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Domestic abuse: learning from case reviews

Summary of risk factors and learning for improved practice around families and domestic abuse.

This learning from case reviews briefing looks at case reviews published since 2019, where children experienced domestic abuse.

The reviews suggest professionals sometimes struggle to keep their focus on children when they are working with families where there is domestic abuse.

The learning from these case reviews highlights that professionals need to understand the dynamics of domestic abuse and the effect it can have on children, and not make assumptions about gender roles within relationships where there is domestic abuse. Professionals must prioritise the impact that living with domestic abuse has on children.

Published: June 2020

Browse our full series of learning from case reviews briefings

Our series of thematic briefings highlight the learning from case reviews conducted when a child dies, or is seriously harmed, as a result of abuse or neglect. Each briefing focuses on a different topic or learning for specific sectors, pulling together key risk factors and practice recommendations.

> See the full series

More about case reviews

We work with local safeguarding partners to ensure that learning from case reviews can be accessed and shared at a local, regional and national level.

Find out how you can apply the lessons from case reviews and improve your practice to help protect children and young people. 

Browse through our list of child safeguarding practice reviews, serious case reviews, significant case reviews and child practice reviews which were added to the National case review repository in the last five years.

Subscribe to our monthly email newsletter alerting you to the case reviews we have added to the National collection of case reviews repository at the NSPCC.

Find out more about case reviews

Related resources

Read our information on what domestic abuse is, how to recognise it and how people who work with children can respond to it.

Learn how the NSPCC Helpline’s new Domestic Abuse Practice Advisors support children and families experiencing domestic abuse in this NSPCC Learning podcast episode.

We share what parents, carers, children and young people have told our helplines about experiencing domestic abuse in the form of coercive and controlling behaviours.

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• Release calendar
• Methodology

Domestic abuse in England and Wales overview: November 2022

Figures on domestic abuse from the Crime Survey for England and Wales, police recorded crime and a number of different organisations.

This is not the latest release. View latest release

Contact: Email Meghan Elkin

Release date: 25 November 2022

Next release: To be announced

Table of contents

• Other pages in this release
• Main points
• Crime Survey for England and Wales

Police recorded crime

• Criminal justice system
• Victim services
• Domestic abuse in England and Wales data
• Measuring the data
• Strengths and limitations
• Related links
• Cite this statistical bulletin

Print this Statistical bulletin

Download as PDF

1. Other pages in this release

This release brings together data on domestic abuse from a range of different organisations. Commentary is split into a number of separate publications:

Domestic abuse prevalence and trends, England and Wales: year ending March 2022

Domestic abuse victim characteristics, England and Wales: year ending March 2022

Partner abuse in detail, England and Wales: year ending March 2022

Domestic abuse and the criminal justice system, England and Wales: November 2022

Domestic abuse victim services, England and Wales: 2022

Redevelopment of domestic abuse statistics: research update November 2022

How domestic abuse data are captured through the criminal justice system

This release supports the  UN 16 Days of Activism against Gender-Based Violence Campaign  and the statistics are used to monitor progress towards the  Sustainable Development Goals (SDGs) .

2. Main points

The Crime Survey for England and Wales (CSEW) estimated that 5.0% of adults (6.9% women and 3.0% men) aged 16 years and over experienced domestic abuse in the year ending March 2022; this equates to an estimated 2.4 million adults (1.7 million women and 699,000 men).

Approximately 1 in 5 adults aged 16 years and over (10.4 million) had experienced domestic abuse since the age of 16 years.

There was no significant change in the prevalence of domestic abuse experienced by adults aged 16 to 59 years in the last year, compared with the year ending March 2020; a year largely unaffected by the coronavirus (COVID-19) pandemic and the last time the data were collected.

The number of police recorded domestic abuse-related crimes in England and Wales increased by 7.7% compared with the previous year, to 910,980 in the year ending March 2022; this follows increases seen in previous years and may reflect increased reporting by victims.

The Crown Prosecution Service (CPS) domestic abuse-related charging rate in England and Wales increased for the first time in four years to 72.7% in the year ending March 2022 but remains below the year ending March 2018 (75.9%).

The National Domestic Abuse Helpline delivered 50,791 support sessions through phone call or live chat in the year ending March 2022, a similar number to the previous year.

Crime Survey for England and Wales (CSEW) data presented in this release for the year ending March 2022, are not badged as National Statistics . They are based on six months of data collection between October 2021 and March 2022. Caution should be taken when using these data due to the impact of the reduced data collection period and lower response rates on the quality of the estimates.

3. Crime Survey for England and Wales

The face-to-face Crime Survey for England and Wales (CSEW) was suspended on 17 March 2020 because of the coronavirus (COVID-19) pandemic. Although the Telephone CSEW (TCSEW) allowed us to carry on providing estimates for certain crimes, concerns around confidentiality and respondent safeguarding led to domestic abuse questions being excluded.

Data collection for the face-to-face CSEW resumed on 4 October 2021. Data based on six months of CSEW interviews, rather than 12 months, have been used in our  articles for the year ending March 2022 . CSEW data presented in this release are not badged as National Statistics and caution should be taken when using these data due to the impact of the reduced data collection period and lower response rates on the quality of the estimates. On the return of face-to-face CSEW interviewing, the upper age limit of respondents completing the self-completion module was removed.

For more information on domestic abuse by age group following the removal of the upper age limit, see section 5 of the Domestic abuse victim characteristics, England and Wales: year ending March 2022 .

Domestic abuse in the last year

The CSEW estimated 2.4 million adults aged 16 years and over experienced domestic abuse in the year ending March 2022 (1.7 million women and 699,000 men). This equates to a prevalence rate of approximately 5.0% of adults (6.9% women and 3.0% men).

Figure 1 shows a higher percentage of adults experienced domestic abuse by a partner or ex-partner (3.5%) than by a family member (2.1%) in the last year. Of those who experienced partner abuse, 84.3% experienced non-physical abuse, 12.9% experienced any sexual assault and 20.8% experienced stalking.

For more information on partner abuse measured by the Crime Survey for England and Wales, see the Partner abuse in detail: England and Wales, year ending March 2022 article and accompanying tables .

Figure 1: One in 20 adults experienced domestic abuse in the year ending March 2022

Prevalence of domestic abuse in the last year for adults aged 16 years and over, by perpetrator-relationship, england and wales, year ending march 2022.

Source: Office for National Statistics - Crime Survey for England and Wales

• Data for the year ending March 2022 are not badged as National Statistics. They are based on six months of data collection from the face-to-face Crime Survey for England and Wales between October 2021 and March 2022. Caution should be taken when using these data due to the impact of the reduced data collection period and lower response rates on the quality of the estimates.
• Partner abuse refers to abuse carried out by a partner or ex-partner.
• Some victims may have experienced both partner and family abuse in the last year.

Download this chart Figure 1: One in 20 adults experienced domestic abuse in the year ending March 2022

Following the removal of the upper age limit for survey respondents in October 2021, when analysing data over time, we use the 16 to 59 years age range to give a comparable time series for analysis. In the year ending March 2022, for adults aged 16 to 59 years, the prevalence rate of domestic abuse was 5.7%. This was not significantly different to the year ending March 2020, a year largely unaffected by the coronavirus (COVID-19) pandemic and the last time data were collected (Figure 2).

The prevalence of partner abuse has remained similar in recent years with no significant change seen in the year ending March 2022 (3.9%) compared with the year ending March 2020 (4.5%). Similarly, there has been little change in the prevalence of family abuse.

Figure 2: Domestic abuse prevalence has not changed significantly compared with the year before the coronavirus (COVID-19) pandemic

Prevalence of domestic abuse in the last year among adults aged 16 to 59, year ending march 2005 to year ending march 2022.

• No data is available for the year ending March 2021 because the Crime Survey for England and Wales was suspended due to the coronavirus (COVID-19) pandemic.
• No data is available for the year ending March 2008 because comparable questions on any domestic abuse, any partner abuse and any family abuse were not included in that year.

Download this chart Figure 2: Domestic abuse prevalence has not changed significantly compared with the year before the coronavirus (COVID-19) pandemic

Domestic abuse since the age of 16 years.

The year ending March 2022 CSEW showed an estimated 10.4 million adults aged 16 years and over had experienced domestic abuse since the age of 16 years. This equates to a prevalence rate of 21.9%, or approximately one in five adults (Figure 3).

Figure 3: Approximately one in five adults had experienced domestic abuse since the age of 16 years

Prevalence of domestic abuse since the age of 16 years for adults aged 16 years and over, by perpetrator-relationship, england and wales, year ending march 2022.

• Some victims may have experienced both partner and family abuse since the age of 16 years.

Download this chart Figure 3: Approximately one in five adults had experienced domestic abuse since the age of 16 years

4. police recorded crime.

The police recorded 1,500,369 domestic abuse-related incidents and crimes in England and Wales in the year ending March 2022. Around two in five (39.3%) of these were domestic abuse-related incidents that cover reports where, after initial investigation, the police have concluded that no notifiable crime was committed.

In the year ending March 2022 there were 589,389 domestic abuse-related incidents recorded by the police in England and Wales. This was a decrease from 613,929 in the previous year, and a return to a similar number seen before the coronavirus (COVID-19) pandemic. The number of domestic abuse-related crimes recorded by the police increased by 7.7% to 910,980 compared with the year ending March 2021. This continues the trend of increases seen over recent years which may, in part, be driven by increased willingness of victims to come forward to report domestic abuse.

Since the year ending March 2019, the number of domestic abuse-related crimes recorded by the police in England and Wales has exceeded the number of domestic abuse-related incidents (Figure 4).

Of all crimes recorded by the police in the year ending March 2022, 17.1% were domestic abuse-related which remained similar to the year ending March 2021 (18.3%) and year ending March 2020 (15.1%).

Figure 4: The number of domestic abuse-related incidents decreased to a similar level seen before the coronavirus (COVID-19) pandemic

Number of domestic abuse-related incidents recorded by the police, england and wales, year ending march 2016 to year ending march 2022.

Source: Home Office – Police recorded crime

• Police recorded crime data are not designated as National Statistics.
• Domestic abuse related crimes are defined as any incidence of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults, aged 16 and over, who are or have been intimate partners or family members, regardless of gender or sexuality.
• The number of incidents refers to how many domestic abuse-related incidents did not get recorded as a crime.

Download this chart Figure 4: The number of domestic abuse-related incidents decreased to a similar level seen before the coronavirus (COVID-19) pandemic

5. criminal justice system.

Among the 41 police forces that supplied data in both years, the police made 31.3 arrests per 100 domestic abuse-related crimes in the year ending March 2022, a decrease from 32.6 in the previous year.

The number of suspects of domestic abuse-related crimes referred by the police to the Crown Prosecution Service (CPS) for a charging decision decreased from 77,812 in the year ending March 2021 to 67,063 in the year ending March 2022, mirroring the decrease in arrests. The decrease in referrals continues the trend since the year ending March 2015 (Figure 5).

Figure 5: The number of suspects of domestic abuse-related crimes referred by the police to the Crown Prosecution Service (CPS) for a charging decision continued to decrease

The number of suspects of domestic abuse-related crimes referred by the police to the cps for a charging decision, england and wales, year ending march 2015 to year ending march 2022.

Source: Crown Prosecution Service

• Data from the Crown Prosecution Service (CPS) are not designated as official statistics.
• In 2019, CPS altered their data collection methodology to include cases from Central Casework divisions in the figures for England and Wales. This change has been applied to all historic data, therefore data may differ slightly from figures previously published.
• These data are referred to by the CPS as the pre-charge receipt of cases. The number of pre-charge receipts referred by the police relies on the police identifying and flagging the cases, by suspect, prior to being referred to the CPS. It also relies on the CPS administrators identifying and flagging those cases on the CPS case management system when they are first registered.

Download this chart Figure 5: The number of suspects of domestic abuse-related crimes referred by the police to the Crown Prosecution Service (CPS) for a charging decision continued to decrease

In contrast, the CPS domestic abuse-related charging rate in England and Wales increased for the first time in four years to 72.7% in the year ending March 2022, but remains below the year ending March 2018 (75.9%).

Over three-quarters (76.4%) of domestic abuse-related prosecutions were successful in securing a conviction in the year ending March 2022. This decreased to a similar proportion seen in the year ending March 2018.

More detail can be found in our Domestic abuse and the criminal justice system, England and Wales: November 2022 article and accompanying tables .

6. Victim services

In the year ending March 2022, the National Domestic Abuse Helpline, run by Refuge, delivered 50,791 support sessions through phone call or live chat (Figure 6). This remained similar to the year ending March 2021, a year affected by the coronavirus (COVID-19) pandemic.

Figure 6: The number of support sessions delivered by the National Domestic Abuse Helpline increased for the second year

Number of support sessions delivered by the national domestic abuse helpline in england, year ending march 2018 to year ending march 2022.

Source: Refuge – National Domestic Abuse Helpline

• Refuge data are not classified as official statistics.
• The 24-hour freephone National Domestic Abuse Helpline (run by Refuge) is available on 0808 2000 247, 24 hours a day, 7 days a week.
• Data from the year ending March 2020 should be treated with caution, due to a period of change in the delivery of the service. The contract to run the service was retendered with a period of implementation of a new model from November 2019 to March 2020.
• A support session is defined as a phone conversation or live chat conversation provided by the National Domestic Abuse Helpline in response to an incoming contact. In addition, the Helpline offers support via email and follow-up calls.

Download this chart Figure 6: The number of support sessions delivered by the National Domestic Abuse Helpline increased for the second year

More detail can be found in our Domestic abuse victim services, England and Wales: 2022 article and accompanying tables .

7. Domestic abuse in England and Wales data

Domestic abuse prevalence and victim characteristics Dataset | Released 25 November 2022 Domestic abuse numbers, prevalence, types and victim characteristics, based upon findings from the Crime Survey for England and Wales and police recorded crime.

Domestic abuse and the criminal justice system Dataset | Released 25 November 2022 Data from across the government on responses to and outcomes of domestic abuse cases in the criminal justice system.

Domestic abuse victim services Dataset | Released 7 September 2022 Data from different organisations on the availability of domestic abuse services and the characteristics of service users.

Domestic abuse in England and Wales - Data tool Dataset | Released 25 November 2022 An interactive Excel-based data tool for domestic abuse statistics. It allows users to explore data for their police force area in more detail and compare with other areas.

Stalking: findings from the Crime Survey for England and Wales Dataset | Released 25 November 2022 Data from the Crime Survey for England and Wales on stalking including numbers, types and victim characteristics.

Partner abuse in detail Dataset | Released 25 November 2022 Data from the Crime Survey for England and Wales on the prevalence and nature of partner abuse.

8. Glossary

Charging rate.

The charging rate is the number of suspects of Crown Prosecution Service (CPS) domestic abuse-flagged cases that were charged as a proportion of all those that resulted in a legal decision to charge, prosecute, or issue an out-of-court disposal.

Domestic abuse

Domestic abuse is not limited to physical violence and can include a range of abusive behaviours. It can also be experienced as repeated patterns of abusive behaviour to maintain power and control in a relationship. The  Domestic Abuse Act 2021  defines domestic abuse as any incident or pattern of incidents between those aged 16 years and over who:

are a partner 

are an ex-partner 

are a relative 

have, or there has been a time when they each have had, a parental relationship in relation to the same child 

The Domestic Abuse Act 2021 outlines the following behaviours as abuse: 

physical or sexual abuse 

violent or threatening behaviour 

controlling or coercive behaviour 

economic abuse 

psychological, emotional, or other abuse 

The Domestic Abuse Act 2021 recognises children under the age of 18 years who see, or hear, or experience the effects of the abuse, as a victim of domestic abuse if they are related or have a parental relationship to the adult victim or perpetrator of the abuse.

Domestic abuse-related crimes

Incidents of domestic abuse that resulted in a crime being recorded by the police and are included in police recorded crime.

Domestic abuse-related incidents

Incidents of domestic abuse that were reported to the police, but following investigation, do not amount to a crime or offence according to the National Crime Recording Standards. These can be added to domestic abuse-related crimes to create a total picture of the demand that domestic abuse puts on the police.

Police recorded crime data are supplied by the Home Office, who are responsible for the collation of recorded crime data supplied by the 43 territorial police forces of England and Wales, plus the British Transport Police. The data are an important indicator of police workload but, unlike the Crime Survey for England and Wales (CSEW), do not include crimes that have not been reported to the police or incidents that the police decide not to record as crimes.

Pre-charge decisions

Of all the suspects referred by the police, pre-charge decisions are those where the CPS has decided whether to charge, take no further action, recommend an out of court decision, record, and outcome of pending response - further investigation or "other".

9. Measuring the data

The domestic abuse data included in this release are sourced from the Crime Survey for England and Wales (CSEW), police recorded crime, other government organisations and domestic abuse services.

The  User guide to crime statistics for England and Wales  provides detailed information about the crime survey and police recorded crime data.

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in our:

Domestic abuse quality and methodology information (QMI)

Crime in England and Wales QMI

How domestic abuse data are captured through the criminal justice system article

10. Strengths and limitations

Statistics on domestic abuse are produced separately by many different organisations in England and Wales. When taken in isolation, these statistics may not provide the context required to understand the national and local picture of domestic abuse.

Crime Survey for England and Wales (CSEW) data presented in this release for the year ending March 2022 are not badged as National Statistics . They are based on a six-month collection period from the face-to-face CSEW, between October 2021 and March 2022. Caution should be taken when using these data due to the impact of the reduced data collection period and lower response rates on the quality of the estimates.

Police recorded crime and outcomes data from the Home Office are classified as official statistics.  National Statistics  are a subset of  official statistics  that have been certified by the UK Statistics Authority as compliant with its Code of Practice for Statistics. All other data included in this release are sourced from administrative datasets that do not fall within the scope of official statistics.

The way in which data on domestic abuse are collected differs between sources and organisations. The data are not directly comparable, since they are collected on different bases (for example, victims, crimes, suspects, or defendants) and may not cover the same cohort because of variation in the time taken for cases to progress through the criminal justice system. As such it is necessary to look at the data presented in its entirety as each individual stage of the system is, in part, influenced by activity at a prior stage.

Alongside this release we have published a  data tool  that allows users to explore domestic abuse data for police force areas in more detail and compare these with similar areas within England and Wales.

11. Related links

Violence against women and girls: research update November 2022 Article | Released 25 November 2022 An update of our current and future research and publications relating to violence against women and girls (VAWG).

The lasting impact of violence against women and girls Article | Released 24 November 2021 Violence against women and girls can lead to significant and long-lasting impacts such as mental health issues, suicide attempts and homelessness, ONS analysis shows.

Crime in England and Wales: year ending June 2022 Bulletin | Released 27 October 2022 Crime against households and adults using data from police recorded crime and the Crime Survey for England and Wales (CSEW).

Sexual offences in England and Wales overview: year ending March 2020 Bulletin | Released 18 March 2021 Figures on sexual offences from the year ending March 2020 Crime Survey for England and Wales and crimes recorded by police.

Statistics on so called 'honour-based' abuse offences, England and Wales, 2021 to 2022 Article | Released 20 October 2022 Home Office release containing statistics about so called 'honour based' abuse (HBA) related offences and incidents recorded by the police in England and Wales.

12. Cite this statistical bulletin

Office for National Statistics (ONS), released 25 Month 2022, ONS website, statistical bulletin, Domestic abuse in England and Wales overview: November 2022

Contact details for this Statistical bulletin

Coercive Control

Case study 5: Betty

Download the whole case study as a PDF file

Betty and Godfrey are an older married couple. Godfrey received a diagnosis of dementia 18 months ago, and has been attending a respite centre two days per week to support Betty to cope with her caring role. The day centre staff have observed Betty being rough with Godfrey and so raised a safeguarding concern with Adult Social Care – but looking into Betty and Godrey’s file, it becomes apparent that Godfrey has been abusive to Betty in the past.

This case study considers issues around working with older people experiencing domestic abuse, dementia and longstanding abuse, and carers as perpetrators and victims of domestic abuse.

When you have looked at the materials for the case study and considered these topics, you can use the critical reflection tool and the action planning tool to consider your own practice.

Case details

Download the case details as a PDF file (550KB)

Betty and Godfrey have been married for 52 years. Betty is originally from Barbados and Godfrey from St Kitts. They have three children. Marcus and Gloria live in the USA. Angela, who is a carer for her son with complex needs, and her husband live nearby.

Godfrey is living with dementia after a diagnosis 18 months ago. Their GP made a referral for a carer’s assessment for Betty due to her being stressed due to Godfrey’s ‘increasingly unreasonable demands’. As a result Godfrey attends a day care centre two days a week to give Betty some respite. Godfrey is described as ‘a real charmer’ and is popular with the staff and centre members.

The centre staff have noted that there is a ‘volatile’ relationship between Betty and Godfrey. Incidents include Betty trying to drag Godfrey out of the car to get him into the centre and Betty talking sharply to Godfrey because he was refusing to leave the centre when she came to pick him up. The staff find Betty trying at times. She gives them very specific instructions about how to provide support to Godfrey, for example what he can and can’t eat. They have found Godfrey likes food that Betty says he doesn’t like.

Recently staff assisting Godfrey found that he had bruising on both of his upper arms. A nurse who was visiting said they could be from being grabbed. Godfrey said that it was true, Betty had grabbed him when they were having a row, but that it was nothing to worry about ‘just the ups and downs of married life’. The nurse told Godfrey about safeguarding and he said he didn’t want a referral made.

When the nurse discussed this with the centre manager they decided that as Godfrey might not have had the capacity to make the decision about going ahead with a safeguarding referral because of his dementia, and because he might be at risk of harm before his next day at the centre, they would make a safeguarding referral.

Notes on Godfreys and Betty’s social care files refer to the police having attended the household twice in the last 8 months after calls from Betty during the late evening in which she said Godfrey was out of control and hurting her.

How would you make safe enquiry with each of Godfrey and Betty?

Who will meet with each of them?

How will you contact them to arrange the meeting?

In this section are two downloadable PDFs – one is a partly completed assessment form related to this case study, and another is an example of what a completed form could look like.

Suggested exercise

Download the partly completed assessment as a PDF file (503KB)

Download the completed assessment as a PDF file (502KB)

Use the partly completed assessment form:

• What actions would you discuss with Betty to ensure her immediate and longer term safety?
• What precautions would you need to take to avoid putting her at higher risk of harm?
• What is your analysis of the situation? Is coercive control occurring? What is the evidence of this?
• What is your conclusion?

Download the blank DASH_RIC as a Word .doc file (226KB)

The purpose of the DASH risk checklist is to give a consistent and simple tool for practitioners who work with adult victims of domestic abuse in order to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage their risk. If you are concerned about risk to a child or children, Safe Lives recommend that you should make a referral to ensure that a full assessment of their safety and welfare is made.

There are two downloads on this page.

One shows a blank DASH risk checklist, with quick start guidance from Safe Lives. The key point is to remember that your professional judgement is key in making a decision about risk; a tool can help, but the score it comes out with is not definitive.

This is especially relevant when working with people with care and support needs, for whom some of the questions may not be relevant.

Download the case study DASH-RIC as a PDF file (206KB)

The other shows an example of a completed DASH relating to this case study, for you to critique and appraise.

Suggested exercise:

• Read the case details and full assessment document for this case study.
• Using the information contained, fill out a blank DASH risk assessment tool.
• Discuss how you found it; did you have all the required information? Would you be able to get all the required information in practice? Would you make a referral to MARAC?

This section picks out three main topics from the case study featured. For Betty and Godfrey’s case study, the topics include:

Working with older people experiencing domestic abuse/lifelong coercive control

Dementia and longstanding domestic abuse, the role of the marac.

A selection of references, tools and further reading for each topic is below.

‘A  review of the impact of domestic abuse for older women  in Health and Social Care in the Community in 2011 highlighted that the issue is significant but that health and social care professionals fail to recognise domestic abuse between older couples.’

This is referred to in an article by Natalie Valios, 26 March 2015, in Community Care which summarises the outcome of the serious case review into the death of Mary Russell. The article offers key pointers for social workers and provides useful links: http://www.communitycare.co.uk/2015/03/26/domestic-abuse-doesnt-stop-at-60/

McGarry et al’s (2011) review of the literature investigating older women’s experience of domestic abuse points to the longer term effect of physical abuse, the psychological impact at the time and cumulatively in later life, and emotional issues which many felt unable to disclose to others – a significant barrier to reporting in older age being that women ‘had kept their experiences ‘hidden’ from family friends and neighbours’ for many years.

The voices of older women survivors – in the accounts of sixteen women, aged 63-79, who had experienced domestic abuse – are highlighted in McGarry and Simpson, (2011).

McGarry et al (2011) also detail some information on the lack of research on the experiences of older women from ethnic minorities, concluding that ‘taken as a whole, the voices of older women from ethnic minorities remain unheard and this clearly represents an additional deficit in knowledge and understanding.’ (2011:11) Social workers working with Betty will need to consider possible limitations of their knowledge base and be proactive in this respect.

Case study 1 Ayesha focuses on intersectionality and building cultural capability .

Advice for health and social care professionals – for example those working in care homes who may be particularly well placed to support older people to begin to talk about domestic abuse and coercive control in their intimate relationships – is available here:

Live Fear Free: Supporting a client who is experiencing domestic abuse or sexual violence.

‘Safe Lives’ offer a range of useful information on working with older people experiencing domestic abuse: http://www.safelives.org.uk/node/861

There is a surprisingly limited amount of research on this topic although findings from Dr Lucy Knight and Professor Marianne Hester’s research highlights that the onset of dementia in the situations studied led to an escalation in the severity of the domestic abuse: http://www.rcpsych.ac.uk/pdf/Knight%20Lucy.pdf

Other papers look at issues related to but not quite focused on the experience of domestic abuse for people with dementia, for example ‘elder abuse’. The lack of separation of domestic abuse and coercive control from ‘elder abuse’ in the literature to date makes it difficult to draw conclusions about domestic abuse and older people.

Blog post: Perpetrators with dementia

Case study example from Solace Women’s Aid: Older domestic violence victims feel helpless in the face of long-term abuse

Podcast: For their Spotlight series, Safe Lives have developed a number of podcasts which explore issues relating to domestic abuse and people with social care needs. One of these is focused on changing attitudes towards older people and domestic abuse.

Access the podcast recording here : Domestic abuse and older people: Are attitudes changing?

Access the transcript of the podcast here

See also Tool 2, Reflection on attitudes towards older people and domestic abuse.

A useful summary of research findings on MARAC processes has been produced by NIHR School for Social Care Research and Manchester Metropolitan University which recognises that MARAC domestic violence processes and safeguarding processes may need to be followed in parallel. This can be found in Tool 3, below.

‘MARACs are ‘multi-agency risk assessment conferences’ that share information about the top 10% high risk domestic violence cases in order to produce co-ordinated actions to reduce the risk and increase victim safety.’

Rachel Robbins et al’s (2014) paper draws attention to the potential and limits of the Multi-Agency Risk Assessment Conferences (MARACs) in supporting adults with social care needs who also experience domestic violence.

Tool 1 below gives specific guidance on MARAC processes with older people.

Tool 1: Safe Lives guidance for MARACS, hidden victims: older people

Tool 2: reflection on attitudes towards older people and domestic abuse, tool 3: nihr domestic violence, adult social care and marac.

Download the tool as a PDF file (191KB)

Historically, older people (60+) experiencing domestic abuse have formed part of a ‘hidden’ group.

There is a need to focus on their experiences and the barriers they face when being identified as victims (or perpetrators) and also in being provided with safe and appropriate services.

There are various reasons why this is not happening in a consistent way across the UK. Services are typically set up with younger clients in mind, older people are less likely to call 999, and particular cultural or generational attitudes often exist towards marriage and family life. Abuse can often be hidden behind other physical and mental health conditions, and a lack of awareness among some professionals prevents recognition of this underlying cause.

There has been an expectation that the introduction of the Care Act 2014 would improve the identification, reporting and response to older victims of domestic abuse, and significant work in Wales and in some areas of England has begun to raise awareness around the specific needs of older victims and perpetrators. Maracs must ensure that wider safeguarding concerns are addressed; this is especially pertinent in older people's cases where there may be an increased chance that the perpetrator and/or victim will require support relating to physical or mental health needs.

This tool outlines:

• What is different about older victims’ experiences of domestic abuse?
• What should happen before MARAC?
• Who are the right people to be at the table?
• What research to do before the meeting (e.g. impact of abuse on the victim, and their views and wishes)
• What representatives from different agencies should offer
• What effective action planning during MARAC looks like
• Tips for professionals working outside the MARAC

Download the tool as a PDF file (534KB)

For this exercise, first of all read the podcast transcript or listen to the podcast

Spotlight Episode 3: Domestic abuse and older people: are attitudes changing? (Safe Lives, 2016)

The podcast features a discussion between Jane, an IDVA (Independent Domestic Violence Advocate) based in a hospital and Mel, who is Adult Social Care’s representative on a local MARAC.

The tool highlights sections of the podcasts as a reference to start off discussion and debate about practice in your areas.

It includes reflective questions on issues including:

• Challenges to practice in this area
• Use of Domestic Violence Protection Orders (DVPOs)
• Identifying coercive control
• The line between concerned or stressed carer, and perpetrator of domestic abuse
• Barriers to older people accessing support
• The use of MARAC

Download the tool as a PDF file (160KB)

This tool summarises a study which was interested in identifying and assessing the effectiveness of social care’s contribution to the development of MARACs and the protection of adults facing domestic abuse, using the city of Manchester as a case study site.

The researchers attended MARACs, interviewed members of MARAC partner agencies and adult social care workers, undertook focus groups with survivors of domestic violence, and focus groups with specialist domestic abuse practitioners.

The 4-page summary outlines:

• Key points from the research
• Findings: service user perspectives
• Findings: agency perspectives
• Interviews with adult social care

Questions for reflection on reading the report are outlined below.

• What is the threshold for MARAC in your area?
• How would you use your professional judgement to make a case for an older person who might not meet the threshold for MARAC, but is at high risk, to be included in MARAC?
• Can you see any tensions between using a Making Safeguarding Personal approach, and MARAC?
• How can these tensions be overcome?

There is also comprehensive reference to MARAC procedures in the LGA & ADASS guide to support practitioners and managers which is available here:

Adult safeguarding and domestic abuse: a guide to support practitioners and managers (LGA and ADASS, 2015)

(see also Case study 3 John Topic – Complex caring relationships )

Further reading:

Knight L and Hester M (2014) Domestic abuse and dementia: what are the characteristic features and patterns of longstanding domestic abuse following the onset of dementia? Safe Vol 48 (4) pp 10-14.

McGarry J, Simpson C and Hinchliff-Smith K (2011) The impact of domestic violence on older women: a review of the literature. Health and Social Care in the Community , 19,1, 3-14 Available here: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2524.2010.00964.x/full

McGarry J. & Simpson C (2011) Domestic abuse and older women: exploring the opportunities for service development and care delivery. The Journal of Adult Protection , 13, 6, 294-301. Available here: http://www.reducingtherisk.org.uk/cms/sites/reducingtherisk/files/folders/resources/victims/Domestic_abuse_and_older_women_McGarry_and_Simpson.pdf

Robbins R, McLaughlin H,  Banks C,  Bellamy C,  Thackray  D (2014) ‘Domestic violence and multi-agency risk assessment conferences (MARACs): a scoping review’,  The Journal of Adult Protection , Vol. 16 (6), pp.389 – 398

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• The evidence base around domestic violence and abuse

Published: 10/02/2022

This podcast examines the evidence base around domestic violence and abuse, perpetration and the interface with children’s social care.

Dez Holmes, Director of Research in Practice, talks to Jo Todd Chief Executive of Respect , Kyla Kirkpatrick Director of the Drive Partnership and Dr Olumide Adisa Senior Research Fellow, Centre for Abuse Research at the University of Suffolk about the evidence base around domestic violence and abuse, perpetration and the interface with children’s social care.

[Introduction] 

This is a Research in Practice podcast supporting evidence - informed practice with children and families, young people and adults.   

Dez: Hello, my name's Dez Holmes I'm the director of Research in Practice and I'm delighted to be joined by Jo Todd, Kyla Kirkpatrick and Olumide Adisa today. We're going to be discussing the nature of the evidence base particularly the evidence base around domestic violence and abuse, the perpetration of that abuse and the interface with children's social care. So let me start by introducing colleagues.  

Jo: I'm Jo Todd, I'm the Chief Exec at Respect, we have a focus on domestic abuse perpetrators on male victims and on young people who cause harm.  

Kyla: I'm Kyla Kirkpatrick, I'm the Director for the Drive partnership which is a partnership between the three organisations, really focusing on responses to perpetrators of domestic abuse and developing those responses.  

Olumide: My name is Olumide Adisa, I'm a senior research fellow and the head of the centre for abuse research at the University of Suffolk and we basically are focused on building a what works everyday list around domestic abuse research and projects as well. So we really have a huge focus on service improvement and actually ensuring that we are building an evidence space, bringing in academics, practitioners and policymakers as well.   

[The whole systems approach of the Drive Partnership and their work with children’s social care] 

Dez: Thank you so much, great to have you all here. Kyla, I think you were going to start by just briefly describing the Drive partnership, the Drive intervention and why you're focusing particularly at this stage around children's social care.    

Kyla: So the Drive partnership came together maybe five, six years ago to take a look at the existing responses to perpetrators of domestic abuse, really looking at what was a long-standing intractable social issue and terms of domestic abuse and how could some of this be approached differently. Social finance is one member organisation and looking at these issues of social justice and particularly building the business case for investment in these areas is a specialism that they bring and they really triggered this debate and discussion and brought in two organisations to provide that expertise in the field. So one being Respect with their expertise in responding to perpetrators of domestic abuse and Safe Lives with their focus on victim-survivors, so the three organisations have worked together over the course of the last five or six years. The very first piece of work was to look at a very particular project, what else could we do and what could we be doing differently to respond to perpetrators and at that time really focusing on addressing issues around high harm, high-risk perpetrators. Perpetrators who otherwise not engaging with services, flying under the radar, not eligible for existing programmes because of complexities around safety, maybe substance misuse, mental health issues and the partnership built a different way of working to work with that very particular cohort.   

Over the course of the last three years, we have expanded that scope and we're looking much more broadly at whole systems around domestic abuse and perpetrators of domestic abuse. So not just focusing on one intervention there's no magic bullet, there's no one size fits all, what needs to change across the whole system in terms of what service delivery but also commissioning and policymaking to really shift the dial on this issue. Briefly the focus here on children's social care came initially from our work with high harm, high-risk perpetrators which take a very multi-agency approach, coordinate response from different services around a case. And we were finding that on individual casework we were making really significant changes when we worked closely with probation, police and children's social care amongst others. And we find that they were really significant changes in high social care who worked with our teams in terms of information sharing, risk management, planning when we were working on a case by case basis. And the Drive case managers were learning from social care, social workers were learning from them and there was fantastic work being done, however, we couldn't shift that into systems change and it was all very focused on individual cases and that particular family at hand. So we really wanted to step into how do we enable this great practice on the ground to meet in the middle with top-down policy and systems change with children's social care. That's what triggered this piece of work specifically looking at what is happening throughout the system for children's social care in relation to the perpetrator of domestic abuse not just focusing on mum and the victim-survivor.   

[What the evidence base tells us about working with people who perpetrate harm] 

Dez: Thank you and it's been a really fascinating piece of work for us at Research in Practice to be a little bit involved in and really chimes with the messages that we hear from children's social care colleagues about that sense of sometimes helplessness, I use that word deliberately, a feeling sometimes described as, 'We don't have anything in our tool kit other than traditional child protection approaches.' Which some would argue almost inherently responsible the parent being harmed which disproportionately is the mother, you know, not exclusively but I think we would all recognise that disproportionately it's mothers who are responsibilised for abuse where children's social care take that approach. So really interesting bit of work and fair to say not an area of work where there was a pre-existing randomised control trial or manualised programme that you could simply role out as the same goes which brings me to the notion of evidence. Olumide, one of the myths that we've sometimes heard in this space is the idea that there's no evidence and I think probably all four of us on this call would disagree with that narrative. I'm interested from your academic perspective what do you think the evidence base or narrative about that evidence base currently tells us about work with people who perpetrate harm?  

Olumide: That's a very interesting question actually, so I think it's to kind of do an overview or, sort of, map how evidence is, sort of, developed in this particular area in the UK. I mean one good place to start is perhaps to look at project Mirabal, I'm sure Jo can say much more about that project because she's involved with that, but I think was a piece of work, research that was done by Professor Nicole Westmoreland and Professor Liz Kelly. I think around 2010 really, so really quite early in terms of the conversations around whether or not we should begin to work with, you know, those who use harmful behaviours. And so in some ways, it was seen as being a very innovative approach to start trying to, sort of, change attitudes in terms of how we should be investing in its area of work and I think another very interesting piece of work actually was looking at this. So Professor Erica Bowen she obviously did this, sort of, meta-analysis of all the studies, I think about ten US (United States)-based studies, to just try to understand how maybe does that type of every day or that type of practice could be translated within the UK (United Kingdom) setting. And she also did find out that there were no published British outcome studies at the time about created programmes, so, you know, I suppose that, sort of, sets apart project Mirabal at the time because it was beginning to ask questions around, you know, can we actually begin to capture new ways or new outcomes in terms of what counts as success. So that was a really interesting piece of work and I know there are reports in 2015 that looked at about twelve Respect accredited domestic violence perpetrator programmes.   

So I think for me I think it's probably still the most comprehensive research on perpetrator programmes in the UK to date, having said that obviously enter Drive and some of what Kyla's been saying and some of the work that they've been doing. You know, the evaluation that they did as well has really contributed to that evidence base and ongoing evidence base, we are seeing much more of a surge of interest in this particular area of work which is really encouraging. And I think that because we now see more research around community-based programmes we're beginning to have a greater understanding of different outcomes that may not necessarily be going to be linked to recidivism but might be linked to outcomes around education, the wellbeing of the victim/survivor. You know, looking at really bigger, greater outcomes that actually do matter in terms of not just tackling domestic abuse but also in terms of preventing domestic abuse as well in the future. So anyway I think that for me, in a nutshell, one of the last pieces of research that I'm going to mention is one that my colleagues did actually. So Professor Emma Bond in 2016 undertook a systematic review of about 53 perpetrator focused interventions and they found that actually that a lot of the evidence was still quite sparse for the UK, but most of them were obviously based on either the Duluth Model or CBT (Cognitive Behavioural Therapy) programmes as well. So it does raise a lot of questions around actually because of the underpinning of all of these programmes there is room for us to begin to look at contextual understanding or contextual evidence building rather than just focusing only on our cities if that makes sense?  

Dez: It absolutely does make sense and like you, I was very, very struck by the Mirabal project, it seemed to me it was possibly the first example of really offering a new way of assessing impact, moving beyond recidivism and centring a bit on survivor's voice. Jo, I know that you in respect were central to that I'm interested in your reflections, are you seeing change in the evidence base, do you root that in different approaches to assessing impact?    

Jo: Yes, there's been a huge change I think over the last twenty years so years, change to the just the amount of work that's happening and the amount of interest in perpetrators but then also to measuring success. And I think we were stuck in the early days of a really kind of what works in terms of police call-outs and convictions of perpetrators kind of framework, so a recidivism framework which wasn't terribly helpful, it's a very blunt instrument if you want to understand whether or not an intervention is having a positive impact. So an example of that is, if you just see a measure of success being that there are fewer police call-outs it could be that the survivor is too scared to phone the police or that her experience of phoning the police has been negative so she doesn't bother anymore. So it's not a good tool for really understanding if it's about perpetrator change or not. So you need a much more detailed piece of work, qualitative as well as quantitative, I think that's really important. I think the research that really matters is the research that listens to survivors in a really detailed way, asks really searching questions of the impact of the intervention or the response generally to him, on her, on the children, on her safety, but also on her freedom.   

And I think that's something that as Olumide was saying was really pulled out in Mirabal for the first time and Professor Liz Kelly and Professor Nicole Westmoreland really focused, the six indicators of success were particularly radical I think in talking about the expanded space for action for women. So it was a concept that I think Liz had been working on already but in the perpetrator context was really important. So what that means is if he is on a behaviour changer programme, which is what Mirabal were focused on, does that have an impact on her independence, her individual agency, her space for actions, her space to be a citizen in the world, to make decisions for herself, to be a fully functioning person. And that's really important because it goes so much further than, 'Is he still hitting her?' Into what women really want which is their own freedom and agency, so I think that set for what all research should focus on now is not just safety but freedom and I think that's where I'd like to see the research going. I think it's also really important that as well as listening to survivors that we listen to practitioners. Now I would say that because we're a membership organisation and we represent loads of organisations around the country that have been working for decades with perpetrators and they really know their stuff, they know what works, they also know how diverse the cohort of perpetrators are.  

I mean on behaviour change programmes the assessment process means that it should only be men that are ready, willing and able to change that are on those programmes, so it is a very specific element of the whole perpetrator cohort. But when working with those perpetrators there's still a huge amount of diversity within them, they're from all kinds of backgrounds, all kinds of personality types, some have experienced trauma, some are living in environments where violence is very normalised, some will have experienced it as children and some won't. And so they are working with that diversity and I really think that listening to the voice of those practitioners about how they do it in the room, what's it actually like in a room of perpetrators trying to change their behaviour. How does that actually work is something we're really keen to keep understanding and I just think it's kind of getting get to the nub of what the point of research is, the point of research is several fold but one of the key things is to influence practice. It's that feedback loop so that what happens in these programmes can be evaluated through research, the research will then find things that can then influence how practice develops and I think if we can utilise or kind of make use of research in that way it's really important.   

Dez: You're making some really important points there about practice informed research and we hear much more about research informed practice but I think you're really highlighting the need for reflexivity there. And also strikes me that what you're describing is a congruence between practice values and research methods and impact measures. If our practice values in this space are about disrupting the cohesion, the control, the voicelessness, the constrictions that victim survivors have faced we must surely go about evaluating impact in a way which gives them voice, centres their expertise and creates more freedom. And offers a narrative so really shifting away from that, sort of, passivity that can sometimes pervade the narrative, so I think quite an important call to action about congruence, the way we do our practice should mirror the way we do or research. Olumide, I'm sure you've got lots of reflections to offer on that?    

Olumide: Absolutely, I think those are really very interesting from Jo. I think obviously one of the things that peeked my interest was when she talked about diversity within the programming and also how we develop perpetrator programmes, I mean there is a lot we can say about that because we know that there is a lot of work to still be done in that area. Because when we talk about diversity what do we mean, you know, you can obviously talk about diversity because, you know, the background or trauma that someone might face, but at the same time if we're talking about it in relation to intersectionality then we know that we still have a lot of room to travel in terms of actually how we design programmes. And actually piece of work that myself, Mina and Catherine my colleague here at the university we did, you know, which was, sort of quite sculpted by Kyla and Drive actually was because of that we notice that, you know, the conversations around black and, you know, other racially minoritised communities were just not really happening You know, we're not really seeing that inclusivity that we wanted to see, we're not really seeing that conversation, you know.   

I mean even on ground in one or two of the community based programmes that I'm familiar with, you know, they're turning away people that might need an interpreter because it just made it very difficult to be delivering group sessions with men when you have non-native English speakers within the cohort. And that then raised question about, 'Well, where do those men then go from that point?' If that makes sense? So I think that one of the things around that small piece of research we did was actually we found that there was a need to have culturally sensitive interventions, to actually ensure there's adequate funding to specialist organisations, and actually the work first developed may need to be looked at as well. Obviously, this is things that practitioners did, you know, mention and I think 58% were responses from professionals and practitioners. So, you know, I agree with Jo that we need to listen to practitioners but I also think that we should also be mindful that even within the group of practitioners there is a place for really identifying the gaps and actually ensuring that we are meeting the needs of a diverse group of men as well.   

Dez: And that point about diversity which was comes through again and again and beyond this field of research as well of course I've heard it argued, I have some sympathy for this, but some of the traditional methods of undertaking research and evaluation, traditionally understood to be good quality research they can actually obscure diversity. So you can end up with what some researchers call a meanification that, you know, the numbers of people in this cohort who were from minoritised groups were relatively small so actually they got kind of smoothed out through the aggregation of data. So research methods that don't centre victim survivor voices indeed the voice of those who perpetrate harm and the practitioners who serve them can loose some of the richness that's required to have intersectionally responsive kind of approaches in our work. Jo, would you like to come in on that point?    

[The disaggregation of data and its benefits] 

Jo: Well, disaggregation is our friend isn't it, that's what we need, you know, if we've got data rather than meanifying it to use your word actually doing the opposite, actually drilling down into it. Making sure you're capturing enough in the data to start with and then drilling down because that's what you really want to understand is, you know, just having a one size fits all broad brush view of the whole cohort of perpetrators is not going to get you very far, you need to understand in the data what the differences are and then to try and draw conclusions that are helpful I think. So yes, disaggregation is always helpful. I take Olumide's point about where programmes are at in the UK, I think there's a lot of really interesting work happening in the global south looking at different ways of engaging perpetrators that we need to learn from here in the west. I think that often gets overlooked, so when we look at international research often what comes to the surface is the USA, Australia, Canada, Europe and often what's obscured because sometimes the intervention on the ground don't look like what we're doing here.   

So that it's not necessarily structured behaviour change work, it's not necessarily criminal justice interventions, it's much more community based grass roots approaches to engagement and kind of to shift thinking from the ground up. I think those approaches are really interesting and we need to look much further afield, I know there's interesting work that's happened in Nicaragua, I think they've got some really interesting stats after twenty years of this kind of very grass roots intervention work that are really interesting around perpetration. And that's just taken a more social change view of the issue rather than an individual change view, so that's something at Respect that we're really looking at now is I don't think it's either/or. We want to focus on individual change, systems change, so that's the kind of children's social care, policing, probation, health that, you know, that we've been touching on already, but also what do we need to do to bring about social change. Whether that's across the UK, whether that's in specific communities, whether we're looking particularly at certain ethnic groups, in certain groups within a city or a town, you know, geographical or whether we're looking at religious based ways of engaging and changing. Changing thinking, changing culture and society, I don't think any of that is simple but I think, you know, there's work going on India, in South Africa and I'm sure there's loads that I don't know about that I'd like to find out more about. So I think if we can have that much more kind of let's all just kind of stop looking down into our own little frame works and look up a bit and see what other people are doing that doesn't look like what we're doing but can be, yes we can learn from.   

Dez: What a great call to act on, of course, we can't drill down and disaggregate whilst honouring qualitative methods, engaging people's voices, so I think that does have quite important implications for what we consider to be good research in this territory. And I can see certainly that trying to understand the impact of community-based interventions that necessitates quite a different evaluative approach, so all sorts of challenges and complexities there. Kyla, come on in.    

Kyla: Yes, I just wanted to reflect on what Jo was saying, I think, you know, I couldn't agree more and it just really struck me your point about we need to stop looking down and in and look up and I feel that, you know, actually there's so many factors that play into the ability to do that. And I think the looking down and looking in for many years it needs to be contextualised, so responding to perpetrators of abuse for too long has been, you know, a tiny little corner of work, a tiny little corner of policy and commissioning. So very fragmented funding flowing through to service providers for short periods of time and often a battle for resources, I find that context so important in any discussion about what's the evidence base, how deep is it, how rich is it because it's framed by this context.   

And the reason that it's just so interesting at the minute is we are at a moment where that context is changing and we are able to zoom out and to look at a lot of the discussion from Olumide and Jo has been about the, you know, winding the scope of what measures are important to look at, not just criminal justice but victim-survivor space for action. What are the different cohorts, profiles of perpetrators that need to be considered, we talked about victim-survivor impact and voice equally we can be looking at children's impact and voice. And I think that with the change in public narrative particularly we're at a moment where that we can zoom out and it's zooming out in terms of practice, policy, commissioning and the framing for research. So I think there is a real opportunity to be looking at all of these different layers because they are deep and wide and the sector just has not had the opportunity to have that stretch for many years and hopefully that change is coming.   

[Why we need to think differently about who sets the research agenda, power and impact] 

Dez: It certainly feels like a bit of a moment in time both in terms of how people respect, no pun intended, work with those who cause harm, the national policy attention and message for change for example. Also perhaps an evolution in how we think about evidence, I'm hearing much more kind of discussion around what might work best for whom under which circumstances which are, you know, necessarily less shorthand than what works and I think speaks to a point about diversity within diversity and diverse methods and being more expansive. Is it the case, and Olumide you might have a particular view on this. Is it the case that some of what needs to change is the way people think about impact? As you three colleagues were talking I kept reflecting on notions of power which of course is central to working with people experiencing domestic abuse, but I think is also central to how we think about impact. If a small group of relatively powerful people set the agenda for what effective looks like what does that then do to the sector's ability to innovate or think expansively or make mistakes? I don't have an answer for that myself, but that's the question that's come up to me as you've been talking.    

Olumide: Yes, that's, you know, a fantastic question really. I think one of the things I'm just going to say before I answer the question around power because they're sort of linked is actually that one of the things that I find very encouraging and for me is something that I've been, you know, like, obviously I'm focused on and I know Kyla's talked about really quite at length is around systems change and I know Jo mentioned the need for that as well. Interestingly looking at things to a system change length actually helps us to look up, you know, rather than looking down and particularly for work when we being to look at work globally, looking at work internationally. Because really systems change, you know, kind of when you apply systems thinking to something you're looking at the interconnectedness of things, you're looking at the interconnections of actors, of resources, of communities. You know, all of that stuff really lends itself nicely to sometimes the… maybe their own structures and I put that in quote and quote way that we say that working with perpetrators might manifest to actually is being done in other settings. Which does not necessarily mean that it's not good knowledge, you know, I think it's just really the way we look, you know, if we're kind of open-minded about, you know, the different types of knowledge as valid not just the one whereas I say, RCT (Randomised Control Trials) or is it coming from Europe, is it coming from US, is it coming from Sweden.  

I think if we're much more open-minded we might just be able to draw really good insights around really what works and really expanding the evidence base really quickly because then what that means is that we can draw on lessons from different settings and vice versa as well. And the last I'm going to say about power is that, I mean we could literally unpack this for the whole day because I feel like there's a lot to be said around who's at the table in conversations in relation to policy, but also in relation to even funding and conversations around commissioning. I think that these are things we cannot overlook particularly we're saying not only create systems change but we want to kind of answer that question what works for whom and under what conditions. We are kind of moving towards this more very realist grounding way of developing evidence from bottom-up rather than from top-down, I think that's really exciting. I also think that we're seeing more awareness of the need for core production in how knowledge is being generated and how training, workforce developing and all of that stuff needs to be happening. And I mean it's really interesting because I feel like we're seeing that in the perpetrator sector, I don't know if I should call it a perpetrator sector, but, you know, in the area of work in relation to perpetrators that actually could be in a way mirrored in other settings within the domestic abuse space actually. And I think it's probably testament to organisations like Drive, like Respect to really understand it and to really begin to I guess dismantle maybe or disrobe that way of doing as always being the norm, to kind of trying to open up new spaces of knowledge and new spaces of understanding. So, you know, for me I think that, you know, that's really refreshing to see.   

Jo: That's really interesting Olumide, I think what I was saying early about one of the audiences for research being practitioners in that practice loop, I think another audience for research is commissioners and policy makers. And it present a real challenge to us I think as practitioners at heart I guess we're kind of, you know, we're much more interested in what works on the ground in the room, but actually to move the work forward we need to make sure that what's being commissioned and how policy makers set the framework is right and we need research for that. And sometimes, you know, what commissioners really want is a cost benefit analysis which seems really dry to those of us that like to be in the room, but actually it's quite important so that there is confidence amongst commissioners, but I think I'll go back to the point of so that they're actually commissioning the right things. And I think the worry as funding streams are created and we've seen, you know, I think you mentioned it Dez, but the reality is we've had no central government funding ever for this work until last year when £10,000,000 came out of the Home Office and then this year £25,000,000 came from the Home Office. And if there's anything, you know, if that's sustained that's a lot of money that needs to be spent well and there's a real risk that it could be spent badly and there's a real risk that if there isn't an evidence base that is fuelling the way that money is spent, the people making the decisions about that money won't necessarily know how to make the right decisions.   

So that's another really important facet of research which is not the sexiest element of research by a long way but is really key, it helps to underpin, I mean the Respect Standard is now going into its fourth edition, we've got accreditation and perpetrators services, we need that evidence base. But we need commissioners and policymakers to understand why it's important why safety in the work is important, what effectiveness looks like, how it's different for different interventions. So a Drive intervention that's got case management of high-risk perpetrators who have already caused high levels of harm are likely to cause further high levels of harm, they're resident to change, they're bouncing around in and out of the criminal justice system but without any real grip on stopping them until an intervention like Drive comes along. So research that underpins what works for them is going to look very different to the Mirabal type research around behaviour change with men who recognise they've got a problem, want to change, are kind of invested in that journey. So it's really important that we are able to kind of tolerate or create the environment for loads of different types of research, the kind of big multi-sites are really needed, it would be great to have some more RCT's, doing an ethical RCT in this area is a real challenge but it's possible, but expensive, in brackets, always that. But also just drilling down into really niche kind of things to investigate as well, it can be really fruitful, so I'd like to see that diversification of just the scope and the grandeur versus smallness of the research landscape I suppose.   

[The role of different parts of the system in creating a better evidence base] 

Dez: Thank you and I guess another lens on the systems change needed is exactly this kind of system dynamic where practice and the voices of victims, survivors and they are not mutually exclusive sources of knowledge of course, where they inform research which in turn informs commissioning and policy which in turn then can fund a more generative system. So really seeing evidence as part of the system change or trying to influence. Kyla, would you like to come in now?    

Kyla: Yes, it's just picking up on several threads of the discussion really and looking at diversification and also value and different kinds of impacts and the policy landscape, but looking at… so if we're looking at that diversifying, looking at placing equal value on different types of impact it just brings to my mind the importance of also triangulation and how these different measures interface with each other. So domestic abuse is about how whole families and often extended families and communities and these issues interface and overlap and we know that the importance of getting the victim-survivor view, the children's view, the criminal justice impact in terms of recidivism. They're all important and research needs to take that into account and have that triangulation of impact and findings and it's complicated. And one of the things that's really particularly complicated I think anyway but particularly when we're working with high home, high-risk cases of domestic abuse is the trauma that is involved for victim-survivors and children and that's not an easy to go in and start doing research and collection evidence. So it's something about the importance of triangulation, but also acknowledging some of the challenges of this work and they are significant, it's very difficult to do ethical research in that context of trauma and collecting data in relation to victim-survivors and children.   

It needs time, resources and a lot of thinking through and then I'd also link that to the triangulation of policy thinking which also is linked to the source of funding for research. So Jo touched on the funding that's flowing through the Home Office which, you know, is very welcome, but we need more departments involved, invested in the research and the shaping of the research and the outcomes of the research and it's hugely important for many reasons to being it's a whole family issue. So we need to be looking at the issue from many angles and in particular we're looking at the impact of interventions on children, you know, one source of evidence for impact is the children's voice but also impact on school attendance, wellbeing and we know from, you know, case studies and anecdotally that we do see this impact. Gathering that data is incredibly difficult, having access to that information and data is incredibly difficult, so we might have the Home Office involved and providing and a framework and a context for research, but if we don't have the department for education in the game and backing that up it's incredibly difficult to set up these research projects and have the level of information sharing that we need. So that's kind of like travelling right down into some of the really logistical challenges of this research and I suppose coming back up to what's the interface between these different sources of evidence and impact measures and how do we join them together.   

Dez: I know I'd observed that some of these dilemmas and challenges that you colleagues are articulating so well are absolutely replicated in the children's social care space as luck would have it given the interface you're interested in. And I think children's social care as a sector are similarly facing the issue of, you know, what works and what matters and how they overlap, but they're not entirely coterminous and how you gather rich evidence from multiple sources in a way that actually accords with your professional values and speaks to the needs of commissions and policymakers. So I think there's a shared struggle actually at both parts of this system.    

Jo: One of the things that we haven't mentioned is listening to perpetrators and it's a challenge I think but an interesting one and I think it's one of the things that the research on Mirabal concluded that actually we really need to hear from those who have used harmful behaviours, been controlling in their relationships. And hear what is going on, what is it that fuels that behaviour, what has helped them to change and at the moment we're not very good at doing that, we've been resistant to doing that I think. And I think part of that resistance is not wanting to give their voices equal weight with the voices of survivors and of course, that's right. We're listening to survivors as the voice of experience who can talk about the impact, but actually, those who cause harm often have insights into what they're doing and why that we need to listen to. So I think, you know, I've mentioned listening to practitioners, listening to survivors. I would add in listening to perpetrators. That doesn't mean we listen to them uncritically and we will be expecting depending on where they are at in a process of change, but we will be expecting levels of minimisation and justification and blaming and those things. But I know the Mirabal research has found over time that when there was success in the behaviour change work that those things diminished and that men at the end of the programme were able to reflect much more on themselves, the impact of their behaviours, where they were at, what was going to keep them safe going forward. And so I do think that's something for research to think about, is how do you incorporate the voice of perpetrators in a meaningful, respectful way and in a way that's respectful to survivors as well.   

Dez: I think that's a really important observation and in fact, as you've been talking I've been quite struck by the ways in which you've referenced the trauma experienced by many people in perpetrator harm or their own needs in their own rights. I suppose it struck me because that's not always in a conversation and Olumide you might have a particular view on this, but it seems to me that many people enter practice, whether that's children's social care or working in domestic abuse services, often because of their own personal views, experiences and desire for change often rooted in their lived experience. The same I think may be true for research roles in its territory, but that sense of personal drive may for some colleagues make them not very inclined to foreground the voice of those who cause harm, I think that would be an entirely human response. But what perhaps is more relevant is that the social narrative, the public narrative for quite a long time has been there are goodies and baddies, there are goodies and baddies in this scenario and listening to the baddies is a betrayal of victim/survivors. So moving beyond that into a more sophisticated space I think is very difficult not only for structural reasons but also for some quite personal reasons for some people and I think naming that could be key. Olumide, any observations on Jo's call to action there around really hearing the voices and views of those who cause harm and doing so in a way that's respectful to victim-survivors?   

Olumide: Yes, no absolutely that's a very key point that Jo has made actually because if we're also going to capture impact I mean surely we should be capturing, you know, the impacts on the service users who obviously in this case are perpetrators, so we can't actually move away from that. But I think one of things I did want to say though and I was obviously thinking with my hat on as an academic is that it's very important that we work with… so we've been talking about research a lot, someone might ask them, you know, 'What do you mean by this research, who's driving the research?' I think it's very important to involve academics and the reason why I say this is because of the ethical aspects of it which are obviously some of the issues that have been raised anyway and I think that you at least in some ways have some sense of comfort that the ethical questions have been, sort of, at least explored around how do you engage with vulnerable groups, how do you engage with survivors, how do you even as a practitioner who might have experienced domestic abuse yourself. You know, if you're going to then involve somebody like that within your participant group, how are you making sure that you're keeping them safe, how are you taking sure that, you know, they can actually engage in the best possible way that doesn't re-traumatise or, sort of, trigger them. So I think those are really important things why it's important that if we're doing research that we take a very collaborative approach where you bring academics, you bring practitioners and you bring survivors to the table, I mean that's how we do our research anyway at the university.   

You know, and I think that a number of universities also follow that approach, but I think that is what's… looking into when it's going back to this commissioning loop around research that those questions are being asked about who is doing the research. Because for me, my worry with this, sort of, sudden interest is like I said it’s a positive thing to see this plethora of research happening, but at the same time we need to be raising questions as well about have we really put an ethical framework in place to really make sure that this research is not going to be causing more harm. You know, which is the whole idea we don't want it to cause any harm actually, not even more harm, but, you know, it shouldn't really be harmful to participants at all. So I think that's what I would say about perhaps one of the observations I had in my mind and the other thing as well around listening to perpetrators, I think also there's something to be said about programmes that already by design incorporate support services for survivors already. I think that for me personally, just from my own experience of evaluating the community based programmes, I think that it's really interesting when you have that type of design because what happens is that you kind of speak to the perpetrators but at the same time you can also speak to the survivors as well. So by nature of that you're already kind of speaking to both groups and so you're not, sort of, privileging one voice above the other and I think actually a lot of times I find that survivors themselves want to actually feed into the research and they want to talk about their experiences. So sometimes I think people think, 'Oh, you know, you're delivering the same service in the same space.' And you know a lot of those questions they tend to happen.   

But actually no, you know, I think this the reason why accreditation is very important and actually ensuring that a lot of programmes meet the quality standards that are required and Jo's not paid me to say this, but, you know, this is where sometimes the Respect's standards do come in. You know, where at least you do have some sense that there is a framework for these programmes and looking at their quality, their quality of service, but also the safety, you know, of survivors even as they're delivering the service as well. When you do that you know that you are likely to get not just only better data, but you're also ensuring that you're already working within, sort of, ethical framework that ensures that you are already understanding the place for the service user's voice and the place for the survivor's voice as well, if that makes sense?   

Dez: It makes a lot of sense and it should not need saying, but it does still need saying that whether in practice or research we start by aiming to do no harm, I think a really salutary message there. Kyla, then Jo and then I'm going to move on to the final question colleagues.   

Kyla: Thanks Dez. I think I'm really just backing up what has been said around perpetrator's voice and I just wanted to say I think that there is an opportunity for collaboration between our practice and researchers on really looking at the right methodology. So tapping into a lot of what Olumide has been saying about the place for perpetrator voice and victim-survivor voice, I know that within Drive we've been thinking a lot about what is the right approach and I think there's more work to be done with research colleagues around methodologies. And as practitioners and service providers we could really do with that kind of collaboration to help us think and learn and build up that evidence base, that literature base to guide methodologies and build up thinking around methodologies for gaining perpetrator's voice.   

And I think also just to add, you know, some insights from The University of Bristol's research onto the Drive project, so working with high harm, high-risk perpetrators and conducting those interviews. So there were some really valuable insights, more works need to be done on this but we certainly were really struck by insights into the role of mental health particularly, rates of suicide and suicide ideation that came to the floor through some of that research. And of course mental health, mental ill-health is not an excuse for domestic abuse, it plays into the context and there are important things for us to learn in that interface, that was something that came out strongly from perpetrator's voice the role and the impact that interventions had on that and similarly the role that children have to play in the process of change. So some particular perpetrator response feedback on how reflecting on their own experiences of abuse as a child, then as a springboard to explore how their behaviour is impacting on their children really was coming through as a trigger for engagement. What we need more research in is did that translated significantly into a trigger for long term change, so we're getting these insights and we need more long term research to really see how that can be followed through effectively, that's coming from the perpetrator's voice.   

Dez: And what's so important there Kyla, in what you're sharing and you're modelling it very well I think, this both/and mindset. We can both be absolutely clear who responsibility sits with for causing harm and acknowledge those people causing harm might have a multitude of needs, adversities, difficult life experiences. None of which is to excuse but it can help us understand and I think that might, you know, that's easy to say I think it's a very, very difficult path to navigate sometimes when you're in practice and research can unlock some of that for us done well and done with nuance. Jo?    

Jo: I just wanted to flag to anyone that isn't really aware of the Respect standard that do know harm is our first principle, so it's right at the top. One of the things that I'm interested about and Olumide was talking about it was the ethical framework for research, obviously, our standard is about an ethical framework for practice and for response to perpetrators. But for research the four Women's Aid federations in November last year published their research integratory framework on domestic violence and abuse and I think that's something for us to look at and to work with them on and to think about how might we create something similar around research and perpetrators of domestic abuse, so that's something I'd like to see happen. I think right at the end of our conversation I just want to flag that we framed it very much around men's violence against women and that's obviously there's loads of reasons for that, it is the majority we started off talking about children's social care and mothers and so that's the context.   

But also I think we're really interested in the context in which women use violence as well and I mean in its broadest form, so women who are the primary coercively controlling perpetrator in a relationship and what that looks like and is that different and how is it similar and there's very little research in that sphere and also that impacts of course on male victims who are very invisible in that space. But also we haven't mentioned at all same-sex relationships and I think again it's an area-, so there's lots of I suppose I mean I always call it parts of the cohort because I do think of, you know, anyone that's causing harm in their families and in their relationship are part of a cohort. You know, even if it's a small kind of segment that we can desegregate into it's really important to understand. I think with same-sex domestic abuse obviously Catherine Donovan has done some really interesting research but it feels it's very much in its infancy and something we need to explore further and then I think just in terms of where the kind of under research elements of the cohort. I think there's lots more to understand about how adults as well as young people who are on the autism spectrum or have learning disabilities or brain injuries, how their use of violence and abuse differs or is similar to, you know, our understanding of perpetrators of violence against women. So, you know, there are some challenges really in the research field for understanding those who don't fit within the main framing f how we view the issue and how we move forward and create the right research to get to the right answers.   

[The responsibilities of colleagues in services and the actions that they can take] 

Dez: Thank you Jo, that certainly came through in the research and the literature, you know, so far as we could say the evidence suggests or the evidence supports, there was always that caveat but we don't actually know if this remains true for, you know, people in same-sex relationships using violence or people from other minoritised groups and I think it's an enduring challenge. I'd like if I may to finish this by playing back what I think the three of you have made such a strong case for, that given, you know, there are numerous challenges associated with continuously improving the evidence base in this territory, the ethical issues, the information… it's the most practical methodological issues. The complex local systems in which effective practice is happening and then alongside that the considerable unarguable capacity and resource constraints facing most if not all of the act is in those local systems and the implication that then has for those who are particularly… I'm thinking smaller community-based organisations. What role can they play in generating the evidence when they are, you know, faced with such considerable resource challenges? You highlighted the tensions that can appear where you have, you know, narrow constructs of what constitutes evidence, narrow constructs of impact.    

You've highlighted the policy fragmentation that can exist, multiple responsibilities across different parts of central government for example and then how that can then play out in terms of fragmented research agendas and indeed fragmented local responses. You've highlighted the need for much more diverse perspectives hearing from many, many different voices around what helps, what matters and indeed where we're lucky what works, they are different but connected things. The need to have much more practice-informed evidence, lived experience informing practice and evidence and there's our policy that is informed by the evidence. The need to really avoid narrow, blunt reductive approaches to impact measurement because if we follow that path any further we're not really going to create the kind of diverse and nuanced based evidence base that all three of you have argued for so well. That nuance and multi-dimension approach to build in the evidence base it seems to me requires and you've said this many times, a much more collaborative approach, if we're to get away from the binary thinking we have to engage in critical thinking and that relies on I think a collaborative endeavour.   

So my question to you for $64,000,000 is if creating better evidence is everybody's responsibility, everybody's business to use a cliché term what role do you think different parts of the system need to play? I'm thinking Jo, you might particularly have a view around how practitioners and service providers could play a role here. Kyla, you might have a view on how local systems can play a role and of course, Olumide come in and tell us what you think the research community needs to be doing. How do we achieve this more nuanced, sophisticated reflective and reflexive evidence base, who needs to do what?   

Olumide: Okay, I will go first. So I think one of the things I wanted to say actually, just I know you've done a really wonderful summary, is I know when Jo was listing some of the gaps in our knowledge I think I would also add our understanding around older people as well. I think that's something that we also need to be focusing on in terms of you know interventions and understanding what the complexities are around that area, I think that's one thing that's not been looked at. So I mean it obviously goes down to the diversifying of the knowledge base and obviously, when we begin to talk about intersectionality it would touch on things around same-sex, it would talk about things like religion, faith and all that stuff and so that's very important. So I think leading nicely into what I want to see, I actually think that there's a role for the research community to like you said be more collaborative with the practice side of things. So I think there's already some really good practice already happening, good partnership work already happening with what some Drive is doing, with what some of Respect. I think there's a lot of collaborations with universities already happening anyway, but I think that one of the things that I probably want us to do is even expand our understanding of who researchers are. So as much as we know we have academic researchers like myself we should also embrace community researchers so those who might actually have a, sort of, hybrid or you might call them, 'Pracademic' where they kind of straddle.   

I don't know if that's… if just made up words now, is that a real word? Right, so, like, you know, those that are coming from some of that practice and academic background. And I think that it's very important to value that knowledge as well, you know, and especially for those might even be survivors themselves and then gone into academia as well and, you know, like, I think understanding that, you know, the journey and the stories and the experiences that people bring to the table where they're lived experiences are so valuable and so vital to this conversation. And also I think going back to what Jo was saying about also being open to even bringing perpetrators or those that have been onto the programme to the table especially after they've actually been on a programme. You know, there was a conference, I think it probably got shelved because of the pandemic, but I remember that they were going to invite one of the men that had been on the programme, I'm not going to mention the name of the conference. I think there was a lot of controversy because of like, 'Oh is this person going to come and speak to, you know, a group of conference attendees about their behaviour?' And all of that stuff. But I think we need to get to that place of being open to listen to the men that have been on the perpetrator programmes themselves to understand more not only about their motivation for change, but also understanding how they want to again create their journey post the programme. So, you know, I mean from some of the men I've spoken to we're seeing conversations where they tell me, 'Oh I want to give back now, I want to really go into the community and talk to more men to understand the impact of domestic abuse and to actually understand how you can change your behaviour and things like that.'   

So I think that we need to begin to change our perspective about how we see perpetrators in this binary lens of, you know, as if they cannot ever be rehabilitated. I think we need to try and change that, you know, I think that for those that are well motivated to want to change whether for the reasons relating to their, you know, they want to be better dads or they want to be, you know, they just really want to be better. And, you know, in terms of their relationships we need to give them the opportunity to change as well, so I think it's being open about that as well. So I think the research community does have a role to play in terms of helping to develop the evidence base further. I mean I'm personally invested in that to kind of ensure that we can actually begin to look at the area of work as not something that… as you're going back to what you said at the beginning, Dez, that people say that, 'Oh there's no evidence.' But actually we know that there is growing evidence, so we need to just portray that evidence more, we need to share that evidence more, we need to be talking about and we need to be ensuring that we're bringing the right people to the table, so academics, practitioners, survivors from different backgrounds and I think valuing different voices is very important.   

Dez: Thank you, a strong call there for greater interdisciplinarity, but also greater inclusivity and I could see that requires not just change from the research community but some pretty significant change to the social discourse on this stuff, none of it's easy as you were saying Jo. So what actions or responsibilities would you like to see being taken by colleagues in practice, colleagues delivering services? I mean I'm old enough to say without embarrassment, I used to think when I worked in a real job that evaluation was a thing that they did to me, constantly trying to prove that we were good enough to someone over there who was miles and miles away from what really mattered. It was certainly one of the prejudices I held when I delivered services, have things changed, what role could colleagues doing the work play in a better evidence base?    

Kyla: Yes, I have some thoughts on that certainly there are things that we can do. So one is I think we can be more open to more nuanced discussions around the evidence base, based on the conversation that we've had today we know that there is evidence there and there are different types of evidence there. But I think we can also be open and hold our hands up to the fact that it's a beginning of a picture and there's a lot more to do and I think at times the conversation could be more nuanced in recognising where current approaches to research and research that's very connected to practice and delivery can open up into a broader space. And I suppose to put it bluntly maybe not in a particularly helpful way, but to get past conversations that are about, 'There's no evidence.' 'Yes, there is.' 'There's no evidence.' ‘Yes, there is.’ There's a huge bridge between those two view points and I think as a sector we can do it better, we can have those conversations and I certainly take that on myself to really encourage that kind of conversation, we don't need to be defensive about this. The other area that I would really like to play my part in improving within the sector is how we collaborate and manage our data. There's an absolute wealth of information and data across services, perpetrator services and I think we can do a lot more within the sector harness that and to really lift it up as a collective set of data that gives inroads into, you know, different kinds of analysis and research and evaluation. But there's some practical and logistical things that we need to put in place across, you know, a high number of services to really start to make better use of the data that we have, so I think they would be the two things that I would say from a provider and a service provider perspective that we could do better. I do think there are things that commissioners can do better too but I'll leave that to Jo, I'm sure she's got thoughts on that.   

Jo: So I was very struck with Olumide's 'pracademic.' And, you know, I think that's great to invent a word and also a concept, I'm going to do my own pun here, we need to drive I think a proactive strategic approach to research and that needs to be a collaborative approach. So what I mean is that those from academia, from practice, from policy, from commissioning need to work together to set a strategic framework for what research is needed, so we get away from this ad-hoc piece meal approach and really think about what would help to build an evidence base that's of value. And that's not just big pieces of research, it's value in all different types. I think Kyla's right we need better data to really understand, we need more qualitative to really get into the data and the nuance of not just what works but how it works and I think that's a really important distinction. You know, I hope we're based the ‘does it work’ and people are beginning to ask, 'How does it work and for whom and in what ways?' So I'd like to see that kind of nuance. So there is something, you know, kind of aspirational about us all working together and, you know, trying to kind of create that atmosphere where we can develop that evidence base.   

Kyla: If I could just jump in I suppose one of the things that I didn't say when I was, you know, holding hands up to what we can do ourselves, I'd like to see commissioners see themselves as part of the solution. So yes, I can see that for them there are probably gaps in the coherence of the information that they have to inform their use of public money, but it's about shifting that thinking to understand the context that we've been talking about today. You know, why are we in the position that we're in and to be part of addressing that by commissioning good evaluation research and services, seeing themselves as part of filling in those gaps that they have rather than passively expecting an under-resourced sector to miraculously be able to provide them all of a sudden. And I think that's particularly when it comes to really wanting to build up an evidence base over a long period of time and looking at, you know, what's happening now but what does that look like in two, three, five years’ time.   

Olumide: This is very important because I think what you've just said about commissioning and just looking at some of the experiences of how some of this work has been commissioned at the community level. I think that commissioners do have a role to play around the transparency of how money is being spent for perpetrator programmes. I mean, one of the questions around social value, I know Jo mentioned cost benefit analysis and all that stuff. I really think that questions around even the social value of those programmes need to be answered and let that evidence inform the direction. You know, I think that actually also nicely ties in to what Jo was saying about the strategic approach, like, you know, it needs to be very place-based in some ways, but also we need to be aware that there's also work that would be happening at the national level and bringing those together. And I think it still goes back to this thing around local system change, national systems change and joining those dots.   

Dez: Thank you colleagues you've made a really I think powerful and compelling case for a much more coherent, collective and collaborative approach where no party gets to see themselves as passive in the face of the evidence base and everybody has their role to play in generating a more useful, more nuance, more sophisticated evidence base. And you've clearly demonstrated the role that all of us in our different guises can play to contributing to that future. Thanks again colleagues.    

Professional Standards

PQS:KSS - Abuse and neglect of children | Relationships and effective direct work | Shaping and influencing the practice system | Designing a system to support effective practice

PCF - Critical reflection and analysis

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Introduction, correlations and typologies, complex interdependencies, group 1 exemplar. victim was never substance dependent, group 2 exemplar. victim was desisting from substance use, group 3 exemplar. victim was substance dependent, discussion and conclusion.

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The Dynamics of Domestic Abuse and Drug and Alcohol Dependency

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David Gadd, Juliet Henderson, Polly Radcliffe, Danielle Stephens-Lewis, Amy Johnson, Gail Gilchrist, The Dynamics of Domestic Abuse and Drug and Alcohol Dependency, The British Journal of Criminology , Volume 59, Issue 5, September 2019, Pages 1035–1053, https://doi.org/10.1093/bjc/azz011

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This article elucidates the dynamics that occur in relationships where there have been both substance use and domestic abuse. It draws interpretively on in-depth qualitative interviews with male perpetrators and their current and former partners. These interviews were undertaken for the National Institute for Health Research-funded ADVANCE programme. The article’s analysis highlights the diverse ways in which domestic abuse by substance-using male partners is compounded for women who have never been substance dependent, women who have formerly been substance dependent and women who are currently substance dependent. The criminological implications of the competing models of change deployed in drug treatment and domestic violence intervention are discussed alongside the policy and practice challenges entailed in reconciling them within intervention contexts where specialist service provision has been scaled back and victims navigate pressures to stay with perpetrators while they undergo treatment alongside the threat of sanction should they seek protection from the police and courts.

The 2019 Domestic Abuse Bill proposes to establish a statutory definition of domestic abuse that includes ‘controlling, coercive, threatening behaviour, violence or abuse’ encompassing ‘psychological, physical, sexual, economic and emotional forms of abuse’ ( HM Government, 2019 : 5). It proposes to widen the scope of Domestic Abuse Protection Orders so that suspected perpetrators of domestic abuse can be compelled to attend ‘drug or alcohol treatment’, as well as ‘behavioural change’ programmes by the family courts (if petitioned by victims or other relevant third parties, such as non-governmental organizations) and magistrates courts (where the police would normally petition) (ibid. Explanatory Note Clause 3: 128). It is proposed that compliance with such orders will be secured in part through electronic monitoring. Breaches of such orders will be a criminal offence, punishable by up to ‘five years’ imprisonment, unlimited fine or both’ (ibid. 30).

The Bill is informed by a prolonged consultation in which over 3,200 responses were received by government and expert opinion—primarily from organizations representing victims and survivors of domestic abuse and stalking—was submitted to two Home Affairs Committees ( House of Commons, 2018 ). Cross-party support for the Bill was secured: as politicians registered the volume of domestic abuse cases raised with them by constituents; amidst news that the daughter of an MP had committed suicide following a relationship in which she suffered psychological—but not physical—torment that caused her to fear that she was mentally ill ( Elgot, 2018 ); and during a campaign by David Challen to enable his mother to appeal her conviction for murdering his coercively controlling father ( Moore, 2018 ). In strengthening the prohibition of ‘coercive control’ ( Home Office, 2015 : 2)—a concept advanced by Stark (2007 : i) to explain ‘how men entrap women in personal life’ through ‘intimate terrorism’—the Bill can be read as a logical extension of three decades of Conservative party policy that conceives the criminalization of a dangerous minority of men who abuse ‘very vulnerable women and girls’ to be a key part of the solution to domestic abuse ( Heidensohn, 1995 ; Gadd, 2012 ). But this Bill was conceived within a more nuanced policy agenda than its predecessors. In the initial consultation document Transforming the Response to Domestic Abuse, which sought views on a raft of new measures, the then-Home Secretary, Amber Rudd, and Justice Secretary, David Gauke, called for policy that (1) recognizes that both ‘women and men are victims of domestic abuse’, though ‘a disproportionate number of victims are women, especially in the most severe cases’ ( HM Government, 2018 : 3); (2) ‘actively empowers victims, communities and professionals to confront and challenge’ domestic abuse; and (3) reduces regional variation in the quality of ‘services to help victims’ and ‘punish and rehabilitate offenders’ (ibid, our emphases). This receptivity to the rehabilitative ambitions of health and social care professionals derived principally from the findings of domestic homicide and serious case reviews (ibid, p21), which reveal the pertinence of a ‘toxic trio’ of domestic abuse, mental health issues and drug and alcohol problems in cases where women or children are killed ( Brandon et al., 2010 ; Robinson et al., 2018 ), and how substance use features in around half of intimate partners homicides in the United Kingdom ( Home Office, 2016 ). Transforming the Response to Domestic Abuse followed suit, highlighting the ‘complex needs’ of those living with ‘drug and alcohol misuse, offending, mental illness and poverty’ ( HM Government, 2018 : 10); domestic abuse ‘victims’ with ‘problematic drug use’ (p24); ‘survivors… who have children on child protection plans’ (p28); ‘women at risk of having their children removed’ (p28); ‘female offenders’ who have also ‘experienced domestic abuse’ (p31); and male ‘perpetrators’, who are too often depicted in terms of the ‘stereotype’ of a ‘drunk… who… loses control and assaults their partner’ (p11). Such ‘simplistic’ depictions were debunked for failing to ‘reflect… the complex reality and lived experience of victims’ and impervious to the ‘dynamics of power and control which are present in many abusive relationships’ (ibid. pp11 and 12). They had previously been challenged by official drugs policy that committed to supporting the disproportionate number of ‘intimate partner violence’ victims and perpetrators accessing substance misuse services ( HM Government, 2017 ).

This article responds to this call to redress the dynamics of power that occur in relationships where substance use and domestic abuse co-occur. We contribute to such an understanding through the presentation of three couple dyads—each comprising a male perpetrator and his female partner—interviewed in-depth for the UK National Institute for Health Research funded Advancing theory and treatment approaches for males in substance use treatment who perpetrate intimate partner violence (ADVANCE) programme 1 . Our conclusion returns to the challenges the 2019 Domestic Abuse Bill poses to policy, practice and criminological theorizing.

Evidence for the relationship between domestic abuse and drug and alcohol intoxication is plentiful in crime surveys but tends to focus, peculiarly, on the behaviour of victims more often than offenders. For example, the 2016 Crime Survey for England and Wales revealed that ‘adults aged between 16 and 59 who had taken illicit drugs in the last year’ were three times more likely to report ‘being a victim of partner abuse’ than those who had not done so ( ONS, 2016 : 25). However, using illicit drugs does not invite assault and the identification of such ‘risk factors’ in the absence of explanation of their relevance accentuates the victim-blaming some perpetrators deploy to control their victims ( Gadd et al., 2014 ). The international evidence reveals that men, but not women, tend to perpetrate more severe assaults when they have been drinking ( Graham et al., 2011 ; Reno et al., 2010 ). Women are more vulnerable to assault when they too are intoxicated, but this is at least partly because those living with abusers are less diligent at pursuing safety strategies when they have been drinking ( Iverson et al., 2013 ). Substance use features in around half of all UK domestic homicides. Since 2011, substance use has been detected among domestic homicide perpetrators more than four times as often as it has among those killed by them ( Home Office, 2016 )

In sum, the relationship between substance use and domestic abuse is not straightforward. Moreover, Different substances have different pharmacological properties. They are used in variable quantities and combinations fostering a range of effects—including docility as much as aggression—that are contingent upon the user’s experience of them, prehistory of use, mood and the context in which the consumption takes place ( Zinberg, 1984 ; Gilchrist et al., 2019 ). Laboratory research reveals that those with low levels of inhibition, empathy and self-regulation and elevated levels of sensitivity to threats and insults (‘instigative cues’) are more prone to violence when they have consumed alcohol up to four hours ahead of a perceived threat or ‘provocation’ ( Leonard and Quiqley, 2017 ). Cocaine consumption can induce similar reactions. Like cannabinoids and opiates—the effects of which are rarely studied in the context of aggression or violence—cocaine can also alleviate anxiety and exacerbate underlying problems with depression, paranoia and hallucinations ( Sacks et al., 2009 ). Consequently, regular use of such drugs, like the consumption of excessive alcohol, can impinge upon mental well-being and intimacy, generating indirect and belated relationships between victimization and substance use that extend far beyond periods of intoxication.

Feminist scholarship on domestic abuse has tended not to engage with the pharmacological impacts of substance use and has focussed instead on how some abusive men retain power over women by attributing their violence to intoxication, by insisting that their drinking caused them to act out of character, or by denying any memory of assaults perpetrated when intoxicated ( Hearn, 1998 ; MacKay, 1996 ). Evaluations of interventions for perpetrators have thus needed to be alert to the ways in which substance use is invoked to minimize violence. Women’s accounts of victimization have had to take precedence over men’s self-reported offending as measure of changes given the potential for such minimization ( Dobash et al., 1999 ). But as Stark’s (2007) review of officially reported ‘intimate terrorism’ cases illustrates, substance can also be implicated in the perpetration of ‘coercive control’ and victims’ responses to it. His analyses reveal that some victims do self-medicate to manage the depression the daily anticipation of violence engenders and that some perpetrators control victims by increasing their dependence on substances before restricting their access to them. Finally, Stark highlights that some women who have been terrorized over many years take matters into their own hands after the law has failed to protect them, mounting grievous attacks on perpetrators when they are too intoxicated to retaliate.

Typological research on men’s domestic abuse perpetration has also addressed the role of drugs and alcohol anecdotally. For example, Holtzworth-Munroe and Stuart (1994) suggest that there are three distinct types of male domestic abuse perpetrator, one of which—the ‘antisocial batterer’—is defined by their dependence on drugs and alcohol, engagement in crime and paternalistic values. The other two groups, they propose, include ‘family only batterers’ who are seemingly ‘normal’ men who are violent at home and conventional in their sexism; and ‘emotionally dysphoric batterers’ with clinically diagnosable ‘borderline personality disorders’ who tend to be overtly misogynistic, especially when their relationships are failing, or they distrust the fidelity of their partners. Yet, what the relationship is between substance use and violence for the antisocial batterer remains untheorized in Holzworth and colleagues’ tests of their typology ( Holtzworth-Munroe et al., 2000 ). This is despite clinical evidence suggesting that drug use and violence co-occur most among men with diagnosed mental health issues, poor concentration and problems understanding and remembering their pasts ( Sacks et al., 2009 ). In relation to ‘family only’ perpetrators, Johnson et al. (2014 : 65) suggest that this group is more likely to be involved in ‘situational couple’ and ‘separation-instigated’ violence that is more ‘gender-symmetrical’, and derivative of arguments over domestic matters, finances, childcare or ‘objections to the other partner’s excessive drinking’ that evolve into ‘fights’. For this subgroup of ‘family only perpetrators’, the link between alcohol consumption and domestic abuse may have more to do with everyday conflicts than personality traits, though the difference between them and intimate terrorists can be overdrawn ( Gadd and Corr, 2017 ). Sociologically speaking, control ‘is a continuum. Everyone controls their partner to some extent’ ( Johnson, 2008 : 87), begging the question as to when and why the desire to control becomes pertinent.

Answers to this question can be found in the few qualitative studies that explore how drugs and alcohol feature in the relationships of couples living with domestic abuse. These reveal that some perpetrators pose greater risks to their partners, not when they are high, but when they are irritable, withdrawing or are struggling to finance alcohol or drug purchases ( Gilchrist et al., 2019 ). One exemplar is Hydén’s (1994) study of middle-class Swedish couples reported to the police for domestic abuse. Follow-up interviews with 20 couples where alcohol consumption was noted by the police revealed that, although drunkenness and its expense were the source of many arguments that led to violence, social drinking, especially at parties, was also what held some relationships together. Afterwards, some couples reconciled on the basis that it was the alcohol that caused the conflict. They asserted that the perpetrator was normally a ‘good person’ who could be helped. Men who had caused injuries when intoxicated often claimed they could only recall feeling hurt—sometimes in ways that reminded them of painful experiences in their pasts—by female partners who criticized them or acted aggressively towards them and not the assaults they themselves had perpetrated.

Evidence of the relevance of emotional pain can also be found in Motz’s (2014) case analyses of couples in therapy. This reveals how some women who had been abused or neglected as children attempted to cope with feelings of vulnerability ‘through the creation of highly dependent relationships with men who… offer… protection, and through getting into states of mind where these feelings can be pushed away… through drugs or alcohol’ (p69). Motz depicts the emotionally impoverished lives of abusive men with whom some drug-using women cohabit, many of whom feared abandonment because of experiences of abuse, neglect or institutional care. Some of these men had ‘little capacity to tolerate emotional intimacy’ (p93) and thus found it ‘impossible to relate’ to their families or sexual partners unless ‘high on drugs’ (p93). Over time, Motz suggests, these couples became ‘doubly dangerous’, leaving their children uncared for when intoxicated, withdrawing or fighting, and unable to ‘come together safely’ in an emotionally connected way to ‘manage and contain distress’ afterwards (p158). ‘Toxic couples’, Motz argues, deny their own dependencies and instead project them onto each other, leading them to view their partners as more out of control than they are. For some men such projection amounted to ‘a fantasized attempt at creating a state of invulnerability and absolute control’ (ibid) when their own lives are in disarray.

Evidence of this kind of ‘splitting’—where good and bad, safe and dangerous, vulnerable and invulnerable, qualities in the self or other are imagined as irreconcilably polarized—upon which such projective processes rely, can also be found in Gilbert and colleagues’ (2001) focus-group study of women enrolled in North American methadone programmes. Participants described how altercations materialized rapidly when high on crack cocaine or when drunk, as intoxication induced paranoid sexual jealousy that led to hostile accusations by men who became like ‘Jekyll and Hyde’. When withdrawing from heroin, some men attacked their partners for failing to provide money for drugs, some women cited ‘irritability’ as explanations for their own use of violence towards their partners when intoxicated or withdrawing, meanwhile others emphasized that drunkenness intensified their male partners’ criticism of them for failing to fulfill household tasks. Some women described engaging in prostitution to raise money for drugs as evidence of their love and care for male partners. When the women subsequently refused to raise funds in this way or sought support from professionals to reduce their own drug use, some male perpetrators threatened further violence whereas others encouraged them to relapse back onto heroin or crack, thus entrapping stigmatized and socially isolated women in relationships with them.

In what follows, we expand the argument for a more relationally sensitive analysis of the dynamics of power that pertain in the lives of couples where domestic abuse towards a partner occurs alongside substance use. Such analyses, we argue, need to be attuned to the gendered power dynamics of drug use and domestic abuse: dynamics that may be reciprocal even while unequal; financial, emotional and pharmacological; involve violence that is perceived as ‘situational’ by one partner and ‘coercively controlling’ by the other; and recalled as involving movements between intimacy and distance among the exchange of insults and assaults, craving for drink and drugs, intoxication and withdrawal. We seek to illustrate these points by drawing on dyad interviews—with male perpetrators in treatment for substance use problems together with their current and former female partners—undertaken for the ADVANCE programme.

The ADVANCE programme seeks to develop and test an integrated intimate partner violence and substance use group intervention that will reduce intimate partner abuse perpetrated by men receiving substance misuse treatment. We report here on the programme’s preparatory workstream. This involved interviewing male domestic abuse perpetrators receiving treatment for substance use and their current or former partners about their relationships and support needs. Adult men were recruited from six community-based substance use treatment services in London and the West Midlands. The treatment services were for people who regarded themselves as ‘substance dependent’, typically because they regarded their drug and alcohol usage as ‘compulsive’, necessary to deal with problems, taking up a lot of time and energy, costing more than they could legitimately afford, and/or very difficult to stop 2 .

Seventy men were screened for lifetime domestic abuse against a partner. Men who currently had court orders preventing contact with their (ex)partners were excluded. Forty-seven of the 70 men screened were eligible, and 37 of these 47 men were then interviewed. Male interviewees were asked to provide contact details of their current or former female partners, and in 14 cases these women were interviewed. All participants were advised that there were limits to the confidentiality that could be afforded where unaddressed risks of harm and safeguarding issues were disclosed. Women and men were always interviewed by different researchers to ensure no information was inadvertently shared between participants. Participants were paid £20 to compensate for their time.

Interviews were undertaken using reflective techniques derived from the Free Association Narrative Interview Method ( Hollway and Jefferson, 2000 ), with participants being supported through active listening to tell the stories of their drug use, relationships, domestic abuse and intervention experiences. Digital recordings of the interviews were transcribed verbatim and transcriptions were checked twice for errors. Timelines were created to track the sequence of events through the life of each participant. Case studies were then written-up as ‘pen portraits’, which sought to capture the complexity revealed in each interview, including apparent contradictions, avoidances and implausible claims. In the 14 cases where both partners were interviewed, men’s and women’s accounts were compared with each other. Although all of the perpetrators interviewed could have been coded as ‘antisocial’ in Holtzworth-Munroe’s (2000) terms, given their drug use and criminal histories, such categorization would oversimplify matters. All but two of the men depicted their violence as situational and/or a product of some form of mutual combat, whereas all but one of their partners depicted coercively controlling abuse, to which around half the women responded with some degree of violent resistance. In terms of their drug use, the 14 men who were interviewed with their partners appeared to be broadly comparable with the other 23 whose partners were not interviewed ( Table 1 ). The majority used heroin with other illicit substances, notably crack cocaine and/or powder cocaine, though some also mixed benzodiazepines with alcohol. Nine out of the 14 were also heavy drinkers. Five of the 14 men also described medical or psychological diagnosis consistent with emotional dysphoria. Eight males disclosed perpetrating violence that was extra-familial in addition to their abuse of partners. Contact with children had, at some point or other, been restricted for all the men in the study.

Self-reported substance use within the sample

Given the high degree of similarity among the men on key variables, we explored if more meaningful distinctions could be drawn by distinguishing the dyads in terms of whether victims had ever used drugs and, if they had, whether they were desisting from substance use or still using. Only four of the women described themselves as substance dependent at the time of the interviews. Five had never been substance dependent, and another five were desisting from substance use, either having become completely abstinent from using or having only had temporary relapses. A three-fold distinction could thus be drawn across the dyads that revealed some important variations in terms of how domestic abuse and substance use manifested themselves.

Group 1. Victim had never been substance dependent ( n = 5)

Within the sample, there were five couples where the female partner had never been substance dependent, though all the women interviewed drank alcohol socially, and one smoked cannabis occasionally. Women in this group had almost no involvement in crime. Four of these women had never been separated from their children, but one woman had children who had been required to live with their grandfather as she would not leave her abusive partner. These non-substance dependent women were typically confused as to why relationships that had started out well had suddenly deteriorated; why their partners engaged in unexplained and peculiar behaviours; and why they had accused them of unfounded infidelities while lying about their own substance use and/or the criminal activity that generally supported it.

Group 2. Victim was desisting from substance use ( n = 5)

Within the sample, there were five couples where the female partner had abstained from using drugs or alcohol, having previously been substance dependent. None of these women had criminal convictions. The stories these desisting women told tended to be of intimacy lost. Sharing feelings and traumas that motivated drug use, and about what made it difficult to give up, had generated understanding and closeness when they had first met their partners. Conflicts had then developed when the men resumed drug use or drinking whereas the women were trying to reduce their own or abstain. Only two of the women in this group had children of their own. In both cases, these women had raised their own children, but with some intermittent professional oversight.

Group 3. Victim was substance dependent ( n = 4)

Within the sample, there were four couples where both the male perpetrator and the female victim were both currently substance dependent. All the women in this group used crack cocaine and heroin to varying degrees. Though they sometimes mentioned love, they often explained their persistence with relationships that had become abusive in terms of daily needs for protection, somewhere to live and the sharing of drugs. The women in this group had much more frequent and entrenched patterns of criminal involvement than the other 10 in the sample. Their criminal involvement activities included shoplifting, petty frauds and prostitution to finance their drug use, typically with encouragement from male partners who relied, to some extent, upon the income the women generated. All four women in this group had been separated from their children when these children were young, though two women had re-established relationships with their children in adulthood.

In what follows, we present one couple from each of these groups to further illustrate the different power dynamics that can pertain in relationships where domestic abuse and substance use co-occur. Italics are used to highlight points where the participants emphasized a relationship between substance use and domestic abuse.

Wayne (early thirties) and Rhian (late twenties) met while she was managing a pub where he drank, sometimes ‘heavily’, during the ‘daytime’. She had never cohabited with a partner before, but he already had a child with another woman and had served at least six prison sentences, two for ‘kidnap’ of his own child. By Rhian’s account, when they first met three years before, the relationship ‘progressed really quickly’: ‘within a couple of weeks’ Wayne was staying in her flat. By Wayne’s account, he and Rhian visited the grave of his grandfather before spending the night together. After that, Wayne said, he ‘couldn’t get rid’ of Rhian: he ‘loved her to bits’ and their relationship was ‘proper good’ for 18 months until he began to ‘blag’ money from her to buy heroin. Rhian’s account, by contrast, was recollected more as an unfolding nightmare, in which she did not know why Wayne was being so controlling until after their baby was born when he revealed he was getting treatment for heroin dependency.

Rhian recalled that Wayne first assaulted her within a couple of months of moving in. After a drink with friends and not knowing that she was already pregnant, Rhian felt ill and went to bed. When Wayne returned home, he became ‘very argumentative’, ‘coming right’ in her ‘face’, accusing her, without foundation, of sleeping with someone else. Rhian wanted to end the relationship then, but Wayne was profusely apologetic, convincing her to keep the baby and get their ‘own place’, explaining his life was ‘empty’ before they met. Wayne provided a detailed account of the emptiness he felt. His mother, who was separated from his father, had worked nights in a pub, leaving her children ‘home alone’ to run ‘wild’. In her absence, Wayne began smoking ‘weed’ regularly. He had ‘weird thoughts’ and would pick fights with anybody , feeling no ‘remorse’ afterwards. Wayne’s mother sought help but did not receive any. Instead, Wayne became abusive to her, ‘calling her a slag’, threatening to hit her when she took his brother’s side, and constantly ‘smashing her house up’. Invited by his cousin to ‘smoke’ heroin to ‘forget’ his grief’ after his grandmother’s funeral, Wayne claimed his clandestine usage escalated from there, Rhian erroneously assuming he was cheating on her, doing nothing to ‘help’ him come to terms with his loss, and causing him to cheat on her. As a ‘druggie’, Wayne said, he became unable to show Rhian ‘affection’ or ‘love anybody’ , including himself.

Wayne’s accusations of infidelity caused Rhian much distress while his behaviour became more erratic and threatening, ‘his jaw… going and his eyes’ being ‘wired’ . He smashed Rhian’s phone because he was ‘convinced’ that he had ‘seen someone’s name’ on the screen. Though their relationship was ‘over’ during most of her pregnancy, Rhian ‘literally couldn’t go anywhere’ without Wayne constantly ‘phoning’ and ‘texting’ her, questioning her about what money she had spent, and sometimes barricading her in the house until she asked his mother to come and get him. After a nurse overheard Wayne discussing drugs on his phone during one of the few antenatal appointments he attended, Rhian took the opportunity to ask him what it was about because she was concerned that social services would see a child protection risk for her baby. Wayne responded by calling Rhian a ‘sick’ ‘liar’ and insisted that it was she, not drugs, that was ‘driving’ him ‘crazy’ .

Wayne apologized after their son was born and claimed that holding the baby inspired him to ‘change’. He and Rhian then took, what she recalled was, a ‘perfect’ family holiday together in which he explained that he had been prescribed Subutex (buprenorphine), a semi-synthetic opioid used to treat heroin dependence . Wanting her son to be raised by two parents, Rhian agreed to let Wayne move back in, but when his drug use resumed, he became ‘physically aggressive again’ . Rhian recounted three occasions when Wayne throttled her, once asking her to put the baby in another room so the child would not see, and on another occasion putting a knife to Rhian’s throat and rationalizing, ‘You’re killing me… So, I should … make it look like you killed yourself’. Sometimes Wayne would speed off, with their baby in the back of the car, in a hurry to buy drugs. Other times, he locked Rhian in the flat for days because he suspected she was ‘cheating’ and feared she would leave him. The violence only ceased, Rhian said, when Wayne called the police on himself after pinning her down and grabbing her by the neck. Rhian said she was pressurized by the police to make a statement against Wayne, but that the case was withdrawn when he made a fraudulent counter-accusation and a friend of his posted content on Rhian’s Facebook page, as if by her, purportedly confessing. Wayne, by contrast, only recalled one assault explaining they ‘didn’t argue a lot’ partly because his ‘mind wasn’t there’ . He admitted driving off with the baby because he was in a ‘rush’ to get drugs but insisted the argument occurred only on his return when Rhian, who thought ‘she was more powerful than everybody else’, punched him ‘in the chest’ to stop him leaving again. In response, Wayne claimed, he had ‘moved’ Rhian by the ‘face’ because she ‘wouldn’t let’ him leave and was ‘kicking’ his ‘legs’ and because he knew he ‘would have ended up battering’ her as he did not always know what he was doing when ‘on heroin’ . Wayne was thus surprised to later be awoken by ‘two police officers’ who arrested him, but relieved when the courts concluded that Rhian had lied, and pleased that, post the break-up, he had been able to access some support for the mental health problems that had been troubling him since his childhood.

Mitchel (early fifties) and June (mid-forties) were in a relationship for over 15 years. They met while in residential rehabilitation for heroin dependence when they both were ‘emotionally raw’. Mitchel felt the ‘deepest love’ for June when they met. June thought she had ‘met her soulmate’: an ‘affectionate’ man with whom she had much ‘empathy’ given his ‘horrendous’ experiences of ‘child abuse’; a man who helped her overcome the death of her son’s (also heroin-using) father. As a teenager, Mitchel too had found ‘comfort’ in heroin use after he was sexually abused by his brother and his brother’s friends while their mother, was out ‘trying to find somebody to love her’ . As a child, June was repeatedly coerced into having sex by a man who threatened to report her to social services for caring for her siblings while her mother received hospital treatment. June said that as a university student, she lacked the social skills to say ‘no’ when she was introduced to heroin. When she became pregnant, she weaned herself off it but relapsed when her mother accused her of inviting the sexual abuse she was subjected to as a child. Having taken heroin to ‘bury’ the ‘hurt’ this accusation inflicted, June self-referred into drug rehabilitation for two years so she could raise her son in an environment in which her desistance from drugs was effectively managed . From Mitchel’s perspective, problems in their relationship emerged after they left the residential rehabilitation. June, he said, was ‘damaged goods’: ‘although the love was there’ she was ‘frigid’. He pursued sex with a woman called Rose and hoped that ‘the three of’ them ‘could love each other’, introducing both women to crack cocaine to facilitate this. But, according to Mitchel, the ‘resentments grew’, until June became pregnant and began ‘hounding’ him to commit to her, even though she knew he ‘loved’ Rose ‘more’, trapping him, paradoxically, in a sexless relationship by becoming pregnant. Owing money to a crack cocaine dealer, Mitchel said, he and June fled to his mother’s house for a ‘fresh start’, during which they could cease using drugs and get their own place.

June, by contrast, made no mention of a polyamorous relationship and said that she had remained ‘clean’ of drugs for a decade after leaving the rehabilitation centre while Mitchel’s drug use resumed . Thereafter, she said, Mitchel would constantly ‘put’ her ‘down and compare’ her to another woman. She said that while the heroin would ‘subdue’ Mitchel, when drunk he became ‘aggressive and arrogant, looking for a problem’ . This abusiveness heightened during her pregnancy; a time when she felt increasingly ‘isolated’ and ‘insecure’. The ‘fresh start’ she had been promised never materialized though this was partly because she started drinking heavily, blurring the line between his ‘put downs’ and her responses to them . Drinking, June said, helped her tolerate Mitchel’s ‘screaming’, but sometimes he was determined to escalate arguments, once pouring a bucket of water over her while in bed. When Mitchell returned from university, where his relationship with Rose had resumed, June said he ‘was drinking pints of vodka’ as well as using heroin while undertaking odd jobs for cash, and that she would come home from work to find him ‘asleep’ in front of ‘a plate full of heroin and needles’ while the children played unsupervised . June said that when she ‘confronted’ Mitchel, he ‘cleared’ out her bank account, leaving her reliant on money borrowed from her mother to provide food for the family. Feeling ‘depressed’, ‘trapped’ and defeated’, June began using heroin again.

Mitchel made no mention of these incidents but said June had become domineering about domestic matters when he returned from university. ‘ Violence’ became their ‘means’ of ‘communication’ at this time with him threatening to hit her ‘back’ when she ‘lashed out’. June explained that she had once hit Mitchel in retaliation, whacking him ‘with a folder’ when he lent her car to an unqualified driver and the police questioned her about it. Mitchel responded, she said, by ‘kicking’ her ‘from the head up’, breaking her jaw, causing her unforgettable pain. June said she lay on top of her son to protect him when Mitchel went ‘ballistic’ because the boy had failed to clear up the kitchen after making his own lunch. June conceded that she ‘hit’ Mitchel ‘right back’. Mitchel said he regretted hitting June ‘like a man’, clarifying that normally he would ‘just’ hit her back with an ‘open hand slap’, but that on this occasion she ‘came at’ him, creating an ‘explosion’ before having a ‘breakdown’, perplexingly ‘terrified’ of him.

The police attended but arrested neither of them as they had both been drinking . So, June said, she tried to leave for a friend’s house with the children and eyes that were too swollen to open, but Mitchel kicked and beat her again. After a period in hospital, June said June contacted a drugs and alcohol dependency team who put her on a methadone programme, but Mitchel started taking the methadone because he feared he would lose the house and his children if June recovered. June’s version was that she only succeeded in leaving Mitchel after she awoke to find him ‘forcing’ tablets down her ‘throat’, to make it look as if she had killed herself by overdose. Mitchel made no mention of this attempted murder but explained how bitter he was that June secured a court order that prohibited him from seeing the children merely because he had made the ‘ mistake’ of buying a very large ‘bag’ of heroin and despite always having done the hoovering and cooking ‘for them’.

Joe (mid-thirties) and Kate (late twenties) had been together for six years. A week after having met in the streets and gone out for a drink , Kate arrived at Joe’s house with just a suitcase and never left. Kate had been sexually assaulted both as a child and as a teenager and was estranged from her family. Joe, whose parents were both deceased, was sexually abused while in care and was estranged from his siblings. Kate’s children lived exclusively with her previous partner, their father, because of Kate’s alcoholism. Joe had been a heavy drinker since his molestation and had served multiple prison sentences: two for attacking men he had seen ‘touch up’ women without their consent and one for assaulting Kate. All but one of Joe’s many previous relationships had involved violence, some grievous and directed at him, but for which he had often been arrested, leading him to the conclusion that ‘it is really sexist out there’: ‘there’s one rule for blokes and one rule for women’.

Despite being ‘frightened of men’, Kate initially found Joe ‘really nice’. She said he ‘spoilt’ her and did ‘sweet’ things, taking her to restaurants and bringing her flowers. They both emphasized that they had loved each other, though Kate said she struggled to ‘handle’ Joe’s attention and was sometimes ‘mouthy’ and ‘hateful’ towards him when drunk, merely to elicit a different ‘reaction’ . From Joe’s perspective, however, ‘every argument’ was ‘about drugs and money’ . He understood that Kate was using drugs —something she barely disclosed in her interview—‘ to block out the pain’ of her past, but the drug use had affected their sex life , while chronic pancreatitis had left her with ‘only… a few years left to live’. Joe did not like Kate ‘clipping’ —‘robbing’ men she deceived into believing they would have sex with her—to fund their drug use and wanted her to steal from supermarkets instead. He said he worried that Kate would be raped or killed by men she had clipped and that he had lost teeth defending her from men she had tricked. Joe admitted being ‘jealous’ and afraid that Kate was ‘cheating on’ on him, though he knew she was not ‘a slag’ despite ‘acting’ like ‘one’. Joe considered himself to be no longer ‘alcohol reliant’, having given up spirits, but claimed that he became ‘addicted’ to heroin a year ago, trying it to show Kate he could ‘understand’ what it was like for her . Heroin withdrawal had been the real ‘devil’ for Joe, leaving him unable to ‘walk’ at times, ‘depressed’ and vulnerable to a descending ‘red mist’ that he claimed rendered his temper uncontrollable . Joe commenced a Subutex prescription during his most recent prison sentence which, since his release, he had shared with Kate to ‘make sure that she ain’t sick’ (i.e., suffering withdrawal symptoms), sometimes also using heroin or crack cocaine in addition to his prescription.

From Kate’s perspective, however, Joe’s protectiveness could be ‘suffocating’. She explained that although Joe initially ‘understood’ how her childhood experiences of the sexual violence affected her, his capacity for understanding was now contingent on whether she had sex with him. He now treated her like a ‘child’ and ‘as his’ property and feared he ‘could kill’ her in an ‘accidental angry’ moment. When coming down from being high or drunk, Joe was often ‘controlling’ and could ‘switch very easily with anyone’. Kate explained that previously, when Joe had been smoking crack, he assaulted a ‘pervert’ who had touched Kate ‘in an inappropriate way’. After he had finished assaulting the ‘pervert’ Joe proceeded to strangle and batter Kate, breaking some of her ribs. Hence, Kate avoided doing anything ‘sudden’ that would make Joe ‘paranoid’, despite having invited him to ‘just fucking kill’ her rather than keep ‘terrifying’ her. After ‘days’ of ‘not sleeping and just drinking’, Joe tried to provoke an argument . When Kate walked away, he mimed ‘putting bullets’ in her head, so she ‘pushed him away’ and he ‘punched’ her. While Joe was in prison for this assault, Kate twice attempted suicide. She continued to blame herself for his violence and drank alcohol ‘to feel happy’ while questioning whether it was ‘really’ her ‘fault’ that Joe was so ‘messed up’, as he has claimed. Joe, by contrast, claimed Kate had hit him ‘over the head with a hammer’ because he ‘wouldn’t buy her drugs’ and explained that the assault on her, for which he went to prison, occurred after she ‘slapped’ him ‘round the head’ because he did not ‘have… money for drugs’. It was unfortunate, he said, that the police drove past just as he was hitting ‘her back’ in ‘self-defence’. Though Kate said she ‘loves’ Joe ‘to death’ she doubted whether the ‘damage’ to their relationship could be ‘mended’. He , by contrast, was desperate ‘to get her clean’, as he imagined this would enable him to get his own ‘life back’. Joe assumed that if Kate became sober enough to see her children again, it would save his relationship with her from ‘ruin’.

In this article, we have presented three relationship scenarios where domestic abuse pertained alongside drug or alcohol dependency. These relationships diverged primarily in terms of the female partners’ histories of drug and alcohol consumption as all men were in treatment for substance dependence. All three men—like the majority of those interviewed in the ADVANCE project—considered ‘drugs’, their own and/or their partner’s use of them to have damaged or ruined their relationships. Their depictions of violence as ‘isolated incidents’ in which they were only partially culpable were consistent with perpetrators’ accounts more generally ( Stark, 2007 ; Women’s Aid, 2018 ; Gilchrist et al., 2019 ). Wayne, Mitchel and Joe all described discrete, regrettable and unplanned assaults that derived from everyday conflicts over alcohol and drug use, financial pressures, sexual jealousies and domestic chores: conflicts that were sometimes accentuated by being intoxicated. Nevertheless, the stories these men told suggested that their need to control became increasingly acute when their relationships were in crisis, when they had secrets to keep, when they felt dependent on drugs or alcohol, were afraid of losing their minds, their partners and their children, when money was scarce, and when homelessness and criminalization were distinct possibilities. As these men projected this sense of being in disarray onto their partners, the women began to feel like they were being driven crazy, in part because they did not have full knowledge of the drug and alcohol use that was consuming the men’s time and minds. As the women began to question what was happening, the men’s attempts to coercively control became more dangerous and desperate, e.g., in the refusal to let partners leave their homes or in their efforts to tempt or coerce the women into consuming drugs. Despite their unhappiness, these men, like their partners, often lacked the emotional strength and economic resources required to separate ( Walby and Towers, 2018 ). Instead, the men often blamed discrete incidents of violence, as they construed them, on drugs and/or money-related issues that could be fixed if they entered treatment and their partners were prepared to fight for the relationship, for the sake of children whose well-being had not been paramount (to the men) previously.

By contrast, Rhian, June and Kate, described steadily accumulating patterns of abuse, forgiven initially as promises of fresh starts, either in new places or after drug treatment, were made. The women’s reasons for enduring domestic abuse or for giving the men another chance began with this hope for change but often mutated as they encountered the financial and emotional difficulties of leaving homes, the prospect of losing their children (forever in Kate’s case) and the concomitant risk of criminalization when the men threatened to report them for hitting back or for using drugs. Hence, the reasons these women stayed were complexly configured around drug and alcohol use. Wayne’s abusive behaviour had proved confusing to Rhian, who knew only that he was a heavy drinker until his heroin use was confirmed after their baby was born. Then, as someone with little experience of either drugs or relationships, Rhian was persuaded to give Wayne another chance while he sought drug treatment, assuming mistakenly that this would redress his violence. June, by contrast, had some empathy with Mitchel, having relapsed with heroin herself and recognizing that her own drinking contributed to their arguments. June had been persuaded that moving might facilitate a fresh start, without drug use. However, when June sought opioid substitution treatment for herself, Mitchel found a new way of controlling her, diminishing her capacity to leave by controlling her access to her prescription and then trying to administer an overdose. The challenges for Kate were different again. She had a long history of heavy alcohol consumption and illicit drug use, the latter of which Joe had joined in with, compounding their mutual dependence on shoplifting and pseudo-sex work to maintain their supplies. Joe construed his heroin use as an attempt to empathize with Kate, though it appeared that he persisted with drug treatment partly because it legitimized his management of her drug use. Joe hoped he would get his ‘life back’ if he could facilitate a reconciliation between Kate and her children. In the interim, Kate suffered grievous violence, while living in Joe’s home: violence that was construed as part of the protection he afforded her against men she had clipped.

For the women in these relationships, criminal justice intervention was often greeted with trepidation, for it rarely provided the protection it promised. Instead, they had often concluded that it was simpler to suffer difficulties within their relationships, attribute violence to drugs use and attribute drug use to earlier traumas, of which there were many in our participants’ lives. For June and Kate, the pains of child abuse, mental health problems and bereavement were partly responsible for the solace they had sought in alcohol and heroin consumption, as well as in their relationships with men. However, as their drug and alcohol usage became complicated by domestic abuse, a range of different strategies were pursued by each couple, typically to avoid attracting the attention of social services or the police. These strategies included taking prescribed medications to minimize their need to commit crime to fund illicit drug use (Joe), moving away while also severing ties with friends and family (Mitchel, June), switching substances (Mitchel, Joe), pursuing relationships with others who use illicit drugs to avoid feeling ‘trapped’ (Mitchel, Kate), consuming drugs or alcohol to cope with the aftermath of conflict (Wayne, Mitchel and June), engaging in crime together (Joe, Kate) and tacitly encouraging partners to participate in drug use (Mitchel, Joe), compounding the risks faced by women who wished to abstain or keep their use moderate. Although drug and alcohol use could increase sociability and enhance feelings of closeness between partners, the fear of dependency also induced feelings of worthlessness—evidenced most vociferously in Wayne’s belief that he could not love anyone and the paranoid accusations this engendered, but also hinted at in Joe’s jealousy and Mitchel’s infidelity.

These cases reveal how the projective dynamics that impart blame, often through men’s claims that their female partners are ‘driving’ them ‘mad’, are easily facilitated by the nuances of sexism and reinforced by the perennial threat of violence. These dynamics were compounded as drinking and drug use generated financial pressures, which intensified conflicts that left the women, as well as some of the men, feeling that their partners regarded sustaining their substance use as more important than their relationship, avoiding criminalization and social services intervention, and the threats posed by those from whom money and drugs had been borrowed or defrauded.

For time-pressured police officers, social workers and magistrates faced with partial evidence and counterclaims, discerning the ‘truth’ of who had done what to whom in which circumstances would have been particularly difficult. Evidently, some abusive men tell highly convoluted stories to exonerate themselves. But some women who are the primary victims in such relationships do not and cannot always tell the whole truth either, not only because they fear further violence and abuse but also because of the stigma of their own drinking and drug use, the fear of child protection proceedings being instigated and the risk of being incriminated by perpetrators they have hit in self-defence or retaliated against ( Wolf et al., 2003 ; Felson and Paul-Phillipe, 2005 ). What is under-acknowledged in many serious cases of domestic abuse is that both perpetrators and victims often share in the shame associated with being abused as adults and children, of failing to protect their own children, anticipate their partner’s needs, having hit back, gotten drunk or engaged in illicit drug use.

Like many of the men in the ADVANCE programme study, the perpetrators we have depicted here dealt with feelings of trauma and grief from their pasts through drug use and by scaring their partners in ways that the women experienced as acutely controlling. While frequently terrifying, such behaviour was not only instrumental and controlling but also expressive of how painful some aspects of their pasts were and how unwilling they were to concede their dependency on both substances and partners who provided care, funds, a place to live and the support needed to maintain precarious relationships with children. Similar experiences of child abuse, mental health problems and drug dependency were sometimes part of the story of intimacy that held these couples together despite grievous domestic abuse. Then, when the risk of criminalization or estrangement presented, men who were coercively controlling sometimes used such prehistories against their partners by threatening to expose them for raising children in contexts that were unsafe. Hence, the ‘madness’ that the women in these relationships often felt was not simply symptomatic of their own mental health problems but projected onto them by men who had become desperate to impose their own versions of reality.

This imposition of the perpetrator’s reality sometimes became more forceful when the criminal justice system intervened. The risk of ‘legal systems abuse’ occurs when perpetrators adept at coercive control harness the powers of the police or the courts to further intimidate their partners ( Douglas, 2018 ). It has, to some extent, been be amplified by the advent of gender-neutral policy, which recognizes that men can be victims too, alongside incident-focussed approaches to policing that direct attention to what has just happened—such as a man being hit—rather than the history of the relationship—such as a woman being terrified or controlled by the same man over a prolonged period ( Walklate et al., 2018 ). The 2019 Domestic Abuse Bill attempts to counter this risk by prohibiting perpetrators from cross-examining victims in the family courts and providing greater recognition of the impact of the ways in which economic abuse makes it harder for many victims to leave. But compelling alcohol and drug-using perpetrators to receive treatment may introduce unforeseen possibilities for coercive use of the law. Some women will consider themselves too culpable to seek support and will ultimately be let down within a criminal justice process calibrated to identify the perpetrator of assaults at the scene and/or whether they were intoxicated, and hence be easily blindsided by the mutualizing discourses some serial offenders offer in their defence ( Tolmie, 2018 ). Others will stay under the misapprehension that the domestic abuse will cease once treatment for substance use begins. This is an unlikely outcome, though intervention is nonetheless worthwhile. There is tentative evidence to suggest that reducing drinking among perpetrators can diminish resort to violence ( Wilson et al., 2014 ) and that opiate substitution treatment can help alleviate dependence on illicitly purchased drugs and acquisitive crime and improve mental, physical and sexual health among heroin-dependent polydrug users ( Gossop et al., 2000 ; Strang et al., 2010 ; MacArthur et al., 2014 ). But, although treatment interventions can reduce the harms of substance use, where drug and alcohol use and domestic abuse co-occur, treatment needs to be part of a range of measures that include support in changes in thinking and modes of relating, securing the housing and economic resources couples need to be able to contemplate living apart, the support and empowerment of survivors, the safeguarding of children and professional help with mental health problems. These skilled forms of intervention are critical to deescalating the dynamics that sustain substance use in the lives of people enduring the worst forms of domestic abuse but are often in short supply.

By contrast, the evidence that domestic abuse perpetrator programmes—as currently commissioned by the UK government—‘work’ remains mixed ( Vigurs et al., 2017 ). Although the best interventions risk encouraging men who have been physically violent to adopt more emotionally abusive tactics ( Kelly and Westmarland, 2016 ), the UK’s Probation Inspectorate is doubtful as to whether the private Community Rehabilitation Companies currently delivering such interventions provide adequate practice in terms of safeguarding victims and their children ( House of Commons, 2018 ). Both the domestic abuse and substance use treatment sectors in the United Kingdom have suffered sustained funding cuts over the last 10 years ( Women’s Aid, 2016 ; ACMD, 2017 ), often secured through the non-renewal of local procurement contracts via competitive tendering processes that favour cheaper and less specialist provision. One danger with compelling drug or alcohol treatment is that it will place clinicians and health practitioners in the ethically compromising position of having to report those who relapse, together with those whose prescriptions have proved insufficient, or who have decided that they would be better trying to reduce their substance use gradually, to the courts where they may face further criminalization ( Seddon, 2007 ; Werb et al., 2016 ).

More generally, models of treatment for alcohol and drug use that acknowledge that ‘relapse’ is common are hard to reconcile with domestic abuse policy founded on compliance with court orders that insist upon ‘zero tolerance’ of reoffending ( Benitez et al., 2010 ). Criminalizing responses are rarely challenged in domestic abuse policy, where academic research has tended to extol the benefits of naming ‘perpetrators’ as such and victims, though sometimes recognized as ‘survivors’, are usually cast as their opposites. Such an approach runs contrary to academic conventions in substance use research where a concerted effort has been used to avoid stigmatizing terminology that reduces individuals’ identities to their drug consumption ( Broyles et al., 2014 ).

Hence, acknowledgement of complexities in the power dynamics of domestic abuse that co-occurs with drug, alcohol and mental health problems raises acute challenges, not only for the delivery of policy that attempts to reconcile safety, justice and rehabilitation but also for academics who have framed the problem of domestic abuse primarily as one of either gender or psychology. Not only do criminologists need to reconceptualize domestic abuse more dynamically but they must also ask why some men choose to secure control in coercive ways when so many other aspects of their lives appear out of control. There is a need to recognize how the interdependencies—including the prospect of economic abuse—involved in intimate relationships are intensified by poverty, stigma, co-dependency, child abuse and neglect, poor mental health and the fear of police and social services intervention. In theory and in practice, we must ensure that shorthand explanations derivative of personality disorders do not obscure what can be learnt from the more complex descriptions both survivors and perpetrators can offer of their relationships. Policymakers need also to ensure that evaluations of treatment options for substance-using perpetrators extend beyond the longstanding fixation with acquisitive crime to include measures that take stock of their impact on children and partners, whether current and former, and to recognize that establishing effective practice will require the reestablishment of expertize and service provision that is increasingly scarce.

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School for Policy Studies

Religious arbitration of marriages involving domestic abuse.

Bible, Quran and Torah placed side by side Photo credit: freepik.com

5 September 2024

Dr Natasha Mulvihill and Dr Nadia Aghtaie host a symposium exploring the religious arbitration of marriages involving domestic abuse.

Following funding awarded by a Zutshi-Smith bequeathal to the University of Bristol, Dr Natasha Mulvihill , Associate Professor in Criminology, and Dr Nadia Aghtaie , Senior Lecturer in Gender Based Violence, organized an international symposium to discuss the religious arbitration of marriages involving domestic abuse.  This builds on their earlier work on faith and gender based violence.

The event on 3 September explored the use of councils, courts and panels to confer divorce or annulment in the Muslim, Jewish and Catholic faiths.  Speakers focused specifically on how these mechanisms recognise and respond to cases involving domestic abuse.

The day opened with Professor Samia Bano , Professor of Law at SOAS (UK), talking about Muslim family mediation and Sharia Council provisions in relation to domestic abuse; and was followed by Dr Nadia Aghtaie , presenting her research on women’s experiences and practitioner perspectives on Sharia Councils.

Professor Michael J. Broyde , Professor of Law at Emory University (US) and former Director of the Beth Din of America, then set out the policy arguments for and against religious arbitration in America, focusing specifically on the case of Jewish divorce.  Community Engagement Officer, Barbie Goldfoot , explained the support provided by Jewish Women’s Aid to UK women experiencing abuse; and Joanne Greenaway , Chief Executive Officer for the London School of Jewish Studies and former Director of Get cases for the London Beth Din, recounted her legal representation work for Jewish women whose husbands refuse to give a religious divorce.

In the afternoon session, Thomas Kulandaisamy , a Matrimonial Tribunal Judge in the Clifton Diocese of Bristol, outlined the Catholic canon law provisions relating to annulment.  The convenors would also like to register the input to this session from Professor Charles Reid , Professor at University of St Thomas (US) and Canon Richard Dwyer (Clifton Diocese).  In their presentations, Nikki Dhillon-Keane, from Safe In Faith , part of the Catholic Diocese of Westminster, and Dr Susan Longhurst , Lecturer at St Mary’s University (UK), shared the experiences of Catholic survivors of domestic abuse and gave details on a new 2-year research project to encourage trauma-informed practice within Catholic matrimonial tribunals.

During lunch, our postgraduate, current and former PhD students showcased their research on posters and talked with attendees:

• Intimate Partner Violence & Spiritual Abuse Amongst Pagans (by Bliss Qadesh)
• Domestic Abuse & Violence: The ‘Threshold’ for Islamic Divorce (by Dr Fouzia Azziz)
• The Triangle of SRHR, Sharia, and the Iranian Legal System (with a Focus on Bodily Autonomy and Violence Against Women's Health) (by Gelara Fanaeian)
• The Wages of Sin is Death: A Thematic Analysis of the Construction of Femicide on Facebook in Kenya (by Judith Kibuye)
• The Materiality of Cyber Commercial Sigheh: A Netnographic Study of Merchandised Sex Within the Irano-Islamic Context (by Minoo Sadat)
• Islamic Feminism and Family Law: A Case Study of the Musawah Movement (by Raisha Jesmin Rafa)
• The Role of Faith in Recovery for UK Christian and Ex-Christian Women After Experience of Domestic Abuse (by Vanessa Read)
• Reproductive Coercion: A Comparison Between UK and Italy (by Rosalba Castiglione)

The symposium closed with mixed groups of faith leaders and faith representatives, professionals from the domestic abuse sector (both secular and faith-based), academics and students, discussing their reflections on the work presented and what actions could be taken.

A symposium report and summary for faith communities and domestic abuse services is due to be published in the coming weeks.  Natasha and Nadia would like to thank the Zutshi-Smith funding panel; all the attendees; our postgraduate and PhD students; and our administrator Isis Thomas for her support in organising this event.

Further information

The project leads, Dr Natasha Mulvihill and Dr Nadia Aghtaie, were funded by a Zutshi-Smith bequeathal to the University of Bristol to convene an international symposium on this issue. This event took place on 3 September 2024 in Bristol, UK. Dissemination outputs will follow and be available at this link .

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Financial abuse - Halima's story

At the start, I was so happy with Kala - he appeared very genuine and caring. Really charming.

But then, our relationship began to change - he started to tell me that because of my dyspraxia I shouldn’t be in charge of finances. We met at uni, I was a full time student but worked too, where I could. He didn’t - and because he was an international student he said he couldn’t work or access any grants or benefits. But he would frequently take money from me. And made me feel guilty if I refused to buy him stuff - he even asked for designer gifts.

I trusted him, and he used this to get access to all my bank cards and details. It even turned out later he’d taken out a loan in my name.

I started getting really suspicious when letters arrived about repayments that I could not afford. I felt worthless and so guilty for letting him into my life in the first place – like it was my fault!

Finally I confided in some mates: Ari and Nadia, who suggested finishing the toxic relationship with Kala and reporting the bank fraud to the police. With their help and support, I was able to finish with Kala, get financial support, rebuild my confidence and my life.

Am I being abused?

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How I escaped ‘trad wife’ hell: Abuse survivor hopes other victims find her book and run

Tia levings entered a fundamental christian marriage at just 19, and as she looked after the children, her husband chose more rural and more authoritarian congregations for the family. she fled the marriage in 2007 before chronicling her story in a new book – which warns of behind-the-scenes evils hidden within the ‘trad wife’ trend. sheila flynn reports, article bookmarked.

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T here was something frighteningly different about the violent energy that night – the way her husband abruptly left the house, the forces she felt telling her to run – that made Tia Levings finally bundle her four kids into the car and flee a man who hid abuse under the cloak of strict religion.

It was only as she passed her husband’s vehicle, his headlights pointing in the opposite direction – back towards the family home they’d just fled – that she realized he’d left to get the gun stored in his office.

“I was still driving; it was the middle of the night,” Tia tells The Independent , recalling with knife-edge clarity “the adrenaline of knowing that we just narrowly escaped the murder-suicide that I’d always feared.”

It was 2007, and Tia had lived for nearly 15 years in an increasingly fundamental Christian marriage. By the time she worked up the courage to escape, they were living in an unheated, isolated urban homestead in Tennessee – and her controlling spouse was forcing her to obey orders while calling him “my lord.”

Fast-forward a little more than a decade and a half, and Tia, now 50, is telling her story in a bone-chilling book – while simultaneously watching, with great concern, the continued glorification of the “trad-wife” lifestyle on social media and in pop culture.

She knows firsthand that the back-to-basics idyll being sold far too often hides a dark and dangerous reality. And she hopes her book, A Well-Trained Wife: My Escape from Christian Patriarchy – which began as a journal to help Tia process her trauma – is getting into the hands of those women still trapped in the same types of life-threatening, open-air prisons.

“I [wrote] it for the woman in her kitchen who is washing dishes endlessly and doesn’t get to go to a bookstore and needs a book like mine, but she’s going to have to throw it in her cart at Target,” she says. “So I knew I needed a certain publishing path in order to reach her. I knew I needed a big publisher.”

She says readers are also helping. “They’re putting my book without its jacket in the little libraries that are around, and they are donating it, and they are sharing it reader-to-reader,” Tia says. “The story is getting out; it is spreading. And I think that there is so much power in that – you never know where it’s going to land.”

The story began far more benignly, with Tia and her parents joining a megachurch in Florida when she was an adolescent. There she was introduced to families following the Gothard movement, a fundamentalist ideology and way of living that was the brainchild of American minister Bill Gothard. The increasing number of Gothard families within her First Baptist congregation promoted homeschooling and could be spotted because the “women dressed like prairie wives, always pregnant and holding a baby,” she writes in her book.

Tia attended church six times a week and, after high school, was told the congregation only helped males advance to further education. So she instead prayed desperately for a husband and, when she met a sailor with a skull tattoo whom she calls Allan in the book, married him a year later – ignoring abusive and controlling red flags and even the advice of a church counselor who warned the couple of their total incompatibility.

Tia gave birth to five children – including baby Clara, who was born with a heart defect and survived just weeks – as Allan moved the family to more and more conservative congregations. Many fellow congregants were adherents of the quiverfull theology, which encourages large families and forbids any type of birth control or family planning.

On the outside, Tia attempted to project a happy family life, even running a successful website in the heyday of the mommy blog – discovering in herself a knack for writing and online content creation. Behind closed doors, Allan was threatening to kill her, leering that he’d take the kids “forever,” calling her a Jezebel and terrorizing Tia physically, mentally and emotionally.

It got worse as she began earning money and accolades for her blog work; Allan began drinking and doubling down on the abusive, patriarchal behavior. Tia tried to shield her children, but his insidious influence crept in as they aged; he traumatized their oldest by making him kill animals, and the same son struck Tia in a scuffle just hours before the then-33-year-old determined to leave – for her kids’ sake and her own.

She sought the help of a new, more progressive church – an Eastern Orthodox congregation they’d recently joined – and even went into hiding with her children until it was established that Allan was no longer a threat to them.

Her parents were also supportive; she’d hid from them for years how bad things were at home. Tia knows just how deceiving outward appearances can be, particularly when it comes to families projecting pious, traditional households – like those flooding social media as “trad wife” influencers.

“I see the trap,” she tells The Independent . “I see the lifestyle that is so all-encompassing that you can’t get out of it. I see the systematized denial of agency and options so that you might wake up one day and want to be out of it, but you’ve closed door after door after door so that there’s no one there to help you. There’s not a bank account to turn to. There’s no agency to just start asking questions or to change your life, if you decide you want something different.

“And that really underscores why this is not just an alternative lifestyle choice,” she says. “It is part of a movement.”

It’s a movement that’s deliberate and strategic, dating back decades and beyond, and she says it’s chilling to hear echoes of proclamations made from pulpits during her childhood in the words of influential politicians today – “especially when JD Vance opens his mouth,” she says.

“He floats the ideas of women not voting; he floats the ideas of no-fault divorce … even though we know that having access to divorce has reduced suicides and domestic violence deaths,” she says. “He floats all of those agendas that are part of Project 2025, which is not anything new.”

The talking points are all there, Tia says. “They are often divorced from the theology that fed them, and I think that’s for a mass audience – but that’s also a good opportunity for someone who comes from that background to say, I know why they are teaching that, and I know what they intend to accomplish with it.”

She’s been hearing it since childhood, when ministers preached regularly against Democratic leaders like Bill Clinton and Al Gore.

“They were pretty open about this when I was growing up – preached it every Sunday,” she says. “We sat in sermons and they said, ‘This election might not go our way … but we have a strategy in place to take over the Supreme Court, and we’re going to get the justices in place, and we’re going to pick God’s man.”

She points to the many US lawmakers and politicians raised “in that viewpoint: That America is a Christian nation, and that we are supposed to have Christianity as a dominant faith and a dominant religion across the globe, and the leadership looks like a patriarchal white male – and women stay at home and raise children and they don’t have access to health care or contraception or equality or employment.”

Tia sees the appeal of the lifestyle on paper, however, as Americans, and particularly mothers, grapple with the multifaceted demands of daily life.

“When we’re exhausted, we turn to very simplified solutions, where fundamentalism can step in and say, Oh, are you tired? It’s because you’re working too hard. And the two-income family really doesn’t work, and women need to stay home ,” she says.

“And at the same time, that system is not advertising the outcome. They shut down the evidence, the testimonies, the science, everything that would say, This isn’t actually a good way to live . We’ve actually lived this way before.”

“That’s where a survivor can come in,” she says.

While she watched the mass popularity grow of reality shows featuring families like the Duggars, where she recognized tell-tale Gothard fingerprints, Tia was caught off-guard by the latest pop culture fad across TikTok and Instagram.

“I really did not see the trad wife social media movement happening, because there have been so many advances for women’s liberation,” she says. “The closest thing [that came] before was the mommy bloggers movement, which I was part of – so I thought we had kind of evolved past it. I was very surprised.”

The glossy content plugs into “this idea that there’s something better out there; life is hard,” Tia says.

“Maybe it speaks to … the very clear binaries of the gender roles, easy answers, the simple formulas,” she tells The Independent . “Sometimes it can just be comforting to watch, because we like process videos and we like pretty aesthetics, and we can tend to think it’s benign and that it’s not part of something greater.

“And some creators are not very plugged into the wider movement. They don’t understand how their work is contributing to this conversation … It’s easier to hold your phone and watch somebody make gentle cheese crackers with a smile on their face and unplug from society a little bit and hearken to what we think is a simpler time.

“They’re not representing the complexity of that age, either,” she says. “They’re showing one dimension of it.”

The current cascade of content can not only be personally triggering for Tia – though she consumes and deconstructs it for her work, writing and speaking about the ills of fundamentalism – but also sparks a range of other emotions.

“I do get angry when I see it celebrated, because it’s glorified abuse – and that’s angering, because there’s victims involved, and they’re usually voiceless victims, like children,” she says.

She’s well aware that, had technology evolved earlier, she could have been one of the aforementioned influencers herself.

“If I’d had social media, I would have been a trad wife social creator,” Tia admits. “I was good at blogging, and I was there when the movement was new. And complicity is something that everyone in recovery has to look at.

“Patriarchy needs women to perpetuate it, so it grooms our participation, and then it holds us there with the guilt of our complicity, and then we become perpetrators. So it’s like the cycle that just keeps going.

“And I had to definitely sit with the complicity of my mask, because I wasn’t presenting the truth of the situation either, not even to myself.”

Now, instead, she’s sharing her story with searing honesty – not just for the woman it might save at Target but for wider members of the community.

“I always call this the cult without walls, and the members are really used to being isolated in plain sight – so they will be your neighbors or someone you see at the grocery store or the park, and they feel alone and separate,” she says, “Try to connect, try to engage in conversation … because if they can trust you, you might be the one they ask for help when it’s time to get out.”

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Groundbreaking SLS Study Documents the Pathways to Prison for Those Experiencing Intimate Partner Violence

• September 4, 2024
• Monica Schreiber
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A new, groundbreaking study provides extensive documentation of the “IPV-to-Prison Pipeline”—the pathways through which women who are survivors of intimate partner violence (IPV) find themselves serving long prison sentences for acts of survival.

The report, Fatal Peril: Unheard Stories from the IPV-to-Prison Pipeline and Other Stories Touched by Violence , is the product of a multi-year study by the Regilla Project , a research initiative of the Stanford Criminal Justice Center that focuses on women incarcerated for homicide offenses growing out of their own abuse.

Fatal Peril gives voice to approximately 650 people serving time for murder and manslaughter in two California prisons, the Central California Women’s Facility in Chowchilla and the California Institution for Women in Chino. Through surveys proctored at the prisons in July and November 2023, the researchers sought to better understand how people experiencing IPV are criminalized for actions they took to survive abuse. Stanford students contributed to the proctoring, data analysis, and drafting of the report.

A First-Ever Approach to IPV Research

The study represents the first time the Composite Abuse Scale and Danger Assessment, two validated instruments used to assess intimate partner violence and intimate partner homicide, have been used in the study of a population who is incarcerated. In addition to quantitative results, the report presents qualitative data collected from hundreds of study respondents who shared their experiences of abuse, the circumstances of the offenses, their experiences of the criminal legal system, and their feelings of regret, remorse, and healing.

The women’s self-reported testimonies of surviving abuse are remarkably similar, according to Debbie Mukamal , executive director of the Stanford Criminal Justice Center, who led the study with Dr. Andrea N. Cimino, an expert in gender-based violence research. Cimino serves as research director and Mukamal is co-director of the Regilla Project, along with David Sklansky , Stanley Morrison Professor of Law and the faculty co-director of the Stanford Criminal Justice Center, which released a companion report in 2023 . “The stories of these women reflect a persistent belief that their lives were in danger,” Mukamal said, “often from an accumulation of their intimate partner’s threats and attempts to kill them, their children, or other loved ones.”  

“These are a group of forgotten women,” Cimino said. “Their experiences of violence were silenced in the courtroom and they have been neglected in IPV research which focuses on non-incarcerated populations.” She hopes the study amplifies survivor’s voices and creates change in the criminal legal system.

Sklansky said: “Our practices of criminal blaming and punishment have long failed to take adequate account of the realities of intimate partner violence, and of the ways in which abused women can be driven to violence by their own victimization. This new report, by giving long overdue attention to the accounts of women serving prison sentences for homicide—and the high rate at which these women report extreme levels of IPV in the year prior to their offenses—underscores the pressing need for comprehensive reform in this area. It deserves urgent study from judges, prosecutors, defense attorneys, law enforcement officers, correctional officials, and policymakers.”

The women’s stories reflect lives lived in constant fear: “I was three days at the hospital because I lost my voice because he strangled me and my neck and throat was purple with bruises. And I couldn’t talk for three days,” reported one respondent. Another said: “He had us scared, both [my children] and me, that if I told anything to the police and they arrested him, he was going to get out and kill us.”   

“As we approach the 30th anniversary of the Violence Against Women Act (VAWA) this month, this new study should embolden us to do more to prevent victimization and to help those who find themselves in abusive relationships,” said retired U.S. Representative Jackie Speier, who represented California’s 14th Congressional District until 2023. “The findings—while based in California—have broad national implications for how we treat some of the most vulnerable women in our communities. Our work is far from done.”

Cory Booker, U.S. Senator from New Jersey, agreed: “This is an urgent report, and it is well timed as we mark the 30th anniversary of the Violence Against Women Act,” he said. “Most incarcerated women are survivors of sexual violence. We must do more as a society to prevent that violence and to help the survivors. Prisons cannot be substitutes for our failures to keep people safe. And for those who enter our prisons and jails, they must be places that do not compound trauma but help people heal from it. I am proud that VAWA Reauthorization includes provisions to address the specific needs of incarcerated women, many of which are highlighted through the study’s stories of women incarcerated for crimes stemming from their histories of abuse. There is a moral imperative to address the issues in this report. To fail to do so harms and implicates us all.”

‘Stark and Troubling’ Findings

Nearly three-fourths of respondents reported experiencing IPV in the year before their offense took place, a rate that is 10 times higher than women in the United States , according to the report. Fatal Peril acknowledges that while IPV exists for people of all genders, the researchers focused on women given their disproportionate rates of severe and lethal intimate partner abuse. 

The respondents recounted physical, psychological and sexual abuse, including being hit, threatened with weapons, having partners who controlled all or most of their daily activities, and having to perform unwanted sex acts. Nearly a third of all respondents said that in the year before their offense, they had been strangled or choked more than once or felt dizzy, confused or blacked out after being choked—injuries that can cause a traumatic brain injury , according to the report. 

Among the 464 respondents who were experiencing IPV, two-thirds of them were in “extreme danger” of being killed by their intimate partner , according to their Danger Assessment scores. It didn’t matter who was killed – stranger, intimate partner, child, family member, acquaintance, or friend – they all were at risk for intimate partner homicide. The data suggests that the risk of being killed due to IPV tragically extends to all of those around the survivor. 

About half of respondents believed they were treated unfairly at trial due to gender, racial, and socioeconomic bias , according to the report. “Respondents who experienced IPV were more likely to perceive gender and income bias compared to those who were not abused,” said Cimino. “Harmful courtroom stereotypes like being called masterminds, femme fatales, gang members, and bad mothers triggered beliefs about the survivor-defendants’ culpability.” 

“Our findings are stark and troubling, and have implications for the entire criminal legal system, from policing to parole,” Mukamal said. “It is particularly critical that the system considers the potential lethality of abuse suffered by these women and how traumatic brain injury from hits to the head and strangulation may affect survivor-defendants’ testimony and experiences in prison.”

Recommendations and IPV Prevention

Kelly Savage-Rodriguez, who advocates for ending life-without-parole sentences through the California Coalition for Women Prisoners, said she “was not surprised by the findings” and was “grateful to see this new data being published.”

“The results affirm my own experiences and those of too many others who have been criminalized for surviving abuse here in California and across the nation,” Savage-Rodriguez said. “These survivors need support, not long prison sentences.”

The report makes recommendations for addressing the impact of IPV on survivor-defendants, including urging the criminal legal system to take measures to more consistently screen for IPV and to better take into account how traumatic brain injuries as a result of intimate partner violence can affect survivor-defendants’ ability to remember and communicate details relating to their abuse and alleged crimes .

The study also calls for enhanced attention to programs and policies that can prevent IPV in the first place , including strengthening access to mental health and substance use treatment to address cumulative trauma for survivors, their children, and their partners. “Cross-sector collaboration between the criminal legal system, the domestic violence response system, and child welfare systems are critical to violence prevention,” said Cimino.

The Regilla Project plans to convene a diverse set of stakeholders this Fall to identify concrete and viable legal and policy solutions to respond to the report’s findings.

Read the Full Report

Learn More About the Regilla Project

About Stanford Law School

Stanford Law School is one of the nation’s leading institutions for legal scholarship and education. Its alumni are among the most influential decision makers in law, politics, business, and high technology. Faculty members argue before the Supreme Court, testify before Congress, produce outstanding legal scholarship and empirical analysis, and contribute regularly to the nation’s press as legal and policy experts. Stanford Law School has established a model for legal education that provides rigorous interdisciplinary training, hands-on experience, global perspective and focus on public service, spearheading a movement for change.

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• UK Visas and Immigration

Migrant victims of domestic abuse concession (accessible)

Updated 5 September 2024

© Crown copyright 2024

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/victims-of-domestic-violence/migrant-victims-of-domestic-abuse-concession-accessible

About this guidance

This guidance explains the eligibility criteria to apply for temporary permission to stay in the UK under the Migrant Victims of Domestic Abuse Concession (MVDAC) formerly known as the Destitute Domestic Violence Concession (DDVC).

If you have any questions about the guidance and your line manager or senior caseworker cannot help you, or you think that the guidance has factual errors, then please email Domestic Violence Immigration Policy.

If you notice any formatting errors in this guidance (broken links, spelling mistakes and so on), or have any comments about the layout or navigability of the guidance, then please email the Guidance Rules and Forms team.

Publication

Below is information on when this version of the guidance was published:

• version 4.0 (formerly titled destitute domestic violence concession (DDVC))
• published for Home Office staff on 04 April 2024

Changes from last version of this guidance

This guidance has been updated to reflect changes to the Immigration Rules made in Statement of Changes HC 590, laid on 14 March 2024.

Introduction

This concession provides a short period of independent immigration status and financial support to certain partners who are victims of domestic abuse, allowing them to leave an abusive relationship to a position of safety and support. During this three-month period of permission to stay the victim must do one of the following to address their immigration status:

• apply for permission to stay in a relevant immigration route
• apply for settlement on form SET (DV) where they are eligible to do so under Appendix Victim of Domestic Abuse (Appendix VDA)
• make arrangements to leave the UK

This concession (which previously only provided for a victim of domestic abuse in the UK with permission as a partner under Appendix FM or Appendix Armed Forces) was expanded from 16 February 2024 to provide a three-month period of status and temporary support to a migrant victim of domestic abuse in the UK as a dependent partner of a migrant in the UK with permission on a work route or as a student. This is in addition to the previous policy of providing the same period of immigration status and temporary support to a victim of domestic abuse in the UK with permission as a partner under Appendix FM or Appendix Armed Forces (Appendix VDA from 31 January 2024).

This policy extension responds to the findings of the Support for Migrant Victims (SMV) Scheme (initially run as a pilot between July 2021 and July 2022, to support migrant victims of domestic abuse who do not have access to public funds to access safe accommodation).

From 4 April 2024, the eligibility for the Migrant Victims of Domestic Abuse Concession (MVDAC) was further expanded to include a spouse, civil partner or durable partner under Appendix EU with pre-settled status under the EU Settlement Scheme (including where that was granted or is now held on the basis of retained rights), and their dependent children.

The policy does not provide for all victims of domestic abuse and not everyone granted permission under this concession will be eligible to apply for settlement under Appendix VDA.

Policy intention

The overall intention of the policy is to protect eligible migrant victims of domestic abuse and their children, and thus support the most vulnerable by:

• providing an eligible victim of domestic abuse a period of 3 months’ permission to stay independent from their partner
• providing an ability to apply for recourse to public funds to enable financial support where required
• facilitating an application for permission to stay in a relevant immigration route, apply for settlement on form SET (DV) as a victim of domestic abuse if eligible under Appendix VDA, or make plans to leave the UK during a short period of lawful status, financial stability and support from specialist services

This is a policy concession outside the Immigration Rules, due to the unique nature of the applications and speed in which decisions must be taken to best support eligible victims.

This policy does not provide for migrants here with status in their own right, such as students and workers, who already have status independent from their abuser and should be financially independent as assessed in their initial application to enter the UK and can retain their current status if they choose, with additional support from the SMV scheme and the charity sector available. Nor does the policy provide for illegal entrants or those who entered the UK temporarily, for example as a visitor who overstayed, as it would be contradictory to the Government’s overall approach to illegal migration.

Any previous permission held is varied automatically upon being granted permission under the Migrant Victims of Domestic Abuse Concession (MVDAC).

Eligibility

This page tells you the requirements which must be met for an applicant to qualify for temporary permission outside the immigration rules, under the Migrant Victims of Domestic Abuse Concession (MVDAC).

For the purpose of this guidance, the definitions are the same as those set out in the Domestic Abuse Act 2021, and in the Domestic Abuse Statutory Guidance .

Eligibility for this concession is limited to those who are, or have last been granted permission as, one of the following:

• a partner under Appendix FM (except for permission as a fiancé or fiancée or proposed civil partner) of a person who is a British citizen, settled in the UK or a European Economic Area (EEA) national in the UK with limited leave to enter or remain granted under paragraph EU3 of Appendix EU on the basis of meeting condition 1 in paragraph EU14 of Appendix EU
• a spouse, civil partner or durable partner under Appendix EU with limited leave to enter or remain as a family member of a relevant EEA citizen (or of a qualifying British citizen), as a joining family member of a relevant sponsor or as a family member who has retained the right of residence, granted under paragraph EU3 or EU3A of that Appendix
• a partner under Appendix FM, Part 11, or Appendix Family Reunion (Protection) of a person with permission as a refugee
• a partner of a person present and settled in the UK under paragraph 285 or 295E of Part 8
• a partner under Appendix Armed Forces or Part 7 (except for permission as a fiancé or fiancée or proposed civil partner) of a person who is or was a member of HM Armed forces
• or as a partner of a person with permission to enter or stay on a work route or as a student
• the applicant’s relationship has broken down due to them being a victim of domestic abuse
• the applicant requires a short period of permission to stay independent from their sponsor partner or lead student or worker applicant
• the applicant wants the option to apply for access to public funds

EU Settlement Scheme (EUSS)

A person may be granted limited leave to enter or remain under Appendix EU (also referred to as pre-settled status under the EUSS) as a spouse, civil partner or durable partner of a relevant EEA citizen (or of a qualifying British citizen or relevant sponsor), where they are, or for the relevant period were, party to a marriage, in a civil partnership or in a durable partnership, with that relevant EEA citizen, qualifying British citizen or relevant sponsor. This means that they can apply under this route where they were granted pre-settled status as the spouse, civil partner or durable partner of that person (including where they have since become a ‘family member who has retained their right of residence’ under Appendix EU, by virtue of their relationship with that person) or where they were granted pre-settled status as a ‘family member who has retained the right of residence’ under Appendix EU.

Other than dependent children, other family members who have or last had pre- settled status under the EUSS are ineligible under this route. Any family members who have or last had an EUSS family permit are also ineligible under this route.

For more information on how the EUSS and the EUSS family permit provide for victims of domestic abuse, under those routes. For more information, see the section ‘A family member who has retained the right of residence’ in EU Settlement Scheme: EU, other EEA and Swiss citizens and their family members and EU Settlement Scheme Family Permit and Travels Permit.

Work routes

Most of the categories under the Immigration Rules relate to work. Not all work routes allow for dependent partners to be granted permission, but, where they do, those partners are included under this concession.

A work route is defined broadly as any route that involves an economic purpose. It includes long standing routes such as UK Ancestry, closed routes such as Turkish worker / businessperson and newer routes such as High Potential Individual.

Work routes can all be found on the work in the UK page at GOV.UK.

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You must inform the applicant in that letter they should make a separate application to the Department for Work and Pension (DWP) to receive public funds which will be assessed against the normal DWP criteria.

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• Open access
• Published: 09 September 2024

Exploring the impact of housing insecurity on the health and wellbeing of children and young people in the United Kingdom: a qualitative systematic review

• Emma S. Hock 1 ,
• Lindsay Blank 1 ,
• Hannah Fairbrother 1 ,
• Mark Clowes 1 ,
• Diana Castelblanco Cuevas 1 ,
• Andrew Booth 1 ,
• Amy Clair 2 &
• Elizabeth Goyder 1  

BMC Public Health volume  24 , Article number:  2453 ( 2024 ) Cite this article

Metrics details

Housing insecurity can be understood as experiencing or being at risk of multiple house moves that are not through choice and related to poverty. Many aspects of housing have all been shown to impact children/young people’s health and wellbeing. However, the pathways linking housing and childhood health and wellbeing are complex and poorly understood.

We undertook a systematic review synthesising qualitative data on the perspectives of children/young people and those close to them, from the United Kingdom (UK). We searched databases, reference lists, and UK grey literature. We extracted and tabulated key data from the included papers, and appraised study quality. We used best fit framework synthesis combined with thematic synthesis, and generated diagrams to illustrate hypothesised causal pathways.

We included 59 studies and identified four populations: those experiencing housing insecurity in general (40 papers); associated with domestic violence (nine papers); associated with migration status (13 papers); and due to demolition-related forced relocation (two papers). Housing insecurity took many forms and resulted from several interrelated situations, including eviction or a forced move, temporary accommodation, exposure to problematic behaviour, overcrowded/poor-condition/unsuitable property, and making multiple moves. Impacts included school-related, psychological, financial and family wellbeing impacts, daily long-distance travel, and poor living conditions, all of which could further exacerbate housing insecurity. People perceived that these experiences led to mental and physical health problems, tiredness and delayed development. The impact of housing insecurity was lessened by friendship and support, staying at the same school, having hope for the future, and parenting practices. The negative impacts of housing insecurity on child/adolescent health and wellbeing may be compounded by specific life circumstances, such as escaping domestic violence, migration status, or demolition-related relocation.

Housing insecurity has a profound impact on children and young people. Policies should focus on reducing housing insecurity among families, particularly in relation to reducing eviction; improving, and reducing the need for, temporary accommodation; minimum requirements for property condition; and support to reduce multiple and long-distance moves. Those working with children/young people and families experiencing housing insecurity should prioritise giving them optimal choice and control over situations that affect them.

Peer Review reports

Introduction

The impacts of socioeconomic position in childhood on adult health outcomes and mortality are well documented in quantitative analyses (e.g., [ 1 ]). Housing is a key mechanism through which social and structural inequalities can impact health [ 2 ]. The impact of housing conditions on child health are well established [ 3 ]. Examining the wellbeing of children and young people within public health overall is of utmost importance [ 4 ]. Children and young people (and their families) who are homeless are a vulnerable group with particular difficulty in accessing health care and other services, and as such, meeting their needs should be a priority [ 5 ].

An extensive and diverse evidence base captures relationships between housing and health, including both physical and mental health outcomes. Much of the evidence relates to the quality of housing and specific aspects of poor housing including cold and damp homes, poorly maintained housing stock or inadequate housing leading to overcrowded accommodation [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The health impacts of housing insecurity, together with the particular vulnerability of children and young people to the effects of not having a secure and stable home environment, continue to present a cause for increased concern [ 7 , 8 , 11 , 14 ]. The National Institute for Health and Care Research (NIHR) Public Health Reviews (PHR) Programme commissioned the current review in response to concerns about rising levels of housing insecurity and the impact of housing insecurity on the health and wellbeing of children and young people in the United Kingdom (UK).

Terminology and definitions related to housing insecurity

Numerous diverse terms are available to define housing insecurity, with no standard definition or validated instrument. For the purpose of our review, we use the terminology and definitions used by the Children’s Society, which are comprehensive and based directly on research with children that explores the relationship between housing and wellbeing [ 15 ]. They use the term “housing insecurity” for those experiencing and at risk of multiple moves that are (i) not through choice and (ii) related to poverty [ 15 ]. This reflects their observation that multiple moves may be a positive experience if they are by choice and for positive reasons (e.g., employment opportunities; moves to better housing or areas with better amenities). This definition also acknowledges that the wider health and wellbeing impacts of housing insecurity may be experienced by families that may not have experienced frequent moves but for whom a forced move is a very real possibility. The Children’s Society definition of housing insecurity encompasses various elements (see Table  1 ).

Housing insecurity in the UK today – the extent of the problem

Recent policy and research reports from multiple organisations in the UK highlight a rise in housing insecurity among families with children [ 19 , 22 , 23 ]. Housing insecurity has grown following current trends in the cost and availability of housing, reflecting in particular the rapid increase in the number of low-income families with children in the private rental sector [ 19 , 22 , 24 ], where housing tenures are typically less secure. The ending of a tenancy in the private rental sector was the main cause of homelessness given in 15,500 (27% of claims) of applications for homelessness assistance in 2017/18, up from 6,630 (15% of claims) in 2010/11 for example [ 25 ]. The increased reliance on the private rented sector for housing is partly due to a lack of social housing and unaffordability of home ownership [ 23 ]. The nature of tenure in the private rental sector and gap between available benefits and housing costs means even low-income families that have not experienced frequent moves may experience the negative impacts of being at persistent risk of having to move [ 26 ]. Beyond housing benefit changes, other changes to the social security system have been linked with increased housing insecurity. The roll-out of Universal Credit Footnote 1 , with its built-in waits for payments, has been linked with increased rent arrears [ 27 , 28 ]. The introduction of the benefit cap, which limits the amount of social security payments a household can receive, disproportionately affects housing support and particularly affecting lone parents [ 29 , 30 , 31 ].

The increase in families experiencing housing insecurity, including those living with relatives or friends (the ‘hidden homeless’) and those in temporary accommodation provided by local authorities, are a related consequence of the lack of suitable or affordable rental properties, which is particularly acute for lone parents and larger families. The numbers of children and young people entering the social care system or being referred to social services because of family housing insecurity contributes further evidence on the scale and severity of the problem [ 32 ].

The COVID-19 pandemic exacerbated housing insecurity in the UK [ 24 ], with the impacts continuing to be felt. In particular, the pandemic increased financial pressures on families (due to loss of income and increased costs for families with children/young people at home). These financial pressures were compounded by a reduction in informal temporary accommodation being offered by friends and family due to social isolation precautions [ 24 ]. Further, the COVID-19 pandemic underscored the risks to health posed by poor housing quality (including overcrowding) and housing insecurity [ 24 , 33 ]. Recent research with young people in underserved communities across the country also highlighted their experience of the uneven impact of COVID-19 for people in contrasting housing situations [ 34 ].

While the temporary ban on bailiff-enforced evictions, initiated due to the pandemic, went some way towards acknowledging the pandemic’s impact on housing insecurity, housing organisations are lobbying for more long-term strategies to support people with pandemic-induced debt and rent-arrears [ 33 ]. The Joseph Rowntree Foundation has warned of the very real risk of a ‘two-tier recovery’ from the pandemic, highlighting the ‘disproportionate risks facing people who rent their homes’ ([ 35 ], para. 1). Their recent large-scale survey found that one million renting households worry about being evicted in the next three months, and half of these were families with children [ 35 ]. The survey also found that households with children, renters from ethnic minority backgrounds and households on low incomes are disproportionately affected by pandemic-induced debt and rent arrears [ 35 ].

The cost-of-living crisis is exacerbating the impact of the COVID-19 pandemic, with many households experiencing or set to experience housing insecurity due to relative reductions in income accompanying increases in rent and mortgage repayments [ 36 ]. People experiencing or at risk of housing insecurity are disproportionately affected, due to higher food and utility costs [ 37 ].

Research evidence on relationships between housing in childhood and health

Housing is a key social determinant of health, and a substantive evidence base of longitudinal cohort studies and intervention studies supports a causal relationship between the quality, affordability and stability of housing and child health [ 38 ]. Evidence includes immediate impacts on mental and physical health outcomes and longer-term life course effects on wider determinants of health including education, employment and income as well as health outcomes [ 39 ].

The negative health impact of poor physical housing conditions has been well documented [ 40 , 41 ]. Housing instability and low housing quality are associated with worse psychological health among young people and parents [ 42 , 43 ]. The UK National Children’s Bureau [ 22 ] draws attention to US-based research showing that policies that reduced housing insecurity for young children can help to improve their emotional health [ 44 ], and that successful strategies for reducing housing insecurity have the potential to reduce negative outcomes for children with lived experience of housing insecurity, including emotional and behavioural problems, lower academic attainment and poor adult health and wellbeing [ 45 ]. A variety of pathways have been implicated in the relationship between housing insecurity and child health and wellbeing, including depression and psychological distress in parents, material hardships and difficulties in maintaining a good bedtime routine [ 38 ]. Frequent moves are also associated with poorer access to preventive health services, reflected, for example, in lower vaccination rates [ 46 , 47 ].

Housing tenure, unstable housing situations and the quality or suitability of homes are inter-related [ 48 ]. For example, if families are concerned that if they lost their home they would not be able to afford alternative accommodation, they may be more likely to stay in smaller or poor-quality accommodation or in a neighbourhood where they are further from work, school or family support. In this way, housing insecurity can lead to diverse negative health and wellbeing impacts relating to housing and the neighbourhoods, even if in the family does not experience frequent moves or homelessness [ 49 ]. Thus, the relationship between housing insecurity and child health is likely to be complicated by the frequent coexistence of poor housing conditions or unsuitable housing with housing insecurity. The relationship between unstable housing situations and health outcomes is further confounded by other major stressors, such as poverty and changes in employment and family structure, which may lead to frequent moves.

The evidence from cohort studies that show a relationship between housing insecurity, homelessness or frequent moves in childhood and health related outcomes can usefully quantify the proportion of children/young people and families at risk of poorer health associated with housing instability. It can, however, only suggest plausible causal associations. Further, the ‘less tangible aspects of housing’ such as instability are poorly understood [ 40 ]. Additional (and arguably stronger) evidence documenting the relationship between housing insecurity and health/wellbeing comes from the case studies and qualitative interviews with children and young people and families that explore the direct and indirect impacts of housing insecurity on their everyday lives and wellbeing. Thus, the current review aimed to identify, appraise and synthesise research evidence that explores the relationship between housing insecurity and the health and wellbeing among children and young people. We aimed to highlight the relevant factors and causal mechanisms to make evidence-based recommendations for policy, practice and future research priorities.

We undertook a systematic review synthesising qualitative data, employing elements of rapid review methodology in recognition that the review was time-constrained. This involved two steps: (1) a single screening by one reviewer of titles and abstracts, with a sample checked by another reviewer; and (2) a single data extraction and quality assessment, with a sample checked by another reviewer) [ 50 , 51 , 52 ]. The protocol is registered on the PROSPERO registry, registration number CRD42022327506.

Search strategy

Searches of the following databases were conducted on 8th April 2022 (from 2000 to April 2022): MEDLINE, EMBASE and PsycINFO (via Ovid); ASSIA and IBSS (via ProQuest) and Social Sciences Citation Index (via Web of Science). Due to the short timescales for this project, searches aimed to balance sensitivity with specificity, and were conceptualised around the following concepts: (housing insecurity) and (children or families) and (experiences); including synonyms, and with the addition of a filter to limit results to the UK where available [ 53 ]. To expedite translation of search strings across different databases, searches prioritised free text search strings (including proximity operators), in order to retrieve relevant terms where they occurred in titles, abstracts or any other indexing field (including subject headings). The searches of ASSIA and IBSS (via ProQuest) and Social Sciences Citation Index (via Web of Science) used a simplified strategy adapted from those reproduced in Additional File 1. Database searching was accompanied by scrutiny of reference lists of included papers and relevant systematic reviews (within search dates), and grey literature searching (see Supplementary Table 1, Additional File 2), which was conducted and documented using processes outlined by Stansfield et al . [ 54 ].

Inclusion criteria

We included qualitative studies, including qualitative elements of mixed methods studies from published and grey literature (excluding dissertations and non-searchable books), that explored the impact of housing insecurity, defined according to the Children’s Society [ 15 ] definition (which includes actual or perceived insecurity related to housing situations), on immediate and short-term outcomes related to childhood mental and physical health and wellbeing (up to the age of 16), among families experiencing / at risk of housing insecurity in the UK (including low-income families, lone-parent families, and ethnic minority group families including migrants, refugees and asylum seekers). Informants could include children and young people themselves, parents / close family members, or other informants with insight into the children and young people’s experiences. Children and young people outside a family unit (i.e., who had left home or were being looked after by the local authority) and families from Roma and Irish Traveller communities were excluded, as their circumstances are likely to differ substantially from the target population.

Study selection

Search results from electronic databases were downloaded to a reference management application (EndNote). The titles and abstracts of all records were screened against the inclusion criteria by one of three reviewers and checked for agreement by a further reviewer. Full texts of articles identified at abstract screening were screened against the inclusion criteria by one reviewer. A proportion (10%) of papers excluded at the full paper screening stage were checked by a second reviewer. Any disagreements were resolved through discussion.

Grey literature searches and screening were documented in a series of tables [ 54 ]. One reviewer (of two) screened titles of relevant web pages and reports against the inclusion criteria for each web platform searched, and downloaded and screened the full texts of potentially eligible titles. Queries relating to selection were checked by another reviewer, with decisions discussed among the review team until a consensus was reached.

One reviewer (of two) screened reference lists of included studies and relevant reviews for potentially relevant papers. One reviewer downloaded the abstracts and full texts of relevant references and assessed them for relevance.

Data extraction

We devised a data extraction form based on forms that the team has previously tested for similar reviews of public health topics. Three reviewers piloted the extraction form and suggested revisions were agreed before commencing further extraction. Three reviewers extracted and tabulated key data from the included papers and grey literature sources, with one reviewer completing data extraction of each study and a second reviewer formally checking a 10% sample for accuracy and consistency. The following data items were extracted: author and year, location, aims, whether housing insecurity was an aim, study design, analysis, who the informants were, the housing situation of the family, reasons for homelessness or housing insecurity, conclusion, relevant policy/practice implications and limitations. Any qualitative data relating to housing insecurity together with some aspect of health or wellbeing in children and young people aged 0–16 years were extracted, including authors’ themes (to provide context), authors’ interpretations, and verbatim quotations from participants. We sought to maintain fidelity to author and participant terminologies and phrasing throughout.

Quality appraisal

Peer-reviewed academic literature was appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies [ 55 ] and the quality of grey literature sources (webpages and reports) was appraised using the Authority, Accuracy, Coverage, Objectivity, Date, Significance (AACODS) checklist [ 56 ]. Because of concerns about the lack of peer review and/or the absence of a stated methodology, it was decided to use the AACODS tool that extends beyond simple assessment of study design. A formal quality assessment checklist was preferred for journal articles that passed these two entry criteria. One reviewer performed quality assessment, with a second reviewer formally checking a 10% sample for accuracy and consistency.

Development of the conceptual framework

Prior to undertaking the current review, we undertook preliminary literature searches to identify an appropriate conceptual framework or logic model to guide the review and data synthesis process. However, we were unable to identify a framework that specifically focused on housing insecurity among children and young people and that was sufficiently broad to capture relevant contexts, exposures and impacts. We therefore developed an a priori conceptual framework based on consultation with key policy and practice stakeholders and topic experts and examination of key policy documents (see Fig.  1 ).

A priori conceptual framework for the relationship between housing insecurity and the health and wellbeing of children and young people

We initially consulted policy experts who identified relevant organisations including research centres, charities and other third sector organisations. We obtained relevant policy reports from organisational contacts and websites, including Child Poverty Action Group (CPAG), Crisis, Joseph Rowntree Foundation (JRF) and HACT (Housing Association Charitable Trust), NatCen (People Living in Bad Housing, 2013), the UK Collaborative Centre for Housing Evidence (CaCHE), and the Centre on Household Assets and Savings Management (CHASM) (Homes and Wellbeing, 2018). We also identified a key report on family homelessness from the Children’s Commissioner (Bleak Houses. 2019) and a joint report from 11 charities and advocacy organisations published by Shelter (Post-Covid Policy: Child Poverty, Social Security and Housing, 2022). We also consulted local authority officers with responsibility for housing and their teams in two local councils and third sector providers of housing-related support to young people and families (Centrepoint). Stakeholders and topic experts were invited to comment on the potential focus of the review and the appropriate definitions and scope for the ‘exposure’ (unstable housing), the population (children and young people) and outcomes (health and wellbeing). Exposures relate to how children and families experience housing insecurity, impacts are intermediate outcomes that may mediate the effects of housing insecurity on health and wellbeing (e.g., the psychological, social, and environmental consequences of experiencing housing insecurity), and outcomes are childhood health and wellbeing effects of housing insecurity (including the effects of the impacts/intermediate outcomes).

The contextual factors and main pathways between housing-related factors and the health and wellbeing of children and young people identified were incorporated into the initial conceptual framework. We then used this conceptual framework to guide data synthesis.

Data synthesis

We adopted a dual approach whereby we synthesised data according to the a priori conceptual framework and sought additional themes, categories and nuance inductively from the data, in an approach consistent with the second stage of ‘best fit framework synthesis’ [ 57 , 58 ]. We analysed inductive themes using the Thomas and Harden [ 59 ] approach to thematic synthesis, but coded text extracts (complete sentences or clauses) instead of coding line by line [ 60 , 61 ].

First, one reviewer (of two) coded text extracts inductively and within the conceptual framework, simultaneously, linking each relevant text extract to both an inductive code based on the content of the text extract, and to an element of the conceptual framework. We assigned multiple codes to some extracts, and the codes could be linked to any single element or to multiple elements of the conceptual framework. During the process of data extraction, we identified four distinct populations, and coded (and synthesised) data discretely for each population. We initially coded data against the ‘exposure’, ‘impacts’ and ‘outcomes’ elements of the conceptual framework, however we subsequently added a further element within the data; ‘protective factors’. One reviewer then examined the codes relating to each element of the conceptual framework and grouped the codes according to conceptual similarity and broader meaning, reporting the thematic structure and relationships between concepts apparent from the text extracts both narratively and within a diagram to illustrate hypothesised causal pathways within the original conceptual framework, to highlight links between specific exposures, impacts and outcomes for each population. While we synthesised the findings by population initially, and present separate diagrams for each population, we present overall findings in this manuscript due to several similarities and then highlight any important differences for the domestic violence, migrant/refugee/asylum seeker, and relocation populations.

Study selection and included studies

Here we report the results of our three separate searchers. First, the database searches generated 3261 records after the removal of duplicates. We excluded 3025 records after title and abstract screening, examined 236 full texts, and included 16 peer-reviewed papers (reporting on 16 studies). The reasons for exclusion of each paper are provided in the Supplementary Table 2, Additional File 3. Second, we examined 726 grey literature sources (after an initial title screen) and included 37 papers. Third, we examined 85 papers that we identified as potentially relevant from the references lists of included papers and relevant reviews, and included six (two of which were peer-reviewed publications). Figure  2 summarises the process of study selection and Table 2  presents a summary of study characteristics. Of the included studies, 16 took place across the UK as a whole, one was conducted in England and Scotland, one in England and Wales and 17 in England. In terms of specific locations, where these were reported, 13 were reported to have been conducted in London (including specific boroughs or Greater London), two in Birmingham, one in Fife, two in Glasgow, one in Leicester, one in Rotherham and Doncaster, and one in Sheffield. The location of one study was not reported (Table 2 ).

Flow diagram of study selection

We identified four distinct populations for which research evidence was available during the process of study selection and data extraction:

General population (evidence relating to housing insecurity in general) (reported in 40 papers);

Domestic violence population (children and young people experiencing housing insecurity associated with domestic violence) (reported in nine papers);

Migrant, refugee and asylum seeker population (children and young people experiencing housing insecurity associated with migration status) (reported in 13 papers);

Relocation population (evidence relating to families forced to relocate due to planned demolition) (reported in two papers).

Evidence relating to each of these populations was synthesised separately as the specific housing circumstances may impact health and wellbeing differently and we anticipated that specific considerations would relate to each population. Some studies reported evidence for more than one population.

Quality of evidence

The quality of evidence varied across the studies, with published literature generally being of higher quality than grey literature and containing more transparent reporting of methods, although reporting of methods of data collection and analysis varied considerably within the grey literature. All 18 peer-reviewed studies reported an appropriate methodology, addressing the aim of the study with an adequate design. Eleven of the 18 peer-reviewed studies reported ethical considerations, and only two reported reflexivity. Most studies had an overall assessment of moderate-high quality (based on the endorsement of most checklist items) and no studies were excluded based on quality. Most of the grey literature originated from known and valued sources (e.g., high-profile charities specialising in poverty and housing, with the research conducted by university-based research teams). Although methodologies and methods were often poorly described (or not at all), primary data in the form of quotations was usually available and suitable to contribute to the development of themes within the evidence base as a whole. Quality appraisals of included studies are presented in Supplementary Tables 3 and 4, Additional File 4.

Housing insecurity and the health and wellbeing of children and young people

The updated conceptual framework for the impact of housing insecurity on the health and wellbeing of children aged 0–16 years in family units is presented in Fig.  3 for the general population, Fig.  4 for the domestic violence population, Fig.  5 for the refugee/migrant/asylum seeker population, and Fig.  6 for the relocation population (arrows represent links identified in the evidence and coloured arrows are used to distinguish links relating to each element of the model). Table 3 outlines the themes, framework components and studies reporting data for each theme.

Conceptual framework for the relationship between housing insecurity and health and wellbeing in the general population

Conceptual framework for the relationship between housing insecurity and health and wellbeing in the domestic violence population

Conceptual framework for the relationship between housing insecurity and health and wellbeing in the migrant, refugee and asylum seeker population

Conceptual framework for the relationship between housing insecurity and health and wellbeing in the relocation population

Exposures are conceptualised as the manifestations of housing insecurity – that is, how the children and young people experience it – and housing insecurity was experienced in multiple and various ways. These included trouble paying for housing, eviction or the prospect of eviction, making multiple moves, living in temporary accommodation, and the inaccessibility of suitable accommodation.

Fundamentally, a key driver of housing insecurity is poverty. Parents and, in some cases, young people cited the high cost of housing, in particular housing benefit not fully covering the rent amount [ 116 ], trouble making housing payments and falling into arrears [ 15 , 92 , 97 ]. Sometimes, families were evicted for non-payment [ 15 , 102 ], often linked to the rising cost of housing [ 109 ] or loss of income [ 102 ]. Some children and young people were not aware of reasons for eviction [ 90 ], and the prospect of facing eviction was also a source of housing insecurity [ 116 ].

The cost of housing could lead to families having to move multiple times [ 116 ], with lack of affordability and the use of short-term tenancies requiring multiple moves [ 109 , 116 ]. Children and young people were not always aware of the reasons for multiple moves [ 15 ]. Multiple moves could impact upon education and friendships [ 77 , 82 ].

Living in temporary housing was a common experience of housing insecurity [ 15 , 71 , 87 , 90 , 94 , 98 , 111 , 112 , 113 , 114 ]. Temporary housing caused worry at the thought of having to move away from school and friends [ 91 ] and acute distress, which manifested as bedwetting, night waking and emotional and behavioural issues at school [ 66 ]. Living in a hostel for a period of time could lead to friendship issues due to not being able to engage in sleepovers with friends [ 102 ].

The inaccessibility of suitable accommodation also contributed to insecurity. Sometimes, when a family needed to move, they had to fulfil certain requirements, for instance, to decorate their overcrowded 3-bedroom accommodation to be eligible for a more suitable property [ 15 ]. Further, some families encountered the barrier of landlords who would not accept people on benefits [ 15 , 85 , 117 ]. Waiting lists for social housing could be prohibitively long [ 97 , 98 , 116 ].

Dual exposures and impacts

Some phenomena were found to be both exposures and impacts of housing insecurity, in that some issues and experiences that were impacts of housing insecurity further exacerbated the living situation, causing further insecurity. These included not feeling safe, exposure to problematic behaviour, living far away from daily activities, overcrowding, and poor or unsuitable condition properties.

Not feeling safe was frequently reported by children and young people, and by parents in relation to the safety of children and young people. Parents and children and young people described being moved to neighbourhoods or localities [ 15 , 69 , 87 , 90 , 103 ] and accommodation [ 87 , 97 , 109 , 112 , 113 , 114 ] that did not feel safe. For one family, this was due to racial abuse experienced by a parent while walking to school [ 69 ]. In one case, a young person’s perception of safety improved over time, and they grew to like the neighbours and area [ 15 ], although this was a rare occurrence.

Often, this experience of being unsafe was due to exposure to problematic behaviour in or around their accommodation, including hearing other children being treated badly [ 112 ], being exposed to violence (including against their parents) [ 111 , 112 , 114 ], witnessing people drinking and taking drugs [ 69 , 83 , 90 , 111 , 112 , 114 ], finding drug paraphernalia in communal areas [ 112 , 114 ] or outside spaces [ 69 ], hearing threats of violence [ 111 ], hearing shouting and screaming in other rooms [ 114 ], witnessing people breaking into their room [ 83 ], and witnessing their parent/s receiving racist abuse and being sworn at [ 83 ].

‘There’s a lot [of] drugs and I don’t want my kids seeing that… One time he said ‘mummy I heard a woman on the phone saying ‘I’m going to set fire to your face’’ She was saying these things and my son was hearing it.’ ( [ 111 ] , p.15)

Another impact related to the family and children and young people being isolated and far away from family, friends, other support networks, work, shops, school and leisure pursuits due to the location of the new or temporary housing [ 15 , 83 , 87 , 97 , 104 , 109 ]. This affected education, friendships, finances and access to services (see ‘ Impacts ’).

Overcrowding was another issue that was both a source or feature of housing insecurity, as this created a need to move, as well as being an impact, in that families moved to unsuitable properties because they had little alternative. Overcrowding was largely a feature of temporary accommodation that was too small for the family [ 67 , 91 ], including hostels/shared houses where whole families inhabited one room and washing facilities were shared [ 100 , 102 ]. In turn, overcrowding could mean siblings sharing a room and/or bed [ 15 , 41 , 64 , 71 , 78 , 109 , 111 , 112 , 113 , 114 , 116 ] (which could lead to disturbed sleep [ 15 ]), children/young people or family members sleeping on the floor or sofa [ 15 , 71 , 102 , 110 ] (which caused aches and pains in children/young people; [ 100 ]), children/young people sharing a room with parents [ 64 , 71 , 94 , 109 , 111 , 112 , 113 , 114 ], a room being too small to carry out day to day tasks [ 112 , 113 , 114 ], a lack of privacy in general (e.g., having to change clothes in front of each other) [ 70 , 111 , 112 , 114 ], living in close proximity to other families [ 114 ], and cramped conditions with little room to move when too many people and possessions had to share a small space [ 15 , 64 , 90 , 97 , 103 , 109 , 114 ].

It’s all of us in one room, you can imagine the tension…. everyone’s snapping because they don’t have their own personal space …it’s just a room with two beds. My little brother has to do his homework on the floor.’ ( [ 97 ] , p..43)

It was thus difficult for children and young people to have their own space, even for a short time [ 98 ], including space to do schoolwork [ 102 , 103 ], play [ 91 ] or invite friends over [ 103 ]. Families sometimes ended up overcrowded due to cohabiting with extended family [ 110 ] or friends [ 91 , 102 ] (‘hidden homelessness’). Other families outgrew their property, or anticipated they would in future, when children grew older [ 70 , 116 ]. Overcrowding sometimes meant multiple families inhabiting a single building (e.g., a hostel or shelter), where single parents had difficulties using shared facilities, due to not wanting to leave young children alone [ 100 ]. Overcrowding could also lead to children feeling unsafe, including being scared of other people in shared accommodation [ 102 ], experiencing noise [ 102 ], and feeling different from peers (due to not having their own room or even bed) [ 102 ]. Living in overcrowded conditions could lead to, or exacerbate, boredom, aggressive behaviour, and mental health problems among children and young people (see ‘ Outcomes ’) [ 72 , 79 , 91 ]. Overcrowded conditions caused a ‘relentless daily struggle’ for families ([ 83 ], p.48).

Similarly, the need to take whatever property was on offer led to families living in properties in poor condition, which in turn could exacerbate housing insecurity, both because families needed to escape the poor condition housing and because they were reluctant to complain and ask for repairs on their current property in case the landlord increased the rent or evicted them [ 86 , 96 ]. Eviction was perceived as a real threat and families described being evicted after requesting environmental health issues [ 74 ] and health and safety issues [ 116 ] be addressed. Families experienced issues relating to poor condition properties, including accommodation being in a poor state of decoration [ 98 ], broken or barely useable fixtures and fittings [ 86 , 90 , 96 ], no laundry or cooking facilities [ 102 ], no electricity [ 67 ], no or little furniture [ 67 , 102 ], broken appliances [ 71 , 96 , 97 ], structural failings [ 97 ], unsafe gardens [ 90 ], mould [ 71 , 90 , 96 , 97 , 104 , 109 ], and bedbugs and/or vermin [ 67 , 76 , 77 ]. Even where the property condition was acceptable, accommodation could be unsuitable in other ways. Many families with young children found themselves living in upper floor flats, having to navigate stairs with pushchairs and small children [ 71 , 74 , 78 , 83 , 87 , 92 , 109 ]. One study reported how a family with a child who had cerebral palsy and asthma were refused essential central heating and so had to request a property transfer [ 75 ]. Lack of space to play was a particular issue in relation to temporary accommodation, often due to overly small accommodation or a vermin infestation [ 80 , 87 , 91 ]. In small children, the effects included health and safety risks [ 87 , 112 ] and challenges keeping them occupied [ 112 ]. In older children and young people, a lack of space meant a lack of privacy [ 63 , 112 ]. School holidays could be particularly challenging, particularly when outside play spaces were unsuitable due to safety concerns (e.g., people selling drugs, broken glass) [ 87 , 106 ], and some temporary accommodation restricted access during the daytime [ 112 ]. With shared temporary accommodation, such as a refuge or hostel, came the threat of possessions being removed by others [ 80 ].

Impacts are defined here as intermediate outcomes that may mediate the effects of housing insecurity on health and wellbeing, for instance, the psychological, social, and environmental consequences of experiencing housing insecurity. According to the evidence reviewed, these were overwhelmingly negative, with only a very small number of positive impacts, and, in many cases, these were offset by other negative impacts. Impacts on friendships, education, family relationships, diet, hygiene, access to services, feelings of being different, feelings of insecurity, parental wellbeing, the financial situation of the family, experiences of noise, leaving negative situations behind, and other impacts, such as leaving pets behind and time costs, were noted. Overlaying all of the above was a lack of choice and control experienced by the children/young people and their families.

A particularly large and disruptive impact of housing insecurity was the effect on friendships and social networks. Over multiple moves, children and young people faced the challenge of building new social networks and reputations each time [ 15 , 90 , 106 ], and worried about maintaining existing friendships [ 90 ]. The beneficial side to this was the potential to have friends all over town, although this was offset by difficulty in forming close friendships due to frequent moves [ 15 ]. Children and young people in temporary, overcrowded or poor condition accommodation often felt ashamed of their housing and concealed it from their friends [ 15 , 73 , 78 , 111 , 112 , 114 , 115 ], and in one case missing out on sleepovers with friends [ 102 ]. Moving far from friends presented difficulties in maintaining friendships and a social life, leading to boredom and isolation [ 102 , 114 ]. The threat of an impending long-distance move could cause sadness and worry [ 114 ] and young people missed the friends they had left behind [ 15 , 90 ]. Other associated social impacts of housing insecurity exacerbated by the wider experience of poverty included turning turn down invitations to go out with friends for financial reasons [ 115 ] or to avoid leaving a parent alone with younger sibling/s [ 114 ], and feeling different from peers, either because of looking unkempt or lacking in confidence [ 115 ].

Another key impact of housing insecurity was the effect on education, and this was closely intertwined with friendship impacts. Faced with moving, often multiple times, sometimes to uncertain locations, families were faced with the decision to keep the same school or to change schools. Multiple moves and/or an unfeasibly long journey to school, led to either a decision to, or anticipating the prospect of having to, change schools [ 15 , 66 , 90 , 91 , 102 , 106 , 108 , 111 , 116 ]. This could in turn impact on the child’s sense of stability, academic performance and friendships [ 90 , 105 , 106 , 111 , 115 , 116 ] and make them feel sad [ 102 ]. In the case of one family, staying at the same school during a move resulted in decreased educational attainment [ 69 ].

Staying at the same school created some stability and allowed for friendships and connections with teachers and the school to be maintained [ 15 , 102 ]. This was, however, quite often the only option, due to the family not knowing their next location, and thus which school they would be near [ 15 , 102 , 113 ], and was not without issues. Those who were unhappy with school were thus effectively prevented from changing schools due to housing insecurity [ 15 , 90 ]. Families were often re-housed at a considerable distance from the school [ 15 , 70 , 93 , 94 , 113 ]. This meant having to get up very early for a long journey by public transport [ 15 , 66 , 70 , 77 , 88 , 90 , 94 , 102 , 105 , 106 , 111 , 113 ], which also caused problems maintaining friendships [ 115 ], increased tiredness and stress [ 15 , 66 , 77 , 102 , 111 , 113 , 114 , 115 ] and left little time for homework and extra-curricular activities [ 113 , 114 , 115 ]. Some children and young people stayed with friends or relatives closer to school on school nights, although these arrangements were not sustainable longer-term [ 15 , 90 ].

Living in temporary housing was associated with practical challenges in relation to schooling, for instance, keeping track of uniform and other possessions, limited laundry facilities, and limited washing facilities [ 112 , 115 ]. Parents noted academic performance worsened following the onset of housing problems [ 111 , 113 , 116 ]. Limited space and time to do homework or revision [ 111 , 112 , 113 , 114 , 115 ], tiredness and poor sleep [ 111 , 113 ], travelling and disrupted routines [ 114 ], disruptions from other families (e.g. in a hostel) [ 114 ], a lack of internet connection [ 114 ], and the general impact of the housing disruption [ 111 , 113 , 116 ] made it challenging for those experiencing housing insecurity to do well at school. Families often had to wake up early to access shared facilities in emergency accommodation before school [ 113 , 114 ]. Some children and young people missed school altogether during periods of transience, due to multiple moves rendering attendance unviable [ 71 , 106 , 111 ], lack of a school place in the area [ 109 ], or not being able to afford transport and lunch money [ 81 ], which in turn affected academic performance [ 106 , 111 ].

‘Their education was put on hold. My daughter was ahead on everything in her class and she just went behind during those two weeks.’ ([ 111 ] , p.15)

Children and young people also experienced an impact on immediate family relationships. Housing insecurity led to reduced family wellbeing [ 82 ], and family relationships becoming more strained, for instance, due to spending more time at friends’ houses that were far away [ 15 ]. In some cases, however, housing insecurity led to improved family relationships, for instance, in terms of a non-resident father becoming more involved [ 15 ], or children feeling closer to their parents [ 106 ].

Some impacts related to the child’s health and wellbeing. Impacts on diet were reported, including refusal of solid food (which affected growth) [ 113 ], stress and repeated moves leading to not eating properly (which resulted in underweight) [ 91 ], insufficient money to eat properly [ 15 , 99 , 106 ], a lack of food storage and preparation space [ 102 , 103 , 112 ], and a hazardous food preparation environment [ 112 ]. Unsuitable temporary accommodation, including converted shipping containers, hostels, B&Bs and poorly maintained houses were particularly likely to be associated with a wide range of other well-being related impacts. Unsuitable accommodation presented various problems, including excessive heat, dripping water, overcrowding, damp, dirt, electrical hazards, vermin, flooding and a lack of washing and laundry facilities [ 41 , 67 , 71 , 74 , 76 , 77 , 81 , 87 , 88 , 102 , 104 , 106 , 109 , 112 , 116 ]. Moving could also impact on access to services and continuity of care, including being unable to register with general practitioners [ 82 ], and difficulty in maintaining continuity of medical care [ 65 ].

Psychological impacts of housing insecurity included feeling different from peers [ 115 ], feeling disappointed in each new property after being initially hopeful [ 15 ], and having trouble fitting in, in a new area [ 15 ]. Feeling insecure (including uncertainty over when and where the next move will be, or if another move is happening) was a further impact of living in insecure housing situations (including temporary housing, making multiple moves, being evicted) [ 15 , 87 , 90 , 114 , 116 ], leading to stress and worry [ 15 , 114 ].

One of the major issues that [she] says affects her mental health is the uncertainty of their situation. She says it is hard to not know where they will be staying one night to the next. It is also difficult to adjust to living without her furniture and clothes ( [ 114 ] , p.17)

Multiple moves, or anticipating a move, disrupted children and young people’s sense of continuity and led to the experience of a loss of security and stability more generally [ 15 , 85 , 87 ]. This led children and young people to feel responsible for helping and providing support to their parents, including hiding their feelings [ 111 , 114 ], or not requesting things be bought [ 15 , 113 ]. Children and young people also felt a sense of displacement and a lack of belonging [ 15 , 115 ]. Loss of stability and security triggered a desire for stability, to be able to settle, have friends over, and not have to worry about moving [ 109 ].

Housing insecurity also had a negative effect on parent-wellbeing, and this impacted the wellbeing of young people both directly [ 15 , 65 , 102 , 106 ] and indirectly through increased arguments and family stress [ 15 , 93 ] and reduced parental ability to care for children with chronic conditions [ 41 ]. Parents also perceived their reduced wellbeing as negatively impacting their children's development [ 41 ]. The threat of sanctions for missed housing payment could lead to reduced well-being among the whole family, characterised by feelings of despair, failure and a loss of hope [ 93 ].

Moving also had a financial impact on families. Moving into much smaller temporary accommodation meant that possessions had to be left behind, with the family having to pay for decorating, carpets, curtains and furniture each time they moved [ 15 , 84 , 98 , 104 , 105 ], incurring considerable debt [ 98 ]. If the new location was far away from school, family, friends and, in some cases, shops, then the family incurred travel costs [ 15 , 87 , 94 , 112 , 114 ]. Because of all this, children and young people’s requests for possessions or experiences (e.g., trips out) were refused [ 113 ].

Excessive noise was another disruption that children and young people experienced in connection with their precarious housing situation. Sources of noise were traffic on a main road [ 15 ] a factory nearby [ 110 ], or from other people in a B&B, hotel, hostel, or neighbouring properties [ 15 , 91 , 102 , 106 , 112 ], and could disrupt sleep and daily activities.

If their current conditions were sufficiently bad, some children and young people felt positively about moving, to leave negative things behind. For instance, a move could take them close to friends [ 15 ] or they may have more space in the new property [ 15 ]. Quite often, however, negative impacts of moving seemed to offset any benefit [ 90 ].

Frequent moves could impact on children and young people’s health and wellbeing in other ways. Space might be even more squeezed by cardboard boxes in preparation for an impending move [ 15 ]. Some children reported having to leave beloved pets behind [ 90 ]. Time costs associated with moving meant less time for other activities [ 15 ]. Multiple moves, particularly across local authority boundaries, could impact the family’s access to services [ 41 , 71 ], including health services [ 90 ], specialist healthcare required to manage children’s health conditions [ 83 ], and social services [ 85 , 93 ].

One key impact that overlaid all of the above but was rarely mentioned was a lack of choice or control [ 109 ]. This was inherent in the families’ and children/young people’s accounts of their experiences of housing insecurity, through talk of not knowing where their next move would be or when, and having to move long distances away from the places they used frequently and the people who supported them. Even the journey into housing insecurity was often outside of families’ control, such as increases in rent, change in income, or eviction notices (see ‘ Exposure ’). Families often could not improve properties in poor condition because they could not afford repairs to properties in poor condition, so felt they had to live with these problems [ 90 ]. Some families avoided reporting problems to the landlord for fear of a rent increase or eviction (see ‘ Exposure ’). Children and young people in particular felt that they lacked control over their housing situation, and in some cases were not aware of reasons for moves [ 15 ].

Several childhood health and wellbeing outcomes have been documented in relation to, and they are overwhelmingly negative. These consisted of mental health problems, physical health problems, tiredness, and stunted child development. Living in temporary housing, making multiple moves, and the instability and insecurity associated with anticipating a move, or being uncertain whether a move would be needed, had an obvious negative impact on the mental health of children and young people [ 41 , 63 , 79 , 107 ], including in terms of self-harm [ 71 , 96 , 97 , 107 , 111 ], thoughts of suicide [ 71 ], anxiety [ 71 , 90 , 103 , 111 , 112 , 115 ], and depression [ 110 , 115 ]. Sometimes these problems manifested as physical pain [ 106 ], nightmares [ 84 ], night waking [ 107 ], or wetting the bed [ 63 , 107 , 111 ]. Stress, anger, isolation, fear, worry about the future (including about having to move again), worry about safety and acute distress were also reported [ 15 , 63 , 73 , 79 , 82 , 84 , 89 , 90 , 96 , 109 , 114 , 115 , 118 ]. One child with distress/mental health problems (as a result of having to make multiple moves) stopped eating properly (resulting in underweight and anaemia), and became socially withdrawn [ 79 ]. Another child reported weight loss and mental health problems due to worry about the future housing situation [ 95 ]. One study reported on stress and anxiety in children due to the trauma of losing their home and the emergency accommodation being unsuitable and temporary [ 111 ].

‘My six year old has been going to the doctors because he’s developed a nervous tick since we’ve been in that room. He was constantly nervous all the time. He’s so unsettled still and he knows that we’re still not settled. He’s really anxious. He’s become violent […]’ ( [ 111 ] , p.13)

Sometimes children and young people’s mental health issues would be displayed through problematic behaviour such as withdrawal, stealing, smoking, drug-taking, aggressive behaviour, and running away [ 68 , 71 , 79 , 84 , 97 , 107 , 114 , 115 ]. Teachers observed that younger children tended to get more withdrawn and older children and young people tended to get more angry and antagonistic, although the same child could cycle between these two states [ 115 ]. Separation anxiety was also reported [ 87 , 111 ].

Children and young people also experienced physical health problems as a result of living in temporary accommodation, poor condition housing, and making multiple moves, including the development or exacerbation of asthma [ 69 , 81 , 90 ] and eczema [ 41 , 81 , 90 , 111 ], stomach bugs [ 71 ], insect bites [ 112 ], infectious diseases [ 41 , 109 , 112 ], headaches [ 113 ], stomach aches [ 109 , 113 ], exacerbation of long-term conditions [ 41 , 75 , 109 ], rashes and asthma as a result of damp [ 100 ], a dermatological condition as a result of living in a hotel [ 91 ], other physical symptoms in young children, such as coughing and vomiting [ 100 ] and musculoskeletal pain from sleeping in unsuitable places [ 102 ]. One study reported illness in a baby following a difficult birth, attributed to housing-related stress in the mother [ 83 ]. Rarer outcomes included weight gain due to a lack of cooking facilities and thus reliance on fast food, weight loss due to stress [ 79 , 95 ] and head lice due to close contact with others [ 115 ]. Some properties presented risk of injury to babies and young children [ 41 ].

Tiredness was also reported, in relation to travelling a long distance to school and to visit family and friends [ 15 , 66 , 77 , 102 , 112 , 115 ]. Tiredness also resulted from poor quality sleep due to the unsuitable nature of the accommodation (e.g., poor state of repair, overcrowded), sleeping on a sofa [ 102 ], and worrying about the housing situation [ 15 , 41 , 87 , 109 , 112 , 114 ].

Impacts on the perceived development of young children were reported, in particular in relation to having no space to play, which impacted standing/walking and emotional development [ 87 , 111 ], and multiple moves, which impacted on potty training and speech development [ 87 , 111 ]. One study reported an impact on growth due refusal of solid food [ 113 ].

Protective factors

Protective factors were not presented in the original conceptual framework. However, we identified specific protective factors that were perceived to lessen the impact of housing insecurity on wellbeing among children and adolescents. These included friendship, keeping the same school, normalising housing insecurity, home-making, having a plan, hope, protective parenting, and some interventions.

Friendship was a key protective factor. Retaining connections with friends and peer networks following moves was important [ 15 , 90 ], and school facilitated this [ 114 ]. Indeed, another related strategy was to keep children and young people enrolled in the same school during and after moves, to retain some stability [ 15 , 70 , 90 , 108 ].

Some sources noted that children and young people tended to normalise and destigmatise their housing insecurity as something to be expected given that the family is poor or receives benefits [ 15 , 62 , 90 ]. This response could be a coping/defence mechanism to try to deal with the negative impacts of being insecurely housed.

Another, more positive, coping strategy was to make the property feel more like a home. For instance, decorating the property could lead to children and young people feeling more settled and ‘at home’, even if the ultimate intention was to move [ 15 ]. Further coping strategies included having a plan of how things could go to keep anxiety at bay and retain some control [ 15 ], seeing the advantages of a location [ 15 ], and hoping for a better house next time, and/or hoping that the family would settle in a permanent home [ 15 ].

Parents also acted to protect children and young people from the negative impacts of housing insecurity, by concealing the full extent of their financial and housing problems [ 113 ], including children and young people in decision-making [ 70 , 90 ] (for instance, allowing children and young people to influence their parents’ decisions on location, where there was a choice [ 70 ]), and presenting their situation as an adventure [ 114 ]. One study also documented parents taking their children out to parks to give them space to run around [ 91 ].

Lastly, some positive findings were reported by an evaluation of the Families Intervention Project (FIP), for families at risk of eviction due to anti-social behaviour [ 118 ]. Families that worked closely with a multi-agency team experienced increased housing security, reduced stress and anxiety, and fewer behavioural problems among the children [ 118 ]. Another study reported positive effects of a peer-led parenting programme on children’s behaviour, although it is unclear how this impacted on their health and wellbeing [ 64 ].

Key findings relating to other populations

Families that have experienced domestic violence.

Domestic violence could be a source of housing insecurity both for families who leave the family home to seek safety and for those who stay. Families that leave can end up moving multiple times (and frequently), perhaps initially to a refuge and then into other forms of temporary housing, with families experiencing uncertainty over when the next move would be [ 90 , 105 ]. One study reported that experience of living in different places was perceived to be beneficial, although little detail was given, and this was offset by difficulty building peer networks [ 90 ]. In one family, the alternative to housing insecurity was for the children to be placed in local authority care, which was avoided through the children and other parent leaving the perpetrator [ 90 ].

Among families who stay in the family home (with the perpetrator leaving), housing insecurity could be created by the perpetrator refusing to pay the mortgage, leaving the family worried and uncertain:

‘ I’ve lost two stone, my son has lost ten pounds – he is only 15 – he is having counselling at school. It has just been a nightmare…He hasn’t paid the mortgage for a year because he wants to get me out so he can have the money… ’ ([ 95 ], p. 68). Friendship was particularly impacted among this population. To prevent the perpetrator from finding them, children were not able to disclose personal information [ 63 ]. This made it difficult to form close friendships.

Parents reported a lack of support offered to children and young people, including services that they needed [ 80 ]. However, where support was offered to parents and children/young people who had moved to escape abuse in their previous home, this support could improve wellbeing [ 63 , 79 , 80 ], acting as a protective factor. Particular forms of useful support included a parenting course [ 79 ] and supportive staff and peers at hostels [ 80 ]. Hostels offered a feeling of safety due to closed-circuit television [ 80 ]. One study reported that refuge and hostel staff were perceived as helpful but powerless to keep families safe in some cases, although children and young people found it helpful to talk and open up to staff about their situation [ 63 ]. One intervention, the Sanctuary scheme, allowed people experiencing/at risk of domestic violence to remain in their own home, with additional security [ 95 ].

Migrant, refugee and asylum seeker families

Migrant, refugee and asylum seeker families experienced similar forms of housing insecurity and similar impacts on everyday life and childhood health/wellbeing as did the general population. However, migrant/refugee families reported having to move suddenly, with very little notice (e.g., 48 h) [ 77 , 82 ]. They also lacked support from services and assistance with housing from the local authority. Consequently, families would end up homeless and have to beg friends to let them sleep on their sofas [ 101 ].

Once homeless, families slept in unsuitable locations, such as on the night bus, in a church, and in the waiting room of the Accident and Emergency (A&E) department. This led to extreme tiredness; in some cases, children were too tired to attend school [ 102 ]. That type of homelessness was a particular feature of the experience of housing insecurity among this population.

‘We had to keep going to McDonalds every night and we would also go to A&E. I would have to wear my school clothes and sleep like that.… They would say we have to sleep where the people wait but it’s just like lights […] The chairs were hard.’ (child aged 9) ( [ 102 ] , p. 22)

Other considerations specific to migrant/refugee/asylum seeker families were language barriers, which compounded the challenge of adjusting to a new area [ 82 ], and pressure to cook British food rather than food from their home country in communal facilities [ 106 ].

Families forced to relocate due to demolition

Two papers identified from the database search examined experiences of relocation; families were living in local authority accommodation in Glasgow and experienced a forced move as the high-rise block of flats they lived in was due to be demolished [ 69 , 70 ]. This forced location creates housing insecurity.

Despite the common source, however, housing insecurity was experienced in different ways by different families. One family reported not wanting to move as the children liked the area and their school and nursery, and one family was offered a flat but needed outdoor space [ 70 ]. Many families experienced the pre-relocation area as unsafe due to problematic behaviour in outdoor shared areas [ 69 ]. Because of this and no access to a private garden children lacked space to play [ 70 ]. Families also reported feeling shame in relation to the local area and the poor condition of their pre-relocation housing (a high-rise block of flats), and were keen to move to a less stigmatising area with better condition housing [ 69 , 70 ].

Most families managed to relocate to areas close enough for their children and young people to attend the same schools. However two families changed schools [ 69 , 70 ]. Children and young people felt shame and stigma relating to the local area and the flats themselves, with many young people reluctant to invite friends over, or others socialising in the corridor without inviting friends inside [ 70 ]. Thus, relocation could have positive impacts on families and children/young people. For three families, moving was a positive experience, with children and young people enjoying having a garden and growing to like their new neighbours and the area [ 69 ].

Although we anticipated potentially different experiences, impacts and outcomes relating to housing insecurity across the four populations, the evidence reviewed suggests many similarities. Some exposures were common to multiple populations, for instance, being evicted or having a forced move, living in temporary accommodation, experiencing overcrowding, exposure to problematic behaviour, poor condition/unsuitable property, and making multiple moves. Common impacts included social, school-related, psychological, financial and family wellbeing impacts, having to travel long distances to attend school and see friends, having to live in a property that was unsuitable or in a poor state of repair, overcrowded and often noisy, all of which could then further exacerbate housing insecurity. Outcomes reported across multiple populations included mental health problems (which could manifest in physical ways, for example, trouble eating and sleeping, or wetting the bed) and physical health problems such as skin complaints and asthma related to poor housing conditions. Protective factors common to multiple populations included friendship and support, staying at the same school, having hope for the future, and parenting practices. Pervasive throughout all populations and accounts was an overall lack of choice or control over the housing situation and poverty as a driving force.

These findings support and build upon previous literature that has examined the impact of housing insecurity on the health and wellbeing of children and young people, in terms of reduced mental and psychological wellbeing [ 21 , 42 , 43 ], ill health relating to homelessness or poor housing conditions [ 40 , 41 ], and disrupted family processes [ 38 ]. Likewise, the findings build upon prior cohort studies that support a causal relationship with child health [ 38 ], by highlighting the details of the hardships faced by children and young people experiencing housing insecurity and exploring relationships between exposures, ‘less tangible’ impacts and health and wellbeing outcomes.

Many elements of the Children’s Society definition of housing insecurity were identifiable in our review findings. A key element of housing insecurity is financial insecurity [ 17 , 19 ]; this was borne out in our findings where families were frequently exposed to high/rising costs of housing or reduced income. Indeed, our review found that families incurred additional costs due to multiple and/or frequent moves and/or moving into temporary accommodation. This could potentially increase financial insecurity, thus creating a vicious circle of housing insecurity and poverty. Having ‘a home that does not provide a sense of safety and security’ ([ 18 ], paragraph 3) was evident when children and young people reported not feeling safe in their accommodation, and relational insecurity was evident in families’ accounts of being moved far from friends, school and support networks.

In addition, we identified certain population-specific considerations. Families experiencing domestic violence faced a difficult choice between choosing to remain in the property and leaving the property, both with insecurity attached. Housing insecurity negatively impacted on friendships for all populations, however this could be potentially more challenging for those escaping domestic violence, due to the need to keep personal information confidential in order to maintain family safety.

Parents and children/young people in migrant, refugee and asylum seeker populations spoke of having very little notice before having to move out of a property, sometimes only 48 h. This created a housing emergency, captured in accounts of families becoming homeless and having to sleep in unsuitable places, such as the Accident and Emergency department waiting room or on a night bus. In some families, parents had no recourse to public funds, so even when children and young people were born in the UK, the family still ended up destitute and homeless, leading to significant worry.

A key factor in relocation was that families were forced to move by a particular date, as the high-rise block they lived in was scheduled for demolition. Many families desired a move, due to a lack of space, overcrowding, and unsafe outdoor spaces. However many did not want to leave behind social networks and schools in the community, and even some who wanted to move had difficulty finding a suitable property (e.g., for their family size).

A key challenge to synthesising the evidence was the complexity of the data, in particular the relationships between exposures and impacts. Factors that families initially experienced as exposures could then become impacts, and particular impacts could then worsen housing insecurity, in a cyclical fashion. For instance, overcrowded conditions could precipitate a move, but then the only property available may be in a poor state of repair, with intolerable living conditions, thus prompting a further move. Another key challenge in synthesising the qualitative evidence was that many elements of the experience of housing insecurity that were experienced simultaneously by children and young people have been artificially separated within the updated conceptual frameworks, making analysis problematic. For instance, those living in poor-condition temporary accommodation may want to move due the poor state of a property, but be worried about where they may end up next and whether children/young people will have to change schools and move far from friends. Such complexity has proved challenging to our overall synthesis. Policymakers and practitioners should be aware that the diagrams illustrating the hypothesised causal pathways simplify the multiple inter-related factors related to housing insecurity that impact on the wellbeing of children and young people. Identifiable common stresses including poverty, financial difficulties and debt, immigration/refugee status and domestic abuse will also exert direct significant effects on family wellbeing that prove difficult to separate from those directly due to housing insecurity.

Limitations

Limitations of the evidence base.

We have identified numerous literature sources, many rich with data relating to the experiences of children and young people, and synthesised these data into diagrams that illustrate hypothesised causal pathways within the original conceptual framework, with accompanying descriptions of the experiences of housing insecurity in children and young people. However, we cannot establish claims for the comprehensiveness of our diagrams that map hypothesised causal pathways from housing insecurity to childhood health/wellbeing based on the original conceptual framework. We mapped associations where they were present in the accounts of children/young people and other informants. However, the evidence base may have missed other potential associations, particularly for populations covered by a small number of studies.

Within the evidence base, accounts from parents or other informants proved extremely useful in examining the impacts of housing insecurity on the health and wellbeing of children and young people, particularly for younger children who are not able to yet articulate their experiences and feelings. Nevertheless, such accounts proved an insufficient substitute for rich and nuanced data directly from the children and young people themselves. Our public involvement group have informed us that children and young people may find it difficult to talk about their housing situation, and noted that we did not identify any research that explicitly examined the perspectives of young people who provide care for a parent.

Likewise, little available information relates to the health and wellbeing of children and young people, and it is difficult to establish whether the evidence we have reviewed has captured all relevant health and wellbeing experiences. The majority of the accounts of young people focused on the impacts (or intermediate outcomes) of housing insecurity, which means that we have been able to present a rich picture of these ‘less tangible’ impacts, but also that the links from these impacts to health and wellbeing outcomes is less well understood. For instance, our public involvement group noted that we had not reported any evidence relating to bullying as a result of experiencing housing insecurity.

Strengths and limitations of the review

Strengths of our review method include the prior use of a conceptual model, developed in consultation with stakeholders and topic experts, and examination of key policy documents, which guided the process of synthesis. Synthesis was thus both deductive (i.e., informed by the a priori conceptual model) and inductive (i.e., conducted using established thematic synthesis methods), which allowed for an organised and yet rich and nuanced picture of the impacts of housing insecurity on health and wellbeing among children and young people in the UK. The review was conducted by an established team of experienced reviewers and a methodologist.

A key limitation is that literature sources were far more plentiful than anticipated, including numerous long and detailed reports identified through grey literature searching. While this enhanced the richness of the dataset, it also expanded the review workload, leading to additional time constraints. Limited time and resource could be allocated for double-checking full texts (in particular in the grey literature) and extractions, and thus only a sample were double-checked. Time constraints also prevented citation searches of key included studies. Nevertheless, such an approach remains consistent with established rapid review methods with minimal consequences for missing or mis-reported evidence [ 50 , 51 , 52 ]. Time and resource constraints also prohibited examination of how experiences may differ according to location within the UK.

Implications for policy

It is important that decisions made about housing at a national and local level reflect the impacts that insecure housing can have on children and young people, and ensures that housing insecurity is prevented in the first place. The current review findings suggest that policies should focus on reducing housing insecurity in its totality among families. One way to do this is to focus on eviction, which is a significant cause of instability and a leading cause of households seeking homelessness assistance [ 25 ]. This could include ending no-fault evictions, as has been done in Scotland for private renters since 2017 and as proposed, but yet to be introduced by the UK government in 2019. Scotland’s introduction of longer tenancy agreements with the removal of no-fault evictions may also facilitate families being able to settle and reduce the need for multiple moves. Similarly, legislating for minimum standards in the private rented sector, as currently being explored [ 119 ], will protect children and young people from being exposed to unhealthy and dangerous conditions.

Other changes could include (1) stipulating minimum requirements for space in family properties and minimum requirements for property conditions; (2) advocating for families living in the private rental sector to improve their housing situation; (3) reducing the use of short-term tenancies so families are not required to make multiple moves; (4) providing affordable housing options that give families more choice; and (5) engaging families in the design of systems and services that meet their housing needs. Addressing poverty more widely should also help to alleviate housing insecurity among families in the UK, as much of the evidence reported on how poverty initiated and/or exacerbated housing insecurity, for instance, by restricting choice and by increasing worry. However, any changes will need adequate support for enforcement, something made clear by the limited effectiveness of policy introduced to protect people from revenge/retaliatory eviction [ 97 , 120 , 121 , 122 ], improve the quality and suitability of temporary accommodation, and, where possible, reduce the need for temporary accommodation through preventative measures.

Among families escaping domestic violence, support systems are needed to avoid destitution caused by the perpetrator (e.g., not paying the mortgage). There should also be systems in place to ensure that families are housed in a permanent residence as soon as possible following the initial placement in emergency temporary accommodation after leaving the family home, with as few moves as possible. Appropriate support with housing should be made available to refugee/asylum seeker/migrant families, including those where the parents have no recourse to public funds, and short-notice and long-distance moves should be avoided, particularly where these take families away from their support systems and communities.

Implications for practice

Where possible, interventions to reduce or eliminate housing insecurity should be implemented. Where this is not possible, interventions should focus on reducing the impact of housing insecurity, for instance, by ensuring long journeys can be avoided, that accommodation is of a decent standard, and by providing adequate support to families and children young people. Practitioners who work to house families should prioritise stable, suitable and good quality housing. Practitioners who interact with children and young people experiencing housing insecurity and homelessness (e.g., clinicians, teachers, social workers) should recognise the complexity of the children and young people’s experiences, including how the situation and circumstances (e.g., escaping domestic violence, migration status) might impact on their health and wellbeing, and that impacts vary on an individual basis, particularly in assessments and family support plans. A multiagency approach should be utilised with families to mitigate the impacts of housing insecurity, poor housing conditions or unsuitable housing. Practitioners should consider the impacts of continuity of school, support and services, and the need for mental health support, parenting and counselling, for instance through providing support with transport to enable children and young people to stay at their current school, and support to maintain friendships. All those working with children/young people and families experiencing housing insecurity should consider ways to offer them optimal choice and control over situations that affect them.

All practitioners and professionals (e.g., teachers) who work with children and young people from families who have escaped domestic violence should ensure that the children and young people are receiving appropriate support from all relevant services, and that appropriate safety measures are in place to protect the family from the perpetrator.

Research recommendations

Future qualitative research could focus explicitly on the health and wellbeing of children and young people experiencing housing insecurity, and how they link with the impacts and outcomes identified in the current review. In particular, research could explore how the health and wellbeing of children and young people are affected by the impacts of housing insecurity on friendships, education, food and hygiene, financial impacts, long journeys, overcrowding, perceived safety, and access to services. Further qualitative research could examine the impact of interventions to address housing insecurity among families in the UK. Interventions with a participatory component that seek to ensure that the voices of children and young people remain central should be prioritised for further research. The voices of specific groups of young people who are likely to be marginalised (e.g., young carers) could be explored in future research. Future qualitative research should report methods of recruitment and data collection and analysis clearly and transparently, and should incorporate meaningful research reflexivity.

Conclusions

Housing insecurity has a profound impact on children and young people in families in the UK. Such housing insecurity can take many forms and result from often inter-related situations that are fundamentally connected to poverty. The resultant housing insecurity can have multiple (often simultaneous) impacts, including those that relate to educational, psychological, financial and family wellbeing impacts, having to travel long distances to attend school and see friends, and having to live in unsuitable, poorly repaired, overcrowded or noisy properties, any of which further exacerbate housing insecurity. Negative experiences can impact on health and wellbeing, in terms of mental health problems (which could manifest in physical ways) and physical health problems, as well as tiredness and developmental issues. Some experiences and situations can lessen the impact of housing insecurity on the health and wellbeing of children and young people. Negative impacts of housing insecurity on health and wellbeing may be further compounded by specific situations and life circumstances, such as escaping domestic violence, being a migrant, refugee or asylum seeker (or having a parent with that status), or experiencing a forced relocation due to housing demolition.

Availability of data and materials

All data presented in this review were already published, either in an academic journal, or a report that is publicly available. Search strings are available in Additional File 1. Data extracted from the published papers and reports included in the current study are available from the corresponding author on request.

the main social security payment in the UK; for more information see https://www.gov.uk/universal-credit

Abbreviations

Accident and Emergency (Department)

Authority, Accuracy, Coverage, Objectivity, Date, Significance

Applied Social Sciences Index and Abstracts

Bed and Breakfast (accommodation)

Critical Appraisal Skills Programme

Coronavirus Disease 2019

Families Intervention Project

United Kingdom

International Bibliography of the Social Sciences

National Institute for Health and Care Research

International prospective register of systematic reviews

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Acknowledgements

We wish to thank Katie Lewis and Liz Kitchin from the University of Sheffield for providing administrative support to the project, Karen Horrocks, from the UK Office for Health Improvement and Disparities, for revising the policy and practice implications, anonymous young people who provided PPI feedback on a lay summary and gave us an insight into key omissions from the evidence base, and Mary Crowder from the University of Sheffield for her support in accessing feedback from PPI members at a local youth organisation. We would also like to thank the policy and practice stakeholders and topic experts with whom we consulted to develop the initial conceptual framework.

This study is funded by the National Institute for Health Research (NIHR) Public Health programme (project reference 18/93 PHR Public Health Review Team). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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EH led the review, and undertook study selection, grey literature searching and selection, data extraction, quality assessment and coding, drafted the synthesis, and drafted and refined large parts of the manuscript. LB undertook study selection, data extraction, quality assessment and coding, compiled study characteristics, checked and refined the synthesis, and drafted and refined parts of the manuscript. HF undertook study selection, grey literature searching and selection, data extraction and quality assessment, co-ordinated patient and public involvement, provided topic expertise, checked and refined the synthesis, and drafted and refined parts of the manuscript. MC designed the search strategy, undertook database searches and drafted and refined parts of the manuscript. DCC undertook study selection and drafted and refined parts of the manuscript. AB provided methodological support and advice, checked and refined the synthesis, and drafted and refined parts of the manuscript. AC provided topic expertise and drafted and refined parts of the manuscript. EG undertook stakeholder consultation and protocol development, drafted and refined parts of the manuscript, and was the guarantor of the review. All authors reviewed the manuscript.

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Hock, E.S., Blank, L., Fairbrother, H. et al. Exploring the impact of housing insecurity on the health and wellbeing of children and young people in the United Kingdom: a qualitative systematic review. BMC Public Health 24 , 2453 (2024). https://doi.org/10.1186/s12889-024-19735-9

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Tyreek Hill's timeline of trouble: From a domestic violence arrest in college to Sophie Hall lawsuit with Dolphins

Tyreek Hill has established himself as one of the best and most electric players in the NFL, but the ride to the top of the league has been a bumpy one.

Hill has periodically found himself in trouble during his NFL career to date. He was accused of domestic violence during his college days, notched allegations of child abuse with the Chiefs and has made headlines with off-field altercations during his time with the Dolphins.

Hill's latest incident involves Instagram model Sophie Hall, who claims that Hill broke her leg while running football drills at the receiver's mansion in June 2023. That incident occurred just eight days after Hill's allegedly assaulted a marina employee in Miami Beach, Fla.

There's little doubt that Hill has talent. He posted 119 catches in 2023 and led the league in both receiving yards (1,799) and receiving touchdowns (13).

But as Hill again finds himself subject to a potential NFL investigation of his actions, it's worth looking at his checkered past. That's especially true considering that red flags surrounded him — and took him off many draft boards across the league — when he joined the NFL ranks in 2016.

MORE: Tyreek Hill offers support of teammate Jaylen Waddle, says he's ahead of curve in growth

Below is an overview of the trouble Hill has faced during both his college and professional careers to date:

Tyreek Hill domestic assault in college

After a couple seasons at Garden City Community College, Hill chose to play Division-I football at Oklahoma State in 2014. But he would only play one season for the Cowboys thanks to his arrest on domestic violence charges.

Crystal Espinal, Hill's girlfriend who was eight weeks pregnant with his child, told police an argument late on the night of Dec. 12, 2014, at Hill's Stillwater home escalated to physical violence. Espinal said she was choked by Hill, who also punched her in the stomach and the face. Still in pain in her stomach, she said she was concerned about the baby.

Hill spent the night in jail and on the next day was charged with felony domestic assault and battery by strangulation. That day, Oklahoma State announced it had dismissed Hill from the football and track programs. 

"Oklahoma State University does not tolerate domestic abuse or violence," the school said in a statement.

Hill initially pled not guilty. In August, represented by a new defense attorney after reportedly failing "to meet monetary obligations" with Cheryl Ramsey, Hill pleaded guilty to the charges and, thanks to a plea agreement with the district attorney’s office, received three years on probation. 

According to The Oklahoman , "the plea agreement was eventually reached thanks in part to Hill’s voluntary efforts. Along with more than $1,000 in fines and court costs, a DNA sample, two years of state supervision, and proof of employment or student status, Hill’s probation requires he complete an anger management course and a 52-week Batterer’s Intervention Program."

In 2015, West Alabama coach Brett Gilliland allowed Hill to join the football team. He played only one season for the Tigers before entering the 2016 NFL Draft.

Espinal eventually gave birth to Hill's son.

Tyreek Hill NFL Draft controversy

Hill was not invited to the NFL Combine and, due to his 2014 arrest, was not expected to be drafted. The Chiefs were willing to take the risk after Hill ran a 4.25-second 40-yard dash at his pro day.

Kansas City drafted Hill in the fifth round of the 2016 NFL Draft at No. 165 overall.

"I just want everybody to understand that we have done our due diligence with regards to full vetting each one of our draft-class members,” said then-general manager John Dorsey, via The Kansas City Star . "We would never put anybody in this community in harm’s way.”

Added Chiefs coach Andy Reid: "There has to be a certain trust here, but there’s just things that we can’t go into and go through. We want people to understand, like Dorse said, we’re not going to do anything to put this community or this organization in a bind. We uncovered every possible stone that we possibly could, and we feel very comfortable with that part of it."

Many Kansas City fans were upset with the selection. At rookie minicamp in May 2016, Hill told reporters he understood their concerns.

"The fans have every right to be mad at me," Hill said. "I did something wrong. I let my emotions get the best of me, and I shouldn’t have did it. They have every right to be mad.

"But guess what? I’m fixing to come back, be a better man, be a better citizen, and everything takes care of itself, and let God do the rest."

Dominating as a punt returner and a receiver, Hill earned three Pro Bowl selections and two All-Pro nods in his first three NFL seasons. Then, before the 2019 season, he found himself in trouble yet again.

MORE: Tyreek Hill wonders why he is 'catching strays' after Chiefs' Super Bowl win

Tyreek Hill child abuse investigation

On March 15, The Kansas City Star reported Hill was  under police investigation for battery involving him and Espinal's 3-year-old son, who had suffered a broken arm. By this time, Espinal had become Hill's fiancee.

The Chiefs said they were aware of the situation but allowed Hill to participate in the team's offseason program in April. The investigation led to Hill and Espinal temporarily losing custody of their son. On April 25, the Johnson County, Mo., district attorney announced that neither Hill nor Espinal would be charged with child abuse, but that a crime had occurred and the investigation remained active. The DA could not prove who did what to the child.

The NFL said it would wait until the Kansas Department of Children and Families concluded its own probe of the allegations before conducting its own investigation.

"I love and support my family above anything," said Hill, who maintained all along he was innocent of committing a crime, via his attorney's statement. "My son's health and happiness is my number one priority. I want to thank the Kansas City Chiefs, my attorneys, my agent and my union for supporting me through this. My focus remains on working hard to be the best person for my family and our community I can be, and the best player to help our team win."

The next night, during the first round of the 2019 NFL Draft, a Kansas City TV station released a recording of Hill and Espinal talking about what happened to their son, the criminal investigation into alleged abuse and how they handled it.

A portion of the Tyreek Hill audio with Crystal Espinal: Espinal: "What do you do when the child is bad? You make him open up his arms and you punch him in the chest." Hill: “You do use a belt. That’s sad,” Hill said. “Even my mama says you use a belt.” — Terez A. Paylor (@TerezPaylor) April 26, 2019

Espinal: "He's terrified of you." Hill: "You need to be terrified of me too, b****." — Terez A. Paylor (@TerezPaylor) April 25, 2019

Early the next morning, the Chiefs suspended Hill indefinitely. GM Brett Veach said Hill would not take part in any team activities "for the foreseeable future." Chiefs CEO and chairman Clark Hunt broke his silence on the saga that Saturday, saying the team would make the "right decision ... at the right time."

Hill's attorney issued a four-page statement to the NFL that dismissed the child abuse claims levied against Hill by Espinal. It was unclear at the time to what extent the league was investigating the matter.

"We will not interfere with that," NFL commissioner Roger Goodell told media in late May. He added that the league had not yet interviewed Hill , citing the ongoing court proceeding as the reason, but that it planned to do so.

On June 7, prosecutors said the child abuse probe involving Hill was no longer an active investigation , confirming that Hill would not face charges. Later that month, Yahoo! Sports reported Hill was scheduled to speak with the NFL. That meeting, on June 26, reportedly lasted eight hours. Unnamed sources told Yahoo! it was a "positive" day for Hill.

On July 19, the NFL declared Hill would not be suspended as a result of the league's investigation, which according to a release had been ongoing since the beginning of the saga despite the NFL's claim it was leaving the matter to local law enforcement. Below is the league's explanatory statement in full:

"Over the past four months, we have conducted a comprehensive investigation of allegations regarding Kansas City Chiefs wide receiver Tyreek Hill. Throughout this investigation, the NFL's primary concern has been the well-being of the child. Our understanding is that the child is safe and that the child's ongoing care is being directed and monitored by the Johnson County District Court and the Johnson County Department for Children and Families. "In conducting our investigation, we have taken great care to ensure that we do not interfere with the county's proceedings or compromise the privacy or welfare of the child in any way. The information developed in the court proceeding is confidential and has not been shared with us, and the court has sealed all law enforcement records. Local law enforcement authorities have publicly advised that the available evidence does not permit them to determine who caused the child's injuries. "Similarly, based on the evidence presently available, the NFL cannot conclude that Mr. Hill violated the Personal Conduct Policy. Accordingly, he may attend Kansas City's training camp and participate in all club activities. He has been and will continue to be subject to conditions set forth by the District Court, Commissioner Goodell, and the Chiefs, which include clinical evaluation and therapeutic intervention. "If further information becomes available through law enforcement, the pending court proceeding, or other sources, we will promptly consider it and take all appropriate steps at that time."

The NFL's decision not to discipline Hill stunned many in and around the league. The surprise stemmed not from the alleged violence — even though the NFL's disciplinary process does not carry the same burden of proof as the legal system does — but from the threatening language in the recording. In particular: "You need to be terrified of me, too, dumb b—."

Said NFL spokesman Brian McCarthy: "When viewed in the context of the full 11-minute, 27-second audio recording and all other information gathered, the statement did not rise to a level of warranting discipline under the personal conduct policy."

MORE: NFL not suspending Tyreek Hill is a surprise — yet, also not a surprise

Tyreek Hill assault allegations, settlement

On June 20, 2023, the Miami-Dade Police Department released a statement announcing that Hill was involved in an altercation  at Haulover Marina in Miami Beach, Fla.

Hill was accused of slapping an employee in the back of the head following a "disagreement."

A police report obtained by USA TODAY outlined that Hill and another man were fishing for tarpon off the marina dock, which was illegal. Then, two women in Hill's party boarded a docked boat before paying for services, which upset the boat's captain.

Hill's responses to the captain? "I can buy you and the boat" and "I’m No. 10 of the Miami Dolphins."

The alleged victim also claimed that one of Hill's associates offered him $200 following the incident.

Miami-Dade Police investigated the alleged assault and battery but announced on June 21 that it was declining to pursue charges against Hill. The victim retained the right to pursue criminal charges through the state attorney's office.

Eventually, Hill reached an undisclosed settlement with the alleged victim to prevent that. And in August of 2023, the NFL announced that it would not punish Hill for his latest off-field misstep.

MORE: What to know about 2023 assault allegations against Tyreek Hill

Tyreek Hill broken leg lawsuit

On Feb. 27, 2024, it was revealed that Hill is facing a lawsuit from Instagram model Sophie Hall, who claims that the Dolphins receiver broke her leg while she participated in a football drill at his mansion.

The alleged incident occurred on June 28, 2023 — just eight days after Hill's altercation at the marina — according to a copy of the lawsuit obtained by the Daily Mail .

"Defendant Hill invited Ms. Hall to participate in offensive drills with him," the complaint reads. "Defendant Hill told her that 'since her 10-year-old son played offensive lineman, she should practice that position as well."

The lawsuit noted that the drills took place in a "playful" manner. However, Hall claims that Hill was "humiliated" after she was able to "hold her own" against him and even knock him back, on occasion. That led the "enraged" 29-year-old receiver to charge at her with "crushing force."

Hill then "forcefully and purposefully shoved Ms. Hall, severely fracturing her leg," which left her in "excruciating pain."

Hall's lawsuit against Hill contains pictures of her X-rays and screenshots of Hill's DMs to her. The Instagram model also  posted a video of herself  in a wheelchair and cast last July, a few weeks after the alleged incident.

Hall had surgery as a result of the injury, has weekly physical therapy sessions and still experiences persistent pain in her leg, as outlined in the lawsuit. Her attorneys also referenced Hill's checkered past without referencing any specific transgressions in the lawsuit.

"Defendant Hill's aggression towards Ms. Hall is consistent with his history of violent and aggressive behavior towards women," the lawsuit reads.

Tyreek Hill detainment 2024

Just hours before the Dolphins' 2024 season opener, Hill was detained by police outside of Miami's Hard Rock Stadium for a driving violation. 

A bystander caught the arrest on video, where Hill is seen in handcuffs with multiple officers at the scene. 

TYREEK HILL ARRESTED BEFORE OPENING KICKOFF RIGHT OUTSIDE HARD ROCK STADIUM #nfl #nflopeningday #fantasyfootball #espn #miami #MiamiDolphins pic.twitter.com/9MtCikLMcS — Nolan (@NolanFried73315) September 8, 2024

In addition, ESPN's Adam Schefter posted a video showing Hill in handcuffs, laying on his stomach on the ground. 

Video of Tyreek Hill’s arrest today: pic.twitter.com/Kope2Ma6tk — Adam Schefter (@AdamSchefter) September 8, 2024

ESPN's Jeff Darlington reported that Hill was "cited for reckless driving as a result of his incident outside the stadium with police." Hill reportedly got into a "verbal altercation with police" after he was pulled over. As a result the officer "chose to place Hill in handcuffs" and he was "cited and released after the situation was deescalated."

TSN's Jacob Camenker and Bryan Murphy also contributed to this report.