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Healthcare and police service use following violence: Data insights from South Wales

Understanding the barriers and facilitators influencing service use – such as police and healthcare – among people who experience violence is essential for improving support for victim-survivors and informing violence prevention initiatives. Administrative data are often limited to the users of a particular service, while linked data provides an opportunity to examine factors associated with the use of multiple services or one over the other.

VISION researchers, Anastasia Fadeeva, Emma Barton, Lara Snowdon and Estela Capelas Barbosa, used linked emergency department (ED) and police data from South Wales to observe  seasonal and annual changes in the use of both services and understand the individual and contextual factors associated with the use of healthcare and police for their recent article, Service use following violence: insights from the linked administrative data in South Wales. 

The linked ED-police data from South Wales allowed identification of incidents of violence recorded in ED data only and in both ED and police data as well as an analsyis of sociodemographic characteristics of victims and characteristics of violent incidents.

Results showed that violent incidents recorded in ED were more likely to be against people who were male and young, occur in more deprived areas, on a street, and with an assailant being a stranger, while the incidents with female victims was greater in the police data. If both services were accessed, the incidence of violence against females was higher among those who approached the police first. When incidents happened at the victim’s home and with the assailant known to the victim, both services were more likely to be used. The incidents that happened at a workplace were less likely to be reported to the police.

Violence continues to be primarily addressed within the remit of the criminal justice system, despite being acknowledged a public health problem. Older age and alcohol consumption were associated with the use of both services.

The researchers concluded that more measures are required to encourage young people to use services. Identifying and addressing barriers for disclosing workplace violence is recommended. Research and policies need to focus on identifying and addressing barriers for reporting violent incidents to the police by workplace victims and males. Relying on a single data source provides a partial and potentially biased picture of violence. Combining and linking different data sources offers a more comprehensive understanding but requires careful interpretation.

To download the article: More measures are required to encourage young people to use services. Identifying and addressing barriers for disclosing workplace violence is recommended.

To cite: Fadeeva, A., Barton, E.R., Snowdon, L. et al. Service use following violence: insights from the linked administrative data in South Wales. BMC Public Health (2026). https://doi.org/10.1186/s12889-026-30031-6

For further information: contact Anastasia at anastasia.fadeeva@citystgeorges.ac.uk

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Steps to Safety will help GPs connect patients with domestic abuse support

Steps to Safety, a domestic abuse sexual violence referral service, is to be established across all integrated care boards by 2029. Referring patients who are experiencing domestic violence will now be core business for general practice.

In support and to ensure assimilation of the programme, the Department of Health and Social Care (DHSC) recently announced that it will be tendering for a national partner to provide centralised assistance to integrated care boards, working alongside the government department, NHS bodies, and domestic abuse organisations.

The DHSC announcement and subsequent funding is vital to the success of Steps to Safety.

VISION Director and University of Bristol Professor in Primary Care, Gene Feder, has written an opinion piece for the BMJ, welcoming the government’s commitment to improve how domestic abuse is handled by the healthcare system. With his fellow academic and GP co-authors, Lucy Potter and Kate Pitt, they urge for programme evidence-based decisions alongside relational, integrated care and proactive outreach.

To download the opinion piece: Steps to Safety will help GPs connect patients with domestic abuse support

To cite: BMJ 2026;395:e101285

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Do all deaths count? A look at Domestic Abuse Related Death Reviews

In England and Wales, domestic abuse-related death reviews (DARDRs) bring stakeholders together to examine and learn from domestic abuse-related deaths. However, decision-making about which deaths to review has not been examined, creating a gap in knowledge about the notifications received, whether a DARDR is undertaken, and oversight and communication of outcomes. An exploratory study, Decision-Making on Deaths Subject to Domestic Abuse Related Death Reviews in England and Wales: Do All Deaths Count?, addresses this gap.

Researchers James Rowlands (Durham University), Elizabeth Cook (VISION consortium, City St George’s University of London) and Althea Cribb (independent) reviewed data collected from the local partnership bodies responsible for decision-making about domestic abuse-related death notifications received between January 2017 and December 2024. They examined the stages from the notification of a death to the decision about whether to undertake a DARDR—which, reflecting the terminology in England and Wales, is described as the “commissioning pathway”—and the oversight and communication of these decisions.

Results showed increasing numbers but a changing profile of notifications: homicide is no longer the most common case type, having been superseded by suicide. However, missing data hampers decision-making. Improved understanding of decision-making about which deaths are reviewed has significant implications for state accountability. Further clarity and guidance are needed for commissioners and other stakeholders regarding notification, identification, and decision-making.

To download the article: Decision-Making on Deaths Subject to Domestic Abuse Related Death Reviews in England and Wales: Do All Deaths Count?

To cite: Rowlands, J.., Cook, E. A., & Cribb, A. (2026). Decision-Making on Deaths Subject to Domestic Abuse-Related Death Reviews in England and Wales: Do All Deaths Count? Homicide Studies, 0(0). https://doi.org/10.1177/10887679261495100

For further information: contact James at james.h.rowlands@durham.ac.uk

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Involving young people in research on abuse

Despite a growing recognition that children and young people experience harm in their romantic relationships, young people’s voices are rarely heard in research on teenage relationship abuse (TRA), including on how to undertake such research with young people with lived experience.

Involving Young People in Research on Abuse: Young People’s Perspectives is a short report from VISION Research Fellows Polina Obolenskaya and Annie Bunce and colleagues that draws on the perspectives of four young people (aged 18 to 25). These views were expressed during an online workshop as a result of having experienced harmful relationships when they were 13 to 16 years old.

Thematic analysis identified five key themes from their discussions:

  1. Participating in research has psychological and practical benefits for young people but they still appreciate remuneration;
  2. It is important to reach out to as many young people as possible to broaden knowledge and perspectives of teenage relationship abuse;
  3. Researchers’ use of language around teenage relationship abuse is vital for involving young people in a meaningful way and for research quality;
  4. Providing choice, safety and clarity helps encourage young people to get involved and maintain their engagement in the research process;
  5. It is important to young people that they are kept informed about how their voices are shaping the research and driving change.

The report concludes with some practical recommendations for researchers.

To download the article: Involving Young People in Research on Abuse: Young People’s Perspectives

To download the infographic: Infographic_Involving young people in research on abuse

To cite: Obolenskaya, P., Bunce, A., Balachandran, I., Balachandran, M., Beat, E., and Waller, K (2026), Involving Young People in Research on Abuse: Young People’s Perspectives. Available at SSRN: https://ssrn.com/abstract=7570338 or http://dx.doi.org/10.2139/ssrn.7570338

For further information: contact Polina at polina.obolenskaya@citystgeorges.ac.uk

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Young people’s perspectives on experience of teenage relationship abuse and professional support

Violence and abuse in children and young people’s intimate relationships are frequently overlooked in research and policy, falling between child protection and Domestic Abuse policy. Focused work with young people with lived experience of harmful relationships is needed to ensure their voices are incorporated in research, policy and practice.

Too Soon Too Late: Young People’s Perspectives on Experience of Teenage Relationship Abuse and Professional Support, a study from VISION Research Fellows Polina Obolenskaya and Annie Bunce and colleagues, explores young people’s thoughts on experiences of violence and abuse in romantic relationships, including recognition, help-seeking, and professional support. The team draws on lived experience accounts of four young people aged 18-25 who experienced harm in their romantic relationships when aged 13-16 (via an online workshop).

This work was designed and co-produced by academics and a domestic abuse charity, SafeLives, as well as three young people from their ‘Changemakers’ network, some of whom had also experienced abuse, who facilitated the workshop.

The workshop transcript was coanalyzed using thematic analysis. Three themes were identified:

  1. violence and abuse in romantic relationships are not easily identifiable/recognizable in those aged 13-16, including among those who appear to be “doing well”;
  2. there are inadequacies and inconsistencies in the professional response; and
  3. earlier identification and more effective responses to harmful behaviors are crucial.

The study concludes that to improve recognition, identification, and responses to harm in teenage relationships, the following is required: adopting consistent and relatable terminology; empowering teachers to spot the signs of harm and strengthening communication between agencies; and tailoring responses to abuse among young people to their specific needs.

To download the article: Too Soon Too Late: Young People’s Perspectives on Experience of Teenage Relationship Abuse and Professional Support 

To cite: Obolenskaya, Polina and Bunce, Annie and Balachandran, Imi and Balachandran, Maya and Beat, Ellie and Waller, Kristie, Too Soon Too Late: Young People’s Perspectives on Experience of Teenage Relationship Abuse and Professional Support (October 06, 2026). Available at SSRN: https://ssrn.com/abstract=7570859 or http://dx.doi.org/10.2139/ssrn.7570859

For further information: contact Polina at polina.obolenskaya@citystgeorges.ac.uk

 
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Sexual violence against Palestinians

VISION Director and University of Bristol professor, Gene Feder, has written an opinion piece, Sexual violence against Palestinians, for the BMJ with colleagues Rubin Minhas, Neve Gordon, Mishal Khan and Nick Maynard.

Conflict related sexual violence (CRSV) occurs across conflict and coercive settings and can be perpetrated by state and non-state actors. Strong accountability for CRSV is required, regardless of who the victims or perpetrators are. Reports across multiple settings show patterns of conflict related sexual violence against Palestinian people. Evidence of CRSV is dispersed across accounts of detention, gendered abuse, humiliation, displacement, and harms to children. The authors bring the evidence together to show why efforts to secure accountability must tackle sexual violence, regardless of setting.

Sexual violence in conflict is a grave violation of human dignity that can inflict profound physical and psychological harm; its consequences can fracture communities and endure across generations. All credible patterns of sexual violence must be subject to accountability, regardless of who the victims or perpetrators are or where the violence occurs.

To download the opinion piece: Sexual violence against Palestinians

To cite: BMJ 2026;395:e101118

Health outcomes of victim-survivors accessing specialist domestic abuse services

Domestic abuse (DA) is a public health problem with wide-ranging impacts for victim-survivors and services responding to it. The purpose of the current study was to explore relationships between victim-survivors’ experiences of abuse, additional needs/vulnerabilities and sociodemographic characteristics, and physical and mental health outcomes and health care help-seeking behaviours following DA.

In the study, Health outcomes of victim-survivors accessing specialist domestic abuse services: the role of abuse experience, vulnerabilities and sociodemographic characteristics, VISION researchers Annie Bunce, Elouise Davies and Estela Capelas Barbosa, conducted a secondary analysis using Women’s Aid Federation of England’s (Women’s Aid) case management and outcomes measurement system, On Track, the largest national dataset on DA.

The team used a series of logistic regression models to understand the relationship between:

  • abuse types (physical, sexual, emotional, financial, coercive control, technology-facilitated abuse (tech abuse) and threats to kill);
  • needs/vulnerabilities (disability; offending, drug and alcohol-related support needs; pregnancy, recourse to public funds and accessing by-and-for services);
  • health outcomes (perpetrator caused harm to or loss of unborn child;
  • attempted strangulation;
  • self-harm (disclosed);
  • feeling depressed or suicidal;
  • injury requiring GP treatment; and
  • injury requiring Accident and Emergency (A&E) treatment).

Stakeholders from Women’s Aid and five other third sector organisations input into the study design and interpretation of results.

The study found:

  • Ninety-six percent of victim-survivors accessing DA services (n = 77,785) were female
  • Almost half (41.24%) had felt depressed/suicidal
  • 5.59% disclosed having self-harmed
  • Almost one quarter (23.41%) had suffered a strangulation attempt
  • 2.54% had suffered harm to or loss of their unborn child caused by the perpetrator
  • Just under 10% had an injury requiring A&E treatment
  • 7.33% had an injury requiring GP treatment

Associations with the type of abuse varied by health outcome, for example physical abuse followed by threats to kill were most strongly associated with attempted strangulation and injuries requiring GP and A&E treatment, whilst tech abuse was most strongly associated with self-harm and feeling depressed/suicidal. Vulnerabilities/needs were more consistently associated with health outcomes, with those with a disability; drug, alcohol or offending support needs, or living in temporary/unstable accommodation more likely to experience negative outcomes across the board, and almost all needs/vulnerabilities being associated with adverse mental health outcomes (with the exception of pregnancy and accessing specialist by-and-for services, which appeared to have a protective effect).

The results highlight the almost inevitable harms to mental health for victim-survivors of DA, the dangers of non-physical types of abuse such as threats to kill and tech abuse and the heightened risk of attempted strangulation. These findings have particularly important and timely implications for the training of health care professionals. Alongside improvements in health care settings, health care professionals, specialist support workers, researchers and policymakers must continue to explore more integrative and collaborative ways of working to further improve the response to DA and intervene before irreversible damage is done.

To download the article: Health outcomes of victim-survivors accessing specialist domestic abuse services: the role of abuse experience, vulnerabilities and sociodemographic characteristics

To cite: Bunce A, Davies E, Barbosa EC. Health outcomes of victim-survivors accessing specialist domestic abuse services: the role of abuse experience, vulnerabilities and sociodemographic characteristics. BMC Womens Health. 2026 May 23;26(1):363. doi: 10.1186/s12905-026-04518-8. PMID: 42177560; PMCID: PMC13374347.

For further information: contact Annie at annie.bunce@citystgeorges.ac.uk
 
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Costing the mental health harms of sexual and physical violence in adulthood

The Global Burden of Disease (GBD) Project showed that mental health disorders account for the greatest share of disease burden among survivors of intimate partner violence against females and of sexual violence against children. Economic costings of sexual violence in adulthood is often not costed and tends not to address the longer-term mental health harms despite the strong associations.

In the study, Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England, VISION researchers Sally McManus, Ladan Hashemi, Anastasia Fadeeva, Niels Blom and Estela Capelas Barbosa, with Sylvia Walby, estimated the annual cost of experience of violence throughout adulthood, in terms of reduced quality of life and health service costs.

Data were analysed from multiple sources, including the probability sample Adult Psychiatric Morbidity Survey and service delivery costs. Results showed that the estimated cost of long-term reduced quality of life adults in England experienced because of violence during adulthood was £3767 million in 2019, with associated healthcare costs in that year of £4130 million. Costs of long-term lost quality of life and healthcare were evident in both women and men, although higher in women. Costs associated with combined sexual and physical violence were particularly high, the great majority of these costs resulting from experience of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim.

Both sexual and physical violence have sizeable and independent associations with long-term mental health and treatment and service use. Violence reduction has potential to reduce health service costs and increase population level quality of life.

Research Highlights

  • Economic costings rarely quantify long-term mental health harms of sexual violence in adulthood.
  • Both sexual and physical violence are associated with sizeable costs.
  • The costs result from long-term mental health harms as well as treatment and service use.
  • Most of the mental health related costs of violence fall to women.
  • Interventions that reduce violence have potential to reduce health service costs and improve quality of life.

To download the article:  Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England

To cite: Sally McManus, Sylvia Walby, Ladan Hashemi, Anastasia Fadeeva, Niels Blom, Estela Capelas Barbosa, Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England, Public Health, Volume 258, 2026, 106400, ISSN 0033-3506, https://doi.org/10.1016/j.puhe.2026.106400.

For further information: contact Sally at sally.mcmanus@citystgeorges.ac.uk
 
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New VISION Policy Briefing Series on ethnicity inequalities and violence

In collaboration with Imkaan, the UK’s only national feminist umbrella organisation dedicated to addressing violence against Black and minoritsed women and girls, VISION Research Fellow, Dr Hannah Manzur, wrote two policies on the intersectionality of ethnicity, sex, gender, and violence focussing first on access to specialist services and second, through a systems theory approach.

The first policy briefing, Ethnic Inequalities in Violence Series: Specialist Services, is based on VISION research on ethnic inequalities, gendered violence, and specialist services. The research team finds critical inequalities in Black and minoritised women’s access to support and emphasises the need for a sustainably funded ‘By and For’ Sector.

The second policy briefing, Ethnic Inequalities in Violence Series: Systems Response, also uses VISION research on ethnic inequalities but looks at violence risks, harms, and service responses from a systems theory approach. This briefing identifies compounding disadvantages, intersecting inequalities, and critical gaps and disparities in victim-survivors’ services access and treatment.

 

Supporting Specialist Services for Black and Minoritised Women Victims of Violence: Access, Impact, & Resources

Specialist services provide life-saving support to people experiencing domestic and sexual violence, including trauma-informed and VAWG-sensitive care, counselling, legal and medical support, safety planning, advocacy, and crisis interventions delivered by trained caseworkers and practitioners. Led by Black and minoritised women, specialist ‘By and For’ services[1] are particularly important in offering essential holistic, wrap-around support, including intersectional advocacy, tailored to the specific needs and experiences of Black and minoritised women victim-survivors. Despite this, specialist services, particularly the ‘By and For’ sector, are constrained by chronic underfunding, limited inclusion and recognition of their expertise, and increased demand for services in an increasingly hostile political landscape for Black and minoritised communities and victim-survivors of violence.

Key Recommendations

  1. Funding: adequate, secured, and sustainable funding for specialist services with increased and ring-fenced ‘By and For’ funding.
  2. Recognition: formally recognise ‘By and For’ services as a distinct and essential model of VAWG prevention.
  3. No Recourse for Public Funds (NRPF): urgently repeal the NRPF condition.
  4. Data: introduce a data firewall for migrant victims, improve national ethnicity data, fund specialist services’ data-infrastucture projects, and engage ‘By and For’ expertise.
  5. Accessibility: evaluate national accessibility to specialist services, especially ‘By and For’ closures and reductions.
  6. Training: statutory services training in service provision tailored to Black and minoritised women victims.
  7. Collaboration: investment in collaborative partnerships, training, and referral protocols, led by ‘By and For’ expertise.

 

Ethnic Inequalities in Violence: Addressing Compounding Disadvantage and Institutional Engagement through a Systems Response to Violence

From data to policy to services, the systems designed to address the complex needs of violence victim-survivors of violence often fall short. Disjointed services, difficult pathways to support, and critical gaps in service provision create a complex system which victim-survivors, particularly those experiencing domestic and sexual violence, are expected to navigate to access support. For Black and minoritised victim-survivors of domestic and sexual violence, violence  causes and contexts, risks, harms, and support needs are shaped by both intersecting inequalities and compounding disadvantages. The combination of existing social disadvantages, under-funded and non-specialist public and specialist services, and disjointed and complex systems[2] requires urgently addressing from an intersectional and systems-based response to violence prevention and victim support.

Key Recommendations

  1. Systems-level responses: Targeted interventions and support provision must be integrated into a systems-level approach through cross-sectoral and multi-agency collaboration. Include funded advisory roles for specialist ‘By and For’ services representatives as systems leaders, not only referal partners.
  2. Build data and evidence linkages and expand cross-sectoral comparative research.
  3. Remove cross-sectoral barriers to support, including repealing the NRPF, introducing data-sharing firewalls, and enhance statutory duties.
  4. Invest in comparative and intersectional research which integrates multiple social contexts and axes of inequality.
  • [2] VISION’s systems theory approach was led by Dr Olumide Adisa. See for example: Adisa 2024, 2025.

 

To download the briefings:

To cite the Specialist Services briefing: Manzur, H. 2026. Supporting Specialist Services for Black and Minoritised Women Victims of Violence: A VISION Research and Policy Briefing in collaboration with Imkaan. London: VISION, Imkaan. https://doi.org/10.25383/city.33524527

To cite the Systems Response briefing: Manzur, H. 2026. Ethnic Inequalities in Violence: Addressing Compounding Disadvantage and Institutional Engagement through a Systems Response to Violence. A VISION Research & Policy Briefing in collaboration with Imkaan. London: VISION, Imkaan. https://doi.org/10.25383/city.33527260

For further information: contact Hannah at hannah.manzur.4@citystgeorges.ac.uk

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Domestic Violence and Abuse-Related Suicide: Evidence from Six Years of Irish Coronial Data

Domestic violence and abuse (DVA) and suicide are both major public health concerns, yet the relationship between them is less well understood. For people experiencing DVA, understanding their connection is key if support services and interventions are to respond effectively.

A new study, Domestic Violence and Abuse-Related Suicide: Evidence from Six Years of Irish Coronial Data, co-authored by Gemma Cox, Sarah Dangar, Katerina Kavalidou, and VISION researcher, Lizzie Cook, contributes new evidence to this emerging area of research. The study is the first in Ireland to examine the intersection between DVA and suicide using six years of national coronial data from the Irish Probable Suicide Deaths Study (IPSDS).

Using a mixed-methods approach, the study draws on coronial records of suicides to investigate the prevalence, circumstances, and characteristics where a link to DVA had been document. A total of 3622 cases of suicide were screened for evidence of DVA; of thse, 15 DVA-related suicides were identified, all of which were female. A series of composite narratives are used to highlight the complex interaction of factors shaping DVA and suicide.

The study highlights the importance of recognising DVA within wider suicide prevention efforts. However, it also raises important questions about how experiences of DVA are identified and recorded within coronial systems that investigates these deaths.

This paper will be of interest to researchers, clinicians, mental health professionals, domestic abuse practitioners, suicide prevention specialists, policymakers, coroners, voluntary and communtiy sector organisations, and others working across health, social care, and justic sectors.

To download the article in the Irish Journal of Psychological Medicine: Domestic violence and abuse-related suicide: evidence from six years of Irish coronial data

To cite: Cox G, Cook E, Dangar S, Kavalidou K. Domestic violence and abuse-related suicide: evidence from six years of Irish coronial data. Irish Journal of Psychological Medicine. Published online 2026:1-8. doi:10.1017/ipm.2026.10220

For further information: contact Lizzie at elizabeth.cook@citystgeorges.ac.uk

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