Understanding forced marriage in Scotland

Executive summary In September 2015, the Scottish Government commissioned a 10 month study to better understand forced marriage in Scotland. This is the first forced marriage study that focuses exclusively on Scotland. The study had three research questions: What is the level and profile of service use relating to forced marriage in Scotland? How are services responding to forced marriage in Scotland? What is the impact of the interventions for forced marriage in Scotland? Methods The study focussed on six areas: Aberdeen, Dundee, East Renfrewshire, Edinburgh, Glasgow and Highland. An analysis of forced marriage policy in each of the six case study areas was undertaken, together with interviews with Protection Leads. One-to-one semi-structured interviews were carried out with a range of professionals including police officers, social workers, legal professionals and staff from Women's Aid organisations and other third sector organisations. Eight in-depth interviews were also conducted with survivors[1] of forced marriage. Additionally, a survey was distributed to 293 organisations - schools and women's organisations in the six study areas, and Women's Aid, minority ethnic and other support organisations throughout Scotland. Key findings and recommendations Level and profile of service use Between 2011 and 2014, there were 191 cases[2] of forced marriage reported by survey respondents, with a fairly even spread across the years. Cases tended to involve young, female South Asian victims being threatened or coerced into marriage largely by their parents and extended families. Age and ethnicity were unknown for around a quarter and a fifth of cases respectively, indicating that better recording of cases is necessary. Of the cases where age was known, the majority of victims were aged 18-25, with under 18s representing around a quarter of cases and under 16s around 1 in 10 of cases. Victims were mainly from Pakistani backgrounds (more than half of cases where ethnicity was known), followed by 'other ethnicity', Indian and Black African. Just over a half of referrals came to the attention of services through referral from other organisations, with under a third self-referrals and the remainder referred by friends or family. The interviews with the eight survivors of forced marriage echo the survey findings. The age range of when the forced marriage occurred was from 14-25. For five of the eight survivors the forced marriage was contracted with one survivor being forced into marriage twice. For two of the eight women, the experience of forced marriage was recent or ongoing (within the last two years). All the survivors interviewed were South Asian. All the women received help only when they came to Scotland - whether from abroad or another of the UK nations. Responding to forced marriage in Scotland Of the professionals interviewed, the majority had little direct experience of dealing with forced marriage but showed a sound understanding of forced marriage. However, those with direct experience of supporting victims of forced marriage had a deeper and more insightful understanding of forced marriage as a process rather than an 'event'. This was reflected at a policy level where there were differing levels of ownership and maturity of forced marriage policy, and where learning from forced marriage cases was identified as a means of improving responsiveness. Most professionals were aware that forced marriage took place in a range of communities, but it was seen as largely affecting South Asian communities in Scotland. This perception was confirmed by the survey findings, which found that the majority of cases where ethnicity was recorded related to South Asian communities. In both the policy analysis element of the study and in interviews with professionals, participants drew heavily from the Scottish Government's multi-agency guidance on forced marriage. A wide range of interventions are currently offered to support victims of forced marriage, most commonly one-to-one support, central to which is risk assessment and safety planning. Person-centred approaches were often used, and the need for therapeutic and practical support was also highlighted. Two third sector agencies interviewed offered mediation (and they were of the opinion that this was an effective intervention), despite the fact that Scottish multi-agency guidance stipulates that mediation should not be attempted in forced marriage cases. In terms of the outcome of support offered, nearly half of survey respondents reported that support offered was effective, but a further third were unsure whether the support offered was effective. Reported barriers to responding to forced marriage included 'race anxiety'; a need for more robust local authority procedures for supporting adult victims of forced marriage who have capacity (i.e. who do not meet the criteria to trigger access to adult protection); a need for further regular training for professionals; and a need for increased community education/public awareness on forced marriage. Multi-agency working was discussed both as very positive but also as a barrier - due to competing priorities and processes, with some agencies having more power than others to intervene and not always utilising the expertise available via specialists. A lack of training and learning opportunities on forced marriage was also identified as a barrier to responding effectively to forced marriage, despite forced marriage training being widely available. The survey results, policy analysis in some areas and interviews with some professionals suggest that a number of agencies and areas do not consider forced marriage a relevant issue for their organisation. This indicates that even with the provision of increased training on forced marriage, it might be challenging to recruit professionals to attend. Community education was thought to be a way to raise awareness within communities to increase reporting, but this intervention can also serve as a preventive measure. Targeted interventions for different sections of communities e.g. young people and elders would need to be developed. Although there was wide publicity about the forced marriage legislation, a lack of public awareness of forced marriage was also cited as a major barrier to increasing reporting and providing support for victims. This links with survivors' accounts that they sought help from family and friends and feared contacting agencies due to perceived confidentiality issues, family pressure, uncertainty about the appropriateness of response, and uncertainty about whether what had or was happening to them warranted agency involvement. There are examples of good practice at both a policy and practice level, including meaningful connections between child and adult protection leads and violence against women leads in some areas, proactive learning, person-centred support and in-depth expertise on forced marriage. Survivors reported that they had received excellent support from third sector organisations, but their accounts of other agencies were more mixed. Impact of interventions There was widespread support for civil remedies for dealing with Forced Marriage, from professionals interviewed and survivors of forced marriage. A number of issues were identified with regard to the implementation of civil remedies, relating to: a lack of consensus about what constitutes 'sufficient' evidence to justify granting a Forced Marriage Protection Order the onus of responsibility being placed on the victim, particularly where the victim is an adult who does not meet the criteria for accessing adult protection confidentiality of the victim not always being maintained In relation to criminalisation, most professionals interviewed thought it sent a strong message to the public that forced marriage was unacceptable in Scotland. However, a number of professionals (including some who supported criminalisation) also raised concerns about the potential for forced marriage to 'go underground', as victims would not wish to criminalise their families. It is too early to say whether this concern is justified. All survivors welcomed legal protection, but most were not supportive of criminalisation. However, one survivor who had pursued an FMPO stated that criminal procedures should be used, but only as a last resort. The impact of forced marriage on survivors of forced marriage included suicidal ideation, self-harm, eating disorders and other mental health problems. Survivors were frequently denied educational opportunities, impacting on their future careers and earning capacity. On a more positive note, survivors' experiences of forced marriage had engendered within them more liberal attitudes to parenting than those that they had experienced from their own parents. Survivors' experiences of statutory service response, including recent responses in Scotland, although positive in places, was patchy. However, it should be noted that some of the women were reflecting on historic cases stretching back a couple of decades and, at times, referring to experiences that happened outside Scotland. Most of the women had had some contact with third sector specialist women's support organisations, and all reported this as an extremely positive experience, although it should be noted that most survivors were recruited through their engagement with the women's sector. For some of the women, this was the first time they had told their story; for all of them it was the first time they had received support. Recommendations 1. Develop an innovative programme of further public/community awareness-raising activity, to prevent forced marriage and to encourage increased reporting 2. Develop further regular training on forced marriage for a range of professionals (including teachers, social workers, police officers, legal professionals and mental health practitioners), and ensure appropriate staff attend and the learning is cascaded and applied 3. Support the continued development of specialist women's sector organisations 4. Support the development of forced marriage policy in local authority areas, in order to increase ownership and consistency of approach at a local policy level throughout Scotland 5. Ensure that therapeutic and practical support is available to victims of forced marriage 6. Evaluate forced marriage interventions to develop better understandings of what types of forced marriage interventions work for whom 7. Address the issues the research identified in relation to implementing forced marriage legislation 8. Strengthen the statutory guidance of the Forced Marriage etc. (Protection and Jurisdiction) (Scotland) Act (2011) to make explicit local authorities' obligations to act in all cases of Forced Marriage 9. Improve record keeping of cases of forced marriage, as information about cases is key to developing learning and for future policy developmen

What Helps? Mothers' and Children's Experiences of Community-Based Early Intervention Programmes for Domestic Violence

Early help or early intervention is increasingly recommended for safeguarding children living with domestic violence, but little is known about what is effective. This article discusses findings from an evaluation of a pioneering early help service in North West England. This new service aimed to improve the safety and wellbeing of families (mothers and children) who were assessed as below the level of ‘high risk’ domestic violence and below the threshold for a child protection order. Between January 2014 and March 2015, families (473 mothers and 541 children) were identified within multiagency safeguarding hubs and referred to the early help service. The service that emerged was somewhat different to the service expected. This article discusses findings from qualitative data gathered from 39 participants (mothers, children and service providers) involved in the programme. Three main issues emerged as themes from the interviews: the benefits of having any service at all for children living with domestic violence who slip off the agendas of professionals working with child protection and high‐risk domestic violence; the importance of flexibility of key worker‐led service delivery; and the suitability of current group work and therapeutic models for meeting the varied needs of families affected by domestic violence

The prevalence of constant supportive observations in a high, medium and low secure service

Aims and Method We explored the prevalence and use of constant supportive observations (CSO) in high, medium and low secure in-patient services in a single NHS mental health trust. From clinical records, we extracted data on the length of time on CSO, the reason for the initiation of CSO and associated adverse incidents for all individuals who were placed on CSO between July 2013 and June 2014. Results A small number of individuals accounted for a disproportionately large amount of CSO hours in each setting. Adverse incident rates were higher on CSO than when not on CSO. There was considerable variation between different settings in terms of CSO use and the reasons for commencing CSO. Clinical Implications The study describes the prevalence and nature of CSO in secure forensic mental health services and the associated organisational costs. The marked variation in CSO use between settings suggests that mental health services continue to face challenges in balancing risk management with minimising restrictive interventions

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Home-body/Kitchen Table Solo Show (2020 – 23) exhibited in 'Rupture, Rapture: Womxn in Collage'

Home-body/Kitchen Table Solo Show, is a composite installation of a series of works made during the pandemic - from within sixty weeks of shielding: In this context, one type of interior is the shell - a networked container maintained by labour and producing waste, reaching for community and receiving shopping. Another interior is the body within, navigating complex dependencies and desires. These works were all made on the edges of a kitchen table and draw on Mendelson's, often positive, experiences of the home-as-skin. A new, painted platform was produced for this exhibition, allowing the 'kitchen table' itself to fold into the work. ‘Rupture, Rapture: Womxn in Collage’ is a publication, residency and survey exhibition. 25 August - 23 September 2023 Patricia Fleming Gallery, Glasgow 'Rupture, Rapture: Womxn in Collage' brings together new and existing works, alongside special commissions to showcase collage in an expanded field, incorporating multimedia, sculpture, sound and performance art. Displaying over twenty collage works by 14 womxn artists, this exhibition challenges the notion of collage as a fixed category or form—instead revealing collage as a feminist praxis of transformation, rupture, and collision. Commissioned works will be presented by 16NSt resident artists’ Edie Baker, Gabrielle Lockwood Estrin, and Hannan Jones, developed in-situ at Patricia Fleming Gallery, along with a collage installation and performance from Jen DeNike (16th Sep), exhibiting the artist’s work in Scotland for the first time. New and historic work will be shown by Sam Ainsley, Claire Barclay, Barbara F. Kendrick, Janie Nicoll, Kate V. Robertson, and Catherine Street. Significant existing works will be displayed by Louise Hopkins, Zoë Mendelson, Victoria Morton, and Alberta Whittle. Curated by Aga Paulina Młyńczak and Nell Cardozo with support from Kelly Rappleye (16NSt Curatorial Collective), Sam Ainsley (artist and former Head of Glasgow School of Art’s MFA) and artist Janie Nicoll, this survey exhibition hosted by Patricia Fleming Gallery displays a diverse repertoire of over twenty collage works, several of which have never been shown before. By putting multimedia sculptural installations together with paper works, Młyńczak and Cardozo aim to expand the notion of what contemporary collage can do. Displaying work from womxn artists at various stages in their careers who use expanded collage processes, this exhibition aims to create an inter-generational feminist dialogue. 16NSt’s Rupture, Rapture: Womxn in Collage project comprises an emerging artists’ residency and publication alongside this exhibition to trace an alternative, feminist lineage of collage in everyday practices by womxn and queer communities, which have traditionally been refused art historical recognition, from scrapbooking to collage poetry. These homegrown acts of cultural transformation inform the ethos of cross-media experimentation and re-assemblage of everyday material that is shared across the works in this exhibition. PUBLICATION Accompanying the exhibition will launch a limited-release publication ‘RUPTURE, RAPTURE’, featuring rarely-seen collage works by Maud Sulter alongside a critical survey of contemporary womxn’s collage in Scotlan

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Large-scale sequencing of SARS-CoV-2 genomes from one region allows detailed epidemiology and enables local outbreak management.

The COVID-19 pandemic has spread rapidly throughout the world. In the UK, the initial peak was in April 2020; in the county of Norfolk (UK) and surrounding areas, which has a stable, low-density population, over 3200 cases were reported between March and August 2020. As part of the activities of the national COVID-19 Genomics Consortium (COG-UK) we undertook whole genome sequencing of the SARS-CoV-2 genomes present in positive clinical samples from the Norfolk region. These samples were collected by four major hospitals, multiple minor hospitals, care facilities and community organizations within Norfolk and surrounding areas. We combined clinical metadata with the sequencing data from regional SARS-CoV-2 genomes to understand the origins, genetic variation, transmission and expansion (spread) of the virus within the region and provide context nationally. Data were fed back into the national effort for pandemic management, whilst simultaneously being used to assist local outbreak analyses. Overall, 1565 positive samples (172 per 100 000 population) from 1376 cases were evaluated; for 140 cases between two and six samples were available providing longitudinal data. This represented 42.6 % of all positive samples identified by hospital testing in the region and encompassed those with clinical need, and health and care workers and their families. In total, 1035 cases had genome sequences of sufficient quality to provide phylogenetic lineages. These genomes belonged to 26 distinct global lineages, indicating that there were multiple separate introductions into the region. Furthermore, 100 genetically distinct UK lineages were detected demonstrating local evolution, at a rate of ~2 SNPs per month, and multiple co-occurring lineages as the pandemic progressed. Our analysis: identified a discrete sublineage associated with six care facilities; found no evidence of reinfection in longitudinal samples; ruled out a nosocomial outbreak; identified 16 lineages in key workers which were not in patients, indicating infection control measures were effective; and found the D614G spike protein mutation which is linked to increased transmissibility dominates the samples and rapidly confirmed relatedness of cases in an outbreak at a food processing facility. The large-scale genome sequencing of SARS-CoV-2-positive samples has provided valuable additional data for public health epidemiology in the Norfolk region, and will continue to help identify and untangle hidden transmission chains as the pandemic evolves.The sequencing costs were funded by the COVID-19 Genomics UK (COG-UK) Consortium which is supported by funding from the Medical Research Council (MRC) part of UK Research and Innovation (UKRI), the National Institute of Health Research (NIHR) and Genome Research Limited, operating as the Wellcome Sanger Institute

Working group on cephalopod fisheries and life history (Wgceph; outputs from 2022 meeting)

Rapports Scientifiques du CIEM. Volume 5, nº 1WGCEPH worked on six Terms of Reference. These involved reporting on the status of stocks; reviewing advances in stock identification, assessment for fisheries management and for the Ma- rine Strategy Framework Directive (MSFD), including some exploratory stock assessments; re- viewing impacts of human activities on cephalopods; developing identification guides and rec- ommendations for fishery data collection; describing the value chain and evaluating market driv- ers; and reviewing advances in research on environmental tolerance of cephalopods. ToR A is supported by an annual data call for fishery and survey data. During 2019–2021, com- pared to 1990–2020, cuttlefish remained the most important cephalopod group in terms of weight landed along the European North Atlantic coast, while loliginid squid overtook octopus as the second most important group. Short-finned squid remained the least important group in land- ings although their relative importance was almost double in 2019–2022 compared to 1992–2020. Total cephalopod landings have been fairly stable since 1992. Cuttlefish landings are towards the low end of the recent range, part of a general downward trend since 2004. Loliginid squid landings in 2019 were close to the maximum seen during the last 20 years but totals for 2020 and 2021 were lower. Annual ommastrephid squid landings are more variable than those of the other two groups and close to the maximum seen during 1992– 2021. Octopod landings have generally declined since 2002 but the amount landed in 2021 was higher than in the previous four years. Under ToR B we illustrate that the combination of genetic analysis and statolith shape analysis is a promising method to provide some stock structure information for L. forbsii. With the sum- mary of cephalopod assessments, we could illustrate that many cephalopod species could al- ready be included into the MSFD. We further provide material from two reviews in preparation, covering stock assessment methods and challenges faced for cephalopod fisheries management. Finally, we summarise trends in abundance indices, noting evidence of recent declines in cuttle- fish and some octopuses of the genus Eledone. Under ToR C, we describe progress on the reviews of (i) anthropogenic impacts on cephalopods and (ii) life history and ecology. In relation to life history, new information on Eledone cirrhosa from Portugal is included. Under ToR D we provide an update on identification guides, discuss best practice in fishery data collection in relation to maturity determination and sampling intensity for fishery monitoring. Among others, we recommend i) to include the sampling of cephalopods in any fishery that (a) targets cephalopods, (b) targets both cephalopods and demersal fishes or (c) takes cephalopods as an important bycatch, ii) Size-distribution sampling, iii) the use of standardized sampling pro- tocols, iv) an increased sampling effort in cephalopod. Work under ToR E on value chains and market drivers, in conjunction with the Cephs & Chefs INTERREG project, has resulted in two papers being submitted. Abstracts of these are in the report. Finally, progress under ToR F on environmental tolerance limits of cephalopods and climate en- velope models is discussed, noting the need to continue this work during the next cycle.info:eu-repo/semantics/publishedVersio