No honour in abuse: harnessing the health service to end domestic abuse

By Alexandra Galvin, Researcher

No honour in abuse: harnessing the health service to end domestic abuse

30th May 2022

Alexandra GalvinDomestic abuse is a public health crisis. It affects more than 2 million people – 1.6 million women and 757,000 men. It blights more lives every year than prostate cancer, breast cancer and dementia combined. Despite its prevalence, only 17% of victims report this crime.

Lack of reporting means most domestic abuse remains hidden. It has only grown worse during the pandemic, when perpetrators, victims and children were locked in together. Recent statistics from the Office for National Statistics reported a 20% increase in domestic abuse offences from the year ending in March 2019. Women’s Aid recorded a 50% surge in users of their Survivors’ Forum in the year 2020 over 2019, while the Asian Women’s Refuge Centre recorded 30% increase in callers during the lockdowns.

Reports of the tragic deaths of Baby Arthur and Baby Star have highlighted the failure by social services in a number of Local Authorities – but the truth is, health professionals share that responsibility. We found that domestic abuse was a factor in 37 of the 46 Serious Case Reviews published in 2021, and of these, 70% mentioned that victims or perpetrators presented to health agencies with possible signs of abuse but these were not addressed.

Health professionals treat domestic abuse like the elephant in the room. This “fear to know” approach is due to their lack of training and referral resources – they do not know how to identify abuse or invite disclosure. This is particularly true when health services are presented with survivors who belong to a closed community. Abuse in these cases is often labelled “honour-based abuse.” This misleading term covers a range of horrific practices: female foeticide, forced marriage, reproductive control, rape, 24/7 monitoring, ban on higher education, etc. With its implication that the victim has trespassed a traditional moral code, and “disrespected” a cultural legacy, “honour abuse” risks legitimising these practices. Instead, they are forms of physical and/or mental violence that traumatise victims (and their children).

“Therefore, the Centre for Social Justice Family Policy Unit has today published a report No honour in abuse: harnessing the health service to end domestic abuse to address this hidden health epidemic.

Key recommendations from the report include:

  1. Government should remove the term “Honour Abuse” from all official documentation, including police and medical records and correspondence, as this is not recognised by many victims or practitioners and risks legitimising the violent practices that it is supposed to define. “Honour” in this context only reflects the perpetrator’s rather than their victim’s viewpoint.
  2. NHS England and the Department of Health and Social Care (DHSC) need to take a lead in combating this health crisis. They should drive home the point that health professionals have a duty of care for any individual affected by domestic abuse – no matter what community or ethnic minority they belong to.
  3. The DHSC should introduce statutory training for all health professionals, including GPs, nurses, and Health Visitors, to train in identifying victims and perpetrators of domestic abuse and their children and offer referral them to appropriate services.
  4. Men and boys should be classed as victims of “intimate violence and abuse against men and boys” and have a parallel strategy, so it does not hinder the need for support for women and girls.
  5. The DfE should invest more in third sector perpetrator programmes, including customised programmes for perpetrators from closed communities, and in research into their effectiveness. It is only by engaging perpetrators that we can prevent the cycle of abuse.
  6. The Department for Levelling Up, Housing and Communities (DLUHC) should issue guidance to Local Authorities (LAs) to commission ‘by and for’ services for victims from certain minority groups which report facing particular barriers to disclosure: language, racism, fear of being ostracised, special diet, etc. More investment in ‘by and for’ services will help provide for the needs of these victims and reduce this health inequality.
  7. Commissioning of support services – community-based and refuges – is time and labour intensive, and invariably benefits the big organisations and charities. This fails to take into account that grassroot charities and groups are often best placed to meet the needs of local survivors. We recommend LAs collaborate and strategically target funding of organizations that support survivors from closed communities and marginalized groups.
  8. Social Prescribing link workers should be trained to identify victims, perpetrators and children experiencing domestic abuse; and know where to refer them to local services.
  9. The new Family Hubs announced at the last Budget and Comprehensive Spending Review should refer to, and where possible deliver, domestic abuse services.
  10. The new Integrated Care Systems and existing Clinical Commissioning Groups should fund services dealing with complex trauma. We echo the Victims Commissioner in calling for a consistent definition for “trauma informed.”
  11. The Royal College of Veterinary Surgeons should issue guidelines calling for training in identification and referral for domestic abuse victims, provided the connection between animal abuse and intimate partner abuse.

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