Domestic violence could be stopped earlier, says study

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abuse, abusive relationships, Children, coercion, control, coping, danger, domestic abuse, domestic violence, fear, harm, health workers, help, impact, isolation, murder, police, professionals, relationships, risk, serious injury, teenagers, training

Domestic violence could be stopped earlier, says study

Victims of domestic violence are abused for almost three years before they get the help they need, and some are subjected to more than 50 incidents during that time, according to a study of the largest database of domestic violence victims in the UK.

The figures from the domestic abuse charity SafeLives reveal that almost a quarter of “high-risk” victims have been to an A&E with injuries sustained during violent abuse, and some went as many as 15 times before the problem was addressed.

Analysis of the SafeLives database, which has records of more than 35,000 cases of adults experiencing domestic abuse since 2009, found that 85% of victims had been in contact with an average of five professionals in the year before they got “effective” help from an independent domestic violence adviser (IDVA) or another specialist practitioner.

“Time and time again no one spots domestic abuse, even when victims and their children come into contact with many different public agencies. It’s not acceptable that victims should have to try to get help repeatedly. This leaves victims living in fear and danger and risks lifelong harm to their children,” said Diana Barran, the chief executive of SafeLives, which was previously called Co-ordinated Action Against Domestic Abuse (Caada).

Barran said the study was “more shocking evidence” that domestic violence could often be stopped earlier. “Every conversation with a professional represents a missed opportunity to get victims and their children the help they need,” she said.

SafeLives estimates that there are at least 100,000 victims at high risk of murder or serious injury in England and Wales, 94% of them women.

The study found that victims and often their children lived with abuse for an average of 2.7 years. Three-quarters reported abuse to the police, and 23% went to A&E because of violence sustained in abusive relationships.

Frances Wedgwood, a GP in Lambeth who provides training on domestic violence to health workers through the national Iris project, said a challenge for doctors was that many women did not come to them to disclose domestic violence.

“Domestic violence is still a very hidden problem and in my experience women do not disclose if they are not asked,” she said. “We need to get better at asking people directly if they need help.”

The study sheds light on the long-lasting impact of living in a family coping with domestic violence. According to the survey, in about a quarter of cases on the domestic violence database the victim has a child under the age of three. The study estimates that 130,000 children in the UK are living with domestic abuse, and that children are directly harmed in 62% of cases.

Among teenagers who suffered domestic abuse in their own relationships, almost half had grown up in households where violence was commonplace, the study found.

Vera Baird, former solicitor general and the current police and crime commissioner for Northumberland, said professionals needed help and training to have the confidence to deal with domestic violence.

“Domestic abuse is not a one-off violent attack. It is deliberate long-term use of coercion to control every part of the partner’s life. Violence, sexual abuse, financial control, constant criticism, isolating from family and friends are all familiar tools,” she said.

“People in that situation do not find it easy to speak and need those who could help to be alert. The alternative is what these figures suggest: victims and their families locked unnecessarily into cruelty and ill-treatment for years.”

Case study

Rebecca, 34, lived with domestic abuse for eight years before she sought help

One time I was having a nap in the afternoon, the baby had been teething so I’d been awake all night, and I woke up he was standing over me with a mop handle carved into a point, like a spear. He was pushing it into my throat, accusing me of cheating. Then he picked me up and threw me against the wall. I ran downstairs but he followed me, kicking and punching me and split my lip.

I locked myself in the bathroom and called 999. When the doorbell rang I heard chatting, calm talking. There was one young male officer, and my ex-partner was telling him that I was postnatal, that I’d gone mental and he was just defending himself. I started shouting at the officer: ‘Why aren’t you helping me?’ I swore and the officer said people could hear me, and it was a public disturbance so I swore again. He put handcuffs on me. He wouldn’t let me put my shoes on, so I wouldn’t move, and he lifted me up by the handcuffs and put me in the back of the car.

I was in a cell for hours asking for a solicitor. The duty sergeant finally came and when he opened the hatch he could see I’d been attacked. He got the officer to come and apologise to me and asked me if I wanted to file a complaint, or if I wanted to press charges against my partner. But I said no. I was exhausted and my baby was at home with my partner, who’d been drinking since the morning. It got worse after that. He was sort of smug, saying he could do what he wanted. I know there’s more training for police now, but that put me off calling the police for years.

By 2003/4 the abuse was worse. We had two girls by that time. I was hospitalised with concussion after he’d kicked me in the head wearing steel-toe-capped boots. The police and the paramedics came and I was patched up and sent home. They asked me if I wanted to press charges but I didn’t want to go through all that, I thought it would make it worse. I didn’t know where the support would come from, where I could get help.

Another time I went to the hospital walk-in. I had a black eye and it wasn’t getting better. A doctor asked me what had happened and I said I’d been punched in the face. He repeated what I said: ‘You were punched in the face.’ I didn’t know what he wanted me to say. I was ashamed, I didn’t want to say my husband did this to me. If he had asked, I’d have told him. But he didn’t.

Social services got in touch because of the paramedics’ reports; he got put on an anger management course. But Christmas Day night he’d been drinking. He grabbed me by the throat and I stumbled and fell; he kept kicking me over and over again. My teeth went through my lip, my nose was bleeding, I couldn’t see. He picked me up and carried me to the bathroom saying: ‘Look what you made me do. Why did you do that?’ I crawled to the living room and phoned the police before he ripped it out of the wall.

I did press charges that time. He was sentenced to four months for ABH. He served two. We were separated, but we got back together. Why? I had such low self-esteem and he was always there, always pestering me, grinding me down. He’d be so nice, helping with the children and I was exhausted, I needed the help. I thought it might be OK.

It was OK for a while. The kids had been on the at-risk register because a couple of incidents had been reported, but they came off that and social services were visiting less. His behaviour just went back to the way it had been before, and that’s when I decided to leave.

I remember the exact moment when I saw the sticker for the Women’s Aid helpline: it was on the back of the toilet door in Asda. It took me a couple of months to call but when I did they offered me refuge. I didn’t even know that existed. They organised transport when he was out. It was quite surreal, but it was such a relief.

Women’s Aid were so helpful, they gave us so much support including counselling. My eldest daughter was seven when we left, her sister was three and their brother was nine months. That was the main reason I left, I was terrified for my kids.

I do think professionals should offer support. If they can’t support victims themselves, they just need to know who can. I think if I’d had that information I would have left earlier.

I was 16 when we got together; he was 23. By the time I was 17 we had a daughter. I thought it was a good relationship, he helped with the parenting and around the house, but about a year later, in 1999, slowly controlling behaviour crept in. He wouldn’t like certain friends, or me going out without him, wearing certain clothes or makeup. It was quite subtle at first, but then when we argued there was pushing, then hair-pulling – each time it was a little worse than before.

Soon it was normal to have slapping, kicking, punching, throwing things. At first I didn’t tell anyone; my self-esteem was very low. I just tried to pretend it wasn’t happening, I didn’t know anything about domestic abuse.

A third of first-time mothers suffer depressive symptoms, research finds

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baby, Children, Depression, depressive symptoms, diagnosis, early years, first-time mothers, four years postpartum, GPs, health professionals, health visitors, irritable, low mood, maternal health, mental health issues, midwives, mothers, new mothers, parents, Postnatal Depression, postpartum, pregnancy, risk, signs, tearful, training, worrying

A third of first-time mothers suffer depressive symptoms, research finds

One in three first-time mothers suffers symptoms of depression linked to their baby’s birth while pregnant and/or during the first four years of the child’s life, according to research.

And more women are depressed when their child turns four than at any time before that, according to the study, which challenges the notion that mothers’ birth-related mental struggles usually happen at or after the baby’s arrival.

The findings have led to calls for all women giving birth in the UK to have their mental health monitored until their child turns five to ensure that more of those experiencing difficulties are identified.

The results are based on research in Australia, but experts believe that about the same number of women in the UK experience bouts of mental ill-health associated with becoming a mother.

In all 1,507 women from six hospitals in Melbourne, Australia, told researchers from the Murdoch children’s research institute and royal children’s hospital in Parkville, Victoria, about their experience of episodes of poor mental health at regular intervals until their child turned four.

The authors found that almost one in three first-time mothers reported “depressive symptoms on at least one occasion from early pregnancy to four years postpartum [and that] the prevalence of depressive symptoms was highest at four years postpartum”. The women’s depressive symptoms are often short-lived episodes and do not mean that the women were diagnosed with postnatal depression. Studies in both the UK and internationally have estimated that between 10% and 15% of new mothers suffer from that clinical condition.

The researchers also found that four years after the child’s birth 14.5% display depressive symptoms, of whom 40% had not previously reported feeling very low. At that time, women with only one child were much more likely (22.9%) than those with two or more offspring (11.3%) to be depressed.

Dr Jim Bolton, a member of the Royal College of Psychiatrists and a consultant psychiatrist at a London hospital, said that one in three women giving birth in the UK were likely to become depressed at some point during those first four years. “If a similar study was done here, I wouldn’t be surprised if the results were similar. Usually the sorts of mothers who are at greater risk of depression are younger mothers who feel they can’t cope and mothers living in situations of adversity or deprivation or partner violence,” he said.

“These findings are about depressive symptoms, which can be very short-lived, not a formal diagnosis of illness or postnatal depression. This study isn’t saying that one in three women gets that,” stressed Bolton, who treats mental health problems in pregnancy and after birth among new mothers in his hospital’s women’s health unit.

The authors recommend that the UK overhauls its monitoring of maternal mental health, which focuses on pregnancy and the early years after birth, because more than half the women who experience depression after becoming a parent are not identified by GPs, midwives or health visitors.

More women could have postnatal depression than the usual estimate of 10%-15% partly because women may mistake the signs of it – which include being more irritable than usual or unusually tearful, inability to enjoy being a parent or worrying unduly about the baby’s health – as being things undergone by all new mothers.

Health professionals do not always spot it or ask the right questions to identify it, though are far more aware of it than ever, Bolton added.

One leading psychiatrist said that the one in three women who had depressive symptoms was between two and five times higher than the estimated number of people in the general population who would experience serious low mood in their lifetime, but was higher than the number of women who experienced the most severe forms of depression. Between 5%-10% of people generally suffer major/serious depression during their lifetime.The study, published in BJOG: An international journal of obstetrics and gynaecology, is the first to follow a sizeable number of new mothers for as long as four years after birth. Elizabeth Duff, senior policy adviser at the parenting charity the NCT, said: “This study has included mothers for four years after birth, so suggests that perinatal mental health needs to be monitored for a longer period. Given the devastating effects of postnatal depression, health professionals should give equal consideration to the mental and physical health of parents with young children.”

A Department of Health spokeswoman said it welcomed any new research that would lead to women receiving better help with maternal depression.

“We want to do everything we can to make sure women and families get as much support as possible throughout pregnancy and beyond. That’s why, earlier this month, we announced that expert training in mental health will be rolled out for doctors and midwives to identify and help women who are at risk of depression or other mental health issues,” she said.

Numbers of midwives and health visitors have been growing under the coalition, while specialist mental health doctors and midwives will help improve earlier diagnosis of such problems, she added. However, the Royal College of Midwives said that even more midwives were needed to ensure mothers received the best possible care of their psychological welfare.

We must identify girls at risk from gangs

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gangs, isolation, risk, self-harm, sexual abuse, sexual exploitation, vulnerability

We must identify girls at risk from gangs

When I met Rita she was 17 and in custody for the 13th time. Her offending had escalated from moped theft and “antisocial” behaviour with boys when she was 11, through to firearms possession. She had been self-harming for the past three years, had contracted chlamydia, was malnourished, had developed an addiction to crack cocaine, and was being sexually exploited by the street gang to whom she was associated.

This had not happened to Rita overnight. It was the consequence of years of exploitation by her male peers, isolation from her friends, exclusion from school, and being sexually abused by a family member when she was eight years old. From a young age, a myriad of professionals had opportunities to intervene and protect Rita, but, instead, her risk snowballed.

A report published this week by the Centre for Mental Health demonstrates that Rita’s case is not a one-off. The report is based on data from 8,000 10- to 18-year-olds, who, following their arrest between August 2011 and November 2012, were screened for 29 different risk factors and health issues, such as family conflict, homelessness and victimisation, as part of a study to identify the most appropriate interventions. The screening process was a pilot run in 37 areas of England. Gang-involved girls were found to be over nine times more likely to exhibit 19 or more of these risk factors than the other young people screened.

Gang-involved girls navigate harmful environments and relationships. According to the study, young women who had “histories of parental imprisonment, poor parental mental health, parental substance misuse, or neglect” were three to five times more likely to be gang-involved than other girls who were screened. In addition, they were three times more likely to be identified as victims of sexual abuse and four times more likely to have been excluded from school.

The same girls were also more likely to have difficulties with their physical and mental health and wellbeing than other young people screened. Like Rita, 30% were reported to be self-harming or at risk of suicide, and were over three times more likely to have sexual health needs.

When public attention is focused on the horrendous accounts of groups of adult men sexually exploiting girls around the country, it is easy to forget about girls and young women who are at risk from their peers. The information provided clearly demonstrates that risk can be present in homes, peer groups, schools, neighbourhoods and in wider society, which increases the vulnerability of girls to street gangs. This report provides a statistical backdrop to the accounts given to me by hundreds of women and girls during the Female Voice in Violence project; now it is time to turn the stories and figures into action.

From preventing vulnerability, to the identification of girls linked to gangs, through to the programmes delivered to support them, and routes of safety that are offered, our processes need to be gender-specific. This groundbreaking report throws into sharp relief the impact of gang-association and the opportunities that exist to intervene across a young woman’s lifetime. Of the girls that were screened, 73% engaged with an intervention that was offered to them. It is critical that all agencies who work with girls and young women use the evidence to mobilise and evaluate interventions that will better identify and protect those involved with gangs.

Thousands Of Children At Risk Of Sexual Abuse Claims NSPCC

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Bullying, Children, missing persons, risk, sexual abuse, sexual exploitation, Teens

Thousands Of Children At Risk Of Sexual Abuse Claims NSPCC

Thousands of children repeatedly went missing from care homes last year, leaving them at risk of sexual abuse, a leading charity has said.

The NSPCC revealed that 7,885 teenagers and children vanished from care in England and Wales last year, with at least 2,959 going missing more than once, some 35 times.

Around 40% of the youngsters were aged 13 to 17, but some were as young as six.

Tom Rahilly from the charity said: “The state needs to be a parent for these children. If any other child went missing their parents would move heaven and earth to find them and to understand why they did it. It should be no different for young people in care.

“Repeatedly going missing should be a big warning sign as this kind of behaviour can put them at serious risk of harm such as grooming or sexual exploitation. But we have to understand why they are doing it.

“Children go missing for many reasons – they’re being bullied, they’ve been put in a home miles from their family and they miss them and their friends, or they just don’t trust staff enough to tell them where they are.

“Many will have been abused before being placed in care and they need a lot of attention and protection. Going missing for just an hour or two can be long enough for them to come to harm.”

The charity is calling for repeatedly going missing from care to be fully acknowledged as sign that a child is at greater risk of harm.

It also wants care staff to make sure that they listen to children about why they have gone missing rather than simply punishing them, and to work with police to stop children going missing and to return them to safety as quickly as possible.

The NSPCC made a Freedom of Information request to all the police forces in England and Wales to obtain the figures, and 29 out of 43 responded in full.

However the charity said that it is estimated that less than half of all missing cases of this kind are reported to police.

Figures from the Department of Education also differ drastically to those supplied by police, putting the number of missing children at fewer than 1,000, the NSPCC said.

Last month concerns were raised by children’s charities about changes to the way that police deal with missing people.

The plans could see the number of cases where officers are called out drop by a third.

Call handlers will class cases as either “absent”, when a person fails to arrive somewhere they are expected, or the more serious as “missing”, where there is a specific reason for concern.

Police deal with around 327,000 reports of missing people each year, the equivalent of around 900 a day, two-thirds of which involve children.

There is often a link between a child frequently going missing and falling prey to sexual abuse.

The NSPCC warned that the changes could put children at risk of being sexually exploited, while the Children’s Society claimed that pilots carried out were too short to prove the plans were safe.

A Department for Education spokesman said: “We welcome the NSPCC’s findings. It is simply unacceptable that some residential care homes do not respond immediately when young people go missing. That is why we are taking immediate action to reform the system, so all homes are safe and secure places where vulnerable children can get the support they need.

“We have already changed the rules so that Ofsted can share the names and addresses of care homes with the police to better protect children who go missing. For the first time, we will also begin collecting national data on all children who run away, not just those missing for 24 hours.

“Decisions about whether to place children at a significant distance from their local community will be taken at a much more senior level as a result of a new duty on local authorities.

“Additionally a new regulation will mean children’s homes should not be open in areas that are unsafe, and children’s home providers will be required to work with the police and LA to consider the risks. We are also taking steps to improve the skills of care home workers so they are better able to identify risks and take action before children run away.”

Chief Constable Pat Geenty from the Association of Chief Police Officers said: “We know that regularly going missing from home can be a warning sign of child sexual exploitation.

“It can also signify that children and young people may be at risk of other forms of abuse, becoming a victim of crime or involved in criminal activity.

“This is why we have acted to improve our response to risk assessing and responding to missing person cases.”

Mental health of Iraq and Afghanistan reservists causes alarm

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army, army reservists, civilian life, discharge, isolation, mental health issues, military personnel, needs, PTSD, risk, stigma, suicide, support, support networks, veterans, welfare

Mental health of Iraq and Afghanistan reservists causes alarm

Ministers must find more money to support thousands of army reservists as evidence grows that part-timers who served in Iraq and Afghanistan are more likely to suffer from serious mental health illnesses than regular soldiers who served alongside them, two leading military charities are warning.

Amid concerns there will be a sharp increase in the overall number of veterans needing expert help over the next five years, the Royal British Legion and Combat Stress say the government must focus on the so-called “weekend warriors” who have become a mainstay of British military operations and will be used to cover deep cuts to the full-time army.

The charities say reserves who fought abroad in recent years are twice as likely to develop serious mental health issues, such at post-traumatic stress disorder (PTSD), but they return to civilian life without proper support for themselves or their families.

The warning comes as some charities have reported a marked rise in the number of veterans coming to them needing help. At the start of a major series in the Guardian on the Iraq war, one former major general said he feared a “bow wave” of new cases would emerge over the next decade.

With the Ministry of Defence wanting to double the number of reservists to 30,000 over the next five years, Chris Simpkins, the director general of the Royal British Legion, and Commodore Andrew Cameron, chief executive of Combat Stress, said: “There is now a pressing need to seriously address the support requirements of reservists and their families.”

In an article for Comment is free, Simpkins and Cameron said: “We must work with the reservist community to raise awareness of mental health conditions and reduce the stigma associated with admitting to mental health issues … we are very clear that now is the time to develop resources, and we suggest that communities and health services that have increased numbers of reservists must receive more funds.”

Drawing on studies by the King’s Centre for Military Health Research, the charities say there is strong evidence to suggest reservists are more prone to mental health problems.

A five-year study of more than 500 reservists who served in Iraq showed they were twice as likely to get PTSD compared with regular soldiers. The report said reservists had “significantly elevated rates of common mental disorders” and warned that “rates of mental illness may continue to rise in the months and years after reservists have returned home”.

The charities say: “The reasons behind this increased risk aren’t fully known but … the differences between support networks for regulars and reservists may provide an answer.

“Unlike their colleagues in the regular forces, reservists do not have an extended period of time surrounded by their peers when they return home from duty, and often swiftly return to their civilian role, without the opportunity to share experiences with others who have served alongside them.

“These support networks are hugely important and the Royal British Legion and Combat Stress, alongside other armed forces charities, are working to minimise social isolation and improve integration between civilian and military life in the reservist community.”

Although UK forces pulled out of Iraq three years ago, and will have left Afghanistan by the end of next year, concern about the welfare of veterans is increasing, with some charities noting a sharp rise in referrals.

The most serious mental health problems, such at PTSD, often do not present themselves for a decade. Cameron said Combat Stress was still getting referrals from men who had served in Northern Ireland.

The charity registered a 29% increase in the number of Iraq war veterans it helped last year, bringing the total to 1,231. It is treating almost 500 Afghan war veterans – there was a 71% increase in the number of new referrals last year.

Major General Tim Cross, who served in Iraq, told the Guardian the problems faced by ex-servicemen would increase as the decade wore on. “I think we are building up. I’ve said for quite a while we [have] got a bow wave coming. PTSD on average takes about 11 years to really show,” he said. “A lot of the Falklands veterans have gone through really difficult times and they now say, I think it’s probably true, more Falklands guys have committed suicide than died during the campaign.”

A similar delayed reaction would happen with Iraq and Afghanistan, he said.

The MoD has set aside £7.2m to improve services for veterans and the government has appointed Lord Ashcroft to conduct a review focusing on the needs of military personnel as they undergo the transition to civilian life.

According to MoD statistics, 964 service personnel were medically discharged in the past five years suffering from mental and behavioural disorders – the second most common cause for discharge.

Of these, only 195 were suffering with PTSD. Though officials say the prevalence of this condition within the armed forces is roughly the same as the general population, there is suspicion among charities, and veterans that this does not reflect the true extent of a problem that might take years to develop.

Professor Marilyn Flynn, an expert on mental health issues in the military, said there was little incentive for serving personnel to admit they may have a problem: “If you say you are not fine, you go into limbo. There is no incentive to admit you might have a problem. You are neither one thing or another. There is a tremendous incentive to say that you are fine.”

Cameron said: “Do we need to do more for veterans? Yes. Can we do more? Probably. Can the charities do it themselves? No. A broken arm is obvious and easy to treat. A broken mind is not.”

 

Mentally ill people nearly five times more likely to be victims of murder than general population

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mental health issues, murder, myths, risk

Mentally ill people nearly five times more likely to be victims of murder than general population

People suffering from mental illness are almost five times more likely to be victims of murder than the general population, researchers have found .

The popular myth of the “mad axeman” on the loose has created an impression that mentally ill people are dangerous which may expose them to greater risk, they say.

Although murders committed by mentally ill people have been widely studied, much less attention has been given to murders of them.

Swedish and American researchers examined 615 murders in Sweden between 2001 and 2008 and found in more than one in five (22 per cent) the victim had been mentally ill.

It is well known that people with mental illness are more at risk of suicide and accidental death. But this is the first time they have been shown to be at increased risk of murder.

The risk of dying by murder was highest among those whose mental illness was complicated by drug abuse. But it was also increased in those with personality disorders, depression, anxiety and schizophrenia.

The researchers blame, in part,  the common perception that people with mental disorders are “unpredictable” or “dangerous”. This, they say, creates “feelings of uneasiness, fear and a desire for social  distance and may increase the risk of victimisation.”

Mentally ill people are also more likely to live in deprived neighbourhoods and may be less aware of risks to their safety owing to their illness.

The researchers based their findings on the entire adult Swedish population of more than 7 million and adjusted their results for sex, age, education, marital status, employment and income.

The findings, published in The Lancet, have implications for the assessment of mentally ill people, say  Roger Webb and colleagues from the University of Manchester in an accompanying editorial.

Doctors should asses their risk of being victims of violence, abuse and bullying, as well as  their risk of committing it. “Anti-stigma campaigns among the public should aim to counter fear of mentally ill people with sympathy for the risks they face.”