“Stuck in the Middle with You”: guidance for General Practice clinicians to better identify the link between domestic abuse and menopause

Research into domestic abuse and menopause in the UK is scarce. There is also very little evidence around the experiences of mid-life women experiencing domestic abuse in the UK. This is despite the fact that over a third (38%) of women killed by their partner or ex-partner are in the 36-55 age range (Femicide Census, 2018). In order to explore and present the links between menopause and domestic abuse, AVA recently launched a new project in partnership with IRISi, and with support from the Emmanuel Kaye Foundation.

Named ‘Stuck in the Middle with You’, this pioneering study was the first of its kind in the UK and aimed to find out how women’s contact with General Practices for menopause-related symptoms could provide opportunities for disclosure and support.

Drawing on a literature review, peer-led research and a consultation with general practitioners, emerging findings indicate a two-way relationship between menopause and domestic abuse. Key insights include:

Menopause impacts women’s relationships, especially with their intimate partner/s and family members.
Domestic abuse impacts menopause symptoms; with negative symptoms or experiences compounding or obscuring one another.
Women view menopause as a pivotal moment for making life changes, suggesting that menopause may be a key time when women are looking for support to escape domestic abuse.
Women highlight a number of intersecting barriers in the way of adequate support in General Practice settings, including, but not limited to: short appointments; lack of routine enquiry; inadequate mental health support; negative experiences with male GPs; generic or unhelpful information on menopause; few/no onwards signposting to specialist support for either menopause or domestic abuse.
Our findings also suggest women experiencing both menopause and domestic abuse are likely to face significantly elevated health needs. A clear lack of specialist support or sensitive routine inquiry means menopause-related appointments are currently a missed opportunity for intervention.

With the advent of the new government Menopause Taskforce and increased media interest in menopause and its impact, we believe this is an important moment to raise awareness of domestic abuse survivors’ needs.

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Partners

AVA

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

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project

https://avaproject.org.uk

SafeLives

SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.

http://www.safelives.org.uk/about-us

IMKAAN

Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.

https://www.imkaan.org.uk

The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.

https://www.health.org.uk

STADV

Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.

http://www.standingtogether.org.uk

Spring Impact

Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.