How social workers’ lack of domestic abuse awareness fails vulnerable adults

Adult safeguarding professionals all too frequently try to manage domestic abuse referrals using only social care interventions, meaning the most effective option is missed, says Sarah Khalil.

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A survivor once said ‘living with lung cancer has been easier for me than living with constant fear and abuse’  .  This statement is from an older person who had lived with domestic abuse for decades and reminds me how torturous domestic abuse can be.  I have heard social workers say ‘we hardly ever see any domestic abuse cases’ and ‘it’s not something we can offer support for’.  What kind of response would that survivor get from those professionals? 

In many areas of the country and indeed in our national policy, a culture has evolved where domestic abuse, adult safeguarding, children’s safeguarding and community safety, are all seen as individual industries, when in reality they are intertwined.  Whilst this siloed approach continues, victims of abuse are crying out for cohesive interventions.

Research suggests that disabled women are twice as likely to experience domestic abuse than non-disabled women. This implies that adults who are vulnerable to abuse and neglect are more likely to experience domestic abuse. Research also tells us that one in three female suicide attempts can be attributable to past or current domestic abuse and women experiencing domestic abuse are 15 times more likely to misuse alcohol. This therefore implies that adults who experience domestic abuse are more likely to become ‘vulnerable adults’.

‘Subordinate, dependent and isolated’

At the end of March, the government provided us with a new definition of domestic abuse, which now includes controlling and coercive behaviour – as well as incidents of threatening behaviour or violence – and distinct definitions of these. Think of those you’ve worked with who were being abused by their adult son or daughter, their partner or ex-partner, their brother or sister, and who were made to feel, in the words of the government definition, “subordinate, dependent, isolated from sources of support” and “deprived of the means needed for independence”.

I’ve managed an adult safeguarding service until recently and have found it incredibly useful to have a broad approach to protecting people that encompasses domestic abuse interventions.  For example, when 81-year-old Mr X is being physically and emotionally abused by his 43-year-old son we can:

  • work out the level of risk he is at using a domestic abuse risk indicator checklist, thereby ensuring we ask the right questions;
  • refer him into the multi-agency risk assessment conference (Marac) so that all agencies can consider how they can assist him;
  • ask the police consider removing the perpetrator with a domestic violence protection order;
  • use a domestic abuse ‘sanctuary scheme’ to put extra security in his house and offer him a referral to his local domestic abuse service for emotional support as well as our standard social care support;
  • liaise with domestic abuse services for expert advice, including how to develop a safety plan.

This response appears to have been sadly lacking within the serious case reviews we read, such as that concerning 83 year old Mrs A in Bournemouth and Poole, who was killed by her son-in-law. We have got to stop the tendency to immediately place victims in one type of safeguarding silo.

I still hear people ask, ‘but why didn’t she leave?’, in relation to domestic abuse. It is a sad fact that women in particular are most at risk of homicide or serious injury at the point of leaving an abusive relationship, which is why the choice to leave needs to be planned and risks managed. Eight out of ten domestic homicides take place at or after the point at which the deceased victim has either left or told the abusive partner that the relationship is over.

Additional barriers to leaving for vulnerable adults

When I’ve interviewed survivors and listened to their stories I am amazed how they have managed to leave. When I speak to adults who are vulnerable to abuse and neglect I am even more humbled as I hear of the additional barriers that they have had to overcome. 

Adults who are vulnerable to abuse and neglect may have substance misuse, disabilities or mental health problems, for example, which can make doing the shopping difficult nevermind orchestrating a safe move from an abusive relationship. They may fear being placed in an institution, losing their carer, their specially-adapted home and contact with their family and grandchildren. Some survivors from a black and minority ethnic background may struggle to leave an abusive relationship due to reasons including a fear of honour-based violence, having no recourse to public funds and their language skills being a barrier to accessing support. 

Research suggests that adults who are vulnerable to abuse and neglect may be less aware of support services. This means we as professionals, who are also their advocates, need to be aware of what is available for them.

We must join up safeguarding and domestic abuse services

A national drive is required from government to conjoin the often separated strands of safeguarding and to listen to the voices of survivors of domestic abuse who are also vulnerable adults. We can so easily miss where systems have affected an outcome or where a child or adult could have been better supported if the right questions and expertise are not used within the separate processes of adults’ serious case reviews, children’s serious case reviews or domestic homicide reviews. This is particularly relevant where adults, including those who are vulnerable to abuse and neglect, have been seriously injured or killed due to domestic abuse. How can we expect learning to occur when it is siloed within the very processes designed to encourage us to learn lessons?

In the meantime my challenge to you is to assess what you can change locally to ensure that survivors of domestic abuse who are also eligble for adult safeguarding support are given the full range of options. In Manchester the safeguarding adults and safeguarding children’s boards have recently completed a joint domestic abuse protocol, our domestic abuse forum is a sub-group to the children and adults safeguarding boards, and we share our expertise from serious case reviews into the processes for domestic homicide reviews and vice versa. 

The new Local Government Association and Association of Directors of Adult Social Services guidance, Adult Safeguarding and Domestic Abuse:A guide to support practitioners and managers, draws significantly from our new procedures. We are dealing with very challenging levels of abuse and violence of all kinds in Manchester, but we are on this journey together and that’s the best way to continue.

 Sarah Khalil was recently appointed as the named nurse for adult safeguarding for Manchester’s clinical commissioning groups and is a member of the Manchester Safeguarding Adult Board. For more information on domestic abuse in Manchester and to download a safety plan please visit our website.  The statistics quoted in this article can be found on the national Women’s Aid website.

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