Recognizing and Responding to Domestic

Violence

A presentation by

Merseyside Domestic Violence Service Ltd.

The cost of domestic violence

• The annual cost of DV in England and Wales is estimated at £16 billion

• The annual cost to the Criminal Justice System is £1.2 billion

• The annual cost of Physical health care treatment resulting from domestic violence is £1.7 billion

• The annual cost to Social Services is £0.28 billion

• The annual cost of civil legal services due to domestic violence is £0.38 billion

• The Home Office estimates the Cost of Domestic Homicide at over 1 million pounds per death.

Women’s Aid (2014) and

Reproductive - unintended

pregnancies, induced abortions, increased risk of miscarriage Sexual - gynaecological problems, STI's, HIV.

1.5 times more likely to have an STI, twice as

likely to have an abortion ,

Mental - increased risk of suicide , substance

abuse , twice as likely to suffer depression and

alcohol abuse, emotionally withdrawn,

isolation, Physical - Homicide, 42% suffer substantial injury,

permanent disability. headaches, back pain,

abdominal pain, fibromyalgia, gastrointestinal disorders, limited mobility and poor

overall health.

HUMAN COST OF DOMESTIC VIOLENCE

• Violence against women has serious consequences for their physical health

• 70% of incidents of DV result in injury• 46% of women sustain a minor physical injury, 20% a

moderate physical injury, and 6% severe injuries (Walby & Allen, 2004)

• What are the most common types of injury?

4

Physical Health

Most

com

mon

typ

es

of

inju

ry• Ruptured tympanic

membrane (ear drum)• Rectal/perineal injury• Genital bruising/contusion• Facial abrasion/contusion• Neck abrasion/contusion• Abdominal

laceration/penetration• Orbital/nasal/zygomatic

(cheekbone) fracture• Damage to lips• Dental damage• Head abrasion/contusion• Thorax abrasion/contusion• Facial laceration• Upper extremity

abrasion/contusion (breast area) In

juri

es

cau

sed

by

perp

etr

ato

r

• Cuts, bruises, and black eyes to miscarriage, bone injuries, spleen and liver trauma, partial loss of hearing or vision, and scars from cigarette burns or knife wounds.

• Bite marks, welts from a weapon

• Breast Injuries, chest and abdomen are more common in victims of dv

• multiple old and current injuries

Defe

nsi

ve i

nju

ries

• These injuries are to the parts of the body used by the woman to fend off an attack: The small finger side of the forearm or the palms when used to block blows to the head and chest

• The bottoms of the feet when used to kick away an assailant

• The back, legs, buttocks, and back of the head when the woman is crouched on the floor

• Injuries inconsistent with the explanation given:

• The injury type or severity does not fit with the reported cause.

• The mechanism of injury reported would not produce the signs of injury found on physical examination.

• Injuries in various stages of healing:• Signs of both recent and old

injuries may represent a history of ongoing abuse.

• Delay in seeking medical attention for injuries may indicate either the victim's reluctance to involve doctors or his or her inability to leave home to seek needed care.

THIS IS AN EXAMPLE OF FINGER BRUISING

AN EXAMPLE OF A BITE MARK CAUSED BY A PERPETRATOR OF DOMESTIC VIOLENCE

AN EXAMPLE OF DOMESTIC VIOLENCE INVOLVING A KICK CAUSING AN IMPRINT OF THE SOLE OF THE PERPETRATORS SHOE

Creating an Environment Where Victims of Domestic Violence are

Able to Disclose

• Information clearly displayed in waiting areas, i.e. posters, leaflets including information on helplines, groups, dv organisations, safety

planning, disclosure.

• Training for all staff including receptionists

• Monitoring of patients who have a pattern of failing to attend appointments

• Clear policies and procedures for staff who may be asking questions

• Ensure staff wellbeing; ensure they have opportunities for self disclosure

• Staff training to recognise indicators of domestic violence

• Multiple abusers - Be aware that patients may attend with family members, friends, or the perpetrator – they too could be colluding with

the abuse

• WHY IS IT IMPORTANT TO CREATE A SAFE ENVIRONMENT?..

Recognising and Responding to

domestic violence

Expectations of the child

protection systemX) Dad must leave

the family home immediately

Y) There must be no contact

Z) Must report to Police

Consequences of these expectations for the mother and

children;X) He will kill me if I leave him, he will

not leaveY) If he is unable to contact me by phone he will turn up unannounced

at the houseZ) Perpetrator is

not convicted

• It is rare that professionals responses to domestic violence are directed toward the perpetrator

• It is common that women become the primary source of preventing further incidents of domestic violence

FAILIURE TO PROTECT YOU NEED TO

TELL HIM TO LEAVE THE FAMILY HOME

YOU NEED TO LEAVE HIM YOU ARE

ALLOWING THE ABUSE TO CONTINUE

YOU LACK MOTIVATION TO ENGAGE

YOU LACK INSIGHT INTO DOMESTIC VIOLENCE

YOU ARE PRIOROTISING HIM OVER YOUR CHILDREN

ONE MORE POLICE CALL OUT AND THE CHILDREN WILL BE REMOVED

YOU ARE TO HAVE NO CONTACT WITH HIM

The risks associated with leaving

• Leaving an abusive relationship can result in women being murdered

• It is important that whenever we have the opportunity to offer support and respite for women and children that we do so without forcing the issue of leaving permanently

How we can support you

• Training

• Development and implementation of policies and procedures

• Identifying referral pathways

• Risk assessments and initial assessments

• Working directly with female victims/survivors and male perpetrators of domestic violence

We now look forward to some questions?

Thank you for your time