Engaging Older People

To better appreciate their knowledge and understanding of Domestic Violence and abuse (DVA)

Catherine Cutt Bernice Gott Evelyn Gompertz February 2017

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Table of Contents

Background ...... 4 Introduction ...... 5 Context ...... 5 Methodology ...... 9 Events ...... 11 Results ...... 15 Conclusions ...... 24 References ...... 25 Appendix 1 – Domestic Homicide Reviews ...... 29 Appendix 2 - Poster ...... 30 Appendix 3 – Client Survey ...... 31 Appendix 4 – Breakdown of abusive behaviours ...... 35 Appendix 5 – % of behaviours considered to be DVA by Survey participants ...... 37

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Background

The Pankhurst Trust (Incorporating Women’s Aid), is a women’s led organisation whose vision is to ensure that people suffering, or at risk of domestic abuse receive appropriate support. PTMWA deliver services from their base at the Pankhurst Centre, the former of and her daughters and the birthplace of the Women’s Social and Political Union (WSPU) and the movement. PTMWA was formed as a result of a merger in June 2014, bringing together two of the leading women’s organisations in the City of Manchester. To benefit from and maintain the strong reputation that both charities brought to the new organisation they operate using two trading names: The Pankhurst Centre and Manchester Women’s Aid. Manchester Women’s Aid has over forty years’ experience of delivering specialist domestic abuse services, providing safe accommodation and support to enable recovery from the impact of domestic violence and abuse (DVA) across the City of Manchester. In addition to refuge and outreach work, specialist services include: IRIS (Identification and Referral to Improve Safety), MiDASS (Midwifery Domestic Abuse Support Service), Independent Domestic Violence Advisors (IDVAs) supporting high risk service users; and the Sahara project for women from BAMER communities as well as delivering group work across the City.

The Pankhurst Centre houses a small museum dedicated to the Pankhurst family, the women’s movement and commemorating women’s historic and contemporary struggle for political, social and economic equality. PTMWA would also like to offer thanks to the following organisations for their support in this engagement project;

 Northwards Housing  One Manchester  Wythenshawe Community Housing Group  Wythenshawe Lifestyle Centre

PTMWA were commissioned by NHS North, Central and South Manchester CCGs to carry out an engagement project into understanding older population’s views and understanding of the impact of DVA on their health and well-being.

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Introduction

One of the specialist services PTMWA deliver is IRIS (Identification and Referral to improve safety), an evidence based training, support and referral service for General Practice (Feder, et al., 2011). In 2015-16 a third of IRIS clients were aged 40 and above (Report, IRIS Manchester, 2016), consistent with IRIS Manchester’s previous data. IRIS National data from 22 of the then 33 areas that commission IRIS also reflected this, with the mean age of clients being aged 39, 54% aged 30-49 years, and 21% were aged 50 and above (Report, IRIS National, 2015). Only 22% of clients accessing other PTMWA services in the same period were aged over 40, dropping to only 13% at aged over 45. This suggests that GPs are able to identify some older victims in their patient population, many having suffered DVA for many years and who otherwise would not have accessed specialist services and received support. DVA data presents younger people as more likely to be victims of DVA, with the majority of high risk victims being in their 20s or 30s (SafeLives , 2015). However in more recent years it has been identified that DVA does not cease just because a turns 50 years of age, and more some researchers have begun to examine this (Mears, 2002). When PTMWA were approached by the Communications and Engagement Team from NHS North, Central and South Manchester CCGs to conduct some initial investigations into the older population’s views and understanding of the impact of DVA on their lives and health, the Manchester Women’s Aid IRIS team, having had the highest proportion of older service users, led the engagement.

Context

There is limited research into DVA in the older population despite data around access to DVA services, which suggests that this is a vastly under represented demographic. Much of the evidence available is international, from small scale studies and with no clear definition of what age ‘older population’ represents. Bourget et al however propose that there is an international increase in domestic homicide among older people (Bourget, et al., 2010), which appears to be reflected in the UK Home Office domestic homicide reviews (DHRs), which demonstrate an increase in the number of victims aged over 60.

• 2011/12 – 122 victims (16 aged over 60 = 13.1%)

• 2012/13 – 102 victims (16 aged over 60 = 15.7%)

• 2013/14 – 121 victims (26 aged over 60 = 21.3%)

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(http://www.safelives.org.uk/sites/default/files/resources/Domestic%20abuse%20of% 20older%20people%20a%20hidden%20problem.pdf) accessed 08/02/2017 Appendix 1 details some of the media reporting of older peoples Domestic Homicides. Since April 2011 there have been over 400 DHRs in the UK and an in depth analysis of 33 cases found that 30% of the victims were aged 51 and over and 39% of perpetrators (Home Office, 2016). Safelives, a national charity dedicated to ending domestic abuse, chose older people and domestic abuse as their first ‘Spotlight’ topic in 2016 stating that “On average, older victims experience abuse for twice as long before seeking help as those aged under 61 and nearly half have a disability. Yet older clients are hugely underrepresented among domestic abuse services.” (http://www.safelives.org.uk/node/861, accessed 02/02/2017). Women’s Aid also highlight that many of the surveys and research conducted do not include any opinions from women over the age of 59 (Womens's Aid, London, 2007) yet other work identifies that older women’s experiences of DVA are unlike younger women’s (McGarry, et al., 2014). As there is a lack of consultation these different experiences are not sufficiently captured or reflected in DVA services (Blood, 2004) (McGarry & Simpson, 2011). It is also acknowledged that there are additional barriers for older victims disclosing and seeking help around DVA, both societal and cultural (McGarry, et al., 2014). What does appear apparent in the research around older people and DVA is that there are common themes identified, which have been captured by Monsura Mahmud and shared in the practice blog on the Safelives website (Safelives Practice Blog, July 2016). It is these key themes have informed the engagement work that PTMWA IRIS have completed with the older population across the City. The first of these themes is that older people may not recognise the behaviour as abusive. Certainly older women may be more accepting of their situations and have been brought up in a society with traditional attitudes to gender and family roles (Straka & Montminy, 2006) (McGarry, et al., 2014). Being raised with an expectation of cultural ‘normality’ can be seen to support and influence DVA regardless of age, but traditional belief’s such as men having the ‘right’ to control women (World Health Organisation, 2009) is something many of the older victims of DVA have been raised accepting. There may also be an element of self-blame from victims, which appeared to increase in longer marriages and was often a further tool used by abusers against victims (Beaulaurier, et al., 2008). In addition there is often an added complication of an unrecognised element of intergenerational abuse, such as adult child on older parent (McGarry, et al., 2014).

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Older people were brought up to respect privacy around family matters and are often reluctant to talk about it (Straka & Montminy, 2006) (Tetterton & Farnsworth, 2011), and it not being socially acceptable to discuss relationships and issues around DVA. Often this was within a setting of the victims feeling ‘shame and embarrassment’ preventing them sharing their experiences with either family members or friends and agencies (Potter, n.d.), or it is regarded as something to keep a secret (Mears, 2002). Many older victims shared the traditional understandings around marriage and stereotypical views surrounding gender in a marriage (Beaulaurier, et al., 2008) (McGarry & Simpson, 2011) (Tetterton & Farnsworth, 2011). The qualitative work of Zink et al also identified that older women had more time and investments in their families, therefore less likely to disrupt or discuss their situation (Zink, et al., 2003).

Many older victims of DVA may be unaware of the help and support available, older victims identified that specialist DVA services were targeted towards younger victims with children (Beaulaurier, et al., 2008) (McGarry & Simpson, 2011) (McGarry, et al., 2014). Access to the internet is often limited and DVA services fluctuate with funding streams, pilots and political agendas. It is also acknowledged that even if an older victim is able to identify specialist services, it is unlikely that current service provision will be appropriate to meet the needs of this particular cohort of victims at present (Blood, 2004). Often victims may feel they have been let down in the past by services. Many of the older women supported by IRIS have reflected back to a time when they had young families and had made an attempt to leave abusive partners, however lack of appropriate practical and emotional support meant that many returned to perpetrators and a life of continued abuse. As a result many older women who have suffered DVA have in fact done so for many years (Tetterton & Farnsworth, 2011), women who have suffered from a young age, describe how this continues to affect them as they get older (Mears, 2002). Working with GPs across the City, PTMWA IRIS are acutely aware of the impact of DVA on health. The effects on older victims health are equally wide ranging, both short and long term, with significant effects on physical health (McGarry & Simpson, 2011) and increased risk to mental health including anxiety, depression and suicide (Fisher & Regan, 2006). Fisher and Regan also found that abused older women were ‘significantly more likely to report more health conditions than those who were not abused’ (pg 200). McGarry et al comment on the effects of prolonged abuse on an older populations physical and emotional well-being (McGarry, et al., 2014). Health also plays a crucial part in understanding why older people may choose to remain in abusive relationships. This can be due to the non-

7 | P a g e abusive partner either being the carer or cared for (Zink, et al., 2003) (Straka & Montminy, 2006). Beaulaurier’s work found that ‘the need to care for an ailing abusive spouse was more important than escaping the abuse’ (Beaulaurier, et al., 2008). There may be also the fear that without care from the perpetrator, victims can face uncertain futures (Tetterton & Farnsworth, 2011) and/or be forced to move into a home (Potter, n.d.). Despite this there remains little evidence and data specifically around DVA and older people in the health arena (McGarry & Simpson, 2011). Safelives identified that older victims may form an assumption that family and friends will be unsupportive if they disclose abuse, or that it will affect their relationships with their children (McGarry & Simpson, 2011). Other barriers are a fear that they will not be believed by their families, or they may in fact direct anger at the victim for the disclosure (Beaulaurier, et al., 2008). Sadly some older victims simply considered that it is too late to leave, most having suffered abuse for many years. Mears describes how women ‘waited patiently until the perpetrator died, and then they were able to live free of violence’ (Mears, 2002).

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Methodology

To address the themes that have been identified, whilst looking to appreciate the nature and understanding of DVA as it relates to older people in Manchester, it was important that we were able to reach as wide a group of older people as possible. We took advice from specialist organisations who already worked with the disabled and elderly and agreed that we would approach existing groups of older people which meet throughout the city. In addition it was identified as an important part of our method that we approach groups in the North, Central and South areas of the city in order to capture any geographic trends in opinion and experience. Our first task was to identify target groups around the city, hence we approached local social landlords to explore if there were evens that were already embedded in the community which we could attend. We liaised with Wythenshawe Community Housing Group, One Manchester and Northwards Housing and arranged to attend the following events/groups:-

 Wythenshawe Forum Grand Day Out  Wythenshawe Forum Knitting Club  Wythenshawe Lifestyle Centre  Patrick Roddy Court Sheltered Accommodation Scheme  Victoria Square Sheltered Accommodation Scheme We publicised our attendance at the events with bespoke posters, an example of which is in Appendix 2. We discussed the running of focus groups with a trained facilitator, who guided us in the types of activities which might be appropriate for our target participants and suitable to each event. We identified and agreed a number of different methods with our facilitators in order to collect similar data from each event. At every event we ensured there were sufficient staff so that any contributors who needed 1:1 care following participation could be supported.

1. Workshops Workshops were run where we had access to larger numbers of participants and we used different methods of data collection which included using anonymous interactive mediums to encourage as much honesty as possible from participants. Following on from this we then held guided discussions with the participants to explore the data collected.

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2. Focus Groups Focus groups were run as directed discussion where we had access to small numbers of individuals and full workshops were not appropriate. The themes for discussion were;

 Types of abuse  Consultation with agencies or lack thereof  Impacts on health

3. Surveys Surveys were completed at events where we were unable to have a dedicated group to facilitate a workshop or focus group, but where we were in a building where older people’s activities were taking place. We were therefore able to capture extra data from individuals we might not otherwise have come into contact with. For all group sessions permission was obtained from participants to make a recording of the discussions which took place to aid with interpreting the discussions accurately. A copy of the full survey is in Appendix 3

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Events

Wythenshawe Forum Grand Day Out - Workshop The Grand Day Out is a weekly group facilitated by Wythenshawe Community Housing Group (WCHG) and run by volunteers from the community. It offers an informal social opportunity for the over 50’s often with guest speakers arranged by WCHG. This workshop took place in October 2016. The group was a large mixed group, although predominantly female. The group was split into two and both completed the two activities. The split was a division of male and female participants. Activity 1 The purpose of this activity was to engage the participants in an interactive activity to seek their opinions on who they would be most likely to disclose DVA to. A number of buckets were labelled with a visual representation and written description of the following agencies; GP, nurse, carer, podiatrist/dentist/optician, social worker, police, housing officer, family/friend/neighbour, social acquaintance such as exercise group leader/bingo, specialist older people’s organisation, religious leader, specialist DVA organisation, DVA telephone helpline, pub staff/taxi or bus driver, no one. Each person was supplied with one green ball, two white balls and one orange ball and asked to place in the buckets labelled above, in line with the below guidance.

Green Ball – in the bucket of the person or service they definitely would disclose domestic abuse to. White Balls – in the buckets of the person or service they would consider disclosing domestic abuse to. Orange Ball – in the bucket of the person or service they would not disclose domestic abuse to. When this was completed the buckets were collected and the results and reasons for the choices were discussed with the particpants.

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Activity 2 The purpose of this activity was to see how many abusive behaviours the participants could name. As a prompt the following selections of recognised abuse types were displayed; Physical violence, emotional abuse, sexual abuse, financial/economic abuse, coercion/threats, using children, using male privilege, intimidation, isolation and minimising/denying/blaming.

Post-it notes were provided and the participants wrote as many abusive behaviours on them and added them to the abuse types.

A discussion followed with the group, with any gaps in behaviours identified, introduced and discussed.

The ensuing discussion provided an opportunity to share information with the group and therefore raise awareness as to the breadth of abusive behaviours. The groups were then swapped and each workshop facilitated a second time.

Wythenshawe Forum Knitting Club – Focus Group This was a well-supported weekly gathering of women who had a common interest in knitting. It was a fairly large group (12 women) and as their primary reason for attending was knitting, it was run as a focus group, allowing them to continue their activity whilst sharing their thoughts and opinions. Two facilitators hosted a directed discussion around what the participants understanding and opinions of domestic abuse were. Their responses were recorded on a flip chart by the facilitators, there was also a note taker and voice recordings were made to aid accurate capture of the discussion.

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This was a particularly lively discussion with a very engaged group around;

 whom they would disclose to and why  types of abusive behaviours  what responses they thought they may receive from various different services  impacts of DVA on health

Wythenshawe Lifestyle Centre - Survey This was not a formal session, however we were given the opportunity to engage with individuals following their participation in over 50’s recreation events such as bowling or dancing, when we were advised that footfall was high. Individuals were approached and surveys completed enquiring about;

Abusive behaviours, who they would most/least likely to disclose to, what they would want to happen following disclosure, health effects, who they thought could be an abuser One to one conversations took place with every individual who participated; again identifying any opportunities to use discussion to raise awareness about any aspects of the responses was taken. A copy of the survey is included in Appendix 3.

Patrick Roddy Court - Workshop Patrick Roddy Court is a sheltered accommodation scheme run by One Manchester Housing Group. We attended a prearranged meeting which included a mixed gender group of residents and staff. As at the Wythenshawe ‘Grand Day Out’ this included the two activities, however due to lower number of attendees the whole group participated in each activity one following the other. Again, each activity was followed by a group discussion.

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Northwards Victoria Square – workshop and focus group Victoria Square is a sheltered accommodation scheme run by Northwards Housing. The sessions were not dedicated but followed ‘breakfast club’ and both were advertised with posters as at Wythenshawe ‘Grand Day Out’ in Appendix 2. The first session was run as a mixed gender workshop using both activities with a whole rather than split group. A discussion of the initial results from both activities was conducted after each. The second session engaged a smaller group so a focus group was facilitated. The results were recapped and a lively discussion around the topics included ensued. Again both sessions ensured sufficient staff availability to discuss individual concerns with participants.

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Results

Participants

Figure 1: Gender and geographical breakdown of data collected from participants

North* Central South Survey Total Female 7 6 21 9 43 Male 2 2 2 2 8 No data 0 0 0 6 6 Total 9 8 23 17 57

*Some of the attendees at North came to both sessions so these are not 9 discrete individuals but 5, however we have included their data from both sessions as the activities were different. Despite commitment from the housing providers in inviting participants to each of the workshop/focus group events there were relatively low numbers of attendees. As highlighted above, we included the data from both the Northwards Victoria Square events, although it was noted that 3 individuals attended at both the focus group and workshop. In addition there was a bigger engagement from females than males, despite the literature being gender neutral and the providers being advised that we hoped for mixed groups.

Disclosure

Workshops The most popular response from both the workshops as to whom to disclose to was family/friend/neighbour, with 27% definitely telling and 9% considering it. This is interesting following the literature review which cited a reticence of disclosing to family members for fear of repercussions. Almost identical was disclosure to a specialist DVA helpline, 27% definitely telling and 7% would consider telling. In the discussions following the activity there were many individuals who made reference to DVA being a private matter and a telephone call to an unknown specialist would allow them to retain their anonymity. These results were consistent across North and South. The GP came third with a positive response of 14% definitely disclosing and 15% considering a disclosure. No one in the North or Central would definitely disclose to a GP compared with 27% in South, however where gender was known it was the females who predominantly identified the GP as being a

15 | P a g e source of help. Interestingly nobody identified in North or South that a nurse could help, yet it is likely that an older person may come into more contact with nursing teams within the GP practice or in an acute hospital setting. Similarly other health professionals were not associated with sources of support with only one person willing to disclose to podiatrist/optician/dentist, yet six definitely not disclosing. Carers and social workers appeared also overlooked with only one person definitely and four possibly looking to them for a disclosure. Three people said they would definitely tell no one. Specialist workers, such as drugs and mental health practitioners and the police were considered options for support in line with the GP. Few people thought of housing officers, landlords/taxi/bus drivers or specialist age targeted services such as Age UK. Figure 2: Percentage of who participants would disclose or consider disclosing to (n=22)

45 40 35 30 25 20 15 10 5 0

definitely consider

As well as who may be favoured for disclosure, it was equally as important to capture who the participant would not consider telling. Highest on the list were social acquaintances such as hairdressers. Respondents regarded these in the ensuing discussion as being places for ‘gossip’ and not regarded as being trustworthy or appropriate to disclose DVA. It was also interesting to note that all the negative responses to disclosing to the police were from the male participants.

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Figure 3: Percentage of who participants would not disclose to (n=16)

35 30 25 20 15 10 5 0

Focus Group The responses from the focus groups were slightly different with their suggestions as to whom they might disclose to. The focus group discussion at South identified the following as people to whom they would definitely disclose to;

 Someone trusted who they have a good relationship – friend  Carer  Police  Housing officer  Social worker As with the more formal activity where participants were provided with a list of options, the first choice for disclosure would be a friend. This could again have an impact on the shaping of services to try to equip friends and relatives around DVA; how to respond appropriately and signpost to specialist services if faced with disclosure. No one in the group identified that their GP could offer any support, nor that they would consider calling a specialist DVA helpline, although one member said that they would use a DV helpline if ‘absolutely desperate’. There was also quite a strong feeling that in reality they may choose to tell no-one. It was very difficult to ascertain from the group discussion who they would not tell, and there was more emphasis on the idea that being a victim of DVA was somehow shameful or a thing that was brought upon by themselves ‘it’s my fault’. They used phrases such as ‘shame would stop it’, and the understanding that they came from a generation who ‘put up and shut up’. In line with some of the literature findings, another member of the group

17 | P a g e stated they would not tell a family member because they ‘wouldn’t believe me’ The group were very forthcoming and some members very generously shared their own experiences. Some had remained with their partners until they had died, others described failed leaving attempts when their families were young. The richness of them sharing their stories was invaluable in contextualising their responses. This felt a more beneficial outcome for the group rather than them being pressured into naming agencies to whom they would not share disclosure. Their responses highlighted that they were a group of strong women, who recognised DVA as a continuum in many women’s lives, yet lacking the knowledge of where they might best seek help and support.

Surveys In the surveys participants were asked to indicate who they may choose to disclose to, from the same list of options used in the workshops and who they would definitely not choose to disclose to. These results were less accurate. Participants were asked to select a ‘top 3’ of who they would disclose to and indicate who they would definitely not disclose to, however there were different numbers of responses in each section. Consistent with the workshops and focus groups family or friends were most popular, with the police followed by a GP. Figure 4: Percentage of who participants would disclose to - survey

60 50 40 30 20 10 0

definitely (n=19) consider (n=26)

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In the surveys, most likely to not disclose to religious leaders, pub/taxi/bus drivers, consistent with the workshop findings. No one said that they would not disclose to the police as opposed to 13% in the workshops. Figure 5: Percentage of who participants would not disclose to - survey

35 30 25 20 15 10 5 0

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Types of Abuse

Workshops and focus groups This exercise was facilitated in the same way as an activity in a workshop and a dedicated focus group, hence the results have been combined. Appendix 4 shows a full breakdown of the abusive behaviours identified in each of the areas. This summary does not account for the number of times an individual behaviour was recorded in the group, just the behaviours themselves. Perhaps surprisingly there was not one behaviour in any of the categories identified by all the groups. This goes a long way to support the lack of a common recognition and understanding of the older population as to abusive behaviours.

Particularly of interest is that there were no sexually violent behaviours identified in the group from Central, yet they identified the largest number of emotionally abusive behaviours. North groups identified the most number of physically violent behaviours but both North and Central were unable to relate to coercion/threats, using children, male privilege, intimidation, isolation and minimising, denying and blaming.

Surveys The survey contained 45 examples of behaviours ranging from ‘punching’ and ‘kicking’ to ‘arranged marriage’ and ‘controls what you wear’. Participants were asked to circle the behaviours that they believed to be abusive ones. Appendix 5 summarises the percentages for each behaviour from all the responses received. Giving a list of suggested abusive behaviours, unlike in the workshops, enabled a much wider response recognition from the participants, with all 45 options being classed as abusive by someone. Thirty four of the behaviours were identified by half of the respondents.

Even given the behaviours however it is interesting that no one behaviour united all the participants and scored 100%. Perhaps understandably, the physical behaviours of punching, kicking and rape all scored highly (88%) but the recognition of humiliation, forced marriage and threats to hurt individuals or those you love was slightly more surprising as only ‘threats’ were identified at the focus groups and workshops events. The lower scoring behaviours were ‘sulking/grumpy’ and ‘disagreements over household duties’, yet still acknowledged as being significant in the context of an abusive relationship with 18% and 23% respectively.

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The simple act of suggesting behaviours triggered a much wider recognition of how domestic abuse might manifest itself. This indicates that some simple awareness raising sessions with the older population may result in a substantial shift in individual’s consideration of their own relationships. With this in mind we also wished to illicit what this population would want to happen if they identified and disclosed DVA.

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What happens next?

In the surveys we gave a list of options as to what individuals might want to happen following disclosure. This was important as it could have an impact on the shaping of specialist DVA service provision for this generation. Although small numbers, the table below shows overwhelmingly that respondents would like face to face support from a specialist DVA worker, within a safe community setting. Figure 4: What participants would like to happen following disclosure

Number of Percentage responses Responded Nothing 0 0 List of support services provided 6 25% Telephone call from a police 0 0 officer Visit at home from police officer 0 0 Telephone call from a social 0 0 worker Visit at home from a social worker 1 4% Telephone call from a specialist 2 8% domestic abuse agency worker Face to face appointment arranged with a specialist domestic abuse agency worker 14 59% somewhere safe such as GPS's or community centre 1 Other ('Just listen to 4% me') Total 24 100%

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Impacts of DVA on health

Workshops and focus groups There was little appreciation from any of the groups as to the link between DVA and individuals health. When prompted to consider specific effects some of the groups stated broken bones and described different injuries that could be sustained, however linking the mental health impacts took much longer. This is despite some of the disclosure and discussion of individuals experiences. There were eleven responses in the survey as detailed below, two of which recognised the controlling aspect of DVA and how an abuser could restrict a victims access to health services per se.

 Person giving you the abuse  Very badly  Controlling partner not allow access  If someone was in a home or had a carer would be difficult to obtain help  Access could be restricted dependent on the ability of the abused person  It would be more difficult depending on individual circumstances  Very difficult particularly if the person is controlled on a day to day basis  Don’t know  Don’t want family to know  I would like to talk to my daughter who is a practice nurse  It wouldn’t in my opinion. I stick up for myself This appears to be a real area where education and identification of victims in a locality convenient to them could impact significantly on the effects of DVA and individuals physical and mental wellbeing.

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Conclusions

The findings of this engagement programme are limited due to the use of mixed methods of data collection, in addition to relatively small numbers of participants. Although attempting to capture opinions from across the three areas of the city, we have more data from South Manchester than Central and North. It is important also to note that there are significant demographics of older people whose opinions have not been adequately reflected in this work as the number of males taking part was much smaller than female, although there is much evidence that DVA is a gender based crime, with women suffering more frequent and severe violence and control (Ansara & Hindin, 2010) and of those experiencing 4 or more incidents of DVA, 89% were female (Walby & Allen, 2004). Also lacking were individuals with a disability, those who identify as being from the LGBT community, those from BAME communities and those with learning disabilities. These are all further marginalised groups who would warrant further consultation on identification of DVA and provision of services. As the groups were facilitated by housing providers, we also lack the opinions of private householders. The fact that the events were held at social groups or meeting spaces means that there still remains a lack of clarity and understanding about those who are isolated or lonely.

From the older community that did engage, it appears clear that there remains a lack of understanding around DVA coupled with a generational acceptance of abusive behaviours. There also seemed little connection made between the effects of DVA, both directly and indirectly on individual’s physical and mental health and wellbeing. This work has highlighted that there are multiple opportunities to engage with this under represented population to offer a programme of education around the impact of DVA on accessing health provision, effects on their health, ability to disclose and opportunity to shape services to meet the different and specific needs of older victims. Difficulty in identifying where victims might feel comfortable to disclose and to whom also warrants further investigation in order to shape future services to meet the need of this particular cohort.

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References

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SafeLives , 2015. Insights Idva National Dataset 2013-14. Bristol: SafeLives, s.l.: s.n. Safelives Practice Blog, July 2016. practice_blog/its-our-right-be-safe-any- age-how-can-we-make-it-easier-older-victims-get-help, s.l.: s.n. Straka, S. & Montminy, L., 2006. Responding to the Needs of Older Women Experiencing Domestic Violence. Violence Against Women and Girls, 12(3), pp. 251-267. Tetterton, S. & Farnsworth, E., 2011. Older Women and Intimate Partner Violence: Effective Interventions. Journal of Interpersonal Violence, 26(14), pp. 2929-2942. Womens's Aid, London, 2007. Older Women and Domestic Violence: An Overview, s.l.: s.n. World Health Organisation, 2009. Violence Prevention The Evidence - Changing cultural and social norms that support violence, s.l.: s.n. Zink, T., Regan, S., Jacobson, J. & Pabst, S., 2003. Cohort, Period, and Aging Effects A Qualitative Study of Older Women’s Reasons for Remaining in Abusive Relationships. Violence Against Women, pp. 1429-1441.

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Appendices

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Appendix 1 – Domestic Homicide Reviews

Pensioner jailed for life for double murder of partner and daughter on puppy farm (Daily Express. 31 October 2014) A double killer who murdered his partner and her daughter at his puppy farm will die behind bars after he was today jailed for life. John Lowe, 82, was told he will spend at least 25 years in jail for the murder of Christine Lee, 66, and her daughter Lucy Lee, 40 Serious case review into death of woman, 81, after alleged attack by husband, 88, recommends more education on issue. (The Guardian, 23 December 2011) The death of an 81-year-old woman following an alleged assault by her 88- year-old husband has triggered a major inquiry that has lifted the lid on the hidden world of domestic violence among old people. Mary Russell died of a bleed to the brain following a "domestic-related" incident at her home in Leigh-on-Sea, Essex, in October last year. She had made eight 999 calls over the preceding seven months. Death of Sunderland pensioner May Stokoe 'could have been prevented' says report (Chronicle Live 3 September 2014) A pensioner's death at the hands of her husband could have been prevented had signs of domestic violence been investigated, a report says. May Stokoe, 79, was stabbed to death at her home by husband James. He then killed himself in the back bedroom of the family home they had shared for 48 years. Retired blacksmith Mr Stokoe, 79, suffered mental health problems and had attempted suicide in March last year, about two months before the couple’s deaths. He was receiving daily visits from mental health workers and had been prescribed anti-psychotic drugs, although he had stopped taking them.

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Appendix 2 - Poster

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Appendix 3 – Client Survey

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Client Survey

Age range (please circle which age range you fall into) Under 50 50–54 55–59 60–64 65–69 70–74 75+

Please circle all the behaviours you would consider to be Domestic Violence and Abuse (DVA)

Disagreements Arranged over Arguing Punching Kicking Marriage household duties Constant Rape Humiliation FGM Nagging Complaining Constantly Uses religious Sulking/ No access to Overriding asking for doctrine to Grumpy finances decisions sex control Talking to No access to family about Not allowed to No access to Not paying for medical you shop passports prescriptions treatment

Forced drug No bills in Constantly Forced No access to use/alcohol your name pregnant marriage accommodation use No access Not allowed to Not allowed to Belittling Name calling to benefits work parent Opinions Multiple Isolation – not All bills in applications for Staling money Withholding allowed to your name credit in your or benefits affection see friends name Jealous of Threats to hurt Controls what Threats of Controls what your you or those you do and suicide if you you wear relationships you love where you go leave Complaints to Threats to Not telling you Threatens to the church / call police/ what your Constantly disclose mosque/ social immigration unfaithful medical history community services status is leader

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Please rank in order the top 3 people who you would be most likely talk to if you were suffering abuse by adding the number to the box. 1 = most likely, 2 = probably, 3 = might consider Please indicate with a ‘X’ in the box of the one person/agency you would definitely NOT tell.

GP Nurse Carer Priest/ Imam / Vicar etc.

The Police Social Worker Housing Officer Friend, family member or neighbour

A specialist Social Podiatrist / Pub staff / Taxi worker (mental (Hairdresser, Dentist / Optician driver / Bus driver health, drugs, fitness class counsellor) instructor, beautician, bingo)

Domestic abuse Specialist older No one Someone else? helpline persons agency e.g. Silver-surfers, Age UK

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If you disclosed abuse to someone what would you want to happen next? Please circle letter a. Nothing b. List of support services provided c. Telephone call from a police officer d. Visit at home from a police officer e. Telephone call from a social worker f. Visit at home from social worker g. Telephone call from a specialist domestic abuse agency worker h. Face to face appointment arranged with a specialist domestic abuse agency worker somewhere safe such as GP’s or community centre i. Other…….

How do you think access to healthcare might be affected if an older/disabled person were suffering DVA?

Can you name anywhere where you could get help and support about Domestic Abuse?

Who do you think could be a domestic abuser?

Thank you for completing this questionnaire, we value your opinions

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Appendix 4 – Breakdown of abusive behaviours

South North Central Female Male Physical violence Hitting Hitting Hitting - Kicking - - Kicking Spitting - - - Pushing - - - Pulling - - - Strangling - - - Physical Fisical - - abuse (physical) - - Violence - - - - Punching Objects - - - perhaps Emotional abuse Belittling - - - Name calling - - - - Verbal - - Mental - Mental Mentally opression Accusations - - - of cheating - Stalking - - - Harassment - - - Ignoring - - Emotional - - - Blackmail Sex without Forced sex - - Sexual violence consent Rape - - - Sexual Demanding - - demands Nagging - - - - - Sexual abuse - Sexual - - - violence - - Unfaithful -

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Not giving Witholding - - Financial/economic abuse money finance Taking over Financial Controlling - the money control Scrutinising - - - receipts Not having - - - bank account Not allowed to - - - work - Gambling - - Using sex - - - workers - - Financial Finances Coertion/threats - - Bullying - - - Lecturing - - - Threatening Threats - - Shouting - - - - I'll kill you - - - Control Threats to - - - kill Using - - Using children children as a Using Children human shield Using male privilege - - Drinking - Alcohol - - - fuelled abuse King of the - - - castle Intimidation - - Bullying - - - - Manipulation Isolation Cut off from - - - family and friends Stockholm - - - syndrome Blaming the - - - Minimising/denying/blaming other person

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Appendix 5 – % of behaviours considered to be DVA by Survey participants

Behaviours considered to be DVA by survey participants Sulking/ Grumpy Disagreements over household duties No bills in your name Arguing All bills in your name Constant Complaining Nagging Complaints to the church / mosque/… Not paying for prescriptions Talking to family about you Overriding decisions Withholding affection No access to benefits Arranged Marriage Not telling you what your… Multiple applications for credit in… Name calling Not allowed to parent No access to accommodation Constantly pregnant Constantly unfaithful Threatens to disclose medical history Threats to call police/ social services Stealing money or benefits No access to medical treatment Constantly asking for sex FGM Not allowed to work No access to passports Uses religious doctrine to control Threats of suicide if you leave Controls what you do and where… Belittling Opinions Forced drug use/alcohol use Not allowed to shop No access to finances Controls what you wear Jealous of your relationships Isolation – not allowed to see friends Threats to hurt you or those you love Forced marriage Humiliation Rape Kicking Punching 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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