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.
An aim of the VISION programme is to examine the nature and extent of contact that people with experience of violence have with various health and justice services.
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.
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.
By Elizabeth Cook, Senior Lecturer in Criminology & Sociology at City St George’s, University of London
As the VISION consortium approaches the end of its third year, work continues on consolidating the learning from various large datasets in crime and justice, health, and specialist services.
What we know is that these datasets are structured in different ways, collected by different agencies, and curated for quite different purposes. They represent particular waysofknowing about violence and abuse: they can help to identify patterns (e.g., what determines whether victim-survivors of sexual violence and abuse access support), prevalence (e.g., of workplace bullying and harassment), trends over time, and associations (e.g., between intimate partner violence, suicidality, and self-harm). However, we also know that large datasets struggle to capture the complex, and sometimes messy, realities of violence and abuse experienced by communities, especially those that are marginalised and minoritised.
Peer action research in Lambeth
In Lambeth, working in collaboration with peer researchers has made visible the evidence gaps that emerge at the intersection of multiple systems of inequality, including racism and misogyny.
We are lucky to be partnered with Lambeth Peer Action Collective (LPAC), High Trees and Partisan as part of a peer action research project. The aim of the project is to explore the role that trusted adults and trusted spaces can play in protecting young people from exposure to violence. Currently, there are 11 peer researchers that work as part of the LPAC: a collective of young people and youth organisations campaigning for change in their community. They are supported by High Trees, a Community Development Trust in Tulse Hill, eight partner youth organisations, and Partisan, a Black-led Community Interest Company providing culturally sensitive mental health support.
What has been achieved so far?
The project builds upon research conducted by the previous cohort of LPAC researchers conducted between December 2021 and August 2022. This project identified the impacts of violence on young people in Lambeth and the structural conditions of poverty, housing, education, urban regeneration, and public safety that were experienced unequally across the community.
Developing these findings further, the second cohort of peer researchers have been participating in weekly research training sessions led by High Trees and supported by VISION. The group has been learning everything they need for the next stage: from safeguarding and finances, to developing research questions, critical thinking skills, and how to evaluate research methods. This month, the LPAC researchers are getting ready to put into practice the interview skills that they have been learning each week in preparation for the next stage of the project – recruitment.
There has been amazing progress so far – not only in forming a research question and defining key concepts, but in developing a shared space for researchers to feel like change is possible and to collaborate with others who want the same.
What have we learned?
There are ongoing conversations about how peer action research can work to redress the imbalance between ‘researcher’ and ‘researched.’ These conversations seem even more relevant to research on violence and abuse, where the issue of power is central to both.
So far, the weekly sessions with peer researchers as well as our meetings with High Trees have taught us a lot about how power operates within institutions and the ways that it can be shared if there is a will to share it. This can be reflected in adequate resourcing, decision-making, access, and sharing skills and knowledge. The project has underlined the importance of respect in research: for different forms of expertise, within spaces, and within research relationships. The project has also challenged adult-centric assumptions about what we suppose that young people need to live better lives.
As mentioned previously, this project highlights the evidence gaps that occur at the intersection of multiple inequalities. In doing so, peer action research can also shape how we utilise large datasets, recognising how different social realities are reflected within existing data (or not).
In this sense, this collaboration has also made hyper-visible the question of: what and who is research for? As others have suggested, action research is not so much a methodology, but a way of thinking about research: it is a way of approaching a specific problem through community, participation, and curiosity. It is not necessarily driven by knowing more about something, but by wanting to change something with what you know.
We hope that this research continues in that spirit!
Two researchers of the VISION consortium project presented at the Health Studies Conference in July.
Dr Elizabeth Cook, Senior Lecturer at City, University of London, presented Indirect victims of violence: mental health and the close relatives of serious assault victims in England.
Dr Annie Bunce, Research Fellow at City, University of London, presented Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey
The free event was on 1 July at University College London (UCL) and organised by the UK Data Service in collaboration with UCL and the National Centre for Social Research. The conference provided updates from the data producers of key UK social surveys with health-related content, such as the Health Survey for England, Understanding Society and the English Longitudinal Study of Ageing. There were also presentations by researchers who conducted analyses using health data.
Researchers from King’s College London, Anjuli Kaul, Laura Connell-Jones, Sharli Anne Paphitis and Sian Oram (VISION researcher), have published a systematic review and meta-analyses in Social Psychiatry and Psychiatric Epidemiology which provides up-to-date estimates on the prevalence and risk of sexual violence victimisation amongst mental health service users.
This review pooled data from 26 studies encompassing a total of 197,194 participants. Sexual violence included any sexual acts, comments or advances (or attempts at said behaviours) made towards a person without their consent. Mental health service users included any person who had been in contact with a psychiatric inpatient, outpatient, community, perinatal, liaison, addiction, veteran psychiatric inpatient, or forensic mental health service.
The researchers searched 3 electronic databases (Medline, Embase, and PsychINFO) for peer-reviewed publications from their dates of inception until 18th July 2022. There were no restrictions on the geographic location of the included studies.
Key findings
The review found that studies consistently showed a high prevalence of past year and adult lifetime (since the age of 16) sexual violence victimisation in psychiatric service users, with higher rates found in women than men. Additionally, both male and female psychiatric service users were found to have an increased risk of experiencing sexual violence compared to non-psychiatric service users. This was the case regardless of whether the study measured past year or adult lifetime sexual violence or sampled a population of inpatients, outpatients or both.
The meta-analyses revealed high levels of heterogeneity within the data, which was likely partly due to the varied instruments used across studies to measure mental health and sexual violence. Additionally, there was not enough data available to calculate the pooled odds ratio of sexual violence victimisation for male or female psychiatric service users, nor was it possible to adjust odds ratios for known confounders such as age, ethnicity, income level or substance abuse.
The findings emphasise the need for healthcare practitioners to effectively recognise and respond to sexual violence in mental health services, and the need for a comprehensive and consistent measurement framework for sexual violence to enable reliable and comparable prevalence data to be collected.
Gene Feder, VISION Director and Professor of Primary Care at the University of Bristol, has written an opinion piece with colleagues commenting on events in Israel and Gaza from a public health and primary care perspective. Responding to the war in Israel and Palestine was published in December in the online edition of the British Journal of General Practice.
Gene and his colleagues are GPs working to further the development of family medicine in the occupied Palestinian territory, specifically in the West Bank, but with links to family medicine in Gaza through the United Nations Relief and Works Agency and through Medical Aid for Palestinians. They also have friends and family in Israel and Palestine.
They have three responses to the current crisis as informed by their work as GPs and connection to Palestinian primary care:
A plea for the protection of health care and health professionals amid the war
A plea for the preservation of public health amid war
A recognition that in the aftermath of October 7th and the invasion of Gaza, the widespread direct and vicarious trauma in Israeli and Palestinian populations will result in permanent physical and emotional damage: the former in the shape of orthopaedic, neurological, and gynaecological (as a result of rape) harm, the latter in the form of widespread anxiety, depression, and post-traumatic stress disorder which will also cascade down the generations.
Given VISION’s commitment to developing evidence on violence prevention, we will be organising roundtable meetings bringing together researchers focusing on post-conflict violence reduction. This is an opportunity for dialogue, perhaps leading to new perspectives and research including systematic assessment of sustainable post-conflict interventions as well as further joint activities.
Sally will use a life-course approach to understanding women’s mental health and wellbeing at work, including the impact of the psychosocial working environment, bullying and harassment at work, and what support and signposting employers can offer in relation to domestic violence.
