Although few studies have explored people’s experiences of domestic abuse and cancer, we know the two co-occur. The few studies we do have show that cancer can trigger an escalation of abuse. But there are no published domestic abuse interventions in the cancer setting.
The key findings demonstrate that cancer and DA frequently co-occur, and that training and support intervention of hospital-based cancer staff increased the rate of DA identifications. There is an appetite for DA and cancer training amongst hospital-based cancer staff.
The evaluation contributes further evidence of the benefit of hospital-based domestic abuse coordinator roles and contributes new evidence for the feasibility of adapting the role for a specific context.
To read the article or download the paper free of charge:
Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention. Dheensa, Sandi et al. European Journal of Oncology Nursing, Volume 0, Issue 0, 102724
The UK Office for National Statistics (ONS) developed a prototype violence against women and girls (VAWG) data dashboard in 2022. The webpages presented statistics and charts on violence against women and girls in England and Wales, drawing on multiple sources. However, due to reprioritisation at ONS, maintenance of the dashboard stopped and as of April 2024 it was no longer accessible.
VISION developed a consultation to ascertain the usefulness of a VAWG data dashboard as a result. The call was open from March to May 2024, and 102 responses were received. Most participants responded in their capacity as individuals (n=61), although 25 stated that they were responding on behalf of an organisation and four on behalf of a group. Some participants both responded as an individual and on behalf of an organisation or group.
Consultation participants responded as people from across a variety of roles and sectors. The most commonly cited were working in research or education (n=40) and in policy or planning (n=28), 27 people responded as someone with lived experience and 13 as members of the public. The remainder comprised those in service provision (n=17), a campaign role (n=10) or some other capacity (8).
Consultation results
Many participants had heard of the data dashboard before the VISION consultation (n=51), although 28 reported that they had not. Of those who had heard of the dashboard before, most had made use of it (n=39).
Most participants reported that having a dashboard that brought together data on violence and abuse would help them either ‘somewhat’ (n=12) or ‘a lot’ (n=39).
Participants were asked what they found to be useful about the data dashboard:
Data discovery
Finding data and finding it faster
Breakdowns and local profiles
Comparisons
Authoritative context
Source material
Participants were asked for their thoughts on the limitations or what was missing from the dashboard:
Wider coverage in relation to topics (health, disability, suicide, law, family courts, policy), types of violence and abuse (homicide, forced marriage, sexual violence), and particular groups (men, perpetrators)
Deeper context in terms of much more nuanced contextual discussion of what the data means, ‘data without context is misleading’
Critical interrogation such as the highlight of methodological limitations
Interactive functionality with more scope for further breakdowns by local authority areas and police forces for example
Improved search function
Positive action such as a ‘section about work being done to support victims/reduce cases’
Human stories meaning to go beyond numbers and to tell the human stories that underpin them
Recommendations
Through this consultation, approximately 100 people told VISION that a VAWG data dashboard is something that they valued having and wish to have again. These included people with lived experience of violence and abuse, people working in health, justice, specialist and other services, researchers and academics across disciplines, and members of the wider public.
A violence and abuse data dashboard is needed because it has:
Symbolic value: indicating that violence against women and girls matters to the Government, and
Practical value: as a functional and easy to use tool facilitating access to high quality data spanning a range of types of violence, groups, areas and years.
In April 2024, ONS’ prototype VAWG data dashboard was withdrawn due to reprioritisation of resources within that organisation. Since then, a new Government has come into office with a stated mission to halve violence against women and girls within the decade. How progress towards this commitment is monitored will be essential to its success. General population health and crime surveys, alongside other data sources, will be key and that includes a revitalised, fit for purpose VAWG data dashboard. To instill trust and collective investment in this goal, a public platform for transparent monitoring is needed and the dashboard could be an effective, useful tool.
Next steps
VISION is a cross-sectoral consortium of academics and government and service partners working with UK data on violence and abuse. We are aware that further development and relaunching of a data dashboard will require a collaborative effort from relevant departments of state, data providers (not least ONS) and external funding. Drawing on our work in this area we aim to coordinate this effort, with three initial objectives:
Resource: Identify partners and funding source(s)
Define: Agree clear definitions to best capture and monitor subgroup and temporal trends in VAWG and violent crime in the population
Design and test a revised violence and abuse data dashboard with people from across sectors
By Dr Natasha Chilman, Research Associate, UKRI Population Health Improvement (PHI-UK), Population Mental Health Consortium, Kings College London
In the United Kingdom, we have the highest rate of homelessness compared to other high-income countries. For many people homelessness is a temporary, although often very impactful, experience in their lives. However, there is a paucity of research and data looking at people who are formerly homeless and living in private households (i.e., rented or owned accommodation).
This blog describes a new study which fills this gap, conducted by Dr Natasha Chilman from King’s College London and colleagues, including Professor Sally McManus from VISION.
The study authors analysed data from the Adult Psychiatric Morbidity Surveys, which is a nationally representative survey of adults living in private households in 2007 and 2014. Out of 13,859 people, 535 people reported previous experience of homelessness.
Some of the key findings of the study were:
A staggering 40% of people who formerly experienced homelessness had experienced violence in their homes at some point in their lives, compared to 7% of people who had never been homeless.
A quarter (24%) of people who formerly experienced homelessness reported experience of sexual abuse, compared to less than 5% of people who had never experienced homelessness.
Almost half (45%) of the formerly homeless group were currently experiencing depression or anxiety, compared to just 15% of people who had never experienced homelessness. People who formerly experienced homelessness were also experiencing more severe symptoms of these common mental disorders.
There were strong associations between former homelessness and health conditions, across common mental disorders, physical health conditions, alcohol/substance dependence, and multimorbidities. These associations persisted even after adjusting for a range of potential confounders, including indicators of socio-economic position and smoking.
Adjusting for adverse experiences including violence and abuse attenuated associations between former homelessness and alcohol/substance dependence related health outcomes, but not mental/physical health.
The findings from this study highlight the urgent need for long-term integrated healthcare support for people who are formerly homeless to continue after they have secured private housing. There were severe inequalities in experiences of violence and sexual abuse for people who have experienced homelessness, underscoring the importance of both violence and homelessness prevention, and of trauma-informed approaches to support.
To read the article or download the paper free of charge:
Chilman N, Schofield P, McManus S, Ronaldson A, Stagg A, Das-Munshi J. The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey. Epidemiology and Psychiatric Sciences. 2024;33:e63. doi:10.1017/S2045796024000659
A report just published by the Department for Work and Pensions (DWP) further confirms high levels of trauma and mental distress among people not in employment and approaching benefits services for support. The report focuses on those in receipt of Employment and Support Allowance (ESA) aimed at people with an impairment or health condition that affects how much work they do.
VISION researcher Sally McManus, with colleagues Claire Lapham and Ann Conolly from the National Centre for Social Research, analysed the government’s main mental health study. They found that nearly one in three (30%) ESA recipients screened positive for post-traumatic stress disorder. This was more than twice the rate for Jobseeker’s Allowance (JSA) claimants (12%), and ten times that of employed people (3%). The analyses show that the claimant population experienced high levels of stress, in which self-confidence was low and anxiety high. Compared to those in employment, few ESA claimants owned their home and many faced serious debt arrears.
Sally presented findings from this study as oral evidence to the Work and Pensions Committee’s Inquiry into Safeguarding Vulnerable Claimants, including domestic violence victims. She drew attention to calls from Women’s Aid for reform they highlight is needed to make the benefits system the lifeline survivors need, rather than a source of re-traumatisation and further harm.
Women’s Aid recommendations include implementing a named domestic abuse lead in every Jobcentre Plus and ensuring staff receive regular, specialist domestic abuse training, so that work coaches and other frontline staff are better able to recognise claimants experiencing domestic abuse. Specialist domestic abuse services need to be properly funded to support and advocate for survivors in making their claims to DWP. Extending the domestic violence easement to up to a year would also help, alongside exempting those who are moving to or from refuges from repayment of Jobcentre Plus advances.
The definitions and methodology used in surveys to measure violence have implications for its estimated volume and gendered distribution. The Crime Survey for England and Wales (CSEW) uses quite a narrow definition of ‘violence against the person’ which excludes crimes which are arguably violent in nature.
VISION researchers Elouise Davies, Polina Obolenskaya, Brian Francis and Niels Blom worked with colleagues Jessica Phoenix, Merili Pullerits and Sylvia Walby to expand the CSEW’s measurement of violence to include threats, robbery, sexual violence and mixed violence/property crimes as violence.
The team investigates the implications of using an expanded definition of violence on the subsequent estimates of interpersonal violence and its distribution (the proportion of incidents of violence committed towards women, and the proportion of incidents that are committed by domestic relations rather than acquaintances or strangers). Additionally, they investigate how the expanded definition of violence shows an increased health burden of violence by investigating the number of injuries and the number and proportion of victims that are strongly emotionally impacted.
This results in a shift in the gender distribution of violence, with a higher proportion of violence against women (from 39% to 58%) and by domestic perpetrators (from 29% to 32%).
Impacts of violence – injuries and emotional harm – are also affected by the change in definition and disproportionally so for women.
However, much less is known about the effects of violence on the close relatives of victims. This is particularly surprising considering the critical role that relatives play in providing support, care, and advocating for victims in the aftermath of violence.
Cook, E. and McManus, S. (2024). Indirect victims of violence: mental health and the close relatives of serious assault victims in England. Social Science & Medicine.
The book’s chapters use retrospective case studies to engage with a systems approach to discover new thinking and applications that may best suit the area of domestic abuse and sexual violence (DASV). All the chapters showcase systems approaches in varying ways to ignite new inquiries and conversations about grappling with the greater complexity of problems.
Dr Adisa and Professor Bond, together with their collaborators, will launch the book at a special event at City St. George’s University of London on Tuesday, 26 November at 5.30 pm. They will explain the book and share their inspiration for the themes covered. A panel of speakers will share their collective vision for systems change in tackling DASV in different systems. The event will also feature poetry (spoken word) performances based on lived/living experiences of domestic abuse and as a survivor-centred response to the book’s themes.
Dr Adisa said:
“I am incredibly excited about the launch event. I have been overwhelmed by the positive and heartwarming reaction to the book from those committed to tackling the problem of DASV and those sadly affected by DASV. I have been impressed with the brilliant contributions made by all the authors who are deeply committed to bringing about change. This event is an opportunity to hear from some amazing speakers and forge new encounters and connections, united in our quest to reduce DASV and mitigate its devastating impact on children, families, and communities.”
Professor Sally McManus, Director of the Violence and Society Centre, and Co-Deputy Director, VISION, said:
“Dr Adisa works at the forefront of systems thinking. This new collection – co-curated with Prof Bond – brings a radical new approach to addressing violence and abuse, rooted in diverse real-world examples of challenge and change. The book houses many rich voices, distinct yet drawn together through common themes of complexity and hope.”
Please join Dr Adisa, Professor Bond, and their fellow collaborators at their 26 November book launch at The Pavilion, University Building, City St George’s, from 5:30 – 7 pm. Drinks and nibbles will be provided.
Adolescent domestic abuse (ADA) goes by many names, sometimes referred to as toxic teenage relationships. ADA includes physical, emotional, and/ or sexual abuse that occurs between young people who are, or were, dating. It is often overlooked in research, policy and practice. As a phenomenon, abusive behaviour between adolescents in intimate relationships remains relatively invisible, due in part to the persistent yet unfounded assumption that domestic abuse is something that only occurs between adults.
The Crime Survey for England and Wales finds that women aged 16 to 19 are more likely to experience domestic abuse than older age groups (ONS, 2020), but despite the prevalence, women in this age group are less likely to be referred to support services (SafeLives, 2017).
SafeLives discovered, on average, experiencing abusive behaviour from a partner begins at age 14 or 15, (2017). Further research in Wales found that among those aged 11-16 years old experienced a range of mental health and social impacts associated with experiencing domestic abuse, including teenage pregnancy, self-harm, and violent behaviour (Young et al, 2021).
With this landscape in mind and led by the need from our partners and to ensure intersectoral collaboration, VISION set up a working group with Thames Valley Police, SafeLives, Islington Borough Council, H.O.P.E Training, Respect, Youth Realities and others to investigate ADA via three activities:
ADA rapid systematicreview to synthesise existing research and data on ADA in teenage relationships (January 2024; funded by the City St George’s, UoL, Policy Support Fund).
ADA workshop: ‘Too Soon, Too Late’ organised by VISION with SafeLives Changemakers and young people who experienced abuse in their relationships when they were aged 13 to 16 (March 2024; funded by the City St George’s, UoL, Participatory Research Fund).
ADA conference, an event to bring together practitioners, people with lived experience, police, researchers, and policymakers working in the ADA environment (April 2024; funded by the City St George’s, UoL, HEIF KE Fund).
The report, Summary of the VISION Adolescent Domestic Abuse activities and events in 2024, is available online. It summarises the findings and recommendations of the review, workshop and conference for a roundtable of police, local government, academics, practitioners and specialist services working in the field held in June 2024. It was produced for the working group as an aid to distil the thinking thus far across the three VISION activities.
ADA Rapid Systematic Review
The VISION review investigates ADA by examining the terminology and related terminology used in the literature. The paper focuses on the perpetration and victimisation as it concerns adolescents, especially those under 16 years old, and the factors that act as protective and recovery mechanisms for young people experiencing ADA.
VISION researchers, led by Dr Ruth Weir, conducted a systematic rapid review of 79 papers from databases for peer-reviewed literature.
The team discovered definitional issues, an overemphasis on quantitative studies, and a lack of attention to ADA when it intersects with cultural factors, gender differences, criminalisation, and poor mental health. Many of the studies report on school-based settings, with limited reporting and understanding of the role of neighbourhood factors in acting as protective and recovery mechanisms. Additionally, literature on impacted adolescents and their help-seeking behaviours is sparse. The review revealed that evidence on abuse affecting adolescents in the UK remains patchy.
Highlights from the VISION ADA rapid review: Gaps, limitations & considerations for future research
ADA workshop:Too Soon, Too Late
Dr Polina Obolenskaya and Dr Annie Bunce, VISION Research Fellows, collaborated on a consultation project, “Too soon, too late”, with the SafeLives Changemakers and with young people who experienced abuse in their relationships when they were aged 13 to 16. The main aim of the consultation was to develop a robust, methodological framework for a future adolescent domestic abuse (ADA) research proposal.
Together with SafeLives, a charity working to end domestic violence, they co-developed the material for the online workshop, a focus group, with young people, which took place in March 2024, and was facilitated by the ‘Changemakers’, a group of young people passionate about amplifying the voices of survivors of domestic abuse. They work alongside SafeLives providing a young person’s expertise on the charity’s work, conducting research, and working to influence policy change.
Some of the preliminary themes from the workshop include:
Lack of recognition amongst young people of both domestic abuse (DA) in general, and ADA specifically.
Young people don’t easily identify their own experiences of ADA as DA.
Young people’s understanding of ADA changes over time.
Young people highlighted the wide variation in experiences of ADA and professional responses to it.
Young people can identify clear priorities for future ADA research.
Young people see school as a key point of early intervention, but feel that improvement is needed in terms of better education around healthy relationships and school cultures that encourage open discussion around DA whilst actively challenging attitudes and behaviours conducive to ADA and sexual violence.
Further information can be found in the report available for downloading online.
ADA Conference
The Adolescent Domestic Abuse conference held on 18 April brought together 161 academics, practitioners, and policy makers to share existing research, policy and practice. Dr Ruth Weir, Senior Research Fellow at the Violence & Society Centre and the VISION research project at City, and Katy Barrow Grint, Assistant Chief Constable at Thames Valley Police, welcomed the delegates.
Louise Rolfe, OBE, Metropolitan Police and National Police Chief Council lead for Domestic Abuse was a keynote speaker. Louise spoke about the national context of domestic abuse, highlighting the most harmful abuse that is seen is coercive control and that domestic abuse accounts for more than 30% of violent crime. She also spoke about the role of the media requiring scrutiny and the need for sustainable long-term systemic solutions.
Professor Christine Barter, Co-Director of the Connect Centre for International Research on Interpersonal Violence and Harm, University of Central Lancashire, also gave a keynote. She provided an overview of her 15 years of research exploring the prevalence, subjective impact and risk factors associated with abuse in young people’s relationships in her presentation, Researching abuse within teenage relationships: A critique of a decade’s work and what we could do better. Her mixed-method body of work addressed both victimisation and perpetration for young people aged 13 to 17.
There were panels on Teenage relationships and abuse: What the research says; Sexual violence in teenage relationships; and Specialist services and local government. Presenters included academics sharing their ADA research from Loughborough University and Durham University and specialist domestic violence organisations like SafeLives, Refuge, and Women’s Aid. Islington Borough Council, representing local government, discussed their work on a multi-agency model project to identify, intervene and protect teenagers experience ADA.
Workplace bullying and harassment (WBH) is bad for people’s health, and this negative health impact can manifest in a variety of ways and be long-lasting.
Over a decade ago the UK government initiated the Fair Treatment at Work survey, aiming to ‘place the issue of bullying at work on employers’ agendas’, yet there has been no major initiative since.
Using data from the 2014 Adult Psychiatric Morbidity Survey, VISION researchers Annie Bunce, Ladan Hashemi and Sally McManus, along with Carrie Myers and Charlotte Clark from City St George’s, University of London and Stephen Stansfeld from Queen Mary, University of London, examined the prevalence and nature of WBH among workers in England, and associations with mental health.
A clear picture of the severity of the problem of WBH in England is painted by four key findings.
One in ten people in paid work reported having experienced WBH in the past year. This is likely to be an underestimate due to underreporting for various reasons;
Those who reported bullying were more likely to be in a financially disadvantaged position;
Over half of people who reported having been bullied at work identified the perpetrator as a line manager; and
Clinically diagnosed common mental disorder was more than twice as likely in employees with experience of WBH compared with those without, and those exposed to WBH were also twice as likely as others in paid work to screen positive for PTSD.
Taken together these findings demonstrate that WBH is common in UK workplaces, it may be driven and exacerbated by issues of inequality, power and hierarchical organisational structures, and it is associated with depressive and anxiety disorders severe enough to warrant health service intervention and treatment.
This power dynamic should not be forgotten when addressing issues in the workplace, but the complexity of workplace environments creates challenges for identifying, understanding and addressing bullying. Reports of WBH can coincide with performance concerns from managers, and, whilst behaviours intended as legitimate performance management activities might be misinterpreted as bullying by the employee, it is also possible that HR practitioners attribute managerial bullying behaviours to legitimate performance management practice to exonerate mangers and protect the organisation.
This links to a recently published piece for The Conversation by Sally McManus and Kat Ford (Bangor University), which sets out how companies can influence and perpetuate violence in society, including via employment practices that conceal the extent of bullying, sexual harassment and other forms of workplace violence (for further information see Six ways companies fuel violence (theconversation.com).
Also, structural issues in the workplace can create pressure for managers which they then take out on those they manage, managers can be victims of WBH themselves, and organisational culture may perpetuate WBH.
Given such complex power dynamics, it is recommended that organisations involve employees at all levels in the development of policies, and collaboratively review the implementation and performance of policies regularly to ensure they are working for the people they are intended to protect. Rather than prescribed ‘tick box’ policies and responses, creative methods incorporating employees’ perspectives may more likely lead to meaningful change.
VISION seeks to highlight the wider contexts in which violence occurs. To tackle the causes of violence and improve violence reduction strategies, governments tend to look to families, communities, schools, health and justice services, and community and voluntary sector organisations for solutions. While these are crucial, a broader and more radical approach is also needed.
For decades, health researchers have raised awareness of various ‘commercial determinants of health’. Initially, this work focused on industries producing harmful products like tobacco, alcohol, fast food and fossil fuels. However, the approach has expanded to show how a much wider range of companies and industries harm our health through their various practices.
We applied an existing framework to unpack the specific ways in which companies and commercial processes might shape not only our health – but also the nature and extent of violence in societies. The analysis was carried out by Kat Ford from the Public Health Collaborating Unit at Bangor University, Karen Hughes from Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Wellbeing, Public Health Wales, and VISION researchers Mark Bellis, Olumide Adisa and Sally McManus.
A summary of six of the ways in which companies can fuel violence has been published in The Conversation. They include political practices like lobbying against safety legislation, and financial practices like investing in regimes with poor human rights records. The full paper details these and other commercial processes and argues that governments need to consider the role and influence of companies if violence prevention is to be effective.
