Study reveals importance of healthcare professionals asking about violence and abuse. New guidance based on survivors’ experiences on how to improve services published

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A major new study, published today by DMSS, NatCen Social Research, Truth and CWASU, and involving over 120 interviews with health professionals and survivors of abuse, shows overwhelming support for “routine enquiry” – the process of asking adult service users about prior experience of violence and abuse in mental health assessments.

However, even though routine enquiry has been Department of Health policy since 2003, the study reveals that it is still inconsistently applied and that some healthcare professionals lack confidence in asking people about experiences violence and abuse or responding to disclosures.

The study, funded by the Department of Health Policy Research Programme, found:

– Despite people with extensive experience of violence and abuse being 5 times more likely to suffer from a mental health problem such as depression the relationship between violence and abuse and mental health is often overlooked. Survivors commented that some staff did not seem to regard their past history of abuse as relevant to their mental health.

– Lack of understanding in primary care – Some survivors had received a dismissive response from health service workers, including GPs and those working in in-patient services.

– Staff reluctant to ask – Interviews with service providers found that while some have implemented routine enquiry effectively others can be reluctant to ask about violence and abuse, in part due to lack of confidence in how to respond, and assumptions about it not being appropriate to some people or in some circumstances, and concerns about a lack of follow-up services being available.

– Lack of available support – this concern is founded; voluntary sector services for survivors reported considerably reduced funding in recent years while also struggling to support people with significant mental health issues, for whom no suitable NHS services were being provided. This was echoed by survivors of abuse.

New guidance

In response to these findings, the REVA study has published briefings for mental health professionals, Primary Care Trusts and commissioners on how services for survivors of violence and abuse can be improved based on survivors’ own experiences.

Mental health service users welcomed being asked about abuse even though disclosure could be difficult and they had the following recommendations for mental health professionals:

• Ask about abuse as early as possible

• Ask with interest and concern (rather than as a ‘tick box’ requirement)

• Ask more than once (as people may not feel able to respond at first)

• Ask of everyone, and

• Responses to any disclosure should be helpful and empathetic; ideally they should be followed up with good services and support, but a lack of availability of services should not be used an excuse to not ask about experiences of abuse.

Measuring outcomes

Following on from interviews with service users and service providers, the REVA project team also developed and tested a Supporting Survivor Outcomes (SSO) tool.

The tool makes it possible to test the effectiveness of mental health interventions, while also giving helpful feedback to users of mental health services about their own progress. It differs from other tools by including measures that go beyond the clinical to encompass the impacts of violence and abuse on everyday life. It also provides an opportunity for service users to give direct feedback on the appropriateness and quality of services.

Feedback from service users involved in the pilot was very positive:

“I think it’s really useful because when I read this I find out about myself – what I can and what I can’t [do] and what is happening – it’s useful, it’s really useful […] Normally I always think about my kids, my house, other things. When I do this then it gives me a chance to think [about] what I am.”

“…because [the questions] relate to how you do your daily activities or the way you interact with other people, they make you think, it makes you think whether you have actually managed or you haven’t, whether there is a problem … that you’re not aware of, or you’re not conscious about”

The study lead, Dr Sara Scott, said: “This study has given us a new insight into the experiences of survivors of violence and abuse in the health service. While many had a positive experience, there remains too much inconsistency and in some cases a lack of understanding and support. In response to this we have published guidance for people at each level of mental health services – from the commissioners and Trusts to front line mental health professionals. This guidance is of particular importance because it gives insights into how services can be improved directly from the users themselves.”

1 DMSS Research provides evaluation and research to health and social care organisations in the public and voluntary sectors.
2. NatCen Social Research. Britain’s leading large independent social research institute with experts in qualitative and quantitative social research.
3. Truth. A global research consultancy, specialising in insight, innovation and strategic thinking
4. The Child and Woman Abuse Studies Unit. CWASU, at London Metropolitan University, is a centre of excellence with an international reputation for research, evaluation, training and consultancy.

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