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  • Violence against women - particularly intimate partner violence and sexual violence against women - are major public health problems.
  • These forms of violence can result in physical, mental, sexual and other health problems.
  • Risk factors for being a perpetrator also include low education, past exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.
  • Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.

The United Nations defines violence against women as "any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or.., whether occurring in public or in private life."

Forms and definitions of violence against women

Intimate partner violence - Refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.

Domestic violence and abuse - a pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, psychological, physical, sexual, financial and emotional abuse. In extreme cases this includes murder.

Sexual violence - any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape

Female genital mutilation (FGM) - involves the complete or partial removal or alteration of external genitalia for non-medical reasons. It is mostly carried out on young girls at some time between infancy and the age of 15. Unlike male circumcision, which is legal in many countries, it is now illegal across much of the globe, and its extensive harmful health consequences are widely recognised. An estimated 66,000 women in the UK are affected by FGM, with 24,000 young girls at risk of FGM.

Forced marriage - a marriage conducted without valid consent of one or both parties, where duress is a factor. The UK Forced Marriage Unit receives over 1,600 reports of forced marriage a year and actively deals with over 400 cases.

‘Honour’ based violence - violence committed to protect or defend the ‘honour’ of a family and/or community. Women, especially young women, are the most common targets, often where they have acted outside community boundaries of perceived acceptable feminine/sexual behaviour. In extreme cases the woman may be killed.

Prostitution and trafficking – women and girls are forced, coerced or deceived to enter into prostitution and/or to keep them there. Trafficking involves the recruitment, transportation and exploitation of women and children for the purposes of prostitution and domestic servitude across international borders and within countries (‘internal trafficking’).

Sexual violence including rape - sexual contact without the consent of the woman/girl. Perpetrators range from total strangers to relatives and intimate partners, but most are known in some way. It can happen anywhere – in the family/household, workplace, public spaces, social settings, during war/conflict situations.

Sexual exploitation – involves exploitative situations, contexts and relationships where someone receives ‘something’ (eg food, drugs, alcohol, cigarettes, affection, (protection money) as a result of them performing, and/or another or others performing on them, sexual activities. Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by person’s limited availability of choice resulting from their social / economic and / or emotional vulnerability. Girls involved in or connected to gangs are at risk of sexual exploitation by gang members.

Sexual harassment - unwanted verbal or physical conduct of a sexual nature. It can take place anywhere including the workplace, schools, streets, public transport and social situations. It includes flashing, obscene and threatening calls, and online harassment.

Stalking - repeated (ie on at least two occasions) harassment causing fear, alarm or distress. It can include threatening phone calls, texts or letters; damaging property; spying on and following the victim.

Faith-based abuse - child abuse linked to faith or belief. This includes a belief in concepts of witchcraft and spirit possession, demons or the devil acting through children or leading them astray (traditionally seen in some Christian beliefs), the evil eye or djinns (traditionally known in some Islamic faith contexts) and dakini (in the Hindu context); ritual or muti murders where the killing of children is believed to bring supernatural benefits or the use of their body parts is believed to produce potent magical remedies; and use of belief in magic or witchcraft to create fear in children to make them more compliant when they are being trafficked for domestic slavery or sexual exploitation. This is not an exhaustive list.

Emerging Issue Arising from the Child Sexual Exploitation in Gangs and Groups Inquiry

The Inquiry into Child Sexual Exploitation in Gangs and Groups (CSEGG) led by Sue Berelowitz, the Deputy Children's Commissioner requires Government and those in local authorities, police, health, youth justice, the judiciary and education to provide information so that for the first time the true picture can be established.

Scope of the problem

Over a third of violence reported to police in Enfield is domestic violence, or intimate partner violence (IPV). IPV affecting predominantly women (86% of reporting victims in Enfield), is the most common form of violence against women, encompassing physical, sexual, psychological, emotional or financial abuse by a current or former intimate partner.

In Enfield there were 9,047 calls for service to police regarding domestic abuse in 2012, with 559 complainants reporting serious and other wounding offences to police (MPS – metropolitan police service). There were a further estimated 600 women presenting at A&E first attendances for violence and 700 receiving treatment from LAS for assault injuries in Enfield. It is estimated that just 19% of domestic violence/IPV in Enfield is reported to and recorded by the MPS, whilst recent studies suggest 25% of victims first report abuse to their GP.

Repeat victimisation is common. 44% of victims of domestic violence are involved in more than one incident. No other type of crime has a high rate of repeat victimisation.

On average two women each week in England and Wales are killed by a partner or former partner, whilst there have been in excess of 10 domestic homicide victims in Enfield since 2007. Nationally, a further 30 women a week attempt suicide to escape violence every day and approximately 10 women a week commit suicide to escape violence. Between 50% and 60% of women mental health service users have experienced domestic violence, and up to 20% will be experiencing current abuse.

Population-based studies of relationship violence among young people (or dating violence) suggest that this affects a substantial proportion of the youth population.

Health consequences

Intimate partner and sexual violence have serious short and long-term physical and mental problems for survivors and for their children, and lead to high social and economic costs. Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term delivery and low birth weight babies.

These forms of violence can lead to depression, post-traumatic stress disorder, sleep difficulties, eating disorders, emotional distress and suicide attempts.

Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being a victim of violence (for females).

Impact on children

Children who grow up in families where there is violence may suffer a range of behavioural and emotional disturbances. These can also be associated with perpetrating or experiencing violence later in life. The World Health Organisation Factsheet 239 Nov 2012 on Violence Against Women - Intimate Partner and Sexual Violence Against Women).

Estimated socio-economic cost

The estimated socio-economic cost of domestic violence in Enfield is £31.5million (Trust for London and the Henry Smith Charity, 2011). This does not include the human and emotional costs to victims/survivors, which will largely be dealt with by public health services, estimated to be £54.2million in Enfield. Therefore the combined cost of domestic abuse and VAWG in Enfield is estimated at £85.7million per annum

The evidence gathered (Sue Berelowitz Inquiry) shows 16,500 children in England displayed three or more signs or behaviour indicating they were at risk of child sexual exploitation. The Inquiry assumes that the numbers of children being abused far exceeds the 2,409 confirmed victims between August 2010 and October 2011.

Key Issues and Gaps

The following issues and gaps were among those identified within the last Domestic Violence/VAWG strategic problem profile within the Enfield Community Safety Service:

  • Need to work with health partners to identify prevalence (low-reporting rates to police, GP is usually first port of call to statutory sector)
  • Improved identification of repeat victimisation across services (victims report victimisation to multiple different agencies)
  • Identify funding in order to provide specialist services to young people under 18, suffering from intimate partner violence – Enfield is a plot for Teenage IPV 13-17 year olds)
  • Obtain data from health services, inc. A&E, NHS and ENFIELD CCG, for the purpose of crime prevention, gauging prevalence and identifying gaps in service provision
  • Development of cross-sector co-ordinated response.

Recommendations for consideration by commissioners including short term and long term priorities

Ensure that providers publicise warning signs of sexual exploitation

Training on sexual exploitation for commissioned services

Ensure that safeguarding leads within all commissioned services understand sexual exploitation and the warning signs

Future contracts specifications for domestic violence incorporate the IRIS (in full) Project work

Prevention

  • Develop focus on early identification and early intervention (just 29% of GP’s in England said they felt comfortable asking appropriate questions of suspected victims of abuse - Royal College of General Practitioners 2012)
  • Introduction of the Identification and Referral to Improve Safety system (IRIS). IRIS is a general practice-based domestic violence and abuse (DVA) training support and referral programme that has been evaluated in a randomised controlled trial. Core areas of the programme are training and education, clinical enquiry, care pathways and an enhanced referral pathway to specialist domestic violence services. The target patient population is women who are experiencing DVA from a current partner, ex-partner or adult family member. IRIS also provides information and signposting for male victims and for perpetrators.

Provision

  • Commission Independent Domestic Violence Advocacy Services (IDVAs), Rape Crisis Centre support and community resources for victims/survivors
  • Enhance alcohol, substance misuse and mental health services for victims/survivors of DV/VAWG
  • Enhance services for people from minority groups
  • Midwives and health professionals should be trained to provide information to mothers from communities which practise female genital mutilation (FGM). Ideally this should take place during the antenatal assessment. The use of targeted questioning in those communities where FGM is practised should be employed as part of an integrated local pathway of care for FGM

Protection

  • Address high level of repeat cases
  • Improve levels of practitioner referrals to the Enfield Multi-Agency Risk Assessment Conference (MARAC) (just 24% of GPs said they were prepared to make appropriate referrals for victims – Royal College of General Practitioners 2012)

Partnership

  • Improve data collection, analysis and information sharing in coordination with data analysts, including those from cross-sector partners
  • Performance management
  • Secure long-term funding to support a partnership response to DV/VAWG

Who is at risk and why?

Whilst women and girls are more likely than men to suffer victimisation, with young women more likely to be victims of sexual assault, domestic violence/IPV generally is not confined by either modifiable (i.e. socio-economic status) or fixed risk factors (i.e. age, ethnicity). However, victimisation itself is a risk factor for a variety of other health problems, diseases and conditions.

The key factor in domestic violence/IPV is the presence of an abuser and a lack of effective protection. Risk factors include recent separation, coercive control, pregnancy and a wide range of additional factors that contribute to level of risk. Given that 86% of reporting victims in Enfield are female, and victim survey’s nationally (Annual British Crime Survey) note higher prevalence of victimisation amongst females, the entire female population of Enfield aged 16+ would be the identified target group, fitting with the Home Office definition for violence against women, which is:

Any incident or pattern of incidents of controlling, coercive or threatening behaviour,  violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse:

  • psychological
  • physical
  • sexual
  • financial
  • emotional

Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim."

This definition, which is not a legal definition, includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.

Local Prevalence/level of need in the population

Acquiring detailed accurate data on domestic abuse / violence against women and girls is made difficult as many agencies do not routinely record this data, or make it accessible.

There were almost 160,000 female residents in Enfield at the time of the 2011 Census. According to the British Crime Survey 25% of all women will experience domestic abuse at some point in their lifetime, which means there are potentially 40,000 survivors of domestic abuse currently residing in Enfield.

Domestic abuse, pregnancy, babies, children and young people

Domestic abuse is more likely to begin or escalate during pregnancy. More than 30% of cases are believed to have begun during pregnancy, with domestic abuse being a prime cause of miscarriage or still birth.

  • Over 70% of young people subject to child protection plans live in households where domestic violence is present, rising to 78% for children who are looked after.
  • The first available data from Single Point of Entry (SPOE) in Enfield shows that 80% of referrals have domestic violence as a factor.

Domestic abuse, mental ill health, alcohol and substance misuse

  • Approximately half of all women who have been treated for mental illness have also experienced domestic abuse.
  • Women who have experienced domestic abuse are 15x more likely to abuse alcohol, whilst survivors are 9x more likely to abuse drugs and 5x more likely to attempt suicide.

Domestic abuse and equalities

  • Women and girls from a BME background may find it more difficult to report an abusive relationship due to cultural belief or a lack of an appropriate service. At the 2011 Census the BME community in Enfield was 60%.
  • Forced marriages, female genital mutilation (FGM) and so called honour-based violence (HBV) are more likely to be prevalent in (although are not limited to) certain communities, including BME communities.
  • People with a long-term illness or disability are more likely to be a victim of domestic abuse, with disabled women or those with mental health problems at higher risk. More than half of all women with a disability may have experienced some form of domestic violence in their lifetime. According to the 2011 Census 4.1% of Enfield’s population were economically inactive due to long term sickness or disability
  • Levels of victimisation affecting LGBT (Lesbian Gay Bisexual Transgender) communities are unknown due to high under-reporting. It’s estimated that the LGBT population in Enfield is 6%.

Sexual Exploitation

  • 2409 victims reported in the call for evidence process.. Respondents to the call for evidence identified sexually-exploited children and young people ranging in age from 4 to 19 with a peak age of 15. Victims involved with a gang tended to be younger than those involved with a group. (page 14 of the Office of the Children’s Commissioner.

Describing the Existing Local Offer

Prevention

  • Domestic Violence Strategic and Domestic Violence Operational Group with multi-agency membership.
  • Domestic Violence Coordinator – coordinates the Coordinated Community Response to Domestic violence and Violence Against Women and Girls in the London Borough of Enfield within the multi-agency partnership.
  • Safe Choices group work programme (for 13-18 year olds) – a six week programme which focuses on positive and healthy relationships, choice and consequence and risk. This is targeted at females at risk of domestic/sexual violence and gang affected girls.
  • Young Persons Advocate – 1:1 support to 11-18 year olds at-risk of sexual violence/exploitation, particularly by gangs/groups.

Provision

  • Independent Domestic Violence Advocacy (IDVA) Project – supports girls from 16 years old. Has received over 400 referrals in first three-quarters of last financial year, with a FY target of 500. The number of referrals has increased each quarter. A comprehensive quarterly report with performance monitoring targets is provided and monitored via the local domestic violence strategic group. Services help reduce repeat victimisation, improved risk assessment and management of victims, increased engagement of civil and criminal justice systems, holds perpetrators accountable, contributes to awareness raising campaigns, provides training and contributes to local multi-agency partnership.
  • Enfield Muslim Women’s Aid – Refuge accommodation and support, counselling and advocacy services predominantly for, but not restricted to, Muslim women.
  • North London Rape Crisis Centre (NLRCC) – supports victims of current or historical rape whether as adults or girls over 13 years old. It received 40 referred rape victims in first three-quarters of last financial year, including 4 under the age of 25. The number of referrals has increased each quarter. A comprehensive quarterly report with performance monitoring targets is provided and monitored via the local domestic violence strategic group. A range of holistic services is provided via NLRCC which include counselling.
  • The Havens is commissioned by Specialised Commissioning London.
  • Level 3 Sexual Health Services provides specialist rape counselling services.
  • Safe House – target hardening of properties for victims of domestic violence.
  • Saheli – special emphasis on support for Asian women of all ethnicities, providing bi-lingual counselling and support with a part time DV specialist funded for 2013.
  • Solace Women’s Aid – offers support, advocacy, counselling, accommodation etc. to women affected by domestic and sexual violence and has several services in Enfield which include Outreach, Floating Support and Independent Domestic Violence Advocacy (IDVA) project. (see above)

Protection

  • Integrated Domestic Abuse Programme (IDAP) via the Probation Trust for offenders convicted of offences relating to domestic violence.
  • IDVA (see above)
  • Local Safeguarding Children’s Board, Children’s Services and other areas of the local authority
  • London Probation Trust – works with abusers who have been convicted, currently increasing due to improved arrest rates and detection rates within the MPS. Works to reduce repeat victimisation and hold perpetrators accountable for their actions.
  • Multi-Agency Risk Assessment Conference (MARAC) – supports repeat victims of DV, currently supporting 340 cases (much improved from the 149 cases in 2010), although it is estimated by the CAADA Quality Assurance process that Enfield MARAC should be supporting 460 cases. Services help reduce repeat victimisation, reduce risk of victims and their children, improved risk assessment, increased engagement of civil and criminal justice systems and holds perpetrators accountable.
  • Police Community Safety Unit / Public Protection

Community Resources - Input into Services and Interventions to Improve Outcomes - Local Offer

See above section 3. The IDVA, Muslim Women’s Aid, North London Rape Crisis Centre, Safe Choices, Saheli and Solace Women’s Aid are all provided via third sector charities. Statutory services, too.

Projected Service Use and Outcomes in 3-5 years and 5-10 years

With a commitment to improving and increasing reporting rates, it would be expected that recorded service use of the MPS would increase. Currently offences reported to police are experiencing a 13.5% increase in the FY in full to date February 2013 (an additional 192 reports to police).

In total across all services where data was available, it would be expected that in excess of 10,000 victims will report domestic incidents in Enfield annually. The British Crime Survey shows that there has been no significant change in victimisation rates since 2004/05 in England and Wales.

In terms of reported and recorded crimes, from MPS data, there has been a stable level since 2008-09 when there were 1,573 offences, this increased to 1,764 in 2012. The 5-year mean is 1,715.

Sexual exploitation of children is an emerging issue and the recommendations of the Office of the Children’s Commissioner will set service plans in the next 3 to 10 years.

Increased referrals and identification of domestic violence and child sexual exploitation would reduce prevalence and reduce repeat incidences. The repeat victimisation rate is currently 21%, based on domestic violence victims reporting to police in Enfield.

Ongoing training and development of processes across the partnership and within individual organisations will contribute to improved outcomes and identification of domestic violence, sexual exploitation and gender based violence (which includes harmful practices such as forced marriage, female genital mutilation and so called ‘honour’ based violence).

Evidence of Effective Interventions

The ‘Call to End Violence Against Women & Girls: Action Plan’, focuses on four key areas of prevention, provision, partnership working and protection.

  • Prevent violence from happening by challenging the attitudes and behaviours which foster it and intervening early where possible to prevent it
  • Provide adequate support where violence does occur
  • Work in partnership to obtain the best outcome for victims and their families (protecting survivors)
  • Take action to reduce the risk to women and girls who are victims of these crimes. Iris Model (Identification and Referral to Improve Safety) for identifying domestic violence within a primary care setting.

Public and User/Patient and Carers Views Including Quality Assurance

Investment decisions based on women’s specific health needs are a practical, cost-effective way of delivering a wider agenda of improving access to services and health outcomes. Health policies that take gender into consideration will increase the likelihood that services will meet their national public health targets, will improve outcomes and provide an effective health system that is fit for purpose. It is central to the NHS constitution and enables everyone to receive quality care and eliminate inequality and discrimination.

Equality Impact Assessments

Women and girls from a BME background may find it more difficult to report an abusive relationship due to cultural belief or a lack of an appropriate service.

Forced marriages, female genital mutilation (FGM) and so called honour-based violence (HBV) are more likely to be prevalent in (although are not limited to) certain communities, including BME communities.

People with a long-term illness or disability are more likely to be a victim of domestic abuse, with disabled women or those with mental health problems at higher risk. More than half of all women with a disability may have experienced some form of domestic violence in their lifetime.

Levels of victimisation affecting LGBT (Lesbian Gay Bisexual Transgender) communities are unknown due to high under-reporting.

Impact on Other Areas

Economic disadvantage

Women are at greater risk of poverty than men and are more likely to suffer recurrent and longer spells of poverty (22 per cent of women have a persistent low income compared to 14 per cent of men), which negatively impacts their physical and mental health. Women are the main ‘shock absorbers’ of poverty in households and feel the pressures of managing on a low budget most. Single parent families, the vast majority of whom are women, are more likely to be below the poverty line, and women are more likely to be in minimum wage, low paid and insecure employment – two thirds of those in low paid work are women. Around twice as many women as men are low paid.

Gender based violence is a risk factor for a variety of diseases and conditions, including but not limited to:

  • Gynaecological disorders
  • Mental health disorders
  • Depression
  • Post-traumatic stress disorder
  • Adverse pregnancy outcomes
  • Sexually transmitted diseases
  • HIV
  • Cardiovascular Disease
  • Cancer

All of these health conditions, as well as the direct physical violence (such as a serious assault, sexual assault or rape for example) will require a patient to be treated by the public health services, regardless of whether or not a crime has been reported to police (in most cases it hasn’t), and regardless of whether or not it has been identified as being the result of domestic violence.

Costs of domestic violence
Enlarge the Socio-economic costs of domestic violence table

The total cross-agency estimated socio-economic and human emotional costs of DV / VAWG in Enfield is £85.7m, which is broken down in the table above.

The reason for including the human and emotional costs is so that they are taken into account in policy making in relation to domestic violence. They are important and their inclusion is necessary if they are to count within the current policy regime. It is important that the inclusion of these issues as costs is not at the expense of their direct and immediate significance. Rather concern with the human and emotional impact, concern with justice and human rights, and concern with the cost of domestic violence are parallel and complementary ways of making the point that domestic violence is important.

The cost of human and emotional impacts is included in Home Office (Brand and Price 2000) costs of crime and in Department for Transport (DTLR 2001) estimates of the costs of road traffic accidents. Thus the inclusion of the human costs is already part of the UK governmental process of evidence based policy making. This report uses the Home Office methodology. The US National Institute of Justice (1996) includes the human costs in its reports on the cost of crime, so this is a recognised international practice

Unmet Needs and Service Gaps

Currently, services can only provide support to those who are brought to their attention, and within Enfield the MPS are the most significant referrer to all commissioned services. However, we know that just 1 in 5 victims report to police. Therefore, a significant proportion of victims are not accessing already available services.

Nationally, according to the British Crime Survey (2011), just 44% of female victims told someone in an official position of their victimisation, with 23% notifying the police and 19% notifying health professionals. In Enfield, the proportion of referrals to the MARAC service in 2012 show that 40% were forwarded by police professionals and just 4% from ENFIELD CCG professionals.

Eighty per cent of women in a violent relationship seek help from health services. Therefore, GPs, Health Visitors, A and E and maternity staff are well-placed to refer women to services.

Prevention Services

  • Mandatory domestic violence / VAWG awareness training for staff across all services who work with perpetrators, who have a significant roles in working with families and young children
  • Introduction of routine enquiry in other areas of health
  • Programmes to support survivors locally who wish to develop awareness about DV/VAWG within the community
  • Programmes to promote respectful relationships within educational establishments and youth resources
  • Respectful relationship programmes delivered by men with an interest in combatting DV/VAWG, delivered to men/young men and to create mentoring programmes for men and boys that promote attitudinal change

Provision Services

  • Development of specialist services for communities with higher rates of under-reporting (BME, LGBT, those with mental ill health etc.)
  • Developing peer support services
  • Enhancing support for frontline practitioners and managers / supervisors to develop their skills and confidence in responding to domestic abuse / VAWG
  • Outreach services for children and young people which is accessible for all ages (current outreach provision excludes support for women who do not have children under 5 years old).
  • Providing community based services for victims/survivors
  • Ongoing provision of refuge / access to safe accommodation for survivors
  • Specialist recovery programmes for children or young people affected by domestic abuse with a whole family approach

Protection Service

  • Increase rates of arrest and conviction
  • Improve identification of repeat victimisation across all services / referral process (i.e. police, public health) – improve volume of practitioner referrals to MARAC
  • Management of CPS process / victim care to limit % of unsuccessful prosecutions
  • Reduce the number of victims experiencing repeat incidents

Partnership

Broadening agency involvement in the partnership response to DV/VAWG

Performance Management

  • Improving data collection, analysis and information sharing
  • Enfield Safeguarding Board is in the process of responding to Child Sexual Exploitation in Gangs and Groups’ recommendations

Recommendations for consideration by commissioners

  • Ensure that safeguarding leads within all commissioned services understand sexual exploitation and the warning signs
  • Future contracts specifications for domestic violence incorporate the IRIS Project work being piloted in Primary Care
  • Ensure that the introduction of new Maternity Payment by Results Tariffs covers training and referrals to Domestic Violence
  • Future safeguarding implements the Inquiry of Child Sexual Exploitation in Gangs and Groups’ recommendations

Prevention

  • Develop focus on early identification and early intervention of domestic violence and sexual exploitation
  • Training on sexual exploitation for commissioned services
  • Ensure that providers publicise warning signs of sexual exploitation

Provision

  • Commission IDVA service and Rape Crisis Centre support NOTE:
  • Enhance alcohol, substance misuse and mental health services for victims/survivors of domestic abuse/VAWG
  • Enhance services for people from minority groups
  • Introduce the IRIS project to General Practitioner surgeries in Enfield

Protection

  • Address high level of repeat cases
  • Improve levels of practitioner referrals to MARAC

Partnership

  • Improve data collection, analysis and information sharing
  • Health providers share non-personalised patient data for the prevention purposes and development of strategic profiles
  • Joint agreement on key performance management indicators

Recommendations for further needs assessment work e.g. gaps in knowledge

Some studies of domestic violence do not include a component for human costs, although it is included in the US study by Miller, Cohen and Wiersema (1996) and the Spanish study by the Institute for Women of Andalusia (2003). One of the reasons for this lack of inclusion is that it was thought too difficult to do from a methodological stance. Others thought that it was inappropriate to put a monetary measure on human costs. Cohen (1988) argues that unless the costs of pain and suffering are included we underestimate the impact of crime and make inappropriate policy decisions. If pain and suffering are included, then there is more reason to spend more on interventions than if we do not include it.

This page was last updated on 21-Jan-2015.