The complex issue of domestic abuse among intimate partners is often compounded by the dynamics of ageing which discourages disclosure. This often goes unrecognised by social workers and the lack of awareness makes identification of abuse even harder.
In a move to address this, a partnership between seven European research institutions, including the University of East Anglia, looked at intimate partner violence against older women (the IPVoW project). Following on from the resulting research, material for practitioners was also developed under the Mind the Gap! project which ran from March 2011 to February 2013.
The following tips are drawn from guidance and a booklet for social care practitioners drawn up as part of the Mind the Gap! booklet by social work academics Bridget Penhale and William Goreham, the UK researchers on the project. This has been supplemented by advice provided by safeguarding adults consultant Ruth Ingram, who co-authored the 2015 edition of the Local Government Association and Association of Directors of Adult Social Services guide Adult safeguarding and domestic abuse.
Understand the signs of domestic abuse
The Mind the Gap! booklet says practitioners must be able to identify signs of possible of domestic abuse, including:
- injuries which are not fully explained;
- lack of financial independence;
- little choice in everyday matters, such as diet, clothes and lifestyle;
- withdrawn and/or subservient behaviour;
- no independent participation in social activities;
- misuse of drugs (including prescription) and/or alcohol.
- Ingram says practitioners should watch, listen to and read accounts of older and disabled women and others with health and social care needs who have experienced domestic abuse as this can help practitioners familiarise themselves with the signs to look out for.
Respond with empathy and use appropriate language
The decision on whether or not an older woman will disclose domestic abuse frequently depends on the relationship between the victim and individual practitioner.
“An approach based on empathy, reliability and respect is more likely to result in a victim feeling confident enough to talk about a distressing situation,” says the Mind the Gap! booklet. “You may be one of only a few people in whom the victim can confide, so your initial reaction is likely to have a significant impact on the outcome.”
The Mind the Gap! booklet advises that practitioners use language which is appropriate for older women, particularly when questioning matters concerning control, coercion, sexual abuse, financial abuse or neglect. It says avoid referring to them as ‘victims’ and using the term ‘violence’ without appropriate explanation.
Provide opportunities to disclose
“If you suspect someone is being abused go the extra mile to create an opportunity to speak to them confidentially and alone,” says Ingram. “If there is no time when they are alone at home you might want to ask other agencies to help – for example, their GP or the housing office.”
The Mind the Gap! guidance says that practitioners should recognise the significance of having contact with the older woman as providing possibly the only opportunity to be identified or self-identify as a victim and receive information about support.
Understand and notice coercive control
Understanding and noticing coercive control and how it affects the woman’s relationship with you is important, says Ingram. The UK government’s revised definition of domestic violence and abuse, issued in 2013, which extended it to include coercive control, defines controlling behaviour as “a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape, and regulating their everyday behaviour”.
It defines coercive behaviour as “an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim”.
The Mind the Gap! guidance stresses that psychological control of the victim and situation is an important contributory factor in much intimate partner violence. In this regard, it advises practitioners to be wary if the victim’s partner intervenes (no matter how convincingly) and particularly if they attempt to negate any allegations on the grounds that the victim does not have sufficient mental capacity to understand what has occurred or is confused about the situation and misrepresenting it.
Social workers should be prepared to challenge any explanations or assumptions regarding the mental capacity or physical incapacity of the victim (regardless of the source) without sufficient evidence to support it, it adds.
Challenge alleged perpetrators
Do not be overly influenced by the age and perceived ill-health of an alleged perpetrator, says the Mind the Gap! guidance. Apparently frail and confused individuals are capable of extremely violent conduct and manipulative coercive control. It is therefore important to take positive action and not to dismiss situations on grounds of frailty or age.
Some perpetrators may believe that it is in their best interest to present themselves as being ‘incapable’, so practitioners should be prepared to challenge explanations or assumptions regarding the mental capacity or physical incapacity of the perpetrator,
Tailor your assessment
Bear in mind that generic assessment tools are not always appropriate for older women who are victims of intimate partner violence, says the Mind the Gap! guidance. It may be necessary for practitioners to ‘interpret’ the process, to make it valid and reliable.
Assessments should not solely be based on information from the victim, particularly where decision-making capacity may be an issue. If necessary, practitioners seek specialist assistance, or conduct further enquiries with individuals who have knowledge of the victim and/or the perpetrator. These should be accessed as soon as practicable, in order that the assessment process is not delayed.
However, the guidance stresses that practitioners should ensure they have appropriate consent or necessary grounds to share information about the victim and/or perpetrator. They should also potential risks to service users’ safety when sharing information prior to contacting other organisations or agencies.
Refer to adult safeguarding but retain focus on domestic abuse
It is likely that many cases where domestic abuse is disclosed will require referral to adult safeguarding, meaning that practitioners should be fully conversant with local safeguarding protocols and understand their obligation to refer, says the Mind the Gap! guidance.
However, it stresses that, though such cases may be classified as “elder abuse”, “it is vital that intimate partner violence is not overlooked, and remains a significant consideration of any action taken”.
Ensure you record the circumstances of the disclosure (how it came about/what was said) even if you are not carrying out an investigation or assessment. This is likely to be important information in any subsequent action.
Managing consent, capacity and duty of care
If the person at risk has capacity to make the decision, ask them if they agree to you sharing their information so that they can access multi-agency help to decrease the risk of abuse, says Ingram. Explain the safeguarding process to them and if they consent make a safeguarding adults referral. If they don’t have capacity in this respect, make a safeguarding adult’s referral on their behalf unless, very occasionally, that is not in their best interests.
The Mind the Gap! guidance stresses that practitioners should have a working knowledge of the Mental Capacity Act 2005, including the principles of presuming capacity on the part of the person and supporting them to make decisions.
However, it also stresses that any action taken by a practitioner should be based on a duty of care, which may not always accord with her apparent wishes.
If you believe someone is at high risk from domestic abuse take responsibility, says Ingram. Either carry out a DASH-RIC risk assessment yourself or make sure that someone else does this (DASH-RIC is the domestic abuse, stalking and honour based violence risk identification, assessment and management model, a checklist to identify and assess risk for all professionals working with victims).
Refer to MARAC (a multi-agency risk assessment conference where professionals discuss individual cases and write an action plan) in line with your local arrangements and make an adult safeguarding referral, she adds. Consent is preferable but lack of consent must not stop you reporting high risk domestic abuse. Ingram adds:
Remember that the person at risk will know most about the risks they face. Also be aware that they will probably be minimising what is happening and its impact on them. Take their safety and yours seriously. Remember that abuse often escalates when the abuser realises they are being challenged, just before and just after any separation.”
Help victims access specialist support
Once someone has disclosed, help them access specialist support and advice, including legal advice, says Ingram. Most people being abused can access measures to enable them to stay in their own homes if that’s what they want to do.
Put 0808 2000 247 (England) 0800 0271234 (Scotland) or 0800 8010800 (Wales) – the 24-hour national domestic abuse helpline numbers – and the Action on Elder Abuse helpline 0808 808 8141 (not 24 hours) in your phone so you can give it to people at risk (they will be signposted from there to relevant local or specialist services, for example, if victims are men or lesbian, gay, bisexual or transgender), adds Ingram.
Know what domestic abuse services are available locally and be confident in explaining what they offer.
“Be proactive and offer services that seem relevant, for example, a pendant alarm; domiciliary care workers who know what to do if they are asked for help about the abuse; a safe place to go to get help (a community luncheon club) or a place of safety through emergency respite arrangements,” says Ingram.