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.

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Mindfulness therapy comes at a high price for some, say experts

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anxiety, attention, breath, depersonalisation, Depression, health professionals, meditation, mindful living, mindfulness, mindfulness meditation, mindfulness therapy, mindfulness-based cognitive therapy (MBCT), NHS, side-effects, stress, teachers, training, trauma memories, vulnerability

Mindfulness therapy comes at a high price for some, say experts

In a first floor room above a gridlocked London street, 20 strangers shuffle on to mats and cushions. There’s an advertising executive, a personnel manager, a student and a pensioner. A gong sounds softly and a session of sitting meditation begins. This is one of more than 1,000 mindfulness courses proliferating across the UK as more and more people struggling with anxiety, depression and stress turn towards a practice adapted from a 2,400-year-old Buddhist tradition.

Enthusiasm is booming for such mindfulness-based cognitive therapy (MBCT) courses, which an Oxford University study has found can reduce relapses into depression by 44%. It is, say the researchers, as effective as taking antidepressants. It involves sitting still, focusing on your breath, noticing when your attention drifts and bringing it back to your breath – and it is surprisingly challenging.

Lifestyle magazines brim with mindfulness features and the global advertising giant JWT listed mindful living as one of its 10 trends to shape the world in 2014 as consumers develop “a quasi-Zen desire to experience everything in a more present, conscious way”.

But psychiatrists have now sounded a warning that as well as bringing benefits, mindfulness meditation can have troubling side-effects. Evidence is also emerging of underqualified teachers presenting themselves as mindfulness experts, including through the NHS.

The concern comes not from critics of mindfulness but from supporters, such as Dr Florian Ruths, consultant psychiatrist at the Maudsley hospital in south London. He has launched an investigation into adverse reactions to MBCT, which have included rare cases of “depersonalisation”, where people feel like they are watching themselves in a film.

“There is a lot of enthusiasm for mindfulness-based therapies and they are very powerful interventions,” Ruths said. “But they can also have side-effects. Mindfulness is delivered to potentially vulnerable people with mental illness, including depression and anxiety, so it needs to be taught by people who know the basics about those illnesses, and when to refer people for specialist help.”

His inquiry follows the “dark night” project at Brown University in the US, which has catalogued how some Buddhist meditators have been assailed by traumatic memories. Problems recorded by Professor Willoughby Britton, the lead psychiatrist, include “cognitive, perceptual and sensory aberrations”, changes in their sense of self and impairment in social relationships. One Buddhist monk, Shinzen Young, has described the “dark night” phenomenon as an “irreversible insight into emptiness” and “enlightenment’s evil twin”.

Mindfulness experts say such extreme adverse reactions are rare and are most likely to follow prolonged periods of meditation, such as weeks on a silent retreat. But the studies represent a new strain of critical thinking about mindfulness meditation amid an avalanche of hype.

MBCT is commonly taught in groups in an eight-week programme and courses sell out fast. Ed Halliwell, who teaches in London and West Sussex, said some of his courses fill up within 48 hours of their being announced.

“You can sometimes get the impression from the enthusiasm that is being shown about it helping with depression and anxiety that mindfulness is a magic pill you can apply without effort,” he said. “You start watching your breath and all your problems are solved. It is not like that at all. You are working with the heart of your experiences, learning to turn towards them, and that is difficult and can be uncomfortable.”

Mindfulness is spreading fast into village halls, schools and hospitals and even the offices of banks and internet giants such as Google. The online meditation app Headspace now has 523,000 users in the UK, a threefold increase in 12 months. But mounting public interest means more teachers are urgently needed and concern is growing about the adequacy of training. Several sources have told the Guardian that some NHS trusts are asking health professionals to teach mindfulness after only having completed a basic eight-week beginners’ course.

“It is worrying,” said Rebecca Crane, director of the Centre for Mindfulness Research and Practice in Bangor, which has trained 2,500 teachers in the past five years. “People come along to our week-long teacher training retreat and then are put under pressure to get teaching very quickly.”

Exeter University has launched an inquiry into how 43 NHS trusts across the UK are meeting the ballooning demand for MBCT.

Marie Johansson, clinical lead at Oxford University’s mindfulness centre, stressed the need for proper training of at least a year until health professionals can teach meditation, partly because on rare occasions it can throw up “extremely distressing experiences”.

“Taking the course is quite challenging,” she said. “You need to be reasonably stable and well. Noticing what is going on in your mind and body may be completely new and you may discover that there are patterns of thinking and acting and behaving that no longer serve you well. There might be patterns that interfere with living a healthy life and seeing those patterns can bring up lots of reactions and it can be too much to deal with. Unless it is handled well, the person could close down, go away with an increase in self-criticism and feeling they have failed.”

Finding the right teacher is often difficult for people approaching mindfulness for the first time. Leading mindfulness teaching organisations, including the universities of Oxford, Bangor and Exeter, are now considering establishing a register of course leaders who meet good practice guidelines. They expect mindfulness teachers to train for at least a year and to remain under supervision. Some Buddhists have opposed the idea, arguing it is unreasonable to regulate a practice rooted in a religion.

Lokhadi, a mindfulness meditation teacher in London for the past nine years, has regular experience of some of the difficulties mindfulness meditation can throw up.

“While mindfulness meditation doesn’t change people’s experience, things can feel worse before they feel better,” she said. “As awareness increases, your sensitivity to experiences increases. If someone is feeling vulnerable or is not well supported, it can be quite daunting. It can bring up grief and all kinds of emotions, which need to be capably held by an experienced and suitably trained teacher.

“When choosing a course you need to have a sense of the training of the teacher, whether they are supervised and whether they themselves practise meditation. Most reputable teacher training courses require a minimum of two years’ meditation practice and ensure that teachers meet other important criteria.”

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.

Teachers left to pick up pieces from cuts to youth mental health services

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behavioural problems, CAMHs, Children, counselling, counsellors, early intervention, emotional difficulties, mental health issues, mental health services, school, stress, support, teachers, training, well-being, young people

Teachers left to pick up pieces from cuts to youth mental health services

As the headteacher of large primary school in the west of England, Joan Cunningham is accustomed to the demanding aspects of managing an intake from a mainly disadvantaged area. However, for the past couple of years, she says, one issue has escalated so dramatically that it is nearly at crisis point. “There is so much more pressure on schools and teachers to deal with children’s mental health and behavioural problems,” she says. “We provide as much support as we can but, with fewer resources available and a massive increase in need … the pressure has been incredible.”

Cuts to mental health and other services for young people mean teachers are increasingly having to fill the gap, even though schools do not always have the resources or training to provide the extra support pupils with mental or emotional issues may need.

“It was already hard to access the right services before cuts but its getting worse,” Cunningham says. “Teachers … are not mental health professionals, and now there is a vacuum in the services we have [traditionally] relied on. Social services departments are under more pressure due to cuts, Sure Starts … have vanished, [and] in many cases the voluntary organisations we used to be able to turn to are disappearing. Sign-posting families to where they can get help is much harder because of all of this.” At a time when families are under greater financial strain and “even very young children” are under pressure to achieve academically, she concludes, the need for support is “growing very fast”.

Child and adolescent mental health services (Camhs) have been particularly hard hit. These specialist services assess and treat children and young people with mental, emotional or behavioural difficulties. Typically, when schools cannot offer the support of their own counsellor, or when a child has especially serious difficulties, they will seek out their local Camhs for help.

In many cases, local authorities commission and fund these services, and the impact of council budget cuts on Camhs in some areas has been severe. According to research by the charity Young Minds, two-thirds of councils in England have reduced their Camhs budget since 2010. And when the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, more than half had cut budgets – some by as much as 30%.

The cuts mean local authorities’ Camhs spending is increasingly redirected towards more serious cases of mental ill-health, at the expense of early intervention services. “Draining money from early intervention services is short-sighted and just stores up problems for the future,” says Sarah Brennan, chief executive of Young Minds. “The result is Camhs feels it is being asked to respond to an enormous number of issues and schools feel Camhs has left them high and dry.”

Chris Harrison, national executive member and former president of the NAHT, says part of the problem until recently has been that targets in education have allowed children’s wellbeing to slip down the agenda. “The issue of mental health [in schools] has been coming to the fore over the past four or five years; there’s a real groundswell of interest, but it isn’t yet a priority in schools. We need to accept that preparation for life is about more than academic results.”

Research by the Teacher Support Network, a charity focusing on teachers’ wellbeing, shows around half of teachers feel pupil behaviour is worsening. Its survey of over 800 teachers also found almost two-thirds were stressed as a result.

The cuts to Camhs mean schools are struggling to provide professional support on site. Some have set aside cash from the Pupil Premium to pay for a regular counsellor. Andy Bell, deputy chief executive at the Centre for Mental Health, says that an “ad-hoc” system of support relies too heavily on the initiative of individual heads or teachers, and is undermined by unsatisfactory and arbitrary access to funds. “We see raising awareness of this issue as a major priority,” he says. “When we conducted research on child behavioural problems we found that three-quarters of parents asked teachers for help … However, some schools are better equipped than others. Many have virtually nothing by way of [professional] support, while others have full-time counsellors.”

Inadequate and underfunded services mean undue stress is being put on teaching staff, who may feel they are not trained or qualified to tackle many of the emotional or mental health problems that come up.

And with anecdotal evidence suggesting the number of young people experiencing mental health problems is rising, the crisis in Camhs is set to get worse. In 2004, the last year that government statistics were centrally collected on the prevalence of mental ill-health among children and young people, 1.3 million children were deemed to have a diagnosable mental illness. The economic downturn, coupled with government austerity and exam stress, means this figure is now probably much higher. And with NHS England estimating that only a quarter of children and young people with a problem are ever seen by mental health services, the figures are just the tip of the iceberg.

Politicians are becoming more aware of the scale of the problem. The health select committee has begun a parliamentary inquiry into Camhs, which campaigners hope will push mental health in schools higher up the agenda when it is published this year. “What we need is a consistent, national system that is accountable. What we need is for Camhs to be transformed.” says Bell.

Harrison says more needs to be done to ensure heads and schools have access to effective support services. “Schools and heads are battered at the moment. We want the government to look at the evidence. It’s common sense. There is overwhelming evidence that students learn better and are more effective in environments where they are supported and their teachers are supported.”

For now, charities and campaign groups are having to help schools themselves. Young Minds offers guidance on its website for teachers and is about to pilot a helpline for school staff, while the anti-stigma campaign Time to Change is running a project promoting pupil wellbeing and offering practical guidance for teaching staff. “Pupils are under much more stress these days and so are staff, yet teachers don’t have training in mental health – or spare time,” says Moira Clewes, lead teacher on health at Sandwich technology school, Kent, one of the schools piloting the project. “We are breaking down misconceptions around mental illness. Students are opening up. Teachers are grateful for advice. You’d be amazed at the impact this is having.”

A Department for Education spokesperson points to a range of initiatives, including the MindEd website, launched in March, designed to help people working with children, including teachers, “to recognise when a child needs help and how to make sure they get it”. The Department of Health says it has a “priority” focus on children’s mental health and, among other things, has put additional cash in to “talking therapies”, adding that it is liaising with the DfE to improve links between schools and Camhs.

For Cunningham, while any help is welcome, she is adamant that “nothing short of a clear, coherent and properly funded approach nationally will work for schools and for children”.

• Some names have been changed

‘Indiana Jones of surgery’ leads UK medics in war-zone training

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disaster and conflict zones, emergency response teams, humanitarian crisis, medical assistance, medical interventions, natural disasters, surgeons, training, war

‘Indiana Jones of surgery’ leads UK medics in war-zone training

More than 1,000 NHS physicians are set to receive specialist training to provide emergency medical interventions in disaster and conflict zones, under the tutelage of one of Britain’s most renowned surgeons.

The first group of 30 clinicians completed an intensive training course earlier this month which equipped them with skills needed for medical procedures with minimal equipment and support. It was funded by the Department for International Development (DFID) and led by the London vascular surgeon David Nott – dubbed the “Indiana Jones of surgery”.

Mr Nott, who has piloted the course alongside the Royal College of Surgeons, has 20 years’ experience working in regions scarred by war and natural disasters, and made headlines five years ago when he amputated a boy’s shoulder in the Democratic Republic of the Congo (DRC), taking instructions from a colleague in the UK via text message.

A register of medics willing to be deployed to humanitarian crisis zones – the UK International Emergency Trauma Register – was set up by DFID last year and now contains more than 1,000 names. Surgeons who have completed the required training may be called up to join emergency response teams in the event of a natural disaster or a major humanitarian crisis where the UK government has decided to intervene directly.

Increasing numbers of British doctors travel to Syria with NGOs to assist at hospitals overwhelmed by victims of the civil war. Although there are no plans yet for the UK government to provide direct medical assistance in Syria, DFID financially supports NGOs providing back-up at hospitals and field clinics. Overall, the UK has committed £348m to aid the Syrian people.

Mr Nott, who has been working as an emergency surgeon for the NGOs Médecins sans Frontières (MSF) and the International Committee of the Red Cross (ICRC) for 20 years, said that the training is sorely needed.

“It’s the first course run like this in the whole world,” he said. “We go through things by scenarios. If there was a chest problem and you need to sort it out but you’re working in a tent, you don’t have much blood stock and you don’t have any intensive care unit, how do you save that person? How do you save the person that is bleeding out from their arm? How do you save someone with abdominal gunshot wounds? There are ways. If you’ve had the training, even if you’ve seen it done only once or twice, then it’s much easier.”

The one-week intensive course had participants working with cadavers in simulated disaster zones. Mr Nott, who will soon travel to Syria with an NGO to teach similar techniques to local doctors in rebel-held areas, said that many doctors in the UK “have the ambition” to work in extreme circumstances.

One of his own students at Imperial College London, Dr Isa Abdur Rahman, 26, was killed working in a makeshift hospital in Syria in May. A number of young doctors, often with family ties to Syria, have risked their lives working for medical charities in the country since the conflict began two and a half years ago.

“You can’t stop the desire of people to go,” Mr Nott said. “If you want to go and do things, it’s a great thing, but you do take huge risks. We’re opening this course not only to consultants but to juniors as well, so at least if they’re not experienced enough at the present time, they are the generation that’s going to follow.”

Mr Nott first worked for MSF in Bosnia in 1993. Since then, he has travelled to dozens of countries including Sierra Leone, Sudan, the DRC and Chad, and has served with the Defence Medical Services in Basra, Iraq, at the height of violence in the city in 2007, as well as at Camp Bastion in Afghanistan.

While working 24-hour shifts with MSF in the DRC in 2008, he had to perform a life-saving amputation on a boy whose left arm had been ripped off, becoming badly infected. Although he had never performed the operation before, he took instructions via text from a colleague who had at London’s Royal Marsden Hospital, and saved the boy’s life.

The following year, while working in the wake of the Haiti earthquake, he saved the life of a baby found in the rubble of a hospital in Port-au-Prince, arranging an emergency flight to Britain for specialist surgery on her skull. The child, Landina Seignon, made global headlines when she was reunited with her mother, who rescuers had feared was dead.

Mr Nott still operates at three London hospitals, working in general surgery at Chelsea and Westminster, vascular and trauma at St Mary’s and in cancer surgery at the Royal Marsden. He takes six weeks’ unpaid leave each year to carry out his humanitarian work.

“I felt that my first mission, to Bosnia, was the most exciting thing I’ve ever done in my whole life,” he said. “To be able to help people that really needed it, who wouldn’t have help without you, was something fantastic. That always stayed with me. It was a burning flame that I couldn’t put out. Life is enriched hugely by doing something like this. We found that all it needs is somebody to get this course up and running and you suddenly see people coming out of the woodwork that also have the ambition to do this.”

In memory of dedication

Dr Isa Abdur Rahman, who trained under Mr Nott, was killed working in Syria in May. The 26-year-old graduate from Imperial College London was working for the UK charity Hand in Hand for Syria when the makeshift hospital in Idlib province where he was based was shelled. His friends set up an online fundraising page in his honour, which has raised nearly £72,000. They plan to use the funds to build a field hospital in memory of Dr Rahman in Homs, Syria.

More than 1,000 NHS physicians are set to receive specialist training to provide emergency medical interventions in disaster and conflict zones, under the tutelage of one of Britain’s most renowned surgeons.

The first group of 30 clinicians completed an intensive training course earlier this month which equipped them with skills needed for medical procedures with minimal equipment and support. It was funded by the Department for International Development (DFID) and led by the London vascular surgeon David Nott – dubbed the “Indiana Jones of surgery”.

Mr Nott, who has piloted the course alongside the Royal College of Surgeons, has 20 years’ experience working in regions scarred by war and natural disasters, and made headlines five years ago when he amputated a boy’s shoulder in the Democratic Republic of the Congo (DRC), taking instructions from a colleague in the UK via text message.

A register of medics willing to be deployed to humanitarian crisis zones – the UK International Emergency Trauma Register – was set up by DFID last year and now contains more than 1,000 names. Surgeons who have completed the required training may be called up to join emergency response teams in the event of a natural disaster or a major humanitarian crisis where the UK government has decided to intervene directly.

Increasing numbers of British doctors travel to Syria with NGOs to assist at hospitals overwhelmed by victims of the civil war. Although there are no plans yet for the UK government to provide direct medical assistance in Syria, DFID financially supports NGOs providing back-up at hospitals and field clinics. Overall, the UK has committed £348m to aid the Syrian people.

Mr Nott, who has been working as an emergency surgeon for the NGOs Médecins sans Frontières (MSF) and the International Committee of the Red Cross (ICRC) for 20 years, said that the training is sorely needed.

“It’s the first course run like this in the whole world,” he said. “We go through things by scenarios. If there was a chest problem and you need to sort it out but you’re working in a tent, you don’t have much blood stock and you don’t have any intensive care unit, how do you save that person? How do you save the person that is bleeding out from their arm? How do you save someone with abdominal gunshot wounds? There are ways. If you’ve had the training, even if you’ve seen it done only once or twice, then it’s much easier.”

The one-week intensive course had participants working with cadavers in simulated disaster zones. Mr Nott, who will soon travel to Syria with an NGO to teach similar techniques to local doctors in rebel-held areas, said that many doctors in the UK “have the ambition” to work in extreme circumstances.

One of his own students at Imperial College London, Dr Isa Abdur Rahman, 26, was killed working in a makeshift hospital in Syria in May. A number of young doctors, often with family ties to Syria, have risked their lives working for medical charities in the country since the conflict began two and a half years ago.

“You can’t stop the desire of people to go,” Mr Nott said. “If you want to go and do things, it’s a great thing, but you do take huge risks. We’re opening this course not only to consultants but to juniors as well, so at least if they’re not experienced enough at the present time, they are the generation that’s going to follow.”

Mr Nott first worked for MSF in Bosnia in 1993. Since then, he has travelled to dozens of countries including Sierra Leone, Sudan, the DRC and Chad, and has served with the Defence Medical Services in Basra, Iraq, at the height of violence in the city in 2007, as well as at Camp Bastion in Afghanistan.

While working 24-hour shifts with MSF in the DRC in 2008, he had to perform a life-saving amputation on a boy whose left arm had been ripped off, becoming badly infected. Although he had never performed the operation before, he took instructions via text from a colleague who had at London’s Royal Marsden Hospital, and saved the boy’s life.

The following year, while working in the wake of the Haiti earthquake, he saved the life of a baby found in the rubble of a hospital in Port-au-Prince, arranging an emergency flight to Britain for specialist surgery on her skull. The child, Landina Seignon, made global headlines when she was reunited with her mother, who rescuers had feared was dead.

Mr Nott still operates at three London hospitals, working in general surgery at Chelsea and Westminster, vascular and trauma at St Mary’s and in cancer surgery at the Royal Marsden. He takes six weeks’ unpaid leave each year to carry out his humanitarian work.

“I felt that my first mission, to Bosnia, was the most exciting thing I’ve ever done in my whole life,” he said. “To be able to help people that really needed it, who wouldn’t have help without you, was something fantastic. That always stayed with me. It was a burning flame that I couldn’t put out. Life is enriched hugely by doing something like this. We found that all it needs is somebody to get this course up and running and you suddenly see people coming out of the woodwork that also have the ambition to do this.”

In memory of dedication

Dr Isa Abdur Rahman, who trained under Mr Nott, was killed working in Syria in May. The 26-year-old graduate from Imperial College London was working for the UK charity Hand in Hand for Syria when the makeshift hospital in Idlib province where he was based was shelled. His friends set up an online fundraising page in his honour, which has raised nearly £72,000. They plan to use the funds to build a field hospital in memory of Dr Rahman in Homs, Syria.

Congo receives £180m boost to health system to tackle warzone rape

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abuse, conflict, Congo, DRC, rape, sexual abuse, sexual assault, Sexual Violence, soldiers, taboo, training, war, War Crimes, weapon of war

Congo receives £180m boost to health system to tackle warzone rape

When Beatrice was raped, by a gang of soldiers who sauntered by her home and saw her alone, she thought it was the end of world. She could not have imagined then that rape was only the start of a terrible downward spiral that would often seem to have no end.

“My husband came and said what happened? You can’t be telling me the truth. He no longer wanted to be with me and he left. I was alone with five children.”

Beatrice, not her real name, now has a sixth child, the result of the rape. The infant is strapped to her back, and sleeps while she sobs at the memories that stalk her, in a dark room in a hospital in Goma, in the violent south-eastern corner of the Democratic Republic of the Congo.

“My husband’s parents totally rejected my child. The village did. Everyone who sees me, curses me. They say I am a soldier’s mistress.”

Beatrice’s ever deepening tragedy is also a national nightmare. By the United Nations’ very conservative estimate, 200,000 women have been through a similar ordeal since 1998.

On a trip to Goma, William Hague, the British foreign secretary, launched the UK’s plan to help tackle the crisis, announcing £180m in new funding for the DRC health system, some of which will go to training medical staff to give proper care for rape victims.

Jonathan Lusi, a surgeon at the Goma hospital, both tends to the very serious injuries which accompany rape, and oversees his patients’ psychological recovery, training to give them independent livelihoods.

“We are in a war. It’s a legal vacuum. There is no government, no authority and no values. Rape is a warning sign something has gone very wrong.”

The DRC, after decades of conflict and turmoil is just one of the world’s battlefields where the routine sexual abuse of women and girls is a weapon of war. No one has any idea how many have been raped in Syria, for example. It is hard enough to count the bodies. It is a crime against humanity that often goes unmentioned because of the squeamishness of public officials and the many challenges to collecting evidence. Corpses are easier to count than rapes, while the victims of rape live in societies that enforce silence.

The tens of thousands of rapes during the Bosnian war, for example, have only led to 30 convictions.

The British government will attempt to break the official silence over the use of sexual violence as a weapon of war by taking the unusual step of using its presidency of the G8 this year to put it at the heart of the agenda of the rich nations’ club that has in recent years been preoccupied with economic woes.

“It’s time for the governments of the world to do something about this,” said Hague in an interview with the Guardian during a visit to Goma. “I will argue it has been taboo or ignored and taken for granted for too long … We can move the dial on something like this. We are big enough in the world to do something about this.”

As well as the money pledged to support the DRC health system, Hague also announced £850,000 in support for an advocacy group called Women’s Initiatives for Gender Justice to help it document cases in eastern DRC and push the international criminal court (ICC) to take heed of sexual crimes in its deliberations. Other funding will go to Physicians for Human Rights, another NGO, for evidence collection equipment such as locked evidence cabinets for eventual prosecutions.

Such prosecutions are not necessarily a distant aspiration. One of the leaders of the rebel M23 militia, Bosco Ntaganda, handed himself in at the US embassy in Kigali, the capital of neighbouring Rwanda, last week and was flown to face war crimes charges at the ICC in the Netherlands, where he denied charges including murder, rape, pillaging and using child soldiers in his first appearance on Tuesday.

Hague was accompanied in Goma by Angelina Jolie, with whom he has forged an unorthodox partnership to campaign on the issue. He credits Jolie’s film last year about Bosnian rape camps, In the Land of Blood and Honey, with helping to inspire the British initiative.

“The hope and the dream is that next time this happens, it is known that if you abuse women, if you rape the women, you will be accountable for your actions,” Jolie told the Guardian. “This will be a crime of war and you won’t just get away with it.”

Hague and Jolie visited a camp on the shores on Lake Kivu which has sprung up as a result of an upsurge in fighting when the M23 advanced into Goma last November.

Set against a breathtaking backdrop of lake and volcanoes, the camp of 10,000 people is a huddle of meagre straw shelters half covered with tarpaulin.

The women here are forced to venture out of the camp to collect firewood or water. Both make them vulnerable to rape and many of the women and girls have been assaulted. All the International Rescue Committee, which runs the camp, can offer to mitigate the threat are “dignity kits” that contain efficient stoves that require less firewood and extra clothes so the women have to look for washing water less often.

“It’s a sad fact that when you ask how to reduce sexual violence the answer is to help them not have to go out,” Jolie said.

On the way out of the camp a woman who had earlier given Hague and Jolie a reserved factual account of her experiences ran up to them on a last minute impulse: “Please help us. We are being raped like animals.” Hague said: “The memory of meeting her will always stay with me.”

Social workers need training to help them better understand self-harm

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autism, awareness, education, family, online support, physical health, self-harm, social workers, support, training, understanding, young people

Social workers need training to help them better understand self-harm

It is estimated that one in 12 young people have self-harmed at some point in their lives, according to charity YouthNet. The charity says 3,000 people aged 16 to 25 visit its digital support service TheSite.org every month after looking up self-harm on a search engine. Yet, despite these statistics, self-harm awareness training for social workers is not always as comprehensive as it could be.

Nushra Mansuri, professional officer (England), at the British Association of Social Workers (BASW), says while some social workers – such as those working in mental health – may be sensitive to the issue of self-harm, there needs to be more awareness of the problem within the profession and that self-harm training is patchy.

“Whatever client group you work with, it will be a feature – it [self-harm training] should be integral because you are working with people whose lives are in crisis – there is a high correlation between the people you work with and people with a propensity to hurt themselves,” she says.

“Social workers need a greater awareness of the issue and need to understand why people self-harm. I wouldn’t lump everyone together, but it can be the impact of trauma, it can be a cry for help, it gives someone, who may have had control taken away from them, a sense of control.”

What mistakes could a social worker who lacks awareness of the issue of self-harm make? “An untrained person may have a tendency to look at the superficial and not go beyond that,” Mansuri says. “A social worker may be out of their comfort zone and not be able to deal with it – dealing with someone’s raw pain is really hard.”

Mansuri adds that social work “doesn’t have all the answers” when it comes to self-harm and that more education is required. “There is an underestimation of the importance of looking at self-harm,” she says.

Jennifer McLeod, managing director of self-harm training provider Step Up! International, says in some regions self-harm training for social workers is inadequate.

“Social workers ought to be trained in spotting the signs; if they aren’t spotted, it could be fatal,” she says. “It’s about listening to what’s not being said, looking for physical signs and emotions – they [people who self harm] are generally hiding something.”

McLeod adds that well-trained social workers will broach the topic with the young people and their families. “There might be denial from parents and social workers will have to find ways of eliciting information from young people.”

McLeod says delegates at Step Up! International training courses are often in a state of panic about the issue as they are uncertain about how to deal with the problem or even broach the subject.

“Some professionals don’t feel confident about bringing up the issue directly, they daren’t ask about it as they think it might make it worse”, she says.

McLeod suspects self-harm is on the increase – and is being talked about more – because of the current economic climate.

“In addition to the emotional and biological changes [young people experience], there is the recession, labour market issues, parents being made redundant – parents may not be managing and may be economically struggling,” she says.

Caroline Hattersley, head of information, advice and advocacy at theNational Autistic Society (NAS), says people with autism face a “raft of challenges” that might make self-harm more likely.

“Autism does bring specific difficulties – we’d like to see more training on understanding autism and its relation to self harm,” she says. “The key is understanding the individual and understanding the underlying causes.” Lacking this understanding could lead to a social worker misinterpreting why someone is self-harming, Hattersley adds.

“The individual might not have done it before, they may be hitting their head because they may have communication difficulties and they’re trying to communicate a physical problem – you might miss an ear infection,” she says.

Hattersley acknowledges that it can be difficult for professionals to admit they are struggling with the issue of self-harm. NAS has set up Network Autism, a forum where professionals can read research, and discuss with each other, the issue of self-harm and how it relates to people with autism.

YouthNet’s chief executive Emma Thomas says all practitioners working with people who self-harm would benefit from a better understanding of the problem. She adds: “If social workers are more aware of services like TheSite.org, many more young people can be directed to safe, anonymous online support to complement the vital offline support they need.”