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    A common breach of human rights

    DVA encompasses emotional and psychological abuse, physical abuse, sexual violence and abuse, stalking and harassment, intimidation and humiliation, manipulation, threatening behaviour, financial control, coercion isolation, , and entrapment.

    It is a common breach of human rights.

    It involves the systematic use of power and control, with far-reaching consequences for individuals, families, children, communities and society as a whole. It is one element of the ‘toxic trio‘ identified as common features of families where harm to children and adults has occurred.

    We know that DVA often goes unrecognised. But how frequent is it really?

    In a nationally representative primary care database of approximately 6% of the UK populationi, only 0.5% of women had DVA recorded, compared to the Office for National Statistics estimated prevalence of 17%. While it is impossible to know exactly how much DVA is under-recorded, it is clear that multiple strategies are needed to improve identification for those affected by DVA. DVA is a big problem.

    A recent study by the Home Office estimated that cost of domestic abuse for its victims in the year ending on 31st March 2017 was approximately £66 billion. That is at least 6 times more than previously estimated. In 2012, the cost of DVA in the UK, including medical and social services, lost economic output and emotional costs, was estimated to be £11 billionii.

    In the United Kingdom, in the year ending March 2017, 7.5% of women (1.2 million) experienced domestic abuseiii, the number is now closer to 2 millioniv. While DVA can affect both men and women, it is a gendered issue. Women are more often exposed to multiple forms of abuse and more frequently so. Women who experience DVA suffer chronic health problems including gynaecological problems, gastrointestinal disorders, neurological symptoms, chronic pain, cardiovascular conditions and mental health problems v, vi, vii, viii.

    The consequences of missing the opportunity to identify DVA and offer support are severe. Seventy-five percent of cases of domestic violence results in physical injury or mental health consequences to womenix. A recent study found that 49.5% of women who had experienced intimate partner violence (IPV) had some form of mental health illness, compared to only 24% of those who had not. Women in the IPV group were also two and a half times more likely to develop a new mental illness within 2 to 3 yearsx.

    DVA is also a major indicator of risk to children and young people. Children’s exposure to IPV is strongly associated with a broad range of emotional and behavioural problems, as well as increased risk-taking behaviour, including alcohol and substance misuse, and academic problems. There can also be direct physical health consequences, including injuries and death, when physical violence between caregivers directly involves childrenxi, xii.

    It is estimated that around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. While DVA is strictly defined as violence and abuse between adults, when adults are involved in an abusive relationship, their children bear the consequences.

     One in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers.

    While physical injury and death when children are caught up in the violence between adults are the most severe cases of children’s exposure to DVA, even when not directly involved, children’s exposure can continue through witnessing and being aware of the violence, as well as through its health, social and financial consequences.

    Health and social care workers are often the first professionals to have contact with women and children affected by DVA. This often happens when the abused parent seeks help, or when children undergo health checks. But it can happen during assessments for emotional or behavioural problems, or when social services, a child’s school or the police become involved.

    In the year ending in March 2018, the police recorded 599,549 domestic abuse-related crimes. This is an increase of circa 23% from 2017. While this numbers are encouraging, only 225,714 arrests for domestic abuse-related offences were made in the same year, implying that just under 90% of the victims do not find justice for what they live.

    Domestic Violence and Abuse is as much a police matter as it is a health issue. This is why the World Health Organisation (WHO) recommends that health professionals who see women with clinical signs of domestic violence should ask them about safety in their relationship and at home. They also advise that responses to disclosure should follow what is known as the “LIVES” principles: Listen, Inquire about needs and concerns, Validate, Enhance safety, and provide Support. By training GPs to correctly and effectively identifying cases of DVA, and providing a first layer of support from Advocate Educators, IRIS not only follows the WHO principles, but goes beyond.

    But there are no equivalent recommendations for children, and there is no agreed approach regarding how best to identify and respond to children who are exposed to domestic violence. This means there is still a lot to be done to tackle this burdensome and costly problem.

    1. Health Improvement Network (THIN) database.[]
    2. Walby S, Olive P. Estimating the costs of gender-based violence in the European Union. European Institute for Gender Equality; 2014[]
    3. ONS. Intimate personal violence and partner abuse compendium. 2018[]
    4. ((ONS. Intimate personal violence and partner abuse compendium. 2019[]
    5. Bonomi AE, Anderson ML, Reid RJ, Rivara FP, Carrell D, Thompson RS. Medical and psychosocial diagnoses in women with a history of intimate partner violence. Archives of internal medicine. 2009;169(18):1692-7[]
    6. Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359(9314):1331-6[]
    7. Tollestrup K, Sklar D, Frost FJ, Olson L, Weybright J, Sandvig J, et al. Health indicators and intimate partner violence among women who are members of a managed care organization. Prev Med. 1999;29(5):431-40[]
    8. Coid J, Petruckevitch A, Chung WS, Richardson J, Moorey S, Feder G. Abusive experiences and psychiatric morbidity in women primary care attenders. The British journal of psychiatry : the journal of mental science. 2003;183:332-9; discussion 40-1[]
    9. Department of Health. Responding to domestic abuse: A handbook for health professionals. London: Department of Health; 2005[]
    10. Chandan, J., Thomas, T., Bradbury-Jones, C., Russell, R., Bandyopadhyay, S., Nirantharakumar, K., & Taylor, J. (n.d.). Female survivors of intimate partner violence and risk of depression, anxiety and serious mental illness. The British Journal of Psychiatry, 1-6. doi:10.1192/bjp.2019.124[]
    11. McTavish JR , MacGregor JC , Wathen CN , et al . Children’s exposure to intimate partner violence: an overview. Int Rev Psychiatry 2016;28:1–15.doi:10.1080/09540261.2016.1205001[]
    12. Holden GW . Children exposed to domestic violence and child abuse: terminology and taxonomy. Clin Child Fam Psychol Rev 2003;6:151–60.doi:10.1023/A:1024906315255[]

    “Just asked my first patient re: domestic abuse. She was fine, and glad I asked”


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    AVA is an expert, groundbreaking and independent charity working across the UK.

    Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

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