a
right to expect information given in confidence to be kept confidential by the
person receiving the information. However, the ‘Duty of Confidence’ is not
absolute and disclosure can be justified without consent in certain
circumstances:a) If it is in the public interest to disclose the information
b) If a Court orders the disclosure or there is another legal obligation to
disclose
When deciding on disclosing information without the consent of the person,
the disclosure would have to be proportionate to the need to protect the
vulnerable adult. If there is doubt whether to disclose such information, the
person wishing to share the information should obtain advice from their
departmental manager and their legal advisors if required.
If there are concerns regarding a persons mental capacity, a decision to make
a safeguarding referral in their best interest, can be made. If further
assessment around mental capacity is needed this can be undertaken later in
the safeguarding process.
Justification from Health Care Professional, for sharing information
without consent.
(* please circle as appropriate)
* a) the patient’s consent was refused, but that the HCP feels that an alert
(SET SAF1 form) should nevertheless be submitted for the following reason(s)
…………………………………………………………………………………………
…………………………………………………………………………………………
………………
OR
* b) the patient was not asked for their consent because the HCP felt that
such a request could further jeopardise the patient’s circumstances as
outlined below.
…………………………………………………………………………………………
…………………………………………………………………………………………
OR
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*c) It is not certain if the person has the mental capacity to give consent to
information sharing regarding a safeguarding alert, so information is being
shared in their best interests.
Healthcare Profession details
Name
Job title
Contact
details
Signed: ………………………………………………Date
………………………
NB. This form needs to be retained in the Patients record (not if hand held
notes)
+ Copy for Safeguarding Adult Lead
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Appendix 5
Domestic Abuse:
A directory of services for
Essex.
May 2011
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Contents
This directory gives professionals information and contact details of
organisations offering support to victims of domestic abuse and services
available to perpetrators.
Introduction
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What is the aim of this directory?
How does this directory work?
Language
What is domestic abuse?
What causes domestic abuse?
Why don’t victims leave?
Who is responsible for the abuse?
The impact of domestic abuse
Safety plans
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Information
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Female victims
Male victims
Lesbian, gay, bisexual and transgender victims
Black and minority ethnic groups
Sexual abuse survivors
Counselling, support and advice
Social Care
Essex Safeguarding Boards
Children and young people
Pets
Male perpetrators
Essex Police
Essex Probation
Health Services
Drug and alcohol services
Money and Benefits
Housing
Local district and borough councils
Multi Agency Risk Assessment Conferences
Independent Domestic Violence Advisor service
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What is the aim of the directory?
The aim of the directory is to:
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Develop awareness of the nature, extent and impact of domestic
abuse.
Develop awareness of the principles of responding to domestic abuse.
Improve local communication and multi agency working.
Share information on services that will help practitioners assist those
who are experiencing domestic abuse.
Share information on services available to perpetrators of domestic
abuse.
How does this directory work?
There are a large number of agencies/ organisations, which can help victims
of domestic abuse. This directory contains details of organisations that can
offer help with particular problems. Details include phone numbers and
websites and a brief description of how that organisation could help. Your
local council may have also produced a directory which gives more details on
local agencies/ organisations which may be able to help.
If you would like any more information about the domestic abuse services
delivered in Essex, please contact the County Domestic Abuse Co-ordinator –
Michelle Williams- email Michelle.Williams@essex.gov.uk 07879116357.
Language
The term “domestic violence” is still used widely by agencies but this
document uses the term “domestic abuse” where possible, to accurately
reflect the fact that it encompasses many forms of abuse, violence and
threats.
There is a choice of term for those adversely affected by domestic abuse
namely “victim” or “survivor”. Some agencies find the term victim demeaning
and prefer to use the term “survivor” as they feel it better reflects the
experiences of these individuals. The terms may be used intermittently.
The document adopts where possible gender neutral language concerning
victims/survivors and perpetrators of domestic abuse.
However, when gendered language is used it is to reflect local and national
prevalence data which shows the majority of domestic abuse incidents involve
male perpetrators and female victims.
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What is ‘Domestic abuse’?
The Government defines domestic abuse as ‘Any incident of threatening
behaviour, violence or abuse (psychological, physical, sexual, financial or
emotional) between adults who are or have been intimate partners or family
members, regardless of gender or sexuality.’ This incorporates issues such
as so called honour based violence, forced marriage and female genital
mutilation. Family members are defined as mother, father, son, daughter,
brother, sister and grandparents, whether directly related, in laws or stepfamily. An adult is defined as any person aged 18 years or over.
All forms of domestic abuse - psychological, economic, emotional and
physical - come from the abuser's desire for power and control over other
family members or intimate partners. Although every situation is unique, there
are common factors involved.
Examples of these behaviours are:
 Psychological / emotional abuse – intimidation and threats (e.g.
about children or family pets), social isolation, verbal abuse,
humiliation, constant criticism, enforced trivial routines;
 Physical violence – slapping, pushing, kicking, stabbing, damage to
property or items of sentimental value, attempted murder or murder;
 Physical restriction of freedom – controlling who the victim or
child/ren see or where they go, what they wear or do, stalking,
imprisonment, forced marriage;
 Sexual violence – any non-consensual sexual activity, including
rape, sexual assault, coercive sexual activity or refusing safer sex;
and
 Financial abuse – stealing, depriving or taking control of money,
running up debts, withholding benefits or bank cards.
Anyone can be a victim of domestic abuse and it happens in all communities
to people from all backgrounds.
Figures show that most domestic abuse happens from men to women:
however, abuse happens in all relationships, including from women to men,
and between same sex partners. It also happens between family members.
a) Whilst this definition does not include children, domestic abuse affects
children adversely and there is evidence that domestic abuse often occurs
alongside child and animal abuse within families. Child abuse can therefore
be an indicator of domestic abuse in the family and vice versa.
b) Victims with physical, mental and learning disabilities may have special
difficulties in seeking help.
23
What causes domestic abuse?
Abusers choose to behave violently to get what they want and gain control.
Their behaviour often originates from a sense of entitlement which is often
supported by sexist, racist, homophobic and other discriminatory attitudes.
Contrary to popular belief, alcohol, drugs or stress does not cause violence.
Alcohol and drugs may make violent behaviour worse, but the responsibility
for the abuse always lies with the perpetrator. Victims/Survivors themselves
may blame the abuse on alcohol, drugs or stress because it may be easier to
do this than to accept that someone they love could be choosing to hurt them.
Why don’t victims leave?
Staying in a relationship may seem like a high risk strategy, however leaving
the relationship will not guarantee that the abuse will stop. Leaving a
relationship is often the most dangerous time for a victim and the children,
with many perpetrators threatening to kill their partners, children or pets if they
leave. Other reasons why victims do not leave the relationship are detailed
below:










Fear of retaliation
Financial dependency
Isolation, lack of social or family support network
Low self esteem,
Love and emotional dependency
Social stigma
Beliefs about marriage
Children
Caring responsibilities
Personal belongings
Who is responsible for the abuse?
The abuser is responsible. They do not have to use abuse. They can choose,
instead, to behave non-violently and foster a relationship built on trust,
honesty, and respect.
The impact of domestic abuse
Victims may be affected by domestic abuse in a number of ways:
24








loss of opportunity
isolation from family/friends
loss of income or work
homelessness
emotional/psychological effects such as experiences of anxiety,
depression or lowered sense of self-worth
poor health
physical injury or ongoing impairment
death
The effects of domestic abuse on victims include the direct effects on them
and their relationships with other people, particularly their children.
Victims need to have accessible options and be supported to make safe
changes for themselves and their children. Resources and support they will
need to leave safely include: money, housing, help with moving, transport,
ongoing protection from the Police, legal support to protect themselves and
the children, a guaranteed income and emotional support. If a victim is not
sure if these are available to them, this may also prevent them from leaving.
Access to culturally specific or specialised support is also an important
consideration for victims from ethnic minorities, LGBT, disabled, asylum
seekers and those with an insecure immigration status. These victims often
face additional barriers to seeking help in the first place such as physical
barriers, language, poverty and discrimination.
Safety Plans
Safety planning can take place whether or not the survivor is still living with or
in a relationship with the perpetrator. Because of the risks involved in
separation safety planning will usually need to increase in strength and
intensity around and after separation. It is crucial that separation is not seen
as the only or essential element in safety planning.
Survivors of domestic abuse and children will almost always have developed
their own safety strategies, and all immediate and subsequent assessments of
the risk to these individuals should include assessing the strategies they
currently use or have thought of.
Practitioners should always consult with specialist agencies, when developing
safety plans with victims.
Plans could include:



A safe place where you can make a phone call, or stay away from the
abuser.
Having a mobile phone that you can always have with you, with credit
on it.
If it is safe for you to do so, carry a list of emergency numbers with you,
or have them saved on your phone.
25
If you leave, and you have time and it is safe to do so, try to take the following
with you:
 Passport for you (and your children), birth certificates, immigration
papers, driving licence, welfare benefits information, marriage
certificate.
 Keys: home, care and work.
 Money.
 Prescribed medication.
 Clothes for you and the children.
 Any items of sentimental value.
If you/they do not feel safe leaving, or planning to leave, this does not mean
that you/they are choosing to be abused. Often, staying can feel the safest, or
only, option.
Female Victims
Women’s Aid provides emergency accommodation, advice and help for
women suffering domestic abuse, and their children. Refuges offer
emergency and temporary accommodation, advocacy and support to women
escaping abuse. Refuges are fully furnished and equipped and all a victim
would need to bring is personal belongings.
Many Women’s Aid also offer drop in centres for counselling and emotional
support, legal, housing and benefits advice.
The National Women’s Aid 24hr free helpline keeps an up to date list of all
refuge accommodation across the county, and can be contacted 24 hours a
day. If they have space any refuge across the UK may accept a woman
fleeing domestic abuse.
For more information about refuges please see:
www.womensaid.org.uk/virtualrefuge/
National Women’s Aid
24hr free helpline
0808 2000 247
www.womensaid.org.uk
Basildon Women’s
Aid
01268 581591
www.basildonwa.org
Braintree Women’s
Aid
01376 321720
www.bwaid.co.uk
Chelmsford Women’s
Aid
01245 493114
www.chelmsfordwa.co.uk
Colchester & Tendring
Women’s Aid
01206 500585
www.colchesterrefuge.org.uk
26
Safer PlacesDomestic abuse
victim support
(Formerly Harlow
Womens Aid and
covering Southend)
08450177668
www.saferplaces.co.uk
Thurrock Women’s
Aid
01375 845899
www.thurrock-wa.org
Male Victims
Safer Places08450177668
Domestic abuse victim
support
Offering outreach support services to male victims.
www.saferplaces.co.uk
MALE (Men’s Advice
0808 801 0327
www.mensadviceline.org.uk
Line and Enquiries)
The Men's Advice Line is a confidential helpline for all men experiencing
domestic violence by a current or ex-partner. This includes all men - in
heterosexual or same sex relationships. The Men's Advice Line offers
emotional support, practical advice and information on a wide range of
services for further help and support.
New Paths
07938 611046
www.newpaths.org.uk
New Paths is focused on male victims of domestic abuse. The organisation
has a drop in centre and a team of life coaches, therapists and advisors.
Survivors UK
0845 122 1201
www.survivorsuk.org
Help for men who have been sexually abused or raped.
Lesbian, Gay, Bisexual, Transgender (LGBT) Victims
Support for lesbian, gay, bisexual and transgender (LGBT) people
experiencing domestic abuse.
Broken Rainbow
08452 604460
www.brokenrainbow.org.uk
Colchester Gay
Switchboard
01206 869191
www.gayessex.org.uk
Essex Gay Men
01245 250256
www.essexgaymen.org.uk
27
Black & Minority Ethnic (BME) groups
Anyone can be a victim of domestic abuse regardless of race or religion. As a
BME individual the other services listed in this directory are available,
however there are sometimes specific cultural issues where particular
agencies may have a better understanding of individual needs.
Asylum Aid
0207 354 9264
www.asylumaid.org.uk
Provides free legal representation and advice to asylum seekers and
refugees. It aims to enable women fleeing serious human rights violations
gain protection in the UK.
Chinese Information
0207 462 1281
www.ciac.co.uk
and Advice Centre
Confidential support for Chinese women who are victims of domestic abuse
on a range of issues. The specially trained bilingual female volunteers speak
English, Mandarin and Cantonese.
Forced Marriage Unit
0207 008 1500
www.fco.gov.uk
The Forced marriage unit gives advice and assistance to people who fear
they are going to be forced into a marriage abroad, fear for a friend /relative
who has been taken abroad and may be forced into a marriage or have been
forced into a marriage and do not want to support their spouse’s visa
application.
All practitioners should always refer to Multi-Agency Practice Guidelines:
Handling Cases of Forced marriage (HM Government 2009) for guidance on
their response, which is available free to download or order from:
www.fco.gov.uk
Jewish Women’s Aid
0800 59 1203
www.jwa.org.uk
Jewish Women’s Aid is an organisation run by Jewish women for Jewish
women and children who have been subjected to domestic abuse. They offer
a range of support and information for victims.
www.karmanirvana.org.uk
Honour Network
0800 5999 247
The honour network helpline is a confidential helpline providing emotional and
practical support and advice for victims and survivors (male & female) or
forced marriage and/or honour based abuse.
Multikulti
www.multikulti.org.uk
Information, advice, guidance and learning materials in community languages.
Newham Asian
020 8552 5524
www.nawp.org
Women’s Project
The group offers support and advice for Asian women and children
experiencing domestic abuse. Although they are based in London they can
offer help over the phone.
28
Southall Black
020 8571 www.southallblacksisters.org.uk
Sisters
9595
Southall Black Sisters provide information, advice, advocacy, practical help,
counselling and support to Asian and African-Caribbean women and children
experiencing domestic abuse and sexual abuse (including marriage and
honour crimes).
Survivors of sexual violence and abuse
Sexual violence includes a range of different behaviours, many of which such as sexual assault or rape, regardless of the relationship they take place
in - are crimes. Sexual abuse and violence can happen to anyone, and in
most cases the victim knows the person who has assaulted them. This can be
a partner or ex-partner, friend or family member.
Sexual abuse is often a component of domestic abuse- for example, partners
and former partners may use force, threats of intimidation to engage in sexual
activity: they may taunt or use degrading treatment related to sexuality, force
the use of pornography, or force their partners to have sex with other people.
Whether someone has recently been assaulted, or the abuse happened a
long time ago, the following agencies can help. You can also speak to the
domestic abuse agencies listed elsewhere in this booklet.
Centre for Action on
Rape and Abuse
(CARA)
01206 769795
www.caraessex.o
South East Essex Rape
and Incest Crisis line
01375 380609
www.thurrockcommunity.org.uk/sericc
National Association
for people abused in
Childhood
0800 085 3330
www.napac.org.uk
Rape Crisis
0808 802 9999
www.rapecrisis.org.uk
rg.uk
Oakwood Place- will be
a dedicated centre for
men, women and children
who have experienced
sexual assault. Further
information will be added
in the near future.
Counselling, support and advice
29
Citizens Advice
www.citizensadvice.org.uk
Bureau
Citizens Advice Bureau offer advice and information about all subjects
including issues such as housing, family law, child support agency and
benefits. All the services are free, confidential and independent.
National Centre for
0844 8044 999
Domestic Violence
Can help with getting an injunction
www.ncdv.org.uk
Rights of Women
0207 251 6577
www.rightsofwomen.org.uk
Rights of Women is a women’s voluntary organisation committed to informing,
educating and empowering women concerning their legal rights.
Samaritans
08457 90 90 90
www.samaritans.org.uk
Samaritans provides confidential emotional support, 24 hours a day for people
who are experiencing feelings of distress or despair, including those that may
lead to suicide.
Victim Support
0845 45 65 995
www.victimsupport.org.uk
Offers free confidential support to anyone, whether or not the crime has been
reported to the police.
Social care
Social Care provides help and advice on adopting and fostering, safeguarding
vulnerable children, and the youth offending service. Also help and advice
for people over the age of 18 who may need support as a result of age,
disability or learning difficulties. If you believe you or someone else is in
danger or that a crime has been committed, your first step should be to alert
the emergency services by dialling 999.
Social Care
(children)
0845 603 7634 &
0845 606 1212 (out of
hours)
www.essexcc.gov.uk
Social Care (Adults
Essex)
0845 603 7634 &
0845 606 1212 (out of
hours)
www.essexcc.gov.uk
Social Care (Adults
Thurrock)
01375 366 083 & 01375
372 468 (out of hours)
www.thurrock.gov.uk
Social Care (Adults
Southend)
01702 215008 & 0845
606 1212 (out of hours)
www.southend.gov.uk
ASKSAL
0845 666663
30
www.asksal.org.uk
SAL stands for Safeguarding Adults Line.
Essex Safeguarding Childrens Board & Essex Safeguarding Adults Board
The term ‘safeguarding’ can apply to both adults and children and is about
protecting them, preventing their abuse or neglect and educating those
around them to recognise the signs and dangers. Abuse can be physical,
emotional or psychological, sexual or financial.
The Essex Safeguarding Childrens Board (ESCB) is a statutory multi agency
organisation which brings together agencies who work to safeguard and
promote the welfare of children and young people in Essex.
The Essex Safeguarding Adults Board (ESAB) raises awareness and
promotes the welfare of vulnerable adults by the development of an effective
co-operative.
This section of the website provides access to
a downloadable version of the multi-agency
child protection procedures for Southend,
Essex and Thurrock the SET Procedures.
ESAB in conjunction with Southend & Thurrock
Safeguarding Adult Boards have produced the
full SET safeguarding adult guidelines December 2010
www.escb.co.uk
microsites.essexcc.gov.uk
Children and Young People
The majority of children witness the abuse that is occurring and in about half
of all domestic abuse situations, they are also being directly abused
themselves. Children can “witness domestic abuse” in a variety of ways. For
example, they may be in the same room and may even get caught in the
middle of an incident in an effort to make the abuse stop; they may be in the
room next door and hear the abuse or see the victim’s physical injuries
following an incident of abuse; they may be forced to stay in one room or may
not be allowed to play; they may be forced to witness sexual abuse or they
may be forced to take part in verbally abusing the victim. All children
witnessing domestic abuse are being emotionally abused. Children can
experience both short and long term cognitive, behavioural and emotional
effects. It is important to remember that each child will respond to the trauma
differently and some may be resilient and not exhibit any negative effects.
It is equally important to remember that the common effects experienced by
children can also be caused by something other than witnessing domestic
abuse and therefore a thorough assessment of a child’s situation is vital to
ensure appropriate treatment. Children are individuals and may respond to
witnessing abuse in different ways, some of these are:
31











anxiety or depression
difficulty sleeping or wetting their bed
easily startled
physical symptoms such as tummy aches
behaving as though they are much younger
problems with school
aggression or withdrawn
lowered sense of self-worth
truanting or start using alcohol or drugs
self-harming
eating disorders
Children may also feel angry, guilty, insecure, alone, frightened, powerless or
confused. They may have ambivalent feelings towards the abuser and the
non-abusing parent.
www.thehideout.org.uk
A website specifically designed for children and young people who are
experiencing domestic abuse.
Childline
0800 111
www.childline.org
A 24 free confidential helpline for children and young people.
NSPCC
0808 800 5000
www.nspcc.org.uk
A 24 free confidential helpline for children and young people.
Get Connected
0808 808 4994
www.getconnected.org.uk/charity
(everyday 111pm, freephone)
For older children and young adults (16-25 years old), Get Connected offers
free, confidential advice.
thisisabuse.direct.gov.uk
A website with information about teenage relationship abuse
Young Minds
0808 802 5544
www.youngminds.org.uk
The charity provides information that helps children and young people cope
with difficult feelings
Pets
The Dogs Trust
0207 837 0006
www.dogstrust.org.uk
Temporary pet care for women fleeing domestic abuse.
RSPCA
0870 333 5999
www.rspca.org.uk
Local RSPCA shelters may be able to give guidance on local temporary pet
32
care.
Perpetrators of domestic abuse
Abusers may blame their behaviour on alcohol, drugs, anger, stress or money
worries, but these are only excuses - they abuse in order to have power over
their victim. If you know someone who you think may be abusing their partner
or family member, or if you are worried about your own behaviour, you can
chose to stop, and there are agencies to support you to change.
Unless someone takes responsibility for their behaviour, they are not likely to
change.
Anger management programmes are never appropriate for someone who is a
domestic abuser. People perpetrate abuse in order to get what they want and
to gain control.
Couple counseling is never ok or safe for a couple in which one partner is
abusing the other. It is dangerous to force the victim to talk about the
relationship in front of the abuser, and also suggests to both partners they
must take equal responsibility, which is wrong. Only the abuser is responsible
for their behaviour and for choosing to stop.
Respect is a registered charity and national membership organisation
promoting best practice for domestic abuse perpetrator programmes and
associated support services in the UK. It provides a helpline for men who
commit domestic abuse, and for people concerned for someone they know
who they think is abusive.
Respect
0845 122 8609
www.respectphoneline.org.uk
(Mon, Tue, Wed, Fri
10am-1pm and 25pm)
Essex change is a project in the community for men who want to change their
abusive behaviours.
Essex Change
01245 258680
www.essexchange.org
Essex Police
Domestic abuse is a crime that Essex Police take seriously. Essex Police will
deal promptly and positively with any domestic incident that they are called to
attend. Where it is possible, the person who is responsible for the abuse will
be arrested. Officers will try to take action that will protect the victim from
further abuse. Essex Police have domestic abuse officers who can give
33
advice. They work closely with other agencies such as Women’s Aid, Victim
Support and Housing in order to get the victim the support they need.
In an emergency dial 999
Non emergency
enquiries
0300 333 4444
www.essex.police.uk
Essex Police – Domestic Abuse
Harlow, Epping and
Brentwood
Colchester
Tendring
Uttlesford &
Halstead
Chelmsford and
Maldon
Braintree and
Witham
Basildon
01279 625431
Rayleigh, Castle
Point and Southend
Thurrock
01702 423151
01206 717834
01255 254078
01376 556223
01245 490840
01376 556223
01268 244092
01375 391212
Essex Probation
Essex Probation work with offenders at most stages in the criminal justice
process, and deliver the accredited Integrated Domestic Abuse Programme
(IDAP) for men convicted of a domestic abuse related offence. An important
feature of the programme ensures victims/ current partners of men attending
the programme have been introduced to a Women’s Safety Worker. There is
a victim unit that provides support to victims of certain offenders.
Essex Probation
Headquarters
(Witham)
West Essex Local
Delivery Unit
Mid Essex Local
Delivery Unit
North East Essex
Local Delivery Unit
South Essex Local
Delivery Unit
South Essex and
Southend Local
Delivery Unit
01376 501626
01279 410692
01245 287154
01206 768342
01268 412241
01702 337998
34
www.essex.probation.org.uk
Thurrock Local
Delivery Unit
01375 382285
Health Services
Domestic abuse can often have negative effects on the physical and
emotional health on victims and their families. In particular pregnant women
are often especially vulnerable to domestic abuse. If a victim requires medical
attention, then they should call 999 immediately for an ambulance.
NHS direct
0845 4647
www.nhsdirect.nhs.uk
NHS direct operates a 24 hour advice and health information service,
providing confidential information on; what to do if you or your family is feeling
ill.
www.nhs.uk
You can get information about a range of health issues and search for a local
doctor, dentist, chemist, optician or hospital.
Your local Primary Care Trust (PCT) can provide you with information on
healthy living and looking after yourself and your family as well as links to the
many different local health services that are available:
Mid Essex PCT
North East Essex
PCT
South East Essex
PCT
South West Essex
PCT
West Essex PCT
01245 398770
01206 286510
www.midessexpct.nhs.uk
www.northeastessexpct.nhs.uk
01702 224600
www.see-pct.nhs.uk
01268 705000
www.swessexpct.nhs.uk
01992 566140
www.westessexpct.nhs.uk
The following hospitals have an Accident and Emergency department:
Basildon &
Thurrock University
Hospitals NHS
Foundation Trust
(Basildon)
Essex Rivers
Healthcare NHS
Trust (Colchester)
Mid Essex Hospital
Services NHS Trust
(Chelmsford)
Southend Hospital
NHS Trust
Princess Alexandra
Hospital NHS Trust
(Harlow)
01268 524900
or 0845
1553111
www.basildonandthurrock.nhs.uk
01206 747474
www.essexrivers.nhs.uk
01245 443673
www.meht.nhs.uk
01702 435555
www.southend.nhs.uk
01279 444455
www.pah.nhs.uk
35
Mental health services in Essex are provided by the NHS in partnership with
Essex County Council and with support from voluntary and independent
organisations. Services are accessed through a GP. For mental health
services available locally contact:
Contact Essex
North Essex Mental
Health Partnership
NHS Trust
South Essex
Partnership
University NHS
Foundation Trust
(SEPT)
NERIL (North Essex
Resource and
Information Line for
mental health)
0845 6037630
01279 827268 – if
you live in
Harlow, Epping
Forest or
Uttlesford;
01376 308100 – if
you live in
Chelmsford,
Maldon or
Braintree;
01206 287303 – if
you live in
Colchester or
Tendring.
0300 123 0808
contactessex@essex.gov.uk
www.nemhpt.nhs.uk
www.sept.nhs.uk
0845 0900 909
MIND
0300 123 3393
www.mind.org.uk
The MIND infoline offers callers confidential help on a range of mental health
issues.
Together- for mental
wellbeing
020 7780 7300
www.together-uk.org
Rethink
0845 4560455
www.rethink.org
Young Minds
0808 8025544
www.youngminds.org.uk
Drug & Alcohol Services
Over 18- Choices,
provided by Open
0844 499 1323
36
www.openroad.org.uk
Road
Under 18-
01245 493311
www.childrenssociety.org.uk
Specialist
Children & Young
Peoples Drug &
Alcohol Service
(EYPDAS)
Alcoholics Anonymous
0845 769 7555
www.alcoholicsanonymous.org.uk
Information for those seeking help with a drink problem
Talk to Frank
0800 776 600
www.talktofrank.com
A national advice service for young people about drugs and alcohol
Money and benefits
Many abusers use money to gain control. This may mean that they take
control of money and benefits and do not allow their partner or family to have
any money. They may create debts in the victim’s name or force them to take
out loans or credit cards.
Whether or not someone has experienced economic abuse they may have
money worries if they are considering leaving. The national charity Refuge
has developed a leaflet called: You can afford to leave
Essex Benefits
Helpline
01245 434205
www.essex.gov.uk/BusinessPartners
This is a helpline for Essex County Council staff and members and advisers in
voluntary sector and external agencies.
Housing (main switchboard)
If a victim of domestic abuse is homeless or threatened homeless due to
domestic abuse or the threat of domestic abuse, the local council may be
under an obligation to help. Enquires should be made to the local housing
advice service regarding the options available. If the abuser has left and
someone wishes to remain in their home, but are fearful because of security
and safety issues, a local Sanctuary Scheme may operate in their area. They
provide additional security measures and support to victims of domestic
abuse. Enquires should be made to the local district or Borough Council.
37
Basildon District
Council
Braintree District
Council
Brentwood
Borough Council
Castle Point
Borough Council
Chelmsford
Borough Council
Colchester
Borough Council
Epping Forest
District Council
Harlow District
Council
Maldon District
Council
Rochford District
Council
Southend
Borough Council
Tendring District
Council
Thurrock Council
01268 533333
www.basildon.gov.uk
01376 552525
www.braintree.gov.uk
01277 312500
www.brentwood.gov.uk
01268 882200
www.castlepoint.gov.uk
01245 606606
www.chelmsford.gov.uk
01206 282222
www.colchester.gov.uk
01992 564000
www.eppingforest.gov.uk
01279 446655
www.harlow.gov.uk
01621 854477
www.maldon.gov.uk
01702 546366
www.rochford.gov.uk
01702 215000
www.southend.gov.uk
01255 686868
www.tendringdc.gov.uk/TendringDC
01375 652652
http://www.thurrock.gov.uk/
Uttlesford District
Council
01799 510510
www.uttlesford.gov.uk
Shelter
0808 800 4444
england.shelter.org.uk
The housing and homelessness charity.
Local Councils (main switchboard)
Community Safety Partnerships (CSP) have a central role to play in ensuring
delivery of appropriate and effective services to victims and to hold
perpetrators accountable at a local level. CSPs are a combination of police,
local authorities, health and other statutory and voluntary organisations. For
more information please contact your local council.
Basildon District
Council
Braintree District
Council
Brentwood Borough
Council
Castle Point Borough
Council
01268 533333
www.basildon.gov.uk
01376 552525
www.braintree.gov.uk
01277 312500
www.brentwood.gov.uk
01268 882200
www.castlepoint.gov.uk
38
Chelmsford Borough
Council
Colchester Borough
Council
Epping Forest District
Council
Harlow District
Council
Maldon District
Council
Rochford District
Council
Southend Borough
Council
Tendring District
Council
Thurrock Council
Uttlesford District
Council
01245 606606
www.chelmsford.gov.uk
01206 282222
www.colchester.gov.uk
01992 564000
www.eppingforestdc.gov.uk
01279 446655
www.harlow.gov.uk
01621 854477
www.maldon.gov.uk
01702 546366
www.rochford.gov.uk
01702 215000
www.southend.gov.uk
01255 686868
www.tendringdc.gov.uk
01375 652652
01799 510510
www.thurrock.gov.uk
www.uttlesford.gov.uk
Multi Agency Risk Assessment Conferences (MARAC)
MARAC is a victim focused process in which the needs of the victims in domestic
abuse cases and the risks posed by the perpetrator are considered in a multiagency forum and a joint safety plan is constructed around the individual.
The purpose of MARAC is to:
 Share relevant information to increase the safety, health and well being of
victims – adults and their children;
 Determine whether the perpetrator poses a significant risk to any
particular individual or to the general community;
 Construct jointly and implement a risk management plan that provides
professional support to all those at risk and that reduces the risk of harm;
 Reduce repeat victimisation;
 Improve agency accountability; and
 Improve support for staff involved in high risk domestic abuse cases
There are six MARAC operating across the county, these mirror the Health
Trust and Probation boundaries and match the areas operated under the
MAPPA process. The aim is to protect the highest risk victims and their
children.
DASH (Domestic Abuse, Stalking, harassment and Honour based violence)
2009 risk assessment model provides a national, accredited risk assessment
process which can be used by any agency. The purpose is to give a
consistent and practical tool to practitioners working with victims of domestic
abuse to help them identify those who are at high risk of harm and whose
39
cases should be referred to a MARAC meeting - in order to manage the risk.
Additional information is available at www.dashriskchecklist.co.uk and
www.caada.org.uk
MARAC
updates and
enquiries
01245-452921
MARACESSEX@essex.pnn.police.uk
Independent Domestic Violence Advisor Service (IDVA)
IDVAs are trained specialists who provide a service to victims who are at high
risk of harm from intimate partners, ex-partners or family members, with the
aim of securing their safety and the safety of their children. Serving as a
victim’s primary point of contact, IDVAs normally work with their clients from
the point of crisis, to assess the level of risk, discuss the range of suitable
options and develop safety plans. IDVAs will represent their clients at the
Multi Agency Risk Assessment Conference (MARAC) and help implement
safety plans which will include actions from the MARAC as well as sanctions
and remedies available through the criminal and civil courts, housing options
and services available through other organisations.
In Essex the IDVAs work with high risk victims that are going through the
criminal justice system and referrals are received from the police. For
additional information please contact 01277 357559
sophie.bartlett@victimsupport.org.uk
40
Appendix 6
Multi-agency practice of Forced Marriage
SUMMARY GUIDELINES FOR HEALTH PROFESSIONALS DEALING WITH
CASES OF FORCED MARRIAGE JUNE 2009.
Please note this is a summary only for Health Professionals from MULTIAGENCY PRACTICE GUIDELINES: HANDLING CASES OF FORCED
MARRIAGE June 2009. H M GOVERNMENT.
1. Introduction
In line with other publications for health professionals on domestic abuse, this
guidance focuses mainly on women’s needs and not men’s. This is because
85% of those seeking help concerning forced marriage are women and the
consequences for women are different than those for men.
Women trapped in a forced marriage often experience violence, rape, forced
pregnancy and forced childbearing. Many girls and young women are
withdrawn from education early. Some are taken and left abroad for extended
periods, which isolates them from help and support – this limits their choices
so that often they go through with the marriage as the only option.
Their interrupted education limits their career choices. Even if women manage
to find work, however basic, they may prevented from taking the job or their
earnings may be taken from them. This leads to economic dependence, which
makes the possibility of leaving the situation even more difficult. Some may be
unable to leave the house unescorted – living virtually under house arrest.
Many women are the main carers at home and the abuse they suffer can have
a devastating impact on their children. Although this chapter focuses on
women, much of the guidance applies to men facing forced marriage – and
men should be given the same assistance and respect when they seek help.
2. How health professionals can make a difference
The Health Service should aim to create an “open environment” where forced
marriage can be discussed openly and where women and young people know
that they will be listened to and their concerns taken seriously. Helping young
women and men who may be threatened by forced marriage should be part of
ensuring all services and departments within the health service are “teenager
friendly”. This involves reassurance about confidentiality and providing
appointment slots during school lunchtimes etc. This would enable young
people to visit unaccompanied if they wish and increase the opportunities they
have to discuss any worries.
Many women may assume that health professionals cannot help them. For
this reason, it is unlikely that a woman will present to a health professional as
a victim of forced marriage.
Although, if a health professional is aware of forced marriage and the ways in
which women can be helped, they are in an ideal position to provide early and
effective intervention. They can offer practical help by providing information
about rights and choices. They can also assist women by referring them on to
41
the police, social care services, support groups, counselling services, and
black and minority ethnic women’s groups.
There will be occasions when a woman does not mention forced marriage or
domestic violence but presents with signs or symptoms, which, if recognised,
may indicate to the health professional that she is within a forced marriage or
under threat of one .She may have unexplained injuries, be depressed,
anxious or self-harming. Some women may attend for a completely different
reason and mention in passing that there are “family problems”; with careful
questioning she may disclose more.
There are many different ways a woman may come to the attention of health
professionals. For example, she may present to:

Accident and emergency (A&E) departments, rape crisis centres or
genito-urinary clinics with injuries consistent with rape or other forms of
violence

Dental surgeries with facial injuries consistent with domestic abuse

Mental health services, counselling services, school nurses, health
visitors, A&E or her GP, with depression as a result of forced marriage.
She may display self-harming behaviour such as anorexia, cutting,
substance misuse or attempted suicide

Family planning clinics or her GP for advice on contraception or a
termination as many women do not want a baby within a forced
marriage

Midwifery services if she does become pregnant.
An interview with a health professional may be the only opportunity some
women have to tell anyone what is happening to them. To prevent this type of
domestic abuse it is imperative that health professionals are prepared to use
these limited opportunities to openly discuss the issues around forced
marriage.
This guidance is intended to help all health professionals recognise the
warning signs of forced marriage, understand the danger faced by women and
respond to their needs efficiently and effectively.
Many health professionals have to make difficult decisions when a woman
presents with issues around forced marriage – particularly when a woman
presents “early” before any crime has been committed or before she is
confident enough to articulate forced marriage as a risk. These dilemmas are
recognised and this document aims to address these together with some of
the practical ways in which health professionals can help women facing forced
marriage.
42
3. How to use routine and opportunistic enquiries to recognise
cases
As with all types of domestic abuse, women under threat of forced marriage,
or already in a forced marriage, present to health professionals in many
different ways. Therefore, health professionals should take a proactive role to
establish whether forced marriage is an issue.
Some health professionals ask women about domestic abuse routinely when
taking their social history – this is often the case for midwives, health visitors
and staff carrying out mental health assessments. It may be useful to
incorporate forced marriage into the routine questions about domestic abuse.
Most women will not be offended by such questions as long as they know the
questions are routine.
Suggested methods of routine enquiry include;

“Because abuse or violence is so common in women’s lives, we now
ask routinely about abuse in relationships so that we can give all
women information about agencies that can help”

“How is your relationship?”

“Are you happy about the baby – is your husband/ partner happy?”

“Are you bonding with your baby?”

“Does your partner or family let you do what you want, when you
want?”

•“Have you ever been afraid of your partner’s or a family member’s
behaviour - are they verbally abusive?”

“Do you ever feel unsafe at home?”

“Has your husband/partner or anyone else at home threatened you?”
Depending on the response a health professional receives, they may go on to
ask:

“Have you ever been hurt by your partner or anyone else at home –
perhaps slapped,
kicked or punched?”

“Have you ever been forced to have sex when you didn’t want to?”
These routine questions can be tailored to any department within the health
service to reflect the types of issues with which women may present. For
43
example, in a child and adolescent mental health service, or any department
where children or young people attend, the questions may focus on the family
relationship – such as:

“How are things at home – do you get on with your parents

“Are your parents supportive of your aspirations – what do they hope
for you?”

“Do your parents have similar aspirations for all your brothers and
sisters?”

“Apart from school, do you get out much?”

“What do you do at weekends?”
Again, depending on the answer, the health professional may go on to ask
more in-depth questions. For example around gender roles within the family
or questions around the marriage of older siblings and the circumstances of
those marriages.
4. How to create opportunities to make enquiries
Some health professionals have more opportunities, or are able to create
opportunities, to see a woman on her own. These include health visitors,
midwives, GPs, practice nurses, school nurses, mental health staff and
professionals in family planning clinics, genitourinary clinics and rape crisis
centres etc. If there are concerns that forced marriage is an issue, the
health professional might ask questions about family life and whether the
woman faces restrictions at home.
Some women trapped within a forced marriage have severe restrictions
placed on them either by their husband or extended family. Some women find
themselves under “house arrest”, facing severe financial restrictions. Others
are not allowed out of the house unaccompanied – they may frequently be
accompanied to appointments. If they are not accompanied it may be one of
the few opportunities a woman gets to tell someone what is happening to her.
There are all sorts of questions a health professional could ask to establish
whether a woman is trapped in a forced marriage. These include:

“How are things at home?”

“Do you get out much?”

“Can you choose what you want to do and when you want to do it –
such as seeing friends, working or maybe studying?”

“Do you have friends or family locally who can provide support?”
44

“Is your family supportive?”
Some health professionals may be concerned that a woman is under threat of
a forced marriage because they are exhibiting some of the behaviours (refer
to the chart of potential warning signs or indicators sections 2.7 & 2.9). They
may be isolated, depressed, withdrawn, misusing alcohol and drugs
(prescribed or non-prescribed), or have unexplained injuries. In these cases,
it may be opportunistic questioning that encourages a woman to disclose
forced marriage. Even if she does not disclose anything the first time forced
marriage is raised, it shows that you understand the issues and it may give
her confidence to disclose at a later date.
Remember:

Some women may not wish to speak to a health professional from their
own community.

Always speak to a woman on her own even if she is accompanied.

If the woman needs an interpreter, never use family members or
friends. You should always use an accredited interpreter. Some women
may be more likely to disclose forced marriage when a telephone
interpreting service is used, as they can speak to the interpreter without
giving their name or details.
5. What to do when a woman discloses that she has been, or is
about to be forced to marry
If a health professional does elicit information that suggests a woman is facing
a forced marriage, they should use careful questioning to establish the full
facts and decide on the level of response required. This may be to offer
advice and provide them with information about specialist advice services.
However, there may be occasions when the level of concern, or the
imminence of the marriage, is such that it becomes a child or vulnerable adult
protection issue – in these cases the appropriate adult or child protection
procedures will need to be followed.
What you should do:
 Maintain accurate records of what has been said and done.
 Consider whether a communication specialist is needed if the woman
or young person is deaf, visually impaired or has learning disabilities
 Refer them, with their consent, to appropriate local and national
support groups, counselling services and women’s groups that have a
history of working with survivors of domestic abuse and forced
marriage
 In accordance with local policy, discuss your concerns with your line
manager and/or the Safeguarding Vulnerable Adults immediately.
45
What you should not do:
 ignore what she has told you or dismiss the need for immediate
protection
 Contact the family in advance of any enquiries by the police, adult or
children’s social care or the Forced Marriage Unit, either by telephone
or letter
 Share information outside child or adult protection information sharing
protocols without the express consent of the woman
 Breach confidentiality except where necessary in order to ensure the
woman’s safety
 Attempt to be a mediator
6. What to do when a woman is under the age of 18 or has children
under the age of 18
If the woman is under 18 or has children under 18 and does not want any
referral to be made, e.g. to children’s social care, the health professional will
need to consider what is in the best interests of the child and whether her
wishes should be respected or whether her safety, or that of her children,
requires that further action be taken. If you do take action against her wishes,
you must inform her.
If you have concerns for the safety of a woman under 18 years old, activate
local child protection procedures and use existing national and local protocols
for multiagency liaison with police and children’s social care.
Refer to the local police child protection unit if there is any suspicion that a
crime has been, or may be, committed. Liaise with the police if there are
concerns about the safety of the woman, her siblings or her children.
7. What to do when a woman is going overseas imminently
There may be occasions when a woman tells you she is being taken
overseas imminently. There may not be an opportunity to refer her to the
police or adult or children’s social care.
There may be too little time to
develop a safety plan or seek protection for her.
In these cases, although you may not be able to gather all the details
suggested, try to gather as much information as possible about her, as there
may not be another opportunity if she goes overseas. Do not assume that
someone else will have collected the information. This information may be
vital in assisting the Forced Marriage Unit to locate her and assist her
repatriation.
Also:

Advise her not to travel overseas and discuss the difficulties she may
face
46

Refer to the local police domestic violence/child protection team

Offer to make an appointment for a future date and discuss with her
what you should do if she does not attend

Maintain accurate records of what has been said and done
REMEMBER:
There are legal remedies that children’s social care and other agencies can
take to prevent a young woman under the age of 18 from being taken
overseas or to assist her return, if she has already gone. These include
making her a ward of court or surrendering her passport or passports (if she is
a dual national).
8. What to do when a woman has already been forced to marry







Devise a safety plan and discuss personal safety advice
Speak to her about the options available to her
Refer her to the Forced Marriage Unit
Refer her to the police if there are concerns that a crime has
been committed
Refer them, with their consent, to appropriate local and national
support groups, counselling services and women’s groups that
have a history of working with survivors of domestic abuse and
forced marriage
If the young woman is under 18 years old refer to section above
Maintain accurate records of what has been said and done
9. Confidentiality, referrals and sharing information safely
A dilemma may arise because women facing forced marriage may be
concerned that if confidentiality is breached and a member of her family finds
out that she has sought help she will be in serious danger.
On the other hand, women facing forced marriage are often already facing
serious danger because of domestic abuse, rape, imprisonment etc.
Therefore, confidentiality and information sharing is going to be an extremely
important issue for anyone threatened with, or already in, a forced marriage.
Health professionals need to be clear about when confidentiality can be
offered and when information given in confidence should be shared. In these
cases, in order to protect a woman, it may be necessary to share information
with other agencies such as the police.
47
Appendix 7
PREVENT
1. Introduction
The Government’s anti-terrorism strategy, known as CONTEST, encourages cooperation between public service organisations. The current terrorism threat level to
the UK is Substantial - this means that a terrorist attack is a strong possibility.
CONTEST has four key principles:




PURSUE: to stop terrorists
PREVENT: to stop people becoming terrorists or supporting violent
extremism.
PROTECT: to strengthen our overall protection against terrorist attacks
PREPARE: where we cannot stop an attack, to mitigate its impact.
The NHS has been identified as a key partner in the Prevent stream.
2. What is Prevent?
The aim of Prevent is to stop people from becoming terrorists or supporting violent
extremism. The Prevent objectives that relate to health organisations are to:
 challenge the ideology behind violent extremism and support mainstream
voices;
 disrupt those who promote violent extremism and support the places where
they operate;
 support individuals who are vulnerable to recruitment, or have already been
recruited by violent extremists;
 increase the resilience of communities to violent extremism; and
 to address the grievances which ideologues are exploiting.
Prevent is one of the most challenging parts of the counter terrorism strategy
because it operates in the pre-criminal space before any criminal activity has taken
place and it is about supporting and protecting those people that might be
susceptible to radicalisation, ensuring that individuals and communities have the
resilience to resist violent extremism.
3. How does this affect you in your work?
Healthcare workers will be the key to the success of Prevent. The focus of Prevent is
working with vulnerable individuals who may be at risk of being exploited by
radicalisers and subsequently drawn into violent extremism. Prevent does not
require you to do anything additional to your normal duties. What is important is that
if you are concerned that a vulnerable individual is being exploited by people involved
in violent extremism you can raise these concerns.
4. Practical steps for healthcare staff
In your work you may notice unusual changes in the behaviour of patients and/or
colleagues that are sufficient to cause concern. It is important that any member of
staff who has cause for concern, and has given their concerns due consideration,
knows how to escalate them and has confidence that they will be taken seriously and
handled appropriately and that, where necessary, specialist advice will be available.
Contracts of employment, professional codes of conduct and safeguarding frame
works such as No Secrets and Every Child Matters require all healthcare staff to
exercise a duty of care to patients and, where necessary, take action for
safeguarding and crime-prevention purposes. Through Prevent this will include
48
taking preventative action and supporting those individuals who may be at risk of, or
are being drawn into, violent extremism.
In order to do this you will need to ensure that you:





attend any Prevent training and awareness programmes provided by the
North Essex cluster
are aware of your responsibilities
are familiar with the North Essex Cluster’s protocols, policies and procedures
are aware of who, within the North Essex Cluster, to contact to discuss your
concerns
are aware of the processes and support available when you raise a concern
5. What factors might make people vulnerable to exploitation
Some of the following factors are known to contribute to the vulnerability of
individuals and could out them at risk of exploitation by radicalisers.




Identity crisis – adolescents/vulnerable adults exploring issues of identity
can feel distant from their family and/or cultural and religious heritage, and
uncomfortable with their place in society. Extremists can exploit this by
providing a sense of purpose or feeling of belonging
Personal crisis – this may include significant tensions within a family that
produce a sense of isolation. A sense of personal crisis may manifest itself in
unusual changes in areas such as behaviour, circle of friends or interaction
with others
Personal circumstances – the experience of migration, local tensions or
events affecting family members in other countries may lead to alienation and
a decision to act violently
Unemployment or under-employment – individuals may feel that their
aspirations for career and lifestyle are undermined by limited prospects. This
may translate to a generalised rejection of civic life and the adoption of
violence
Any change in an individual’s behaviour should not be viewed in isolation and you will
need to consider how significant the changes are. You will need to use your
judgement in determining the significance of any unusual behaviour, and where you
have concerns you should escalate in line with local policies and procedures.
6. What should I do if I have concerns?
In accordance with the Safeguarding Vulnerable Adults Policy, in the first instance
you should contact the Safeguarding Vulnerable Adults Lead within your area. This
should be done immediately that concerns are raised. A discussion will then take
place to determine whether this is a concern that needs to be referred onwards.
49
Appendix 8
FEMALE GENITAL MUTILATION
Adapted from SET LSCB PROCEDURES 2011
Definition
Female genital mutilation (FGM) is a collective term for illegal procedures which
include the removal of part / all external female genitalia for cultural or other nontherapeutic reasons.
The practice is not required by any religion and is medically unnecessary, painful and
has serious health consequences at the time it is carried out and in later life.
The procedure is typically performed on girls of any age, but is also performed on
new born infants and on young women before marriage / pregnancy. A number of
girls die as a direct result of the procedure, from blood loss or infection.
Female genital mutilation may be practised illegally by doctors or traditional health
workers in the UK, or girls may be sent abroad for the operation.
The Law
FGM is illegal in this country by the Female Genital Mutilation Act 2003, except on
specific physical and mental health grounds (see www.fco.gov.uk/fgm)
It is an offence to:

Undertake the operation (except on specific physical or mental health
grounds)

Assist a girl to mutilate her own genitalia

Assist a non-UK person to undertake FGM of a UK national outside the UK
(except on specific physical or mental health grounds)

Assist a UK national or permanent UK resident to undertake FGM of a UK
national outside the UK (except on specific physical or mental health grounds)
RECOGNITION
Any medical provision for a pregnant woman who has herself been the subject of
female genital mutilation provides the opportunity for recognition of risk and
preventative work with parents.
A child may be considered at risk if it is known older girls in the family have been
subject to the procedure. Pre-pubescent girls of 7 to 10 are the main subjects, though
the practice has been reported in babies.
Suspicions may arise if a family is known to belong to a community in which FGM is
practised and are making preparations for the child to take a holiday, arranging
vaccinations or planning school absence and the child may refer to a ‘special
procedure’ taking place.
50
Indications that FGM may be about to take place include:

The family comes from a community that is known to practise FGM

A child may talk about a long holiday to her country of origin or another
country where the practice is prevalent, including African countries and the
Middle East

A child may confide to a professional that she is to have a ‘special procedure’
or to attend a special occasion

A child may request help from a teacher or another adult

Any female child born to a woman who has been subjected to FGM must be
considered to be at risk, as must other female children in the extended family

Any female child who has a sister who has already undergone FGM must be
considered to be at risk, as must other female children in the extended family
Indications that FGM may have already occurred include:

Prolonged absence from school with noticeable behaviour change on return

Bladder and menstrual problems

Reluctance to receive medical attention or participate in sport
RESPONSE
Any suspicion of intended or actual FGM must be referred to Children’s Social Care,
in accordance with modules 5 and 6.
Children’s Social Care must inform the Police CAIT at the earliest opportunity and
convene a strategy meeting /discussion within two working days if:

There is suspicion that a girl or young woman, under the age of eighteen, is at
risk of undergoing this procedure

It is believed that a girl or young woman is at risk of being sent abroad for that
purpose or

There are indications that a girl or young woman has suffered mutilation or
circumcision
The strategy meeting / discussion must include discussion around other children in
the wider family and household network.
A strategy meeting / discussion must include a health professional with knowledge
and understanding of FGM i.e. designated nurse/doctor, involved with the family. A
legal advisor should be invited or consulted prior to the meeting / discussion about
protective options which might be considered.
51
In planning any intervention it is important to be mindful of cultural factors but this
should not preclude action being taken to safeguard that child. Careful consideration
should be given to the inclusion of workers or members from that community or
family members and whether parents are included in this process.
Legal proceedings under the Children Act 1989 should be considered.
A second strategy meeting / discussion should be held as soon as possible and in
any event within 10 working days of the first meeting, with the same chair.
Child protection conference
A girl believed to be in danger of FGM may be made the subject of a protection plan,
under the category of risk of physical abuse, if the criteria are met.
52