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Medicine’s reckoning with genocide and crimes against humanity

Gene Feder, Professor of Primary Healthcare and VISION Director, has written an opinion piece with colleagues stating that accountability for human rights must guide every collaboration in medicine and science.

In their BMJ publication, Medicine’s reckoning with genocide and crimes against humanity, the authors build the case that in the nearly eight decades after the Genocide Convention in 1948, prevention has advanced in principle but faltered in practice. Many states remain indifferent, but medicine must not. Beginning with genocide, medical and academic leaders have a duty to implement reforms to safeguard the line between valuable collaboration and toxic complicity, break institutional silence, and declare medicine’s commitment to the right to existence and life for all peoples, in all states.

For further information: Please contact Gene at gene.feder@bristol.ac.uk

To cite: Minhas R, Shellah D, Maynard N, Goodwin-Gill G, Chalmers I, Feder G et al. Medicine’s reckoning with genocide and crimes against humanity BMJ 2025; 391 :r2277 doi:10.1136/bmj.r2277

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Practitioner in Residence: Navigating complex cases in Domestic Abuse-Related Death reviews

 

Danielle Sharp is the founder and Chief Executive of the Centre for Safer Society, an organisation dedicated to supporting services in designing evidence-based responses to reduce violence, abuse, and harm. Through the Centre, Danielle conducts service evaluations, develops impact-driven strategies for organisations working to end violence and abuse, and serves as an Independent Chair for statutory Domestic Abuse-Related Death reviews – work that brings her face-to-face with the families of those who have been killed or died by suicide.

For most of her career, Danielle has worked in the domestic abuse and violence against women and girls (VAWG) sector. She began in frontline roles supporting young people and families before moving into strategic positions developing and commissioning evidence-based local responses to domestic abuse. Her work then expanded to national level at SafeLives, where as Head of the Knowledge Hub she led projects such as the Home Office One Front Door pilot, and Multi-Agency Risk Assessment Conference (MARAC) national oversight.

It is through her work as an Independent Chair for Domestic Abuse-Related Death reviews that Danielle identified the practice challenge that will form the focus of her Practitioner in Residence (PiR) research at the Violence and Society Centre (VASC). In several reviews, a recurring issue has emerged: cases where practitioners identify ‘bi-directional violence’ or ‘dual-allegations’ between individuals. This creates significant difficulties in accurately assessing risk, determining whether there is a primary victim and primary perpetrator, and making informed safeguarding decisions.

While some valuable resources exist, such as Michael Johnson’s domestic abuse typologies and the Respect practice toolkit for identifying primary victims and perpetrators, these tools are not yet consistently embedded across all agencies responding to domestic abuse. Particularly within policing and social care, practitioners often lack accessible, practical guidance to navigate these complex cases with confidence.

With the support of VISION Co-Investigator and Senior Lecturer Dr Elizabeth (Lizzie) Cook, Danielle’s focus in the PiR programme will be to bridge the gap between research and practice by developing practical resources for professionals. These tools will equip practitioners with greater clarity and confidence when navigating cases involving dual-reports, ultimately improving risk assessment and decision-making.

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

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Impact of consecutive COVID-19 lockdowns on GP referrals of women experiencing domestic abuse in England and Wales

To curb COVID-19, three periods of severe physical distancing measures (‘lockdowns’) were imposed by the Government throughout 2020 and 2021 in England and Wales: between 23 March and 1 June 2020 (68 days), 5 November 2020 and 2 December 2020 (27 days) and between 6 January and 8 March 2021 (61 days). These lockdowns resulted in societal changes, including full or part-time school and workplace closures, and reduced community mixing.

The pandemic also necessitated a change in clinical consultations in primary care, with a shift from predominantly face-to-face to mostly remote consultations (telephone, digital and video), complicating the provision of care and support, including safeguarding. The lockdowns made it harder for people to disclose domestic violence and abuse (DVA) to health professionals, as online consultations can form barriers to support.

Long and enforced lockdowns can make it harder to disclose DVA and can have a detrimental impact on DVA victim-survivors and their families. Previous studies suggest that the COVID-19 pandemic and its lockdowns have led to an increase in DVA incidence. Refuge, the organisation running the 24-hour national DVA helpline in England, reported that calls surged by 60% during 2020 compared with the previous year. There is, however, scarce evidence on the impact of consecutive lockdowns over a period of almost 2 years on referrals from primary care to DVA support services in England.

The research team, led by Dr Jasmina Panovska-Griffiths and others including VISION researchers Professor Gene Feder and Dr Estela Capelas Barbosa, evaluated the impact of the three successive national lockdowns on the referrals from general practice (GP) to the Identification and Referral to Improve Safety DVA services. Their study, Interrupted time series and non-linear regression analyses to evaluate the impact of the three consecutive COVID-19 national lockdowns on the general practice referrals of women experiencing domestic violence and abuse in England and Wales, is the first to evaluate the continual impact of the COVID-19 pandemic and the three consecutive national lockdowns in 2020 and 2021 on DVA referrals. The researchers also explored the relationship between stringency of lockdowns and number of DVA referrals.

Anonymised data on daily referrals, interrupted-time series and non-linear regression quantified the impact of the three national lockdowns over 2020 and 2021 comparing analogous periods in the 2 years before and after, reporting incidence rate ratios, 95% Confidence Intervals and p values. Time spent at home and workplace visits over the lockdown periods were quantified as proxies for the stringency of the different lockdowns.

The first national lockdown in early 2020 led to a reduced number of referrals to DVA services. Over the second and the third lockdown, there was a possible increase in the number of referrals. The first national lockdown was more stringent (58% decline in workplace visits; 22% increase in time spent at home) than the second (34% decline in workplace visits; 14% increase in time spent at home) or the third (18% decline in workplace visits; 18% increase in time spent at home).

Increased freedom of movement alongside easier access to GP services during the two latter, less stringent, lockdowns compared with the first, stringent, lockdown could have contributed to the different trends in referrals. The research team determined that ensuring access to primary care and adequate and continuing provision of specialist support for people experiencing DVA is important during national emergencies. Further research, coproduced with DVA survivors and DVA agencies, is necessary to establish and evaluate the most appropriate support during both potential future national lockdowns and other systemic closures (eg, school holidays).

Recommendation

More stringent systemic closures will lead to a reduced number of referrals to a specialist DVA programme, while more relaxed system closures may result in increased referrals. This highlights the importance of ensuring adequate access to support, such as primary care, where people can safely disclose DVA and be referred to service providers during system closures, regardless of the stringency.

For further information: Please contact Jasmina at jasmina.panovska-griffiths@queens.ox.ac.uk

To cite: Panovska-Griffiths J, Szilassy E, Downes L, Dixon S, Dowrick A, Griffiths C, Feder G, Capelas Barbosa E. Interrupted time series and non-linear regression analyses to evaluate the impact of the three consecutive COVID-19 national lockdowns on the general practice referrals of women experiencing domestic violence and abuse in England and Wales. BMJ Public Health. 2025;3:e002408. https://doi.org/10.1136/bmjph-2024-002408

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Neighbourhood characteristics and violence rates: Investigating associations over time

Violence is a critical issue in the UK, both in terms of its impact on individuals and communities and its prominence in public and media discourse. Violence has many negative effects for victims, ranging from emotional and/or physical impacts to isolation and withdrawal from social life. Victims of violence suffer the effects for longer periods of time compared to victims of other crime types and the societal economic cost of violence is also considerable with the total cost of violence in London alone in 2018–19 was £3 billion.

Few studies have examined violence at the neighbourhood level, and even fewer have investigated how changes in neighbourhood characteristics relate to changes in violence over time. The recent study, Increases in disadvantage and instability are associated with rising violence, led by Ferhat Tura (Bournemouth University) with Oluwole Adeniyi (Nottingham Trent University) and VISION researchers Ruth Weir (City St George’s University of London) and Niels Blom (University of Manchester) investigates the association between changes in neighbourhood characteristics and changes in violence rates in England and Wales between 2011 and 2021.

They argue that rising levels of social disadvantage—particularly in relation to unemployment, poor health, lone-parent households, residential mobility, and social housing—are associated with increased neighbourhood-level violence.

The research team highlights that increased ethnic heterogeneity when it coincides with growing deprivation (e.g. poor health and no qualification) is associated with rising violence risk. There is a need to address structural inequalities through investment in housing, health, education and community stability. Policy responses should extend beyond criminal justice to promote long-term violence reduction and community well-being.

Recommendation

Social policies should focus on long-term investment in deprived neighbourhoods, including affordable and stable housing to reduce residential turnover and improve long-term outcomes for residents.

For further information: Please contact Ferhat at ftura@bournemouth.ac.uk

To cite: Ferhat Tura, Ruth Weir, Niels Blom, Oluwole Adeniyi, Increases In Disadvantage and Instability Are Associated With Rising Violence, The British Journal of Criminology, 2025;, azaf080, https://doi.org/10.1093/bjc/azaf080

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Reducing young people’s exposure to violence in Lambeth

High Trees Community Development Trust and the Lambeth Peer Action Collective (LPAC) were recently awarded further funding from VISION to co-develop an evaluation framework to measure the impact and value for money of open access youth work and provision on reducing young people’s exposure to violence in Lambeth.

The project draws on an existing collaboration and partnership between VISION, High Trees and LPAC that explored the role trusted adults and safe spaces play in protecting young people from violence. The findings from the original partnership support emerging national data about the role that youth organisations, positive activities and trusted adults play in supporting vulnerable young people. However, existing approaches to evaluation surface challenges about how youth work is measured, monitored and evaluated. Through previous LPAC research with young people, youth practitioners and organisations, the team observed a disconnect between how practice is recognised and valued by young people and how funders, commissioners and policymakers expect impact and value for money to be measured.

This contributes to gaps in the quality, consistency and reliability in evidence, particularly as smaller youth organisations have limited capacity and resources to contribute to large-scale evaluations using established methods. For those offering open access youth work and services, where provisions can be accessed by young people regardless of background or need, demonstrating impact and value for money proves even more difficult as these interventions are longer-term, open-ended and/or unstructured across different settings.

Therefore, building on the previous LPAC research and an initial Cost-Consequence Analysis (CCA) produced by VISION, the aim of the current project is to co-produce an evaluation framework, including components for economic evaluation, that supports youth organisations in Lambeth to measure and demonstrate the impact (and potential value for money) of youth service provision.

For further information on the original research, please see the blog, The story so far: Co-production in Lambeth

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

Webinar: Exploring Natural Language Processing in violence prevention data

Do you work with text data in the field of violence prevention?

Are you interested in exploring how Natural Language Processing (NLP) can be used as an analytical tool?

Research Fellow Darren Cook from the UKPRP VISION Consortium and the Violence & Society Centre at City, St George’s, University of London will demonstrate how NLP techniques can be applied to domestic violence and abuse data in an upcoming webinar on 13 November 2025 from 10 – 10:50 am.

What is NLP?

Natural Language Processing (NLP) focuses on the interaction between computers and human language, such as interpreting and categorising free text from police or medical notes. This approach enables machines to understand, interpret, and generate human language in meaningful and useful ways. It allows computers to analyse and process text data, capturing not only the content but also the intent and emotion behind the words.

13 November 2025, 10 – 10:50 am, online only 

To register for the event and receive the Teams link, please email: VISION_Management_Team@city.ac.uk

Practitioner in Residence: Improving services for those experiencing teenage relationship abuse

Aisling Barker

Aisling Barker, Violence Against Women and Girls Workforce Development manager at Islington Council, and qualified social worker, is the latest practitioner to join the City St George’s University of London (CSGUL) Practitioner in Residence programme. She became aware of the programme through her work on teenage relationship abuse with co-Deputy Director of the Violence and Society Centre (VASC) at CSGUL and VISION consortium Senior Research Fellow Dr Ruth Weir.

Aisling and her team in Islington have been supporting professionals in their practice with adolescents for five years. They identified concerning trends in violence and abuse in relationships where the victim was as young as 13 years of age but the person causing harm was also as young as 14 or 15 years old. An alarming lack of support available for these young people was apparent – particularly those who were causing harm to their partners at that young age.

Aisling presented the work of her team at the first conference on Adolescent Domestic Abuse hosted by VISION in April 2024. Driven by curiosity the team began to analyse cases to understand where there were system strengths and gaps. They found knowledge and practice gaps in services responding to young people where there was harm in their relationships. They also found that young people often had good relationships with practitioners such as youth workers, gang workers and youth justice case workers. Identifying an opportunity for practice improvement, Aisling and her team developed a training and support package for services working with young people affected by criminality and offending behaviour. Aisling also presented the findings from their case analysis and a case study at the second National Working Group on Teenage Relationship Abuse roundtable in November 2024 also hosted by VISION.

With the support of Ruth and the VASC and VISION teams, Aisling’s focus as a Practitioner in Residence will be documenting and examining the impact of this training and support package as an innovative approach to the prevention and early intervention on violence against women and girls.

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

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VISION hybrid seminar: An overview of systematic reviews on violence 

This event is in the past.

Join us for a hybrid seminar at City St George’s on 10 September exploring two VISION systematic reviews: one on experiences of violence among people in insecure migration status and the other on the effectiveness of UK domestic and sexual violence and abuse support services and interventions.

The interdisciplinary UK Prevention Research Partnership (UKPRP) Violence, Health and Society (VISION) consortium brings together evidence on violence prevention from across health, social, crime and other sectors. A key method for producing comprehensive evidence syntheses is the systematic review.

In this seminar, we bring together two very different systematic reviews of evidence on violence:

  • The first presentation, by Alexandria Innes and Hannah Manzur, is global and examines the nature and prevalence of violence among people in different types of insecure migration status.
  • The second presentation, by Annie Bunce and Sophie Carlisle, focuses on the UK and summarises what we do and don’t know about the effectiveness of domestic and sexual violence support services and interventions. 

For further information, please also see the VISION Policy Briefings stemming from the research:

  1. Insecure migration status increases risk of multiple forms of violence
  2. Measuring the effectiveness of UK support services and interventions for domestic and sexual violence and abuse

Register in person or online here: Ticket Tailor – VISION Hybrid Seminar – 10 Sept 2025

  • In person: Rhind Building, St John Street, London, EC1R 0JD followed by an afternoon tea in the Violence & Society Centre. 
  • Online: A Microsoft Teams link will be emailed the morning of the seminar

For further information, please contact VISION_Management_Team@citystgeorges.ac.uk

Insecure migration status increases risk of multiple forms of violence

Insecure migration status is defined as any person who does not have a long term secure immigration status and might fear removal from the country if they fail to comply with their visa restrictions, even if the failure to comply is unknown to them, if forced due to fear for their physical safety, or is coerced.

Research produced by Drs Alexandria Innes and Hannah Manzur of the VISION consortium and PhD student Jana Kriechbaum, Violence and Society Centre at City St George’s University of London, found that people in insecure migration status face or fear violence where violence prevention efforts and violence protection are either not extended to them, or are not made accessible to them.

Findings from their VISION Policy Briefing

The prevalence of violence against people in insecure migration status is a cause for concern. Prevalence of violence is not meaningfully different for people based on type of insecure status, such as those with undocumented status, asylum seekers and refugees, or employer-dependent visas.

Women on spousal visas connect experiences of domestic violence to insecurities associated with their immigration status. The power imbalance embedded in relationships that involve one citizen and one foreigner is exacerbated by attaching the relationship to dependent visa restrictions. Women on spousal visas associated their inability or unwillingness to leave a violent homelife with a fear of immigration removal, therefore prolonging their exposure to violence.

Recommendations

  1. Decouple immigration enforcement from violence prosecution and victim support
  2. Expand protections for survivors of domestic violence
  3. Strengthen protections for victims of work-related exploitation and improve employer regulations
  4. Address state violence in detention and border contexts
  5. Align immigration policies with public health frameworks

To download the VISION Policy Briefing: Insecure Migration

To cite: Innes, Alexandria; Manzur, Hannah; Kriechbaum, Jana (2025). VISION Policy Briefing: Insecure Migration. City, University of London. Report. https://doi.org/10.25383/city.29860142.v1

For further information, please contact Andri at Alexandria.Innes@citystgeorges.ac.uk

A Lived Experience perspective of the 2025 VISION annual conference

by Justin Coleman, Violence, Abuse and Mental Health Network

The UK Prevention Research Partnership VISION consortium’s 4th annual conference on violence prevention was a truly impactful day. As part of the Violence, Abuse and Mental Health Network Lived Experience Advisory Group (VAMHN LEAG), representing a lived experience perspective, I found the discussions both thought-provoking and essential. The event skilfully blended academic rigor, professional expertise, and, crucially, profound lived and learned experience, prompting vital questions about how we truly move forward in creating a more inclusive and effective violence prevention landscape.

The Imperative of Inclusive Practice: Who Are We Really Serving?

A key takeaway was the urgent need for radical inclusivity. While Violence Against Women and Girls (VAWG) was rightly highlighted and the clear and marked volume and % percentage numbers are stark, I question if we’re inadvertently creating gaps for other survivors. As a male survivor of abuse, as a child, I wonder if our messaging and funding focus heavily on one demographic, how do we ensure male survivors, LGBTQ+ individuals, and marginalised communities (young and older) feel seen and supported? True trauma-informed practice, to me, means moving beyond “what’s wrong with you?” to “what happened to you?” for everyone who is impacted by all forms of violence and abuse. No matter who you are, this simply shouldn’t happen to anyone.

Data, lived experience, and investment: Are we looking at the full picture?

The power of data in policy was clear, but it also raised concerns. Are investment strategies relying on outdated statistics? If resource allocation isn’t based on continuously updated, comprehensive data, are we truly capturing the evolving landscape of violence and the needs of all survivors today? Quantitative data alone can miss nuanced realities that lived experience and ethnographic insights provide. We need a dynamic balance where current lived realities inform and refresh our understanding, ensuring our leadership is deeply connected to ‘our’ diverse lived experiences.

Redefining safety and dignity: Beyond the checklist

The concept of “safety” in support spaces commented on at the conference resonated deeply. Can we ever guarantee “safety,” or should we strive for environments that are continually “safer” and more “supported”? This shift moves us beyond ticking a box to an ongoing commitment. The most impactful word was “dignity.” Shouldn’t ensuring dignity be a fundamental aim at every stage of a survivor’s journey, enabling genuine opportunity for healing and empowerment?

Breaking silos: The path to unified prevention

Effective violence prevention demands a cross-government, cross-sector approach. We need to collaborate beyond our immediate professional bubbles, integrating insights from areas like the criminal justice system to inform victim services. While “whole-family” approaches were discussed, I questioned if we can expand this to truly embrace “whole-community” approaches, ensuring LGBTQ+ individuals, isolated people, and every member of society has an equitable voice and space in prevention, responsibility, and repair.

Moving forward: A collective responsibility

This conference was a crucial step, bringing vital voices to the table. The co-produced animation with VAMHN and SafeLives, available on the City St George’s University of London YouTube channel, https://youtu.be/z6LbYDGfBZw?si=3-tJYXDqLfM16pE-, is an excellent resource for understanding lived experience engagement. To truly mobilise an effective cross-government response, we must continue to ask:

  • Are our investment decisions agile enough to respond to current data and the evolving needs of all survivors?
  • Does promoting the financial cost of crime and low conviction rates discourage reporting?
  • How can we ensure every violence prevention initiative is genuinely trauma-informed and inclusive, making all children, male, LGBTQ+, and all marginalised survivors feel equally seen, heard, and supported? What is the cost of not being inclusive?
  • Are we creating enough opportunities for genuine connection and partnership across diverse stakeholders at events like this, rather than just delivering information?
  • Are we bravely embracing “safer” and “dignity” as guiding principles, continuously improving how we support survivors?
  • Are we actively breaking down silos to build robust and equitable prevention and support systems?

The future of violence prevention depends on challenging existing paradigms, embracing inclusivity, advocating for trauma-informed practice and care, and working together from all perspectives with updated knowledge and a shared commitment to a safer journey towards dignity for all. This VISION conference stimulated valuable questions and directions, strengthening my determination to build connectivity, dignity, and safer spaces for survivors.

To read the latest Violence, Abuse and Mental Health Network newsletter: June VAMHN newsletter

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