Domestic Abuse COVID19 Dr Pavan Uppal Clinical lead

Domestic Abuse & COVID-19 Dr Pavan Uppal Clinical lead – IRIS Domestic Abuse East Surrey

What is Domestic Abuse? • • Psychological Physical Sexual Financial Emotional Controlling & Coercive behaviour FGM & Forced Marriage Includes 16 -18 y/o (March 2013)

Physical Abuse • • • Slapping Punching Pinching Beating Kicking Assault with a weapon Strangulation Suffocation Destroying your possession

Emotional Abuse Pressure tactics Sulking Constant criticism Being told that you are useless, ugly or worthless • Threats to kill or harm you, your children or your pets • Threats to commit suicide • Threats to take the children away or report you to Social Services • • Embarrassing you in public Intimidation Bullying Being locked in or kept in isolation away from family and friends • Not being allowed money, food, sleep or freedom • Being controlled • Stalking and harassing you especially after separation • •

Verbal abuse • Being called names • Being constantly shouted at • Making threats

Sexual Abuse • Being forced to have sex against your will • Being made to perform acts that you are not happy with • Being forced to watch or make pornography or take pornographic pictures • Being forced to have sex with or in front of other people • Being degraded on the basis of your sexual orientation

Financial Abuse • • • Forcing you to take out loans or debts Withholding money Forcing you to beg for money Not allowing you to earn your own money or have access to joint accounts Making you account for any money spent – produce receipts or bills Constant monitoring or questioning of your finances

Poll 1

How common is it? • 1: 4 women • 1: 7 men • 7 women a month are killed by a current or former partner in England Wales • 62% of children living with domestic abuse are directly harmed by the perpetrator of the abuse, in addition to the harm caused by witnessing the abuse of others • On average victims at high risk of serious harm or murder live with domestic abuse for 2 -3 years before getting help • 85% of victims sought help five times on average from professionals in the year before they got effective help to stop the abuse ONS (2016), March 2015 Crime Survey for England Wales (CSEW)

DA & Lockdown • Refuge - 25% increase in calls and online requests for help since the lockdown • UK - at least 16 killings between 23 March and 12 April 2020 (including children) • Compared with 10 year average - 5 deaths • Over 90% (91%) of victims said pandemic had negatively impacted • 61% said the abuse had worsened • More than two-thirds (68%) said they felt they had no one to turn to during lockdown • One-fifth (20. 3%) said that they had tried to leave during the pandemic but had been unable to access housing or refuge space • Pandemic is causing an escalation in abuse, not the abuse it self

DA & COVID • COVID-19 will have a detrimental impact on the safety and lives of patients affected and their children • Home may not be a safe place • Usual routes to support and safety will be limited • Primary Care plays a vital role • Phone and video consultations • Check for DA in records before consultation

Poll 2

Ask • Ask the patient if it is safe to talk o Yes or No • If not - ask for a suggested safe time to call back • Perpetrator may be in the house or enter the house/room at any time • Ask if the patient feels safe and if there is any immediate danger • Advise calling 999 if there is any immediate danger – or call yourself if they are unable • Closed questions surrounding safety

Respond • Validate the patient’s experience o I believe you o This is not your fault • Extremely vulnerable situation if isolating with the perpetrator • What support the patient has • What support they might need

Risk Assess • Is the abuse escalating? • Do they feel unsafe to stay in the home/in immediate danger • Pregnancy • Time of Leaving • If there are children in the home, make an immediate safeguarding referral o Support available to victim o Children

Refer/Signpost • Discuss with o Practice Safeguarding Lead o Colleagues o Local safeguarding professionals • Discuss a follow-up appointment • IRIS Domestic Abuse Aware Practice - refer to IRIS Advocate Educator • Otherwise, share contact details o Local domestic abuse services in your area o Local national helpline

Record • Document all enquiries, disclosures and referrals on the patient’s record • Read code 14 XD (history of domestic abuse) and hide the consultation from online access • Code any disclosure on the medical records of any children or vulnerable adults in the household (see the RCGP national recording guidance) • Document concerns, even if the patient does not disclose domestic abuse

Resources • • • Your Sanctuary - https: //www. healthysurrey. org. uk/domestic-abuse/help National 24 hour helpline – 0808 2000 247 24 hour Domestic Abuse & Forced Marriage Helpline – 0800 027 1234 Men’s Advice Helpline – 0808 8010327 RESPECT – 0808 802 4040 (perpetrators) GALOP – 0800 999 5428 (LGBTQ+)

Coercive controlling behaviour and the link to domestic homicide DR TARA JONES, SURREY-WIDE DESIGNATED GP FOR SAFEGUARDING CHILDREN AND ADULTS NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

What is coercive controlling behaviour? Coercive control 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… …with the intention of -Isolating -Exploiting -Depriving of independence -Regulating everyday behaviour NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

What might this mean? Isolation; friends, family, workplace Exploitation; domestic servitude, financial abuse, sexual abuse, emotional abuse, use of substances to increase control, Deprivation of independence; time, activities, stalking, online surveillance, basic rights. Regulating everyday behaviour; what you wear, where you go, who you speak to NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

The scale of the problem 2018 CSEW 8% of women (1. 3 million) experienced DA in the year to end March 2018 29% of women age 16 -59 (4. 8 million) have experienced DA since the age of 16 95% of DA survivors reported experiencing CCB (Kelly et al 2014) Female victims of DA are far more likely than men to experience ongoing degradation and frightening threats (Myhill 2015) NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

Poll number 3 ……. NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

Why do we need to act? 50% of female murder victims murdered by current or ex-partner (3% men) Domestic murder seen as loss of control/crime of passion/”red mist” But in fact, an act of exercising total control Jane Monckton-Smith “ 8 steps to domestic homicide” August 2019 CCB found in ALL 372 murders https: //www. bbc. co. uk/news/uk-49481998 NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

8 steps to domestic homicide Pre-relationship stalking/abuse Relationship becoming serious very quickly Presence of coercive control Trigger threatens perpetrator’s control Escalation of control tactics Change in thinking by perpetrator Planning HOMICIDE (victim, children, self) NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

Local domestic homicide reviews Death of 29 year old woman (2017) Lessons learnt include “a lack of understanding of CCB by professionals” Need for greater professional curiosity Death of 39 year old woman (2016) Controlling and grooming of professionals by perpetrator “Health professionals identified gaps in DA knowledge when no violence was involved” NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

Identifying possible victims Depression/anxiety Self-harm/attempted suicide Substance misuse Miscarriage/pregnancy/STIs Facial/genital injuries Delayed presentations/inconsistent explanations Frequent attendances Hard to place symptoms NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

Power and Control wheel (Duluth model) NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

The final word from a family devastated by coercive control and domestic homicide HTTPS: //WWW. YOUTUBE. COM/WATCH? V=H 9 RXVZ 6 A 0 DI NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG

syheartlandsccg. surrey. safeguarding@nhs. net NHS Surrey Heartlands CCG I NHS Surrey Heath CCG I NHS North East Hampshire and Farnham CCG