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Systems analysis of service coordination in domestic abuse, primary care and child mental health services

    The impact of intimate partner violence (IPV) on parental and child mental health is well documented, as is the associated increased use of healthcare services by survivors of IPV. UK policy emphasises the importance of partnership working between health services and domestic abuse agencies, along with clear referral pathways for victims of violence and abuse and co-ordinated local responses. However, in general, current policy and guidance is focused on the response to adult victims with more limited advice as to how this should be operationalised for working with children.

    With first author Dr Claire Powell (University College of London), VISION researchers Dr Olumide Adisa and Professor Gene Feder and others explored how services work together to support parents and children experiencing both parental IPV and parental or child mental health problems by drawing on the perspectives of professionals working in primary care, children and young people’s mental health services (CYPMHS), and domestic abuse services.

    The team conducted a qualitative study, interviewing professionals in geographically contrasting local authority areas in England. They carried out framework analysis using a systems approach and mapping techniques to understand the service interrelationships and boundary judgements of professionals.

    Results showed that

    • The relationships between domestic abuse services, CYPMHS, and primary care were complex, involving funders and commissioners, local authority strategic groups, and wider services such as schools and children’s centres.
    • Participants consistently identified a gap in the relationship between statutory CYPMHS and domestic abuse services.
    • There were mental health service gaps were for children living with ongoing or intermittent IPV and for children and parents with needs falling below or between service thresholds.
    • There was a gap in services for users of abusive behaviour to prevent future IPV.
    • Staff perspectives revealed differing views on treating the effects of trauma, and the co-ordination and sequencing of care.

    Improving the response to children and adults experiencing mental health problems in the wake of IPV requires a systems perspective to understand the barriers to service co-ordination. The findings indicate a particular need to address the gap between CYPMHS and domestic abuse services.

    To download the paper: Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives – ScienceDirect

    To cite the paper:  Claire Powell, Olumide Adisa, Lauren Herlitz, Shivi Bains, Sigrún Eyrúnardóttir Clark, Jessica Deighton, Shabeer Syed, Ruth Gilbert, Gene Feder, Emma Howarth, Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives, Children and Youth Services Review, Volume 169, 2025, 108076, ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2024.108076

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    VISION researcher, Lizzie Cook, speaks at Dutch Embassy Just Talk(s) event on femicide

      On 10 December 2024, celebrated globally as Human Rights Day and the final day of the 16 Days of Activism against Gender-based Violence campaign, the Dutch Embassy in London organised a panel discussion on femicide and the criminalisation of violence against women and girls.

      Lizzie Cook was invited to speak as part of the event which was opened by the Dutch Ambassador Paul Huijts and Liaison Magistrate Wendela Mulder, and moderated by Lotte Wildeboer. The afternoon consisted of talks by Professor Sandra Walklate (of the VISION Advisory Board), Judith van Schoonderwoerd den Bezemer-Wolters (Dutch Public Prosecutor for Domestic and Sexual Violence), Katie Hoeger and Angela Whitaker (VKPP and College of Policing), and Janine Janssen (Dutch Police Academy). The event was part of a series of Just Talk(s) organised by the Dutch Embassy which seek to foster dialogue and exchange ideas on particular issues.

      The panel addressed a range of themes including challenges in current definitions of femicide, the implications for data and measurement, and what this means for prevention.

      To read more about some of the themes discussed in this panel, do take a look at Lizzie, Sandra and Kate Fitz-Gibbon’s 2023 special subsection of Current Sociology: Re-imagining what counts as femicide which brings together contributions on femicide from the UK, South Africa and Latin America.

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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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        Addressing abuse in teenage relationships

          This VISION Policy Brief highlights emerging findings and policy recommendations from ongoing research and stakeholder engagement into abuse in teenage relationships carried out by the UKPRP VISION consortium.

          Abuse—whether physical, emotional, or sexual—within young people’s relationships is often overlooked in both research and policy. The Crime Survey for England and Wales (CSEW) finds that young women aged 16 to 19 are more likely to experience domestic abuse than any other age group. Despite this high prevalence, this age group is less likely to be referred to support services. Furthermore, the CSEW does not cover individuals under the age of 16, leaving a major gap in understanding of prevalence.

          Key findings:

          • Lack of consistent terminology and recognition – various terms are used to describe abuse in teenage relationships, including ‘teen dating violence’, ‘adolescent domestic abuse’, ‘teenage relationship abuse’ and ‘youth intimate partner violence’. Both the workshop with young people and the roundtables identified that young people generally do not associate the behaviours they experience with any of these terms and are more likely to use language like ‘toxic relationships’.
          • Very limited UK research on risk and protective factors for under 16s – our rapid review found that in the last 10 years there was only one UK academic study that looked into risk and protective factors for abuse in teenage relationships for those aged under 16.
          • Importance of schools and communities – unlike adult domestic abuse, which is largely experienced in private, abuse experienced in teenage relationships is more likely to occur outside of the home, especially within schools.
          • Very difficult to measure extent of issue – due to the current Home Office definition of domestic abuse there is very limited and consistently recorded administrative data collected on those under 16 who are experiencing abuse.
          • Need to take a more radical review of systems – our discussion highlighted the difficulty of addressing abuse in teenage relationships within the current systems.

          Recommendations for change:

          • Develop a national strategy – prevention and early intervention
          • Explore support for young people – victims and those carrying out harmful behaviours
          • Commission research into under 16s – including those with lived experience and taking a whole systems approach
          • Improve measurement in under 16s
          • Agree terminology and produce an associated education programme

          To download the policy briefing: VISION Policy Brief: Addressing Abuse in Teenage Relationships

          To cite: Weir, Ruth; Barrow-Grint, Katy (2025). VISION Policy Brief: Addressing Abuse in Teenage Relationships. City, University of London. Report. https://doi.org/10.25383/city.26539906.v1

          For further information, please contact: Ruth at ruth.weir@city.ac.uk

          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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            VISION-funded research: Surviving Economic Abuse survey initial findings released

              Tackling economic abuse should be part of the solution to meet the new government’s ambitious target to halve violence against women and girls in a decade. It is important that the government’s measurement approach can understand the range of ways that economic restriction, exploitation and sabotage that victim-survivors experience at scale across the UK.

              Recent survey results from Surviving Economic Abuse (SEA) tell a powerful story that highlights experiences of economic abuse across the UK. The full report will be launched by SEA in March 2025, but their early release of key findings include:

              • Economic abuse is often understood to only be about creating dependency through restriction, but it can take many forms e.g., having a partner or ex-partner steal money, refuse to pay bills, or scare their partner into taking out credit. Early analysis suggests that a wider range of behaviours may continue post-separation than previously thought.
              • The data shines a light on the dangerous situation for young women- an area that SEA and VISION are seeking funding to explore further. 18–24-year-olds experienced more economic abuse than any other age group, for example 12% of this sample had been prevented from having log-in information (e.g. passwords, usernames) to key accounts such as online banking, utilities accounts, emails by a partner or ex-partner compared to 4% of all women.
              • Black, Asian and racially minoritised women in the UK may be more than twice as likely to experience economic abuse from a partner or ex-partner than White women, with women with a Black/African/Caribbean or Black British ethnicity particularly at risk.
              • Disabled women in the UK may be nearly twice as likely to experience economic abuse from a partner or ex-partner as non-disabled women

              The VISION consortium was delighted to financially support SEA’s research, A rapid impact survey to monitor the nature and prevalence of economic abuse in the UK, through our Small Projects Fund in spring 2024. Their full report will be widely shared in 2025, including on the VISION website and through our networks.

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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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                How much violence is there?

                  This VISION Policy Brief proposes improvements to the definitions and measurement of violence using the Crime Survey for England and Wales (CSEW), in order to more fully capture different aspects of violent crime, including violence against women and girls (VAWG). The briefing is aimed at researchers, national statistics offices, and others involved in violence research and policy. It draws on a paper recently published in The British Journal of Criminology, Definition and measurement of violence in the Crime Survey for England and Wales.

                  Key findings:

                  • The current definition of violent crime excludes key types: The Office for National Statistics (ONS) headline measure of ‘violent crime’ currently excludes sexual violence, robberies, threats of violence, and many incidents of violence where criminal damage was also involved.
                  • A broader definition would better capture scale, harm and inequalities: We use a broader measure of violence that includes these currently excluded forms of violence. This broader measure not only reveals a higher prevalence of victimisation in the population as a whole, it also reveals hidden inequalities. Women are more likely than men to experience sexual violence and threats of violence: excluding these from current estimates leads to rates of violence in women, especially domestic violence, being underestimated. The proportion of people physically and emotionally harmed by violence is also better estimated using this broader definition, particularly affecting estimates for women.

                  Recommendation for change:

                  • National statistics on violence in England and Wales should show violence estimates using a broader definition of violence alongside violent crime statistics to give a more comprehensive overview of violence and its societal impact.

                  To download the policy briefing, please see below. To download the paper upon which the policy recommendation is based, please see: Definition and Measurement of Violence in the Crime Survey for England and Wales: Implications for the Amount and Gendering of Violence | The British Journal of Criminology | Oxford Academic

                  The citation for the paper: Davies, E., Obolenskaya, P., Francis, B., Blom, N., Phoenix, J., Pullerits, M., and Walby, S. (2024), Definition and Measurement of Violence in the Crime Survey for England and Wales: Implications for the Amount and Gendering of Violence, The British Journal of Criminology. https://doi.org/10.1093/bjc/azae050

                  VISION Policy Briefing for downloading:

                  Violence Measurement_VISION Policy BriefingDownload

                  Violence in the workplace in the United Kingdom

                    Our latest research examines two nationally representative datasets, The Commercial Victimisation Survey (CVS) and the UK Household Panel Survey (UKHLS), to examine variance in the prevalence of workplace violence by industrial sector and occupational group.

                    The authors, Dr Vanessa Gash and Dr Niels Blom, found 28% of commercial businesses reported criminal victimisation on their premises in the past year, including 8% reporting violent victimisation (namely assaults, robberies, and threats).

                    Using individual-level data, the report also found 8% of employees had been threatened, insulted or physically attacked at work in the past year, and a similar percentage have felt unsafe at work, with public sector workers most at risk.

                    The authors call for enhanced recognition of the problem of workplace violence for a significant proportion of workers in multiple different sectors, alongside improved policies to minimise workplace violence going forward.

                    Figure 1. Prevalence of Violence and Fear of Violence in the Workplace by Sector, UKHLS data 2020-2021, weighted estimates

                    The report can be downloaded here: VISION Policy Report – Violence in the workplace in the UK: Business and individual-level exposure

                    Acknowledgements:

                    The report benefited from input and insights from the Home Office, who provided us with access to the Commercial Victimisation Survey used here.

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                    The benefits system: source of support or hindrance to victims of violence?

                      Previous VISION research showed how 4% of domestic violence victims lose their job as a result of abuse and that half of unemployed women have experienced intimate partner violence in their lives.

                      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 report can be downloaded from the DWP website: A health, social and economic profile of ESA recipients: Adult Psychiatric Morbidity Survey 2014 – GOV.UK

                      To cite:

                      Claire Lapham, Anne Conolly, Sally McManus (2024): A health, social and economic profile of ESA recipients: Adult Psychiatric Morbidity Survey 2014 DWP ad hoc research report no.79.

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