Domestic Abuse Bill

Baroness Wilcox of Newport Excerpts

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Wednesday 27th January 2021 Lords Chamber

[Baroness Burt of Solihull (LD)]

My Lords, in this group the Committee has already heard a great deal about the role of substance abuse in domestic abuse. I pay tribute to the noble Baroness, Lady Finlay of Llandaff, for her tremendous work in this respect. I will focus my brief remarks on the unholy triumvirate of substance abuse, domestic abuse and mental ill-health. There is a strong link between the three.

Some research findings have already been quoted. The most striking that I came across was on substance abuse: abused women are 15 times more likely to abuse alcohol and nine times more likely to abuse drugs. This is one way, but hardly a good one, to alleviate the stress and the pain. Research suggests that women experiencing domestic abuse are more likely to experience mental health problems; women with mental health problems are also more likely to experience domestic abuse. It makes total sense, when you think about it.

It is a vicious circle: domestic abuse leads to mental ill-health, which is often used to abuse the victim further. For example, it can be a tool of coercive control—threatening to “tell social services” and telling the children that “Mummy can’t look after you”. When a victim discloses to a public authority, the abuser may say, “You can’t believe her—she’s mad”. On mental health repercussions, domestic abuse is associated with depression, anxiety, PTSD and substance abuse in the general population. Of course, this all has a profound effect on the children.

The Children’s Commissioner estimates that over 500,000 children are living in households infected with substance abuse and domestic abuse. Children experiencing mental health issues as a result of domestic abuse have strong links with poorer educational outcomes and a high level of mental ill-health. Sadly, that is only to be expected. So the importance of, and interrelationships between, substance misuse, mental ill-health and domestic abuse can hardly be overestimated. That is why we support all the amendments in this group, and I have added my name to three.

Of those to which I have added my name, Amendment 21 specifically writes into the general function of the commissioner the need to include the provision of support for domestic abuse victims suffering from mental health issues and addictions. Amendment 42 sets out the requirement that the commissioner’s advisory board includes at least one person with experience in mental health and substance abuse. Amendment 94 obliges local authorities to provide mental health and substance misuse support to victims. Unless support of this nature is given, this strong interlink between the three will never be broken.

[Baroness Wilcox of Newport (Lab) [V]]

My Lords, I welcome the important contributions made by noble Lords on this difficult subject. It is important to recognise that domestic abuse does not happen in a neat silo; as so many noble Lords have commented, it is inherently bound up with wider issues of mental health and substance abuse.

I agree with my noble friend Lord Hunt of Kings Heath, who so strongly highlighted the impact of devastating cuts to our public services through a decade of austerity. I restate his comments about the Royal College of Psychiatrists’ call for the Government to reverse the cuts and enable local authorities to invest £374 million into adult services to cope with the increased need. Report after report now highlights the poor preparedness of our public realm to cope with this dreadful pandemic, as a consequence of the austerity decade, when council funding was cut to the bone.

Mental health services have been particularly impacted by this austerity, leading to a lack of services and long waiting times. Victims and survivors with mental health problems also face barriers accessing many other vital services due to strict eligibility criteria or not being able to engage in the way that services require. Too often, such barriers are leading to people being bounced around different services, having to constantly re-tell their story.

There is, however, an awareness of the complex and interrelated needs of those with mental ill health, but many services are unequipped to support them, and few services exist that can care for people with both mental health and substance misuse issues. This is despite research showing that substances are often used as a form of self-medication for unmet mental health needs and as a way of coping with abuse.

As the noble Baroness, Lady Finlay of Llandaff, spoke so knowledgably about, there is a close link between domestic abuse and alcohol, with the perpetrator drinking heavily. There are also instances of the victim drinking, leading to uninhibited behaviours, and this can trigger the abuse. Similarly, the victim may use alcohol and drugs to self-medicate. During the pandemic, there has been an increased level of alcohol consumption, exacerbating a known problem.

There is, therefore, a great need to ensure that the commissioner’s remit includes alcohol and other substances. She needs to be able to receive evidence on alcohol abuse to inform where support services must be improved, and to contribute directly to the national alcohol strategy.

In conclusion, the importance of multiagency and holistic working in this area cannot be overemphasised. It is important to recognise that mental health and addiction problems can create additional vulnerabilities that people perpetrating abuse may seek to exploit.

[The Minister of State, Home Office (Baroness Williams of Trafford) (Con)]

My Lords, I thank all noble Lords who have spoken in this debate on the complexities of alcohol and substance misuse and mental health and the correlation with domestic abuse, from the point of view of both the victim and—as my noble friend Lady Stroud said—the perpetrator. I thank the noble Baroness, Lady Finlay, for tabling these amendments and her work in chairing the Commission on Alcohol Harm.

I will start with the final comments of the noble Baroness, Lady Wilcox of Newport. She and I are cut from the same cloth in knowing the effectiveness with which multiagency work can help in all sorts of ways. The way that agencies communicate with each other can get to the heart of some of the problems in society.

I also acknowledge the contributions of the noble Baronesses, Lady Boycott, Lady Hayter, Lady Jenkin and Lady Jolly, and thank the noble Lords, Lord Brooke and Lord Ribeiro, for their expertise and their input into the Alcohol Health Alliance’s report for the Commission on Alcohol Harm, which was published last year. It highlights these complex relationships between alcohol, mental health and domestic abuse. I welcome the report; it makes for important reading.

As the noble Lord, Lord Marks of Henley-on-Thames, has illustrated, there is a frequent coexistence of domestic abuse, mental health problems and the misuse of drugs and alcohol, with complex interrelationships between them. The relationships are nuanced, and the noble Baroness, Lady Finlay, is right to identify this. It is also clear that there is no excuse for domestic abuse, and it is vital that people affected by domestic abuse get the healthcare they need.

I reassure noble Lords that we intend to reflect the importance of joining up domestic abuse, mental health and substance misuse services in the statutory guidance to be issued under Clause 73. We have a number of other, parallel measures to ensure that the join-up should be reflected in local health commissioning and the support that people receive. Noble Lords will know that local authorities, clinical commissioning groups and other partners produce an assessment of the local population needs, called the joint strategic needs assessment. This should include consideration of the needs of victims and survivors. The assessment informs a local area’s health and well-being strategy and the commissioning of services, including mental health and substance misuse services.

I will say something about local authority spending because noble Lords have referred to it. Local authority spending through the public health grant will be maintained in the next financial year. Local authorities can continue to invest in prevention and essential front-line services. This includes drug and alcohol treatment and recovery services. We are working on increasing access to substance misuse services, and we have appointed Professor Dame Carol Black to undertake an independent review of drugs to inform the Government’s work on what more can be done to tackle the harms that drugs cause.

I also draw noble Lords’ attention to ongoing work in the health system to create new integrated care systems where NHS organisations, in partnership with local councils, voluntary service partners and others, take collective responsibility for managing resources, delivering NHS care and improving the health of the population they serve. The development of a new integrated care system is a real opportunity to improve the join-up between different services and provide truly integrated care.

I turn to the specifics of the amendments. On Amendments 21 and 29, which relate to the role of the domestic abuse commissioner, the Bill already confers on the commissioner a wide remit in tackling domestic abuse. She has already started to provide public leadership on domestic abuse issues by raising awareness of key matters and monitoring and overseeing the delivery of services to ensure that they are as effective, evidence-based and safe as they can be.

The description of the role states that the commissioner must adopt a specific focus on the needs of victims from groups with particular needs, which could include mental ill-health or substance misuse. However, as an independent office holder, it will be for the commissioner to determine her priorities, which will be set out in a strategic plan developed following consultation with her advisory board, the Home Secretary and others.

As for Amendment 42, which relates to the composition of the advisory board, Clause 12 already provides that at least one member of the board must be a representative of the health care sector, and there is sufficient latitude for the commissioner to appoint other specialists as she sees fit.

--- Later in debate ---

[Baroness Bertin (Con) [V]]

My Lords, I congratulate the noble Baroness, Lady Burt, on her speech. She set out the case for the amendments very eloquently. I will speak to Amendments 51 and 54 to which my name is attached. If the horror of losing someone you love is not bad enough, many families, in particular in cases of domestic abuse homicide and suicide, have to put up with the reality that their loved ones may have been saved had earlier interventions been made. This is why I am supporting the amendments put forward by the designate domestic abuse commissioner to establish an oversight mechanism on investigations into domestic abuse related homicides and suicides. She is someone who knows what needs to be done and we should support her with what seem like reasonable and sensible asks.

The number of women being killed by men has not budged at all over the past decade. Clearly, much more work has to be done to identify the changes needed to prevent future deaths. I believe that Amendments 51 and 54 in particular would be an important step on that journey. An oversight mechanism is absolutely critical. There is a great deal of learning coming from domestic homicide reviews, which were introduced in 2011, and from bereaved families’ selfless contributions, but the lack of oversight and of publication of findings at a national level means that this learning is often being lost or limited to local areas. DHRs, for instance, can be desperately hard to find, buried on community safety partnership websites, which means that wider learning can become next to impossible.

It is also too often the case that recommendations are not implemented effectively or are implemented in the short term, but actions drift over time. A clear oversight and accountability mechanism, led by the commissioner working with the Home Office, would help to drive effective implementation and share lessons nationally in the long term as well as the short term. As a police officer put it to me this week, one recommendation that is good for one force will probably be good for forces all over the country. The same mistakes will be happening again and again, and that simply cannot carry on when we have a death toll as high as we do.

Beyond domestic homicide reviews, there is a range of other investigations into the circumstances surrounding an individual’s death which contain recommendations relating to the response of public authorities, as the noble Baroness, Lady Burt, set out. There is currently, however, no systematic way of identifying these investigations for the purpose of ensuring that recommendations are followed up and that key themes across investigations are examined and acted on in order to prevent future deaths. I believe that Amendments 51 and 54 would help address this.

I will finish by talking briefly about suicide. Mental health has been talked about in previous groupings, and I thought my noble friend the Minister gave some very thorough and thoughtful answers. Sadly, not enough data and shared learning are being collected on suicides as a result of domestic abuse. The correlation is undoubtedly high, but we really do not have a clear picture of the true scale of the problem. One report published by the University of Bristol suggested that nearly 200 victims a year went on to kill themselves on the same day they visited A&E with a domestic abuse related injury. If these figures are accurate, the scale of missed interventions is simply unacceptable. Amendments 51 and 54 would surely complement the endeavour to join up multi-agency thinking and accountability, especially regarding health care providers who we know have such a big role to play. I therefore urge noble Lords to back these amendments.

[Baroness Wilcox of Newport (Lab) [V]]

My Lords, I am speaking in support of Amendment 51, which would extend the list of public authorities that have a duty to co-operate with the domestic abuse commissioner, to include the Independent Office for Police Conduct, Her Majesty’s Prison Service, the National Probation Service, the Prisons and Probation Ombudsman, and the Chief Coroner. I am speaking also in support of Amendment 54, which would place a new duty on public authorities to carry out reviews and investigations into deaths where domestic abuse has been identified as a contributory factor, to notify the Secretary of State for the Home Office and the office of the domestic abuse commissioner on completion, and to provide them with a copy of their findings.

Thus, the domestic abuse commissioner is proposing to establish an oversight mechanism on investigations into domestic abuse related homicides and suicides. They are intended to ensure that a more systematic collection of investigations into suicides and homicides, in which domestic abuse is identified as a contributory factor, is made together with a robust accountability framework. This is to ensure that individual recommendations are acted upon, and that key themes across investigations are identified, to help target key policy changes needed to prevent future deaths.

The pandemic has created so many problems for our society, notwithstanding the area of domestic abuse. A number of domestic abuse charities and campaigners have reported a surge in calls to helplines and online services since the lockdown conditions were imposed. It is a sobering insight into the levels of abuse that people live with all the time. Coronavirus may exacerbate triggers, and lockdown may restrict access to support or escape. It may even curtail the measures some people take to keep their own violence under control.