Dual Risk - Suicide Prevention in a Domestic Abuse Setting - The Hidden GapThe Hidden Gap Why domestic abuse, mental health and suicide prevention need joining up.

Speaker A: Hello and welcome to the really useful Conversations podcast. It's been a while and, um, this is the first episode in a short series that I'm producing, specifically talking about the issue of suicide risk in a domestic abuse context. Dual Changing the Narrative. As many of you may know, my name is Andrea Newton and I've spent more than 25 years helping people to have conversations that matter. More recently, my work has focused on the intersection where suicide risk, domestic abuse and coercive control come together. And, um, I found myself increasingly drawn to one question in particular. Why are we still treating domestic abuse, mental health, suicide risk, as if they sit in three completely separate boxes? Because you know what? People's lives don't work like that. And when our thinking becomes too separate, when the pathway for those issues is separate, when they even sit under, uh, different departments at the local authority, people can fall through the gaps. This podcast series is being released specifically in the run up to World Suicide Prevention Day in September. And given that this year's theme is changing the narrative, I honestly can't think of a more important narrative to change than the one surrounding domestic abuse and suicide. Now, before we go any further, I want to be really clear about something. This series is not about blaming anybody. It's not about blaming professionals that work in this arena. It's not about criticising domestic abuse services, criticizing mental health support, criticizing suicide prevention. In my experience of working in these sectors, people care deeply and work incredibly hard, often frustrated by the lack of resources that seem to be available to them. And, um, most of them are doing the very best they can with the limited resources, training, knowledge and time that's available to them. The purpose of this series is something much simpler. Curiosity. Joining the dots and helping us look at a problem that's been identified through a slightly different lens. Because this isn't about doing more, it's actually about seeing more. Perhaps asking just one more question. When people think about death linked to domestic abuse, most people think about homicide. And, um, you might say, rightly so, every domestic homicide is a tragedy and every life lost matters. But in the latest national review, We've identified around 150 suspected victim suicides linked to domestic abuse in a single year. That's compared with around 125 intimate partner homicides. Put another way, that's around three people every week dying by suicide in the UK in the context of domestic abuse. And you know as well as I do those numbers will not be absolutely accurate. If anything, those numbers will be a significant underestimate of what the reality Actually is. But think about that. Even if it is three people every week, every year and over a five year period, the figure for suspected victim suicide is actually 553. 553 people, 553 families, 553 stories. And yet so many people have never heard those figures. Which raises a question, because if three people a week are dying, why aren't we talking about it? Why isn't this a bigger part of domestic abuse conversations or suicide prevention conversations? And why do so many professionals that I've worked with over, uh, the last 12 months tell me that they've never actually received any training on the connection at all? As I said, I don't think it's because people don't care. I think it's because historically we've looked at these issues through three different lenses. Uh, domestic abuse, those services quite rightly focus on safety, risk, protection, actions of perpetrators, recovery, etc. Mental health services focus on distress symptoms, treatment and recovery, and suicide prevention. Both services focus on risk, crisis, safety and support. And all of those things matter. And all of those perspectives are important. The problem is people don't experience life according to separate professional categories. For some victims, domestic abuse, mental health difficulties and suicide risk are not separate stories. They're all part of the same story. And if we're only looking through one lens, we may miss something important. Which brings me to one of the biggest narrative shifts that I think we need to make. For years we've asked the question, what's wrong with them? What's wrong with them? That they're anxious, that they're depressed, that they're drinking, that they keep going back, that they feel suicidal. But increasingly, trauma informed practice is encouraging us to ask a different question. Not what's wrong with them, but what happened to them? What happened that led them here? What pressures are they carrying? What fear are they living with? What losses have they experienced? And what is it that they are trying desperately to survive? Because that context changes everything. Let's take what we might say would be a typical example. Let's say a woman goes to her gp. She's exhausted, she can't sleep, she's anxious, she's tearful, and she tells the GP that she's struggling to cope. Life's just overwhelming right now. She may be prescribed medication, she might be referred for talking therapy, counselling, she might be given specific support for depression or anxiety. And you know what? None of those things are wrong. Mental health support matters, counseling matters. Medication can be incredibly helpful in the right situation. But what if nobody asks what's actually happening in her life right now that's making her feel that way? What if nobody asks about the fear, control, isolation, intimidation or monitoring? What if nobody asks whether somebody at home is controlling her money, checking her phone, criticizing everything she does or making her feel as though she's walking on eggshells every day? And, uh, let's be honest, people are not going to ask those specific questions. Because if the only question is how do we treat depression, we may miss what's actually driving the depression. And, um, if we miss what's driving it, we risk simply treating the smoke but leaving the fire still burning. Now, to be, um, absolutely clear, not everybody experiencing depression is living with domestic abuse. And, um, equally, not everyone experiencing domestic abuse will become suicidal. But when coercive control is present, we need to be curious enough to ask whether the distress we're seeing might be connected to what somebody is, is indeed living through. Because sometimes the question isn't why are they depressed? It's what is making life feel unbearable and overwhelming. And whilst we're talking about questions, let's tackle another one, perhaps the most common question of all. Do you know what? If it's that bad, why don't they just leave? I understand why people ask it. From the outside, leaving can seem like the obvious answer. But one of the biggest myths surrounding domestic abuse is that leaving is the automatic solution to the problem. Because actually, the reality is often far more complicated. People stay for many reasons. As I know from my own experience, those reasons could be to do with their children, could be fear, could be finances, housing, isolation, hope, love, shame, trauma and years of being ground down and told they're worthless, selfish, incapable of functioning on their own, or quite simply crazy. And here's something many people don't realize. Leaving can be one of the most dangerous times. Risk doesn't necessarily disappear after separation, and for some victims it can actually escalate. Threats intensify, harassment increases, stalking begins, child contact becomes another route for control, and financial abuse tightens further. The person who's causing the harm may feel their control is slipping away and so they fight even harder to regain it. And from a suicide prevention perspective, we need to recognise something else. Thoughts of suicide don't necessarily simply disappear after separation either. For some people, leaving brings relief. For others it brings grief, fear, identity collapse, financial uncertainty, um, and the overwhelming task of trying to rebuild a future they can no longer imagine. Domestic abuse exit isn't simply a physical act of getting up and leaving a relationship. It's a complicated psychological process of disentangling identity, belief and perceived safety. And, um, without support for that internal exit, risk doesn't necessarily reduce. In fact, sometimes it intensifies. Perhaps the question isn't why didn't they just leave? Perhaps the better question is what risks were they managing every day? Because changing the narrative means moving away from judgment and towards curiosity. Curiosity is where better conversations start. It's where better safeguarding exists. And, um, it's where better decisions are made. Over the coming episodes, we're going to talk about coercive control, about myths and assumptions about men, about suicide risk, about professional curiosity. And we're going to explore why awareness on its own isn't enough. Because awareness doesn't save lives. What we do with that awareness though, that might. And let's be really clear, another myth that people often believe is that domestic abuse is all about women being harmed by men. And I also want to take this opportunity of putting the record straight. We also need to be changing the narrative there and recognise that men are actually 40% of the victims. We're forgetting about situations where it's the woman that's the abuser. Uh, we're overlooking that because stereotypically, that's not what we're used to, that's not what we're looking for. We're overlooking or we're missing same sex relationships where again, men absolutely can be victims. And when we talk about domestic abuse, it's important that we also think about the different ways that that abuse happens within families. It isn't always intimate partner. So please stick with me over this short series and learn a little bit more about this really important subject. And if you're a domestic abuse practitioner, a gp, a counsellor, a social worker, a police officer, a mental health professional, a safeguarding lead manager, volunteer, or simply somebody who cares about getting it right. I'm running a free webinar in September for World Suicide Prevention Day. It's online, it'll be via Zoom, and it's called Changing the Confident Conversations About Suicide in a Domestic Abuse Context. And, um, in that free webinar, we'll explore the connection between domestic abuse and suicide risk in more depth. We'll challenge some of the myths and we will look specifically about conversations that we might need to have in those situations, questions that can open up the conversations and how we can all become more confident in recognising when domestic abuse and suicide risk may be part of the same story. As I said at the beginning, this isn't about blame, it's about equipping good people with another lens. It's about helping us ask just one more question and ultimately it's about helping to save lives. So if you'd like to join me, you'll find all the details of that webinar on the confidentconversations.co.uk website. And if you know of somebody else who would benefit from this conversation, please do feel free to share this episode with them. Because you know what, if around three people every week are, ah, dying by suicide in the context of domestic abuse, this isn't somebody else's issue. As a community, as, ah, a society, we all have a part to play. Changing the narrative starts by asking better questions. Questions that move us away from judgment and towards curiosity. Questions that help us see the person behind what's being presented. Um, and that might just open the door to hope. Until next time, take really good care and please do join me in changing the narrative. See you soon.