Deflection, denial and disbelief : social and political discourses about child sexual abuse and their influence on institutional responses : a rapid evidence assessment

The aim of the Independent Inquiry into Child Sexual Abuse (IICSA or ‘the Inquiry’) is to investigate whether public bodies and other non-state institutions have taken seriously their responsibility to protect children from sexual abuse in England and Wales, and to make meaningful recommendations for change, to help ensure that children now and in the future are better protected from sexual abuse. As defined in current government policy in England and Wales, child sexual abuse involves forcing or enticing a child or young person under the age of 18 to take part in sexual activities. It includes contact and non-contact abuse, child sexual exploitation (CSE) and grooming a child in preparation for abuse (HM Government, 2015b). However, definitions and understandings of what counts as child sexual abuse have been subject to substantial change over time. As part of its work, the Inquiry commissioned this rapid evidence assessment (REA) to understand what the social and political discourses have been about child sexual abuse, and the ways in which these discourses may have influenced responses to child sexual abuse by institutions. These questions have cross-cutting relevance for the work of the Inquiry. The overarching aim of this REA was to summarise the existing evidence base about social and political discourses concerning child sexual abuse in England and Wales from the 1940s to 2017 and identify the ways in which those discourses may have influenced institutional responses to such abuse

Guidance for Trust managers : implementing and sustaining routine enquiry about violence and abuse in mental health services (REVA project, briefing 2)

Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. However, by 2006 it was apparent that mental health provider trusts were not generally implementing the policy and a two-year initiative was launched to pilot an approach to introducing routine enquiry and embedding it in clinical practice. The pilot involved a total of 15 trusts and its evaluation identified key lessons for effective implementation of routine enquiry in all trusts. In 2012 the Department of Health funded follow-up research on responding effectively to the needs of survivors of violence and abuse to include case-studies of four of the original pilot trusts to implement routine enquiry (the REVA study). This guidance is based on findings from this study

A briefing for mental health professionals : why asking about abuse matters to service users (REVA project, briefing 3)

There are high prevalence rates of violent and abusive experience in both the childhoods and adult lives of mental health service users. Histories of childhood sexual and physical abuse amongst women service users are particularly well documented. Although many of the samples in studies are small, figures of over 50% are not unusual (Palmer et al, 1992; Bryer et al, 1987; Walker and James, 1992; Wurr and Partridge, 1996). In secure settings this figure is even higher (Bland et al, 1999). Studies of severe domestic violence among psychiatric in-patients report lifetime prevalence ranging from 30% to 60% (Golding, 1999; Howard et al. 2010). The REVA study, on which this briefing is based, has also found that people who suffer violence and abuse are much more likely to have a mental disorder, self-harm or attempt suicide than those with little or no experience of this kind (Scott et al, 2013). Given the prevalence of experiences of abuse among users of adult mental health services it is vitally important that these experiences are identified to ensure appropriate diagnosis, support and referral. Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. Yet actually disclosing experiences of violence and abuse can be very difficult. Survivors can feel a deep sense of shame and responsibility for the abuse they have experienced – feelings that are often strategically encouraged by their abusers (Clark and Quadara, 2010). These feelings can be compounded by unhelpful responses from professionals when they try to disclose (Imkaanetal, 2014). And survivors consistently say that disclosure has to be ‘at the right time for them’, which may be immediately or many years after the abuse (McNaughton Nicholls, 2012). In this briefing paper we present findings from research funded by the Department of Health Policy Research Programme on responding effectively to the needs of survivors of violence and abuse: the REVA study. The study included specifically asking survivors of violence and abuse about their views on routine enquiry, their experiences of disclosing abuse and their recommendations for how staff should ask clients about abuse

Addressing violence and abuse to achieve government priorities : new evidence from research funded by the Department of Health

A quarter of the population have experience of violence and abuse in their lives. Such experiences are major and under-acknowledged factors shaping people’s mental health and service needs. Public services are required to respond to both the needs of people with mental health problems, and those who have experienced abuse and violence. Our research highlights the strong links between the two – and the necessity for services to address these links if they are to respond effectively to clients’ needs

Evaluation of the pilot of domestic violence protection orders

In 2011/12, a 15 month pilot took place in three police force areas (Greater Manchester, West Mercia and Wiltshire) to test a new civil provision, Domestic Violence Protection Orders (DVPOs). DVPOs were designed to provide immediate protection for victim-survivors following a domestic violence incident in circumstances where, in the view of the police, there are no other enforceable restrictions that can be placed upon the perpetrator. DVPOs aim to give victim-survivors time, space and support to consider their options by placing conditions on perpetrators, including restricting/removing perpetrators from households, and preventing contact with, or molestation of, victim-survivors. The approach, introduced by the Crime and Security Act 2010, comprises an initial temporary notice (Domestic Violence Protection Notice, DVPN), authorised by a senior police officer and issued to the perpetrator by the police, followed by a DVPO that can last from 14 to 28 days, imposed at the magistrates’ court

A briefing for commissioners : what survivors of violence and abuse say about mental health services (REVA project, briefing 4)

The Department of Health publication, Commissioning services for women and children who have experienced violence or abuse – a guide for health commissioners, clearly acknowledges that ‘victims of violence or abuse tend to use health services more than average’ and that this is ‘despite often finding it hard to access services’ (Golding and Duggal, 2011: 22). The guidance goes on to state that it is precisely because of this that ‘it is in the NHS interest to identify these women and children, provide opportunities for them to disclose, and provide services [..] to help them improve their physical and mental health’ (ibid). The policy that has been implemented to support this process is known as ‘routine enquiry’ (RE). Since 2003 it has been Department of Health policy that all adult service users should be asked about experiences of violence and abuse in mental health assessments. However, asking about experiences of abuse and violence is not enough. To be effective the policy of routine enquiry has to be underpinned by the provision of appropriate and effective services for survivors of abuse. As the commissioning guidance notes, ‘commissioners should be aware of the importance of clear referral pathways, so that health professionals know where and how to refer women and children to local services’. For appropriate services to be available, commissioners also need to be aware of the type of services and care pathways that people who have experienced abuse feel are appropriate to meet their needs. In this briefing we present information drawn from interviews with mental health service users who have experienced domestic and/or sexual violence. This briefing focusses on the links between experience of abuse and mental health and the implications this has for commissioners to create an effective service landscape. The REVA research included the experience of both male and female service users. Useful guidance focussing on commissioning services specifically for women and girls who have survived violence is also available: see Woman’s Aid and Imkaan, 2014 ‘Successful commissioning: a guide to commissioning services that support women and children survivors of violence’, see www.womensaid.org.uk for details

Evaluation of the pilot of domestic violence protection orders

In 2011/12, a 15 month pilot took place in three police force areas (Greater Manchester, West Mercia and Wiltshire) to test a new civil provision, Domestic Violence Protection Orders (DVPOs). DVPOs were designed to provide immediate protection for victim-survivors following a domestic violence incident in circumstances where, in the view of the police, there are no other enforceable restrictions that can be placed upon the perpetrator. DVPOs aim to give victim-survivors time, space and support to consider their options by placing conditions on perpetrators, including restricting/removing perpetrators from households, and preventing contact with, or molestation of, victim-survivors. The approach, introduced by the Crime and Security Act 2010, comprises an initial temporary notice (Domestic Violence Protection Notice, DVPN), authorised by a senior police officer and issued to the perpetrator by the police, followed by a DVPO that can last from 14 to 28 days, imposed at the magistrates’ court

Violence, abuse and mental health in England (REVA project, briefing 1)

In 2006 the Department of Health introduced routine enquiry about peoples’ experience of violence and abuse as part of adult mental health assessments. This was in response to evidence that such experience was a significant aspect of the histories and difficulties of many service users. This research extends the evidence base by showing how mental illness is linked with experience of abuse and violence. It is based on a representative community-based sample rather than a patient population and examines experiences of both women and men across the life course

A briefing for service providers and commissioners : measuring outcomes for survivors of violence and abuse (REVA project, briefing 5)

The long-term consequences of violence and abuse can only be addressed if appropriate services for survivors are available. Many such services are located within the voluntary sector, and the fact that they are oversubscribed indicates a high level of demand, but there is limited robust evidence as to whether, how and why they work. Third sector organisations need to demonstrate their effectiveness, particularly in the context of competitive commissioning (Harlock, 2013). However, cuts to already under-resourced services in the violence against women and girls (VAWG) sector have made it difficult for many, especially smaller services, to develop meaningful measurement frameworks or to fully engage in commissioning processes (Callanan et al., 2012; Women’s Aid & Imkaan, 2014). The lack of standardised sector-specific outcome measures also means that services may be required to conduct multiple monitoring exercises for a variety of different funding streams, with none fully reflecting the reality of their work. To address these gaps, one strand of the REVA project has involved developing an outcomes framework to reflect the work of such services more accurately. In doing this, we built upon work underway in the specialist women’s voluntary sector by Women’s Aid, Imkaan, Rape Crisis England and Wales, and consulted with a range of individuals and organisations through the REVA Reference Network. We also drew on tools developed and used within the health and mental health sectors. Our aim was for the measures to be suitable for use in a range of types of services addressing various forms of violence and abuse located in both the voluntary and statutory sectors. The resulting outcomes tool was piloted in seven voluntary sector and NHS settings in 2013-14