Project Summary

Last year, over 2 million people in England and Wales are estimated to have experienced domestic abuse. This includes physical (e.g., hitting), verbal (e.g., insults) and controlling behaviours (e.g., isolating someone from their family). Domestic abuse costs health services £2.3 billion each year. Domestic abuse has destructive consequences on survivors’ lives, with effects rippling across families and subsequent generations [Shields et al., 2020]. Long-term physical and mental health issues are experienced by domestic abuse survivors [Loxton, Dolja-Gore, Anderson, & Townsend, 2017], with victimisation associated with depression, anxiety, psychosis, schizophrenia, bipolar disorder and serious mental illness [Chandan et al., 2020], post-traumatic stress disorder [Jones, Hughes, & Unterstaller, 2001], and eating disorders [Bundock et al., 2013]. Domestic abuse also affects families, and particularly children. Children exposed to domestic abuse have a higher risk of behavioural, emotional, social, and cognitive difficulties [Holmes et al., 2022]. Domestic abuse victimisation reinforces health inequalities as intersections with deprivation and culture can increase the risk of experiencing domestic abuse and/or barriers to seeking support [Lacey, Jiwatram-Negron, & Powell Sears, 2020]. Domestic abuse reduces economic participation, social well-being, and health outcomes for under-served communities and contributes to increasing inequalities [Bellis, Hughes, Perkins, & Bennett, 2012].

Stopping domestic abuse is challenging, with contradictory research evidence on how to achieve this, particularly in relation to domestic abuse identification and screening. The UK National Screening Committee (NSC) (2019) review identified large gaps in understanding effective ways to ask patients about domestic abuse (screening), emphasising screening should not be standalone, but integrated into an effective referral intervention pathway. UK guidelines (NICE) are clear in advising healthcare professionals that they should screen for domestic abuse [Nice, 2013; WHO, 2014]. However, healthcare professionals rarely ask about domestic abuse and often fail to identify victimisation [Correa, Cain, Bertenthal, & Lopez, 2020]. Professionals do not feel competent or confident responding to domestic abuse [Rose et al., 2011]; are incapable and uncomfortable discussing DA [Taylor, Bradbury-Jones, Kroll, & Duncan, 2013]; lack knowledge regarding responding to victims [Rose et al., 2011]; receive little training on how to respond to domestic abuse [Rimmer, 2017, Waldersee, 2019]; and do not see it as a requirement for their role [Waldersee, 2019].

Survivors are frequent users of mental healthcare services; however, their victimisation often remains hidden because they struggle to tell others about their abuse. Waldersee (2019) found that only 7% of referrals to Independent Domestic Violence Advisors (IDVAs) are made through health services, despite 72% of victims working with an IDVA reporting they accessed health services because of their abuse. In short, mental healthcare professionals’ hesitancy and reluctance to ask, alongside their inability to recognise signs of domestic abuse, results in inadequate care of survivors [Bradbury-Jones & Broadhurst, 2015].

Given the strong association between domestic abuse and mental health, this represents a key setting where intervention can occur and is the main focus of this research. Therefore, this project will build new knowledge about screening, examining the day-to-day practice of mental healthcare professionals, alongside patients’ experiences. We will co-develop a new identification and response framework for domestic abuse survivors, identifying how to embed this into practice, ultimately improving patient care and outcomes.

• Work phase 1 (December 2023 to April 2024): We will give mental healthcare professionals in Northamptonshire and Leicestershire a questionnaire about their knowledge/attitudes, how able they are to identify and respond to domestic abuse, what (if anything) they currently do to uncover victimisation and help patients access further support. We will recruit different professionals from different mental health services, who work with diverse groups of patients, some of whom might experience health inequalities (related to mental health, domestic abuse, and health generally) so we understand specific issues that affect these groups.
• Work phase 2 (August 2024 to December 2024): Interviews with professionals and patients/service users (either individually or in groups) will increase our understanding of current practice and what helps or hinders in identifying domestic abuse and supporting victims. We will explore gaps in what is currently provided in existing mental health services.
• Work phase 3 (December 2024 to February 2025): Working with professionals and service users, we will combine our findings to develop this new way of identifying and responding to domestic abuse for professionals to use in mental health services. We will test how effective this is in a future research project.

Impact and dissemination (project end May 2025): Our new way of identifying and responding to partner violence, including how professionals need to be trained, and how to help IPV victims will be a key output. This will be shared with professionals and patients/the public, through journal articles, reports, and summaries of findings. A video for practitioners, coproduced with our PPI members, will explain best practice in identifying domestic abuse and enabling patients to seek help.

References

Bellis, M. A., Hughes, K., Perkins, C. & Bennett, A. (2012). Protecting people promoting health. A public health approach to violence prevention for England

Bradbury-Jones, C., & Broadhurst, K. (2015). Are we failing to prepare nursing and midwifery students to deal with domestic abuse? findings from a qualitative study. Journal of Advanced Nursing, 71(9), 2062-2072.

Bundock, L., Howard, L. M., Trevillion, K., Malcolm, E., Feder, G., & Oram, S. (2013). Prevalence and risk of experiences of intimate partner violence among people with eating disorders: A systematic review. Journal of Psychiatric Research, 47(9), 1134-1142.

Chandan, J. S., Thomas, T., Bradbury-Jones, C., Russell, R., Bandyopadhyay, S., Nirantharakumar, K., & Taylor, J. (2020). Female survivors of intimate partner violence and risk of depression, anxiety and serious mental illness. The British Journal of Psychiatry, 217, 562-567.

Correa, N. P., Cain, C. M., Bertenthal, M., & Lopez, K. K. (2020). Women's experiences of being screened for intimate partner violence in the health care setting. Nursing for Women's Health, 24(3), 185-196.

Holmes, M. R., Berg, K. A., Bender, A. E., Evans, K. E., O’Donnell, K., & Miller, E. K. (2022). Nearly 50 years of Child exposure to Intimate partner violence empirical research: Evidence mapping, overarching themes, and Future directions. Journal of Family Violence, 37, 1207–1219.

Jones, L., Hughes, M., & Unterstaller, U. (2001). Post-traumatic stress disorder (PTSD) in victims of domestic violence: A review of the research. Trauma Violence & Abuse, 2(2), 99-119.

Lacey, K. K., Jiwatram-Negron, T., & Powell Sears, K. (2020). Help-seeking behaviors and barriers among black women exposed to severe intimate partner violence: Findings from a nationally representative sample. Violence Against Women, 27(4), 1-21.

Loxton, D., Dolja-Gore, X., Anderson, A. E., & Townsend, N. (2017). Intimate partner violence adversely impacts health over 16 years and across generations: A longitudinal cohort study. PLoS One, 12(6), e0178138.

NICE. (2014). Domestic violence and abuse: How health services, social care and the organisations they work with can respond effectively.

Rimmer, A. (2017). Domestic violence is poorly covered in medical training, study finds. British Medical Journal, 359, j4646.

Rose, D., Trevillion, K., Woodall, A., Morgan, C., Feder, G., & Howard, L. (2011). Barriers and facilitators of disclosures of domestic violence by mental health service users: Qualitative study. The British Journal of Psychiatry, 198(3), 189-194.

Shields, M., Tonmyr, L., Hovdestad, W. E., Gonzalez, A., & MacMillan, H. (2020). Exposure to family violence from childhood to adulthood. BMC Public Health, 20(1637).

Taylor, J., Bradbury-Jones, C., Kroll, T., & Duncan, F. (2013). Health professionals’ beliefs about domestic abuse and the issue of disclosure: A critical incident technique study. Health and Social Care in the Community, 21(5), 489-499.

UK National Screening Committee. (2019). Screening for partner violence external review against programme appraisal criteria for the UK national screening committee. 

Waldersee, V. (2019). Half of UK healthcare professionals ‘untrained’ to spot domestic abuse. 

World Health Organisation. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non- partner sexual violence. Geneva: WHO.