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Improving healthcare for survivors and perpetrators of domestic violence and abuse

"For a variety of reasons, survivors and perpetrators of DVA often do not receive adequate healthcare and we hope our research will go some way to rectifying this." -- Prof Gene Feder, Centre for Academic Primary Care

19 November 2014

Healthcare professionals, researchers and survivors of domestic violence and abuse (DVA) are meeting today [19 November] at a conference in Bristol to discuss the findings of a five-year research programme, the largest of its kind in the UK.

Funded by the National Institute for Health Research (NIHR), the Programme of Research on Violence in Diverse Domestic Environments (PROVIDE) aims to improve outcomes for survivors of DVA and the quality of healthcare for survivors and perpetrators.

The conference precedes National Domestic Violence Awareness Week, which runs from 25 to 29 November, and raises awareness of the issues and support available to the 1.2 million women and 784,000 men who experience domestic violence and abuse in England and Wales each year.

The programme found that one in six of all men consulting their GP about a mental health issue, was a current or recent victim/perpetrator of DVA and that GPs need to be aware of the strong association between negative behaviours, DVA and men’s mental health states whether they are victims or perpetrators. There were similar findings in sexual health clinics.

Other key findings from the PROVIDE project include:

  • There is a clear need for mental health services to establish appropriate strategies and responses to DVA to ensure optimal care of this vulnerable population.
  • Lifetime and past-year male victims and perpetrators of DVA (who overlapped substantially), experienced similarly poor mental health.
  • Health professionals should receive training on domestic violence in same sex relationships, including how to make sensitive enquiries about the possibility of abuse, and the impact of abuse on physical and emotional wellbeing and sexual risk behaviours.
  • Health professionals need to be aware of the local and national domestic violence organisations that offer support to the lesbian, gay, bisexual and transsexual (LGBT) community.
  • Attitudes to help-seeking are affected by differing subject positions such as gender and sexuality.

PROVIDE involved many researchers and participants, including more than 2500 men, from 16 general practices in the South West; two sexual health clinics in London; and a unique clinical trial involving 260 women recruited from DVA agencies in Bristol and Cardiff.

Chief investigator Prof Gene Feder, from the Centre for Academic Primary Care at the University of Bristol, said: “For a variety of reasons, survivors and perpetrators of DVA often do not receive adequate healthcare and we hope our research will go some way to rectifying this. Doctors and other healthcare professionals often find it difficult to identify survivors and perpetrators of DVA.”

Researchers from across the country surveyed the extent and impact of abuse in general practice and sexual health clinic populations; studied the relationship between DVA and mental health; developed training to increase clinicians’ confidence in responding appropriately to male patients affected by DVA; and trialed a new method of offering psychological support to women survivors of DVA.

Co-investigator Prof Marianne Hester from the Centre for Gender and Violence Research at University of Bristol said: "These findings show us how complex it can be to detect experience of, and perpetration of, potentially abusive behaviours in men who present in general practice.

“We found that men who experience or perpetrate domestic violence do present, often with symptoms of anxiety and depression, and they consider it appropriate to be asked about domestic violence. If trained to refer to specialist services, without the need to decide if a patient is a victim or perpetrator, then practitioners can better address the needs of these patients, which will lead to positive outcomes for the patient as well as their wider family network."

The conference will also discuss early promising findings from PATH (Psychological Advocacy Towards Healing), a clinical trial that compared additional psychological care with usual supportive care for women who have experienced DVA. The PATH intervention aims to empower women by acknowledging the impact of abuse upon psychological wellbeing. It involves training DVA advocates to deliver a psychological intervention. The trial outcomes were mental health measures, including symptoms of depression, anxiety and post-traumatic stress disorder.

Programme manager and researcher, Dr Jayne Bailey said: “When women go to their GP, they are often not identified as DVA survivors or they are referred to mental health services and do not get any practical help such as finding new accommodation or access to finance. On the other hand, when DVA survivors approach support organisations they often receive the practical support but not the counseling they need. PATH aims to bridge this gap by training DVA advocates to be able to counsel survivors effectively.”

The PROVIDE Conference brings together academics, policy makers, commissioners, health professionals, support organizations and survivors from across the UK. It is being held at Engineers House in Bristol on Wednesday 19 November.

PROVIDE is a collaboration between the University of Bristol, Kings College London, the London School of Hygiene and Tropical Medicine, University of Central Lancashire, third sector organisations Cardiff Women’s Aid, Bristol Next Link and RESPECT and Bristol City Council. It is supported by commissioners of health and social care. 

Further information

Notes for editors
If you would like to arrange an interview with one of the researchers, please contact the University of Bristol press office on 0117 3318092 or email

The PROVIDE programme represents independent research commissioned by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) Programme (RP-PG-0108-10084).

About the NIHR
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world.

For further information, visit the NIHR website.

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