Analysis

Domestic violence and abuse: how one nurse’s innovation is supporting people with learning disabilities

People with learning disabilities can be especially vulnerable to domestic violence and abuse, and nurses can play a vital role in helping them
People with learning disabilities are especially vulnerable to domestic violence and abuse

People with learning disabilities are especially vulnerable to domestic violence and abuse, and nurses can play a vital role in helping them

  • Nurses have a responsibility to help people who experience domestic violence and abuse
  • A nurse has designed an informative card for people with learning disabilities about domestic violence and abuse and help available
  • Learn about what constitutes domestic violence and abuse, and how abusive relationships can develop
Picture: iStock

When primary care liaison nurse Sarah Atkinson discovered a client's history of domestic violence and abuse, she knew she had to find a way of helping her.

There was a note saying long-term

...

People with learning disabilities are especially vulnerable to domestic violence and abuse, and nurses can play a vital role in helping them

  • Nurses have a responsibility to help people who experience domestic violence and abuse
  • A nurse has designed an informative card for people with learning disabilities about domestic violence and abuse and help available
  • Learn about what constitutes domestic violence and abuse, and how abusive relationships can develop
People with learning disabilities are especially vulnerable to domestic violence and abuse
Picture: iStock

 

When primary care liaison nurse Sarah Atkinson discovered a client's history of domestic violence and abuse, she knew she had to find a way of helping her.

‘There was a note saying long-term domestic violence situation,’ recalls Ms Atkinson, who qualified as a learning disability nurse in 1997. ‘But during all the primary care appointments I attended with her no one ever asked how she was or whether she was safe.’

At one point the woman was admitted to hospital, following an assault by her partner. ‘The next time I saw her, I asked who she had talked to about what had happened. She told me she had no one.’

What is domestic violence and abuse?

According to the National Institute for Health and Care Excellence, domestic violence and abuse includes controlling, coercive or threatening behaviour, violence or abuse between those who are either family members or current or previous intimate partners. It includes psychological, physical, sexual, financial and emotional abuse.

 

‘She didn’t see anything wrong with his behaviour and thought it meant he loved her’

Primary care liaison nurse Sarah Atkinson
Sarah Atkinson

Ms Atkinson witnessed the partner’s controlling behaviour at first hand.

‘During our appointments, he would ring every couple of minutes to see where she was and she would often put me on the phone to corroborate,’ says Ms Atkinson, who works for Nottinghamshire Healthcare NHS Foundation Trust.

‘One day she turned up wearing layers of clothing. When I asked if she was hot, she said that’s what her partner had put out for her to wear that day. She didn’t see anything wrong with his behaviour and thought it meant he loved her.

She also relied on me to get her to important health appointments, as she had no money.

The situation continued for several years, with children removed from the home because of the threat of violence. In the past, the woman had been given cards containing information including sources of support.

‘But she couldn’t read, so they were of no use whatsoever. She used to throw them in the bin,’ says Ms Atkinson.

‘Eventually I thought there must be a resource in an accessible format designed to help those in her position.’

Despite extensive research, she found nothing suitable.

‘It just didn’t exist. I was shocked,’ says Ms Atkinson. ‘Everyone I approached said if you find one let us know, because it would be really useful.’

Encouraged by colleagues, she decided to create something herself, and the wallet-sized card was launched in November 2019. Later Nottinghamshire Police asked if they could include it in their revised handbook on domestic violence and abuse.

A key aspect of its development was involving clients throughout, through various learning disability service user groups, including one where a member had been killed in an incident of domestic violence.

Domestic violence card created by nurse Sarah Atkinson (front)

Domestic violence card created by nurse Sarah Atkinson (back)

Cards now being used in other settings as well as learning disability services

‘They were keen to get it right, because they’d lost someone,’ says Ms Atkinson. ‘I’d show them a picture which I thought was straightforward, but they would give me a different view, which made me think again.’

The colours black and yellow were chosen because they work best for those who have visual impairments.

Available electronically and as a printed card, it is now being used in other settings as well as local learning disability services, including for people with dementia, hospitals, children’s services, for patients where English is not their first language and with the travelling community.

Funding has just been agreed for every local GP surgery to have copies.

Feedback has been positive, according to Ms Atkinson, who hopes the card will enable health and social care professionals to start a conversation. ‘When I began the project I looked for figures and they’re not there. It’s not documented,’ she says.

‘But we know it’s happening because we’re seeing more of it. Learning disability services need to be more aware of domestic abuse. It’s still a taboo subject in society.’

How abusive relationships may develop

Figures are scarce on how many people with learning disabilities experience domestic violence and abuse.

‘They have been largely neglected,’ says University of Kent professor of learning disabilities Michelle McCarthy.

She led a two-year qualitative research study, published in 2015, that involved 15 women with mild to moderate learning disabilities who had experienced domestic violence and abuse but had left the relationship.

Some perpetrators target women with learning disabilities

‘We talked to them about the relationship they’d had, what had happened and the kind of support they might have had or sought,’ explains Professor McCarthy, whose background is in social work.

University of Kent professor of learning disabilities Michelle McCarthy
Michelle McCarthy

‘We did it because there wasn’t a lot of evidence – and there is still very little.’

She believes that some perpetrators specifically target people with learning disabilities because they believe they are easier to manipulate and abuse.

‘Women with learning disabilities are often keen to have a relationship because of the isolation they feel,’ she says. ‘In our research, the men often didn’t have learning disabilities themselves, but did have characteristics in common.’

Perpetrators may have a history of abusing partners

These included mental health problems, and drug and alcohol issues. ‘They often have a history of abusing previous partners and may be well-known to the police already,’ she says.

Relationships tended to become established quickly, with a typical pattern involving the man asking to move into the woman’s flat shortly after meeting, saying they were homeless.

‘The woman will say she invited him for a couple of days, but that turns into several days then weeks and eventually they are living there,’ says Professor McCarthy. ‘My impression is they were railroaded.’

Tactics include deliberately isolating someone from friends and family

To extricate themselves, many faced having to leave their home. ‘But for women with learning disabilities, achieving a home of your own is a very big thing. You can be very reluctant to give it up,’ says Professor McCarthy.

Deliberately isolating the woman from friends and family was another tactic.

‘And women with learning disabilities start out with a much smaller circle of contacts anyway,’ she says.

Those who are living independently and have little contact with services can be the most vulnerable to abuse as they are off the radar.

 

Asking questions about domestic violence and abuse should be part of an annual health check

Nurses can be reticent to broach the subject, she believes. ‘They can feel, if someone discloses domestic violence, what then? But we all have a responsibility,’ says Ms Atkinson.

‘We’re happy to ask questions about physical health, such as how often someone has a bowel movement, yet we won’t ask, “Are you safe at home? Is anyone hurting you or making you feel scared?” It should be part of an annual health check.’

Some may also find it hard to understand when clients stay with their abusive partners. ‘Sometimes you want to change the world and you can’t,’ says Ms Atkinson. ‘My original client is still living with her partner. But at least now she has other numbers she can call for help. She has extra tools in her kit.’

How can nurses help?

  • Obtain training on recognising signs of domestic violence and abuse and keep your knowledge up to date
  • Ask the question. ‘Disclosure is a positive thing. As a nurse, you’re in a privileged position and people trust you. It may be the first time someone says what’s happening to them and you can help,’ says primary care liaison nurse Sarah Atkinson.
  • Work with other professionals to deliver the best service
  • As a learning disability nurse, you can’t be expected to be an expert on domestic violence and abuse. But there are many working in this field, so link with them, says University of Kent professor of learning disabilities Michelle McCarthy
  • ‘It’s not your sole responsibility to help someone,’ says Ms Atkinson, who advises contacting local safeguarding services and specialist organisations such as Women’s Aid
  • Providing accessible information for clients is a key role for learning disability nurses, says Professor McCarthy. ‘Most of the women interviewed as part of our study didn’t know women’s refuges existed

Further information

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