Domestic and Sexual Violence and Abuse

The Government defines domestic violence as “Any incident of threatening behaviour, violence or abuse … between adults who are or have been intimate partners or family members, regardless of gender or sexuality.” This includes issues of concern to black and minority ethnic (BME) communities such as so called ‘honour based violence’, female genital mutilation (FGM) and forced marriage.

Domestic violence can take many forms including psychological / emotional abuse, physical violence, physical restriction of freedom, sexual violence and financial abuse. A term which is increasingly used to refer to domestic violence is ‘domestic abuse’, which has the advantage that it reflects the non-physical abuses referred to above. The main characteristic of domestic violence is that the behaviour is intentional and is calculated to exercise power and control within a relationship.

What are the needs of the population?

Police in Devon attended an average of one domestic violence incident every hour (8,798 incidents in 2010-11 and 8,957 in 2011-12). Domestic Violence accounts for roughly a quarter of all violent crime. This figure represents only a small proportion of incidents as on average there have been 35 domestic violence assaults before a victim calls the Police (Povey et al, 2008), leading to large discrepancies between estimated victimisation rates and reported crime levels.

Nationally, 35% of homicides are domestic violence related with 130 women and 30 men killed each year. There were three domestic homicides in Devon in 2011-12. The cost of homicide was estimated by the Home Office at well over one million pounds: a total of £1,774,681 in 2010[1]. The the cost of domestic homicide to Devon could have amounted to over £5 million in 2011/12.

An estimated 7% of women and 4% of men were victims of domestic violence in the last 12 months. This equates to 13,972 women and 8,011 men in Devon (Home Office Domestic Violence Ready Reckoner). This model does not account for the victims who are male and/or aged over 59 years old. There are 122,400 women aged 60 years or older are living in Devon. Assuming the same victimisation levels a further 8,078 older women could be victims of domestic abuse.

An estimated 30% of women and 17% men will be victims of domestic abuse in their adult lifetime. This equates to 63,433 women and 35,407 men (aged 16-59) in Devon. They have endured behaviour ranging from threats, financial restrictions and prolonged psychological abuse to forced marriage, physical abuse and rape. These people are often abused by people that they know well. As a result, they may suffer repeated abuse over many years.

Women are disproportionately high victims of this crime (77% of DV crime in 2011/12 involved a female victim) with women at greater risk of repeat victimisation. The British Crime Survey has consistently shown that victims of domestic violence were more likely to experience repeat victimisation than victims of other types of crime. Repeat victimisation accounted for three quarters (73%) of all incidents of domestic violence as measured by the 2010/11 survey.

Children and Young People are often present or in close proximity to incidents. Child(ren) were recorded as resident in the household in 41% of domestic abuse incidents recorded in 2011/12 (3,649 incidents), up from 39% (3,418 incidents) in 2010/11. In Devon 65% of children on a child protection plan are living in a household with past or ongoing domestic violence (based on a case study sample of 100 cases, 2010).

In 2011/12 822 cases, assessed to be at very high risk, were taken to Multi Agency Risk Assessment Conferences (MARACs) in Devon a rise of 26% from 2010/11. Domestic violence can contribute to families being separated, recent reviews of MARAC cases indicate, however, that around 50% are living away from the home (for example with relatives or in care).

There are additional risks in black and minority ethnic (BME) communities such as so called ‘honour based violence’, female genital mutilation (FGM) and forced marriage (Walby and Allen 2004). Although in Devon only 2% of incidents in 2011/12 involve a victim from a BME group which is lower than the BME share of the population locally. Nationally there has yet to be a conviction for Female Genital Mutilation since it was legislated against in 1985.

An estimated 2.5% of women and 0.5% of men were victims of sexual assault in the last 12 months. This equates to 4,228 women and 1,041 men in Devon. Due to the hidden nature of violence and abuse there are barriers to individuals disclosing abuse, professionals enquiring about abuse and victims and perpetrators accessing services. As a result only a small proportion of victims will report the crime to the police.

In Devon 41% of sexual offence victims were under 17 years of age and 69% under 25 years of age (2010-11). In Devon 601 sexual violence offences were reported in 2010-11 (205 of which were recorded as Rape).

Sexual Abuse is the primary reason for 3.1% of children with child protection plans, and 160 (46.9%) children entering care in 2010/11 did so due to abuse or neglect. In a national study it was reported that 16% of children aged under 16 years of age experience sexual abuse during childhood (NSPCC, 2000). For Devon this would represent around 20,000 children[2].

The impact on health and wellbeing

The impact of domestic and sexual violence and abuse can have health and wellbeing impacts not just at the time of the incident but across a persons entire life-course. Clients using specialist domestic and sexual violence and abuse services in Devon have presented with needs including:

Child Abuse

Poverty and Financial Problems

Crime and Criminal Justice

Homelessness and Housing Problems

Mental Health Problems

Self harm and suicide attempts

Substance Misuse

Issues relating to physical health, poor sexual health and physical injury

Victims of abuse may have multiple support service needs:

help escaping abuse

a safe place to stay

health and social care needs

counselling and psychological support to overcome trauma

emotional and practical support

legal advice and assistance through the courts

Some needs may not be a direct result of violence and abuse but create additional difficulties when accessing appropriate help and support, and include:

poverty

caring responsibilities

substance misuse

ongoing mental health conditions

physical disabilities

uncertain legal status

language or cultural barriers

Perpetrators of domestic violence may have unmet health needs, particularly in relation to substance misuse, self harm, overdose and mental health needs.

The cost of domestic and sexual violence

The costs of domestic violence and sexual abuse both by victims and perpetrators are extensive. Nationally Sexual Violence cost £21 billion and Domestic Violence £20.1 billion in 2007/08 (New Philanthropy Capital 2008). By 2009 this had fallen to £15.1 billion for Domestic Violence (Walby, 2009). It is likely that the current recession will reverse some of this downward trend and that we will see an increase in service usage over the next few years. Devon, domestic violence costs over £70 million a year in lost economic output and service costs (Walby, 2009).

Estimated cost of Domestic Violence in Devon (2009)

Risk Pyramid

Risk pyramids illustrate the number of events per annum across Devon. This is intended to illustrate both the scale of the problem, and the distribution of different health-related outcomes and behaviours. The pyramid below, which is based on 2010 data profiles risks from domestic violence across Devon.

Domestic and Sexual Violence and Abuse in Devon

Services are delivered in the community and within acute settings and are delivered by a variety of providers. With services in Devon being provided in so many different ways and settings across the area, it makes presenting comparable data difficult.

It is not possible at this stage to establish the extent unique individuals use multiple services or the extent to which the sexual violence overlaps domestic violence.

For further information refer to the Domestic and Sexual Violence and Abuse JSNA 2011

References

[1] Home Office (2005) The economic and social costs of crime against individuals and households 2003/04 combined with Home Office (2011) Revisions made to the multipliers and unit costs of crime used in the Integrated Offender Management Value for Money Toolkit

[2] Cawson et al., 2000, Child Maltreatment in theUK: A Study of the Prevalence of Child Abuse and Neglect, NSPCC, p.85

What works?

There is a choice of effective treatments to suit the variety of potential service users. Those seeking initial advice may benefit from brief interventions given by generic workers in almost any setting, whilst those at high risk may benefit from more intensive support given by specialist workers.

Some treatment of domestic violence is cost-effective and examples of the effectiveness of programs are shown below. Domestic violence has a high impact on health and social care systems, where major savings can be made.

Service	Evidence of Effectiveness	Source
Domestic Violence and Abuse Outreach	Effective – Client reported outcomes were positive (68% reduced risk; 78% feel safer; 78% improved quality of life; 90% confident to access support, p.34)Effective (improved outcomes for 1 to 2 years) 10 trials involving 1527 participants.	CAADA Best Value Report (2011)Cochrane Review (2009) Advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partners abuse (Review)
Domestic Violence and Abuse MARAC (Multi Agency Risk Assessment Conference) Independent Domestic Violence Advisor (IDVA)	Effective – For every £1 spent on MARAC IDVA work generates over £4.30 of saving to public agencies p.44MARAC IDVA’S responsible for highest reduction in client risk p.33)Client reported outcomes were positive (78% reduced risk, 80% feel safer, 80% improved quality of life; 84% confident to access support p.34	CAADA Best Value Report (2011) & Safety in Numbers – CAADA report
Domestic Violence and Abuse SDVC (Specialist Domestic Violence Court) IDVA	Effective – Client reported outcomes were positive (78% reduced risk; 60% feel safer; 60% improved quality of life; 72% confident to access support, p.34)	CAADA Best Value Report (2011)
Domestic Violence and Abuse Refuge / Emergency accommodation	Effective – Client reported outcomes were positive (70% reduced risk; 60% feel safer; 54% improved quality of life; 54% confident to access support, p.34)CAADA found to be cost effective: 180 women, 250 children a year at cost of £538,183 (2009-10).	CAADA Best Value Report (2011)Review of Refuge and supported housing for victims of domestic violence and abuse (14.9.2010)
Domestic violence and abuse Sanctuary Scheme	Effective – if the victims express a desire to remain at home. Outcomes include reporting feeling safer and preventing the disruption and expense of homelessness.	JONES Anwen et al. (2010) The effectiveness of schemes to enable households at risk of domestic violence to remain in their homes: research report,London:Great Britain. Department for Communities and Local Government, 2010
Common Assessment Framework (CAF) and Team Around the Child (TAC)	Effective – where joint working facilitated to be achieved. Based on a sample of 80 case studies indicated that early intervention using the CAF process demonstrates potential savings of between £5,000 and over £100,000. Around 10 cases showed a potential saving of over £101,000.	Easton, C., et al (2011) Early intervention, using the CAF process, and its cost effectiveness: findings from LARC 3, Slough: National Foundation for Educational Research.
REPAIR (domestic violence and abuse community family intervention programme working with perpetrator, partners and children)	Effective- 95% reduction in levels of risk posed by men who complete the whole programme REPAIR evaluation found the programme saves the public purse in Devon £158,890 per annum.	Sue Penna Associates (2008)
Sexual Violence Independent Sexual Violence Advisor (ISVA)	No long term studies available as they are a recent service. Process review suggests they are effective but must be careful not to duplicate work across the sector such as IDVA role.	Robinson. A., (2009) Independent sexual violence advisors: a process evaluation,London:Great Britain. Home Office
Domestic Violence and Abuse Training	Effective: (1,303 front-line workers trained 2010-2011) National research suggests that training of primary care clinicians is cost effective.Effective: Improved knowledge and awareness for staff, some studies showing increased domestic violence detection and some not. Onward referral can be an issue.	ADVA service Review Norman R, Spencer A, Eldridge S, Feder G. Cost effectiveness of a programme to detect and provide better care for female victims of intimate partner violence. Journal of Health Services Research & Policy (2010); 15(3): 143-149 Davidson L L, Grisso J A, GarciaMorenoC, Garcia J, King V J, Marchant S. Training programs for healthcare professionals in domestic violence. Journal of Women’s Health and Gender Based Medicine 2001; 10(10): 953-969

What is currently being done in Devon?

Funding specialist intervention services for families living with and experiencing domestic violence which in 2010-2011 reached 3,000 women, men and children in Devon. Services are: IDVA’s (MARAC); IDVA’s (SDVC); Outreach; Children and Young People’s workers; women support workers:
Multi-Agency Risk Assessment Conferences (MARAC) operate monthly across Devon to ensure that high risk victims of domestic violence receive a coordinated response from agencies.
Specialist Domestic Violence Courts (SDVC) have been established
The Devon & Torbay Sexual Assault Referral Centre (SARC) has been established in Exeter providing immediate physical and psychological help and support following a rape or sexual assault.
Independent Sexual Violence Advisers (ISVA’s) have been funded by the Home Office to work in the SARC’s
Multi-agency, specialist domestic abuse training for 2000 delegates per annum
Provision of refuge emergency housing for women and children escaping domestic violence
REPAIR – a programme to support perpetrators to change their violent behaviour and their families (partners and children)
Part-fund Devon’s Sexual Abuse Line
Funding of SEEDS Devon, a survivors reference group to influence agency practice change
Funding of BME Action Group including money for women with No Recourse to Public Funds
Building partnerships through with community and voluntary organisations to promote services, run education campaigns and provide training.
A Joint Strategic Needs Assessment was undertaken to establish the needs of the population and make recommendations about how services could be changed in order to improve the way those needs are met.

For further information on current and planned activities in Devon refer to the Devon Domestic and Sexual Violence and Abuse Strategy and for further information on services in Devon refer to the ADVA service directory.