Following on from the first year of IRIS in Herefordshire, which was funded by the Home Office through Standing Together Against Domestic Abuse ( STADA), we are thrilled to confirm that a further 12 months funding has been secured jointly from Herefordshire Council and the Integrated Care Board. Research has shown that this is great value for money as the estimated cost of domestic violence and abuse, including physical and mental health costs, is £66 billion per year (Home Office, 2019).
Our Herefordshire Services Manager, Catherine Collis reports on the last 12 months and its significant impact..
IRIS in Herefordshire is delivered by a full-time Advocate Educator employed by West Mercia Women’s Aid and a Clinical Lead who is employed in her substantive position as Advanced Nurse Practitioner by Herefordshire General Practice. They work as a team to deliver the IRIS training programme and provide ongoing support to health professionals to utilise their newly-acquired knowledge to engage with patients whom they feel may be living with domestic abuse. An evaluation of the cost-effectiveness of IRIS found that implementing the IRIS programme saved £14 for each woman aged 16 or older registered in general practice (Barbosa et al, 2018); The same study shows an increase in quality of life for each woman affected by domestic abuse.
The funding will ensure that victim survivors of domestic abuse from all regions of the county will be able to access specialist support through their GP practice via the WMWA Advocate Educator, who takes referrals directly from each practice. In a rural county such as Herefordshire this means that the county is able to address some of the additional risks and challenges faced by those experiencing domestic abuse and who live in rural areas, risks which have been identified in a number of studies, including; ‘The impact of rurality on women’s ‘space for action’ in domestic abuse (Farhall, Kate, Harris, Bridget, & Woodlock, Delanie, 2020: Findings from a meta-synthesis). International Journal of Rural Criminology, 5(2), pp. 181-203) and in analysis of victims of domestic homicides which indicated that there is a greater risk of being a victim in a predominantly rural area Quantitative analysis of domestic homicide reviews: October 2022 to September 2023 (accessible) – GOV.UK
The specific challenges faced by those ln rural areas was also the subject of findings of the 2019 National Rural Crime Network research ‘Domestic abuse in rural areas’ National Rural Crime Network – Rural Services Network which highlighted amongst other things that:
- Rural victims are half as likely to report their abuse to others
- Rural victims’ abuse goes on significantly longer
- Rural victims cannot readily access support services
- Rural victims live in a society that de facto protects the perpetrators
- Rural victims are isolated, unsupported and unprotected in a rural hell, which is purposefully ‘normalised’
GP staff will continue to have access to IRIS training and support, ensuring that confidence in asking their patients about domestic abuse is maintained. The Herefordshire IRIS project has already gone beyond that of other IRIS projects across the country by training 58 trainee GP’s and will be delivering IRIS training to social prescribers in the near future. The ambitious plans continue into year two when training will be expanded to include Wellbeing Coaches and out of hours locum doctors from across the county, again something which IRIS has not achieved in other areas of the country. To date 15 of the 19 surgeries across Herefordshire have either booked or completed training for their clinical and non-clinical staff, and referrals to WMWA have shot up from 5 or less per year from GP practices to a current total of 81 referrals – including 10 men who are offered a referral to Cranstoun,(Herefordshire Male Victim Services) – since the launch of IRIS Herefordshire in February 2024, this reflects the impact of IRIS nationally as most recent research (Panovska-Griffiths et al, 2020) shows; that the IRIS programme is sustainable and that practices with IRIS are 30 times more likely to make a referral to specialist support for their patients than those without IRIS.
Trends that were identified are:
- Relative wealth and high social standing of the alleged perpetrators i.e. successful professionals or business owners, giving them greater access to financial and social control
- Divorce and post-separation abuse
- Male referrals were higher than we see through our helplines
- Isolation and loneliness due to rurality was a significant factor
- Staying in Herefordshire was key and housing options are limited
- Largely older victim survivors who faced homelessness and destitution due to trapped wealth and economic abuse
Domestic Abuse is clearly a health issue with victim survivors presenting with chronic conditions, addictions and a significant mental health impact as a consequence of their experience of abuse. The work undertaken by the Herefordshire IRIS Advocate Educator suggests that clients referred by GPs to date are clients who would not have self-referred to WMWA or gone to the Police. Most had not heard of Women’s Aid, and/or did not interpret their lived experience as domestic abuse. The view of the IRIS Clinical Lead for Herefordshire is that “IRIS training equips clinicians to have the confidence to ask their patients about Domestic Abuse; to gain knowledge of the common conditions that exist within victim survivors (gynaecological, pregnancy, IBS, chronic pain, poor mental health); to understand more about DA in all its guises and understand how to make initial brief assessment of risk / safety. GPs have always had a key role in safeguarding their patients and the IRIS training has really connected clinicians with West Mercia Women’s Aid through (the Advocate Educator’s) ability to work quickly and closely with women providing specialist support to safety.”
The training is part of continuous professional development in safeguarding for both clinical and administrative personnel, and as has been highlighted from sadly too many domestic homicide reviews, it is not uncommon for both perpetrators and victims to have contact exclusively with their GP without any other professional support network. To date 440 individuals have been trained: 196 admin and reception staff are fully IRIS trained, 109 clinicians are fully IRIS trained, and a further 135 clinicians are partially IRIS trained.
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