House of Commons - Home Affairs

Select Committee on Home Affairs Written Evidence

APPENDIX 29

Memorandum submitted by the Stella Project

1. EXECUTIVE SUMMARY

1.1 The Stella Project is concerned that some of the most vulnerable domestic violence survivors, those with drug and alcohol problems, are unable to access safe housing due to their complex needs. With trained staff and support from an outreach worker from a local drug/alcohol agency refuges can be supported to provide safe housing for some drug/alcohol users. There are some examples of good practice in London illustrating how partnership working between individual agencies and between departments in local government can be effective. However this is not widespread across the UK.

1.2 For women escaping violence with more chaotic drug/alcohol use, refuges are simply unable to provide the high level of support required. Unable to escape to a place of safety from which they can begin to address their substance use, many women have their children removed. There are very few women only residential drug services in the UK, and even less where children can accompany their mothers. None have procedures in place to support a mother and her children around domestic violence. Therefore, the Stella Project recommends the development of specialised 24 hour residential services which can support women (and their children) around domestic violence and problematic substance use.

1.3 With an increased awareness of the links between domestic violence perpetration and alcohol intoxication, there needs to be the development of specialised initiatives to address alcohol and drug related domestic violence. Drug/alcohol workers lack sufficient knowledge and support to work with drug/alcohol users who are also domestic violence perpetrators and perpetrator programmes do not have any elements in the course which specifically address the links between domestic violence, alcohol and drug use.

1.4 The Stella Project recommends the development and pilot of a specific module or programme which actively addresses these issues. This should be supported by effective partnership working with local drug and alcohol agencies which can provide outreach support and referral links where needed.

1.5 Furthermore, information and training about the requirements of reporting and sharing information to Multi-Agency Risk Assessment Conferences (MARACs) does not commonly reach drug and alcohol agencies. Drug and alcohol practitioners need to be actively engaged in this process.

1.6 Finally, the Stella Project wishes to highlight the need for improved joined-up work across central government when addressing alcohol, drug and domestic violence policy. For example, the recent update to the Alcohol Harm Reduction Strategy was a missed opportunity to address alcohol related domestic violence. The National Tackling Violent Crime Programme which address two forms of high volume crime, domestic violence and alcohol related crime, fail to make the links between the two.

2. ABOUT THE STELLA PROJECT

2.1 As the leading agency addressing drug and alcohol related domestic violence and abuse, the Stella Project works across all 33 London boroughs for positive, sustained improvement in the way services are delivered to survivors, their children and perpetrators of domestic violence affected by problematic substance use.

2.2 We aim to influence the development of policy to reflect and acknowledge the link between domestic violence, drug and alcohol use. Through training, support and consultancy, the Project works to build the capacity of agencies and develop the skills and expertise of practitioners to effect change in practice.

2.3 Established in 2002, The Stella Project is a partnership between the Greater London Domestic Violence Project (GLDVP) and the Greater London Alcohol and Drug Alliance (GLADA). The Greater London Domestic Violence Project works to end domestic violence across the capital by supporting direct service providers and promoting joint working. The Greater London Alcohol and Drug Alliance (GLADA), established by the Mayor of London in 2002, is a strategic network of organisations and agencies concerned with the problems caused by drugs and alcohol in London.

3. SUPPORT FOR VICTIMS

3.1 Drug and alcohol use increases the risk of serious injury to domestic violence victims and children. Women are less able to protect themselves and their children from injury when intoxicated and a number of studies have found that the perpetrators use of alcohol, particularly heavy drinking, was likely to result in more serious injury to their partners than if they had been sober.[104]

3.2 There is increasing recognition that women presenting to domestic violence agencies have alcohol and drug problems. US research shows that 30-40% of women using refuge services had substance problems, mainly alcohol.[105] There is a lack of research from the UK into this issue however what we do have is telling. A one week screening period of women in domestic violence agencies in East and West London (n=80) revealed that 44% reported their own problematic substance use.[106] This figure rose to 92% of women in touch with outreach or tenancy support services.[107]

3.3 Screening by domestic violence agencies often results in survivors being excluded from admission to safe accommodation or using services that do not understand, or respond to, their dual needs. There are only a few refuges in London which are willing to accept women with additional support needs around (non chaotic) drug and alcohol use. These pioneering projects are attempting to take on more complex cases through innovative approaches to partnership work and without extended resources. They are able to support one or two women at a time. However, the majority of refuges feel they are unable to take on this work without resources and leadership.

3.4 There is one refuge in London specifically for women with complex needs and provides 24 hour support. A drug and alcohol support worker is funded from the local Drug Action and Alcohol Team. This is an excellent example of joint working between local government departments and should be encouraged. However, this refuge is only available for women who have been resident in the London Borough of Southwark for more than six months.

3.5 Women with more unstable and chaotic drug and alcohol use outside of the London Borough of Southwark cannot be supported by refuges due to the complexity of the cases and the need for specialist support. Survivors of domestic violence are over-represented in drug/alcohol treatment: One recent British study found 40-67% of women had suffered violence and abuse in the last five years.[108] A UK study of 60 women using crack cocaine found that 40% reported being regularly physically assaulted by a current partner and 75% being physically assaulted by a current or past partner.[109] In a study of inner London treatment agencies in 2000, 30% of women reported physical violence from their current partner[110] although this figure is estimated to be higher due to women's fear and difficulty in disclosing their experiences of violence and abuse.

3.6 Data from the US consistently shows that women attending substance use services have suffered higher levels of domestic abuse. 60-70% of women are reported as suffering physical or sexual abuse at some point in their lives.[111] This figure increases when other forms of abuse, eg. psychological abuse, are included. For many of these women, unable to be supported in most refuges, a specialised service which can address both their drug and alcohol problems and provide safety and emotional support addressing experiences of violence and abuse is needed.

3.7 Furthermore, the Advisory Council on the Misuse of Drugs' Hidden Harm inquiry recommended that effective treatment for drug using parents can have major benefits for the child. For women also experiencing domestic violence, their physical safety and emotional well being must be addressed first before there is any chance of reducing drug use. There are very few women only residential drug services in the UK, and even less where children can accompany their mothers. None have procedures in place to support a mother and her children around domestic violence.

3.8 Therefore the Stella Project recommends the development of specialised 24 hour residential services which can support women (and their children) around experiences of violence and abuse and problematic substance use.

4. PERPETRATOR PROGRAMMES

4.1 Home Office research on domestic violence offenders (n = 336) showed that 48% were classified as "alcohol dependent".[112] Further research based on small scale studies in London and Nottinghamshire found that 63% of men attending domestic violence perpetrators programmes reported that they had substance misuse problems.[113] The US research also shows that about half of men attending alcohol and drug services admit to perpetrating such abuse Gondolf's multi-site evaluation of perpetrator programmes has shown that the man's drunkenness after programme intake made him 3½ times more likely to re-assault his partner than a man who did not get drunk. If the man was drunk nearly everyday, he was 16 times more likely to re-assault than those who seldom or never drank.[114]

4.2 At present, no perpetrator programmes in the UK contain modules which address the links between alcohol, drugs and domestic violence. While programmes give clear messages that alcohol and drugs do not cause domestic violence, a more sophisticated response is required to fully address the myths and beliefs related to alcohol disinhibition and violence.

4.3 The Stella Project recommends the development and pilot of a specific module or programme which actively addresses these issues. This should be supported by effective partnership working with local drug and alcohol agencies which can provide outreach support and referral links where needed.

5. BARRIERS TO MULTI-AGENCY WORKING

5.1 Practitioners have highlighted how experiences of domestic violence impact on a woman's ability to access and be retained in drug or alcohol treatment.[115] Equally drug or alcohol use within the context of an abusive relationship can impinge on a woman's ability to seek help and safety from a domestic violence agency. For domestic violence perpetrators, reducing substance use (including alcohol) may reduce levels of physical injury but has not been shown to reduce the actual occurrence of domestic violence (ie non physical abuse such as psychological and sexual violence).[116]

5.2 Drug, alcohol and domestic violence practitioners have many fears about taking on work from the other field. It is unrealistic to expect each sector to become specialists in the "other's issue". The Stella Project advocates a partnership approach with each sector working to a set of standards which commits them to routine questioning, providing information to service users and sharing information with other agencies where necessary. Furthermore, we promote a model of cross sector outreach work eg domestic violence advocates providing regular outreach at a local drug/alcohol agency and vice versa.

5.3 Of particular concern is the fact that drug and alcohol agencies do not feel capable of providing effective responses to their clients who are perpetrators of domestic violence and abuse. It is a common belief that this area of work is not within their remit. Furthermore, information and training about the requirements of reporting and sharing information to MARACs does not commonly reach drug and alcohol agencies. Therefore, the Stella Project further recommends greater support to drug and alcohol practitioners to actively engage them in this process.

5.4 However, with ever-competing requirements in reporting and funding priorities unless there are targets and standardised requirements to develop this area of work, it is easily sidelined. For example, National Treatment Agency requirements in reporting from drug/alcohol agencies (NTDMS) do not stipulate reporting of experiences of violence and abuse and how this impacts on treatment. Without this, many agencies do not ask about or respond to domestic violence and the issue remains hidden for many of their service users. The Stella Project recommends that the NTA initiate reporting requirements about experiences of violence and abuse amongst service users.

5.5 A more integrated approach to this issue from central government is required. For example, the recent update to the National Alcohol Harm Reduction Strategy (Safe.Sensible.Social) while making scant references to domestic violence did not outline any initiatives of how to address alcohol related domestic violence. The National Tackling Violent Crime Programme which address two forms of high volume crime, domestic violence and alcohol related crime, fail to make the links between the two effectively. New initiatives such as alcohol arrest referral and brief intervention pilots could provide an opportunity for action and the Stella Project calls on central government departments to ensure this opportunity is not missed. More detailed recommendations are outlined in the Stella Project Response to Safe Sensible Social which is attached.

THE STELLA PROJECT RESPONSE TO SAFE SENSIBLE SOCIAL—THE NEXT STEPS IN THE NATIONAL ALCOHOL STRATEGY

The Stella Project is a partnership between the Greater London Domestic Violence Project (GLDVP) and the Greater London Alcohol and Drugs Alliance (GLADA) and works for positive, sustained improvement in the way services are delivered to survivors, their children and perpetrators of domestic violence affected by problematic substance use. Although primarily focused on work in Greater London, we are the leading agency with expertise in this area and our work has national significance.

While it is encouraging that the Government is progressing in the implementation of the 2004 National Alcohol Strategy, the Stella Project is concerned that the new document Safe. Sensible. Social has not been subject to consultation. In this absence, the Stella Project wishes to highlight some areas that need further clarification with regards to addressing alcohol related domestic violence.

"Due to the large fall in violent crime since 1995. as measured by the BCS, the actual number of offences where the offender is believed to be under the influence of alcohol has dropped by about a third since 1995". (22)

It is important to stress the different position with regards to domestic violence. An analysis of BCS statistics since 1995 show that the percentage of domestic violence assaults where the offender was thought to be under the influence of alcohol at the time has increased steadily from 30% in 1995 to 53% in 2005.[1]

The Stella Project believes that this analysis should be highlighted in any guidance issued from central government to support local partnerships in addressing alcohol related offending. Key stakeholders referred to in the strategy such as the Regional Directorates of Public Health and Government Offices should also be aware of these statistics.

"Two domestic violence enforcement campaigns (DVECs) have also been carried out to improve police performance in relation to evidence gathering and enforcement and, through such efforts, to increase the number of offenders brought to justice". (42)

The Stella Project welcomes the police attention given to monitoring alcohol related domestic violence during a recent 2006 DVEC. Recommendations coming from the evaluation pointed to the difficultly in gaining accurate recording of alcohol use and the need for better data collection in this area. The Stella Project would like to see a focus on distinguishing between those offenders who consume small amounts of alcohol and those who consume at binge, hazardous or harmful levels. It is also important to stress that although physical assaults may be linked to alcohol use, other aspects of domestic violence perpetrated by the same offender (eg emotional and financial abuse) often take place in the absence of alcohol.

"In the Stella Project in London and the A&E data sharing initiative in the South-East, 22 hospitals collected data on violent crime and shared information to reduce violent crime, offered support to victims and helped to ensure that perpetrators were dealt with through the criminal justice system". (42)

The above quote is incorrect. The Stella Project was not involved with the A&E data sharing initiative. Furthermore, it is important to highlight that domestic violence monitoring in this data sharing initiative was not cross referenced with alcohol use. The Stella Project would, however, encourage such cross referencing in future data collection initiatives.

Data collection is important and much needed. However, initiatives need to go further and be more innovative to address alcohol use by victims and perpetrators of domestic violence. Future Tackling Violent Crime Programme initiatives need to specifically address the needs of both perpetrators and victims who are using alcohol problematically. For example, opportunities should be explored for giving brief intervention and advice regarding alcohol use to domestic violence offenders and referral to appropriate services. Trained practitioners can take this opportunity to challenge myths related to alcohol related domestic violence. The Stella Project would like to see support for pilots modelled on this approach such as that taking place in the London Borough of Lewisham. There is a need for such pilots to be fully monitored and evaluated for their outcomes—in particular whether they achieve a reduction in repeat victimisation and help to increase victim safety.

"The Home Office will develop new guidance and support for Government Office for the English regions and a wide range of stakeholder groups represented at a local level . . ." (49)

In this role, the HO can encourage more integrated approaches by, for example, encouraging the use of cross cutting LAA targets which address alcohol related domestic violence (the Stella Project has produced guidance on this available at

http://www.gldvp.org.uk/C2B/document_tree/ViewADocument.asp?ID=96&CatID=76)

Funding devolved to local level must be linked to targets to reduce alcohol related harm. Further guidance needs to illustrate how local partnerships can support children affected by parental alcohol misuse and the need for family support services which address the interlinking issues of alcohol, poverty and domestic violence.

"The Home Office aims to establish a small number of alcohol arrest referral schemes by Autumn 2007". (88)

It is imperative that specialist referral workers are trained in domestic violence and support is given to develop links with appropriate services for victims and perpetrators. Monitoring could focus on whether such interventions can increase attendance on community based perpetrator programmes with the ultimate aim of reducing repeat victimisation and increasing safety to victims.

"Models of Care for Alcohol Misusers (MoCAM) and associated guidance have taken into account the needs of both victims and perpetrators of domestic violence". (89)

The Stella Project welcomes the references to domestic violence in MoCAM and the recognition of the need for specific guidance for "integrated care pathways" for both victims and perpetrators. The Stella Project eagerly awaits this additional guidance due to be published in Q4/2007.

MoCAM further recommends the use of alcohol brief interventions and advice pilots in healthcare settings. Given the research relating to the numbers of women in alcohol services who have experienced domestic violence, the Stella Project believes that some simple steps can be taken to address this under the banner of "brief interventions". Practitioners need to be alert to the fact that a person's drinking may be related to their experiences of domestic violence which may affect the type of advice that is given. All healthcare settings should have details of alcohol services which offer gender specific service or domestic violence support. For example, Turning Point's service in Watford General Hospital A&E provides a direct referral into an alcohol and domestic violence group. At a minimum, all service users should be issued with info of local domestic services alongside alcohol information. This falls in line with the guidance produced by MoCAM.

"Elsewhere in the CJS, the courts can, for example, attach an Alcohol Treatment Requirement (ATR) to a community order or suspended sentence order . . ." (53)

The Stella Project would like the courts to consider mandates which combine an Alcohol Treatment Order (ATR) alongside an Integrated Domestic Abuse Programme (IDAP). Consideration should be given to which substance misuse agency will monitor and deliver the ATR given to domestic violence offenders. For example, there are a number of substance misuse agencies in London who have trained staff on domestic violence and would be more appropriate to support such an alcohol order.

"The NPS is also piloting the Lower Intensity Alcohol Module (LIAM) for those offenders whose alcohol misuse and offending needs are not sufficient to lead to a referral to one of the existing substance misuse programmes but might require referral to another programme (eg tackling violent behaviour) . . ." (53)

The LIAM module may be a more viable and effective requirement of a community order given to a domestic violence perpetrator where alcohol use is problematic. Staff delivering this programme should be trained on the dynamics of domestic violence and the links with alcohol use.

Finally, given the high number of prisoners who have experienced violence and abuse throughout their lifetime and who also have problematic alcohol or drug use, any interventions in prison settings around alcohol and offending should address the link.

2 October 2007

104 Brecklin, L. (2002) "The role of perpetrator alcohol use in the injury outcomes of intimate assaults", Journal of Family Violence, 17 (3), pp 185-196. Back

105 Downs, W R. (1999) "Violence Against Women: The Need for Improved Medical Screening, Identification and Service Provision". Paper presented at University of Hull, England. October 1999. Back

106 Humphreys, C & Regan, L. (2005) Domestic Violence and Substance Use: Overlapping Issues in Separate Services, Final Report, available to download at www.gldvp.org.uk Back

107 This was based on a small sample therefore further research would be needed to confirm this finding. Back

108 Humphreys, C & Regan, L. (2005) Domestic Violence and Substance Use: Overlapping Issues in Separate Services, Final Report, available to download at www.gldvp.org.uk Back

109 Bury, C & Al. (1999) An examination of the needs of women crack users with the attention to the role of domestic violence and housing, Report for the Lambeth, Southwark and Lewisham Health Authority in collaboration with the National Addiction Centre and the Brixton Drug Project). Back

110 Powis, B, Gossop, M, Bury, Payne, K and Griffiths, P. (2000) "Drug Using mothers: social, psychological and substance use problems of women opiate users with children". Drug and Alcohol Review 19, 171-180. Back

111 See for example, El-Bassel, N, Gilbert, L, Schilling, R and Wada, T. (2000) "Drug Abuse and Partner Violence among Women in Methadone Treatment". Journal of Family Violence. 15 (3), 209-228 and Karageorge, K and Wisdom, G. (2001) Physically and sexually abused women in substance abuse treatment: treatment services and outcomes. Virginia: Center for Substance Abuse Treatment. Back

112 Gilchrist, E, Johnson, R, Takriti, R, Weston, S, Beech, A and Kebbell, M. (2003) Domestic violence offenders: characteristics and offending related needs, Findings 217 London, Home Office. Back

113 Humphreys, C & Regan, L. (2005) Domestic Violence and Substance Use: Overlapping Issues in Separate Services, Final Report, available to download at www.gldvp.org.uk Back

114 Gondolf, E W. (2002) Batterer Intervention Systems: Issues, Outcomes and Recommendations, Sage: USA. Back