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Natural Language Processing: Interrogating free text in mental healthcare records to capture experiences of violence

    Violence can be categorised in a variety of ways for example physical, sexual, emotional, and domestic but all cause significant physical and mental morbidity within general populations. Individuals with a severe mental illness have been found to be significantly more likely to experience domestic, physical, and sexual violence compared to the general population. For these individuals, experiences of violence are important risk factors however, this is not routinely collected by mental health services.

    In general data on all forms of violence has been inadequately available from healthcare records. This is partly due to the lack of routine enquiry by professionals at points of clinical contact, and partly because instances of violence are difficult to identify in healthcare data in the absence of specific coding systems.

    A general challenge for using health records data for research is that the most valuable and granular information is frequently contained in text fields (e.g., routine case notes, clinical correspondence) rather than in pre-structured fields; this includes mentions of violence whether experienced as a victim or perpetrated. Capturing violence experiences across mental healthcare settings can be challenging because most instances are likely to be recorded as unstructured text data. Therefore, natural language processing (NLP), is increasingly in use to extract information automatically from unstructured text in electronic health records, particularly in mental healthcare, on clinical entities.

    Dr Ava Mason from Kings College London and VISION researchers Professor Robert Stewart, Dr Angus Roberts, Dr Lifang Li, and Dr Vishal Bhavsar worked with colleagues to apply NLP across different clinical samples to investigate mentions of violence. They ascertained recorded violence victimisation from the records of 60,021 patients receiving care from a large south London NHS mental healthcare provider during 2019. Descriptive and regression analyses were conducted to investigate variation by age, sex, ethnic group, and diagnostic category.

    Results showed that patients with a mood disorder, personality disorder, schizophrenia spectrum disorder or PTSD had a significantly increased likelihood of victimisation compared to those with other mental health diagnoses. Additionally, patients from minority ethnic groups for Black and Asian had significantly higher likelihood of recorded violence victimisation compared to White groups. Males were significantly less likely to have reported recorded violence victimisation than females.

    The researchers demonstrated the successful deployment of machine learning based NLP algorithms to ascertain important entities for outcome prediction in mental healthcare. The observed distributions highlight which sex, ethnicity and diagnostic groups had more records of violence victimisation. Further development of these algorithms could usefully capture broader experiences, such as differentiating more efficiently between witnessed, perpetrated and experienced violence and broader violence experiences like emotional abuse.

    To download the paper: Frontiers | Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis

    To cite: Mason AJC, Bhavsar V, Botelle R, Chandran D, Li L, Mascio A, Sanyal J, Kadra-Scalzo G, Roberts A, Williams M, Stewart R. Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis. Frontiers in Psychiatry 2024 Sep 10. doi:103389/fpsyt.2024.1181739

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    Centring otherness with migrant women affected by domestic abuse

      Victims-survivors with insecure immigration status in the UK are subject to complexities that limit their access to safety, support, and justice. While campaigners have been advocating for more equitable pathways for provision and support over the years, migrant women continue to navigate hostile environments characterised by dehumanising language and anti-migrant bureaucratic systems.

      This chapter, written by VISION researcher Dr Olumide Adisa for the book, Otherness in Communication Research: Perspectives in Media, Interpersonal, and Intercultural Communication, reports on how a feminist dialogic approach (characterised by open, inclusive dialogue and a foundational understanding of social, economic, and political equality for women) was used to centre the often ‘silent voices’ of migrant women affected by domestic abuse.

      Feminist dialogical approach acknowledges the complexities that characterise the migrant victim’s journey through the system—the relationship between the self-other, in a peculiar hostile environment which views the other as a ‘threat’. Migrant women continue to endure this othering within agencies as they seek safety and support. For example, some professionals conflating ‘foreignness’ with ‘insecure immigration statuses’, when confronted with difference. This theorisation of self and other lends itself to a social justice-oriented practice.

      Using different art forms (co-produced with migrant women) and purposeful conversations, attendees were able to encounter migrant women as not a distant ‘other’ whom ‘we’ observe and theorise but as equal partners in the creating and reshaping on knowledge systems on safety, support, and justice.

      This chapter draws on quotes from survivors to funnel through a hopeful lingering over otherness that positions migrant women as deserving of consideration and care, and considers empowering aspects about the other that may often be dismissed in professional circles, but nonetheless are important as a protective element of a safety net.

      To download the chapter: Centring Otherness with Migrant Women Affected by Domestic Abuse | SpringerLink

      To cite: Adisa, O. (2025). Centring Otherness with Migrant Women Affected by Domestic Abuse. In: Magalhaes, L. (eds) Otherness in Communication Research. Palgrave Studies in Otherness and Communication. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-73788-6_16

      For further information, please contact Olumide at olumide.adisa@city.ac.uk

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      Intimate partner violence impacts affected by relationship status and offence type

        Intimate partner violence and abuse has a detrimental impact on victim-survivors’ health and wellbeing. However, intimate partners include a range of different relationship types, which are rarely differentiated or contrasted in research. In this paper, VISION researchers, Dr Niels Blom and Dr Polina Obolenskaya, investigate with Dr Jessica Phoenix and Merili Pullerits, whether different types of intimate partners commit different types of violence/abuse and whether the injury and wellbeing impact on victim-survivors varies by intimate partner relationship type.

        They estimate models for victim-survivors’ emotional impact and injuries using the Crime Survey for England and Wales (2001–2020). Intimate partner relationships are differentiated into four groups (current versus former partner, and spouses/partners versus boy/girlfriends). Violence and abuse are grouped into physical violence/abuse, sexual violence/abuse, threats, and economic crimes.

        The team found that for both men and women, offences committed by current partners are more likely to involve physical violence/abuse than offences by former partners. Ordered logit models indicate that female victim-survivors of physical violence/abuse or economic crimes experience more severe emotional impacts when the perpetrator is their current or former spouse/partner compared to a current or former boy/girlfriend. Women’s risk of injuries from physical violence and economic offences are higher when committed by current compared to former partners. Few differences are identified for men’s emotional impact and injuries.

        The type of intimate partner relationship is associated with type of violence/abuse experienced, and for women, with the resulting emotional impact and injury. Future research and policies aimed at reducing harms from intimate partner violence and abuse and supporting victim-survivors should therefore consider distinctions in relationships to deliver more targeted interventions.

        To download the paper: Physical and Emotional Impacts of Intimate Partner Violence and Abuse: Distinctions by Relationship Status and Offence Type | Journal of Family Violence

        To cite: Blom, N., Obolenskaya, P., Phoenix, J. and M. Pullerits. Physical and Emotional Impacts of Intimate Partner Violence and Abuse: Distinctions by Relationship Status and Offence Type. J Fam Viol (2024). https://doi.org/10.1007/s10896-024-00786-w

        For further information, please contact Niels at niels.blom@manchester.ac.uk

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        Deputy Chief Constable awarded Practitioner in Residence at Violence and Society Centre

          Katy Barrow-Grint, Deputy Chief Constable, Gloucestershire

          City St George’s, UoL, offers a Practitioner in Residence programme at the School for Policy and Global Affairs. It is for mid-level and senior policy practitioners within the UK and provides a platform to grow and explore their practice in partnership with the school.

          Katy Barrow-Grint, Deputy Chief Constable in Gloucestershire and an executive leader in national policing, became aware of the opportunity via her work with VISION Senior Research Fellow, Dr Ruth Weir,  on the VISION adolescent domestic abuse (ADA) research programme. Having recently written a book entitled ‘Policing Domestic Abuse’ with Ruth and others, the research identified a national gap academically and in policing with how ADA is understood.

          Katy’s focus will be on how police constabularies document ADA and developing a better understanding of the impact of the statutory age limitations on the practical work police officers do on the front line.

          Forces do not routinely record ADA as the statutory guidance states that domestic abuse occurs in relationships where both parties are aged 16 or over. As a result, whilst crimes against young people will be recorded and investigated, they are not necessarily classified as domestic abuse, and it may be that child protection, domestic abuse or front-line response teams deal with the case.

          Her project work will seek to understand how forces are recording such incidents, and what type of officer and role is investigating. Katy will work with policing nationally through the National Police Chief‘s Council (NPCC) domestic abuse and child protection portfolios and collate an up-to-date picture across all forces in England and Wales to understand how they are recording and who is investigating ADA.

          Katy is also undertaking specific localised work in Oxfordshire, Gloucestershire and Northumbria, hosting roundtables with Dr Ruth Weir and  practitioners from all relevant agencies to gain a qualitative understanding of the problems staff encounter when dealing with ADA.

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          Migrants’ experiences of violence while in insecure migration status

            Violence is a major public health issue. Moreover, there is evidence that violence is significantly related to social inequality. Existing studies have found links between violence and gender, ethnicity, place of residence and socioeconomic status.

            Although economic globalization impacts trade, goods, and services, the movement of people has been increasingly restricted since the 1990s. The number of people globally who live with insecure migration status is difficult to estimate, but includes people worldwide undertaking irregular journeys and crossing international borders without authorization, people living without the correct immigration documentation, and people in temporary or dependent statuses in destination countries.

            The global movement of people in the context of strict immigration laws and policies places significant numbers of people in insecure migration status worldwide. Insecure status leaves people without recourse to legal, governmental or social protection from violence and abuse.

            This review synthesized qualitative studies that reported how migrants associated physical and physically enforced sexual violence they experienced with their insecure migration status. VISION researchers, Andri Innes, Annie Bunce, Hannah Manzur, and Natalia V. Lewis, generated robust qualitative evidence showing that women experienced sexual violence while in transit or without status in a host state, and that they associated that violence with their insecure migration status. This was the case across the various geographic routes and destination countries.

            They found evidence that women associated intimate partner violence with lacking (legal) access to support because of their insecure migration status. Women connected their unwillingness to leave violent circumstances, and therefore their prolonged or repeated exposure to violence, with a fear of immigration removal produced by their insecure migration status.

            To protect people in insecure migration status from experiencing violence that they associated with their migration status, it’s necessary to ensure that the reporting of violence does not lead to immigration enforcement consequences for the victim.

            To download the paper: Experiences of violence while in insecure migration status: a qualitative evidence synthesis | Globalization and Health | Full Text

            To cite: Innes, A., Bunce, A., Manzur, H. et al. Experiences of violence while in insecure migration status: a qualitative evidence synthesis. Global Health 20, 83 (2024). https://doi.org/10.1186/s12992-024-01085-1

            For further information, please contact Andri at alexandria.innes@city.ac.uk

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            VISION/VASC Webinar Series: Into the Light Index

              We are pleased to announce our next webinar for the VISION and Violence & Society Centre (VASC) Webinar Series on Tuesday, 21 January, 1100 – 1150.

              Deborah Fry, Director of Data at Childlight – Global Child Safety Institute and Professor of International Child Protection Research at University of Edinburgh, will present on the Into the Light Index, published last year on the prevalence of technology-facilitated child sexual exploitation and abuse. She will also discuss some of the measurement challenges in this field and how they are documenting and exploring those challenges.

              Professor Fry undertakes primary research to measure the magnitude, drivers and consequences of violence against children, barriers and enablers to appropriate prevention and response systems including in school settings and the effectiveness of existing interventions.

              She leads the data division at Childlight – Global Child Safety Institute. The Data Institute, funded by the Human Dignity Foundation, aims to take a data driven, evidence-based approach to understanding the prevalence of child sexual exploitation and abuse across the globe and translating that data into sustainable action that safeguards children. The mission is to establish a world leading independent institute that gathers, translates and visualises the prevalence of child sexual exploitation and abuse across the world.  

              To register for the event in order to receive the Teams invitation, please contact: VISION_Management_Team@city.ac.uk

              The purpose of the VISION/VASC webinar series is to provide a platform for academia, government and the voluntary and community sector that work to reduce and prevent violence to present their work / research to a wider audience. This is a multidisciplinary platform and we welcome speakers from across a variety of fields such as health, crime, policing, ethnicity, migration, sociology, social work, primary care, front line services, etc. If interested in presenting at a future Series webinar, please contact: VISION_Management_Team@city.ac.uk

              This webinar series is sponsored by the UK Prevention and Research Partnership consortium, Violence, Health and Society (VISION; MR-V049879) and the Violence and Society Centre at City St George’s, University of London.

              United to End Violence Against Women and Girls: An Online Animated Campaign  

                Violence against women and girls (VAWG) is a pressing issue in Iran, a Middle Eastern country marked by its patriarchal structure and systematic and pervasive gender discrimination. Educational programmes addressing this issue are scarce, and cultural barriers often hinder open discussion. The United to End Violence Against Women and Girls campaign aims to break this silence through a series of animated videos and images designed to inform public discourse and to empower victims to seek support.

                 The United to End Violence Against Women and Girls project was led by VISION researchers Ladan Hashemi and Sally McManus, in collaboration with colleagues from other UK universities including the University of Bristol, Goldsmiths University, Animation Research Centre at the University for the Creative Arts, and Leeds Beckett University. 

                They worked with an animation production team in Iran, a social media advisor, and two advisory groups. The advisory groups were Mehre Shams Afarid, an Iran-based non-governmental organisation (NGO), and IKWRO, a London-based charity providing services to women victims of violence from the Middle Eastern and North African (MENA) region—to incorporate culturally specific insights.

                Although the project initially focused on Iran, engaging with the UK-based NGO revealed an interest in extending its reach. As a result, English subtitles were added to make the animations accessible to a wider audience. This collaboration helped the content resonate with audiences both in Iran and within the global diaspora community, particularly those from the MENA region.

                The animations are grounded in evidence from a survey of 453 women in Iran, which explored the manifestation of various forms of VAWG in Iran and women’s perspectives on how to eliminate it. The survey was designed by Fatima Babakhani, CEO of Mehre Shams Afarid.

                Key findings from participants’ open-ended responses to the survey showed that, despite structural inequalities and deeply ingrained societal, cultural, and religious norms that perpetuate VAWG, change is possible through education and legal reforms.

                As one survey participant noted: “Unfortunately, many still don’t understand what violence truly is. Raising awareness is the solution.”

                The first four United to End Violence Against Women and Girls campaign animations focus on coercive control, economic abuse, technology-facilitated abuse, and active bystander interventions, with two more animations in development.

                With guidance from an Iranian social media advisor, a digital strategy was developed to maximise the campaign’s impact. Instagram was chosen as the primary distribution platform, as it is the most widely used social media platform in Iran, with over 47 million users. The animations are also shared on YouTube to further extend the campaign’s reach.

                Influencers and women’s rights activists with followings from thousands to millions were partnered with to amplify the campaign’s reach. The online campaign officially launched 25th November, on the International Day for the Elimination of Violence Against Women and Girls.

                By leveraging evidence-based content and strategic partnerships, we hope to spark meaningful conversations and drive change across Iran and the diaspora communities from the MENA region.

                Join us in raising awareness and advocating for change. Please follow and share the campaign links on your social media to help spread the message.

                Link to Instagram page

                Link to YouTube channel

                This project was funded by City St George’s, University of London Higher Education Impact Fund (HEIF) Knowledge Exchange and by the UKPRP VISION research consortium.

                For further information, please contact Ladan at ladan.hashemi@city.ac.uk

                Domestic abuse in cancer care: Improving the identification and support

                  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.

                  In an attempt to plug that gap, Sandi Dheensa, University of Bristol researcher, and colleagues, including VISION Deputy Director Estela Capelas Barbosa, have conducted a service evaluation on a domestic abuse intervention for hospital-based cancer professionals. Their study, Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention – European Journal of Oncology Nursing, is the first to evaluate a DA training (and support) intervention for cancer professionals in England.

                  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 – European Journal of Oncology Nursing

                  To cite:

                  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

                  Or for further information, please contact Sandi at sandi.dheensa@bristol.ac.uk

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                  VAWG data dashboard consultation highlights usefulness of tool

                    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

                    To download the report:

                    Consultation: Is there a need for a Violence Against Women and Girls (VAWG) data dashboard

                    Or for further information, please contact Sally at sally.mcmanus@city.ac.uk

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                    Report launch: A transformative justice framework to address adolescent relationship abuse

                      This event is in the past.

                      Despite a general awareness of the prevalence of harm young people are experiencing in their relationships, there is little data and evidence supporting the prevention of and responses to such harm through the adoption of a survivor centred transformative justice approach.

                      Talia Kensit, founder and former CEO of Youth Realities, explored adolescent domestic abuse as a Fellow with the Churchill Fellowship, a UK charity which supports individual UK citizens to follow their passion for change, through learning from the world and bringing that knowledge back to the UK.

                      Her travels and research resulted in Prevention, Intervention and Healing: Addressing Adolescent Relationship Abuse, a framework of best practice upheld by the theory of transformative justice. It is Talia’s recommendation that in order to address the epidemic of harm experienced by young people in their intimate relationships, we must implement polices and practice through prevention, intervention and healing.

                      The Violence & Society Centre at City St George’s, UoL, and the UK Prevention Research Partnership VISION consortium are pleased to host Talia’s Churchill report launch on Wednesday 6 November from 4 – 6 pm at City St George’s, UoL, Clerkenwell campus.

                      Talia will also be joined by:

                      •  Ruth Weir, City St George’s, UoL, Taking a collaborative approach to understanding more about abuse in teenage relationships
                      • Christine Barter, University of Central Lancashire, Qualitative findings looking at the nature and impact of IPVA in young people’s relationships
                      • Jeff Temple, University of Texas, Dating violence prevention program: implementation and effectiveness

                      Seating, drinks and nibbles will be provided.

                      To register for the event: Select tickets – Report launch: A transformative justice framework to address adolescent relationship abuse – City St George’s , University of London, Clerkenwell campus (tickettailor.com)

                      For questions about the event: violenceandsociety@city.ac.uk

                      All those registering will receive an email by 30 October from the Violence and Society Centre with the room and building number where the launch will be held on our Clerkenwell campus.