Public Health Approach to addressing Domestic Abuse in Knowsley

1. Public Health Approach to addressing Domestic Abuse in Knowsley Matthew Ashton Director of Public Health Knowsley MBC

2. Overview • Background • Process • Key findings • Political scrutiny • Scrutiny Recommendations • Key messages

3. Background • Domestic abuse is a significant public health issue, having a major impact upon those directly affected and their families. • Locally, it had been raised as a issue at the Safeguarding Children’s Board and through the wider Knowsley Partnership. • Previous needs assessments (and consequently services) developed from a Community Safety perspective. • Need for new needs assessment from health perspective

4. In Knowsley (source: Life style survey 2012) (source: Crime Survey for England & Wales 2012) www.apho.org.uk/diseaseprevalencemodels - modelled estimates (source: Life style survey 2012) http://www.apho.org.uk/resource/item.aspx?RID=111120 – modelled estimates 1 in 61 people have Cancer (source: QOF April 11 – March 12)

5. Population impact?

6. Aims of Needs Assessment The aims of the needs assessment were; • To assess the levels of domestic abuse, and health and wellbeing needs of those affected in Knowsley • To identify the causes and drivers of domestic abuse • To explore the links between domestic abuse and other risk taking behaviours • To investigate the extent to which current service provision is addressing the needs

7. Process • Conduct Literature / evidence review • Data intelligence collation and analysis (incl. service mapping and intelligence) • Stakeholder engagement • Scrutiny review

8. Overview of trend

9. Financial Impact in Knowsley £56m human and emotional £11m housing, civil, legal employment and other costs. £3.8m physical and mental health care costs. £2.4m criminal justice costs. £452,000 social care costs. Calculated using estimates from (Järvinenet al, 2008) for domestic violence. Total annual cost to Knowsley economy estimated as £73 million.

10. Health and Wellbeing Needs – Victims and their children Victims Children and Young people Mental health and wellbeing Behavioural and emotional problems Links with substance misuse Child Maltreatment and Child abuse – identifying and dealing with it Education / housing Unsettled childhoods Long term impacts affecting life chances Links with crime, gangs and violence. Short term • Physical health (minor – severe) • Sexual health • Eating disorders / self harm • Fear and safety concerns (safety primary concern) Short and long term • Mental health and wellbeing (depression, suicide, self harm, confidence, self esteem) • Substance misuse (particularly alcohol) • Housing • Employment & Poverty • Difficulties with relationships (intimacy, trust) • Isolation

11. Political Scrutiny • Scrutiny review by elected members on the draft needs assessment to; • Inform, sense check and develop recommendations • Three evidence sessions, involving expert witnesses, plus visits to MARAC and NICE stakeholder session

12. Identified needs / issues

13. Scrutiny recommendations • That the strategic approach to domestic abuse be reviewed • That data and intelligence issues in relation to domestic abuse be resolved • Seek all opportunities to break the cycle of domestic abuse through a greater focus on prevention • That support for victim survivors is reviewed • That support for affected children is reviewed • That the way perpetrators are dealt with is reviewed

14. Key messages • Domestic Abuse is a significant public health issue in Knowsley • Applying a public health approach to the needs assessment important • Involving members through scrutiny of draft needs assessment was integral to raising profile, gaining ownership and development of recommendations. • It raised issues for local authority and health commissioners, wider public sector and providers about referral processes and support services • Addressing mental health problems, alcohol issues and healthy relationships potentially could significantly impact on domestic abuse levels. • Current focus on dealing with consequences rather than prevention

15. Communication Strategy Methods Posters Postcards Beermats Bus / Taxis Media Releases Facebook Twitter Community Messaging One Stop Shops GP Practices

16. Questions? Matthew.ashton@knowsley.gov.uk

17. Recommendation 1 That the strategic approach to domestic abuse be reviewed by: • Considering the strategic governance arrangements for domestic abuse; • The council and its partners considering joint commissioning arrangements for domestic abuse specific services to enable a more flexible use of resources; • Services focussing on addressing the behaviour of perpetrators as well as resolving the needs of the victim survivor; and, • Standards/expectations being developed in the response times to resolve domestic abuse incidents completely.

18. Recommendation 2 That data and intelligence issues in relation to domestic abuse be resolved through: • Undertaking further work to improve the recording of domestic abuse across partner agencies and exploring other sources of insight (particularly for teenage intimate partner violence and child on parent abuse); and, • Exploring opportunities for the streamlining of referral forms from various agencies to ensure a consistent approach and improving referral processes particularly from the Vulnerable Persons Unit (VPU).

19. Recommendation 3 by: • Developing a systematic approach to the primary prevention of domestic abuse; • Considering the inclusion of evidence based programmes on violence and domestic abuse within the school curriculum and ensuring that their effectiveness is assessed; • Investigating further the content of parenting programmes and exploring the introduction of a specific module on domestic abuse; and, • Developing work with Her Majesty’s Prison Service that explores the use of more domestic abuse programmes/modules on programmes for prisoners where domestic abuse isn’t necessarily their trigger offence. 

20. Recommendation 4 That support for victim survivors is reviewed by: • Considering the threshold level and pathways for low-medium risk victim survivors; and, • Delivering training on domestic abuse awareness and how to support those affected to all front line responders including the police.

21. Recommendation 5 That support for affected children is reviewed by: • Evaluating the effectiveness of programmes to identify and support the needs of children affected by domestic abuse and show they make a difference; • Reviewing the support for children affected by domestic abuse that fall below the threshold for wellbeing support and identify whether their needs are being adequately addressed; • Collecting insight from children and young people on the impact of domestic abuse and using this information to inform commissioning decisions; and • Testing the feasibility of rolling out Operation Encompass across Merseyside, through police colleagues given that some of Knowsley’s school age children may attend schools across local authority boundaries.

22. Recommendation 6 That the way perpetrators are dealt with is reviewed by: • Assessing the long term effectiveness of existing perpetrator programmes; • Exploring the reasons why there are disproportionately higher levels of cracked and ineffective domestic abuse trials in Knowsley; • Exploring the greater use of sanctions for perpetrators who do not attend or complete community perpetrator programmes; • Considering the use of civil action against perpetrators of domestic abuse where criminal convictions are not possible; and, • Considering the broader use of Integrated Offender Management (IOM) for domestic abuse offenders to allow for a more intensive intervention to reduce the risk of reoffending and the risk of harm.