Kent and Medway: Highlighting the relationship between domestic abuse and suicide

Our work in this area started with a question from our Community Team about how many suicide-related Domestic Homicides Reviews (DHRs) they should be planning for. We realised that there was barely any local, or even national, data to be able to answer the question about links between suicide and domestic abuse.  

We set about researching what we could with what was available: 

Exploring the levels of suicidality amongst victims (63 per cent) and perpetrators (61 per cent) (based on 928 Domestic Abuse, Stalking, Harassment and Honour Based Violence (DASH) risk assessments. 

Reviewing 93 nationally published Domestic Homicide Reviews (DHR) –26 per cent contained a suicide of either victim or perpetrator (NB most DA-related suicides do not result in a DHR) 

Undertook a Thematic Analysis of recent suicides amongst Children and Young People (CYP) in Kent which showed that some of the deaths were amongst CYP living in a household impacted by DA 

Reviewed levels of suicidal thoughts amongst male victims of DA through partnership with an organisation called Dads Unlimited who support men primarily experiencing family breakdown  

We could see that there was a strong link, but we did not have enough data to really understand the issue at a very local level. It was only when we included specific questions relating to domestic abuse in our local Real Time Suicide Surveillance System (RTSS) that we began to get detailed and comprehensive data.  

We are using this data locally to raise awareness of the link and to improve services and support.  Nationally, we want to share our learnings and encourage more data collection and research so that we can build a comprehensive national picture.  

Initially, we set up a working group with key stakeholders (Suicide Prevention team, DA stakeholders and our Community Safety Team colleagues) in 2019 to begin scoping the scale of the issue locally, as well as understanding the data we had access to. This led to DASH risk assessment data being sent over to the Suicide Prevention team via three DA providers, which a member of our team used as our starting point for data analysis.  

Towards the end of 2020 we established our Real Time Surveillance System (RTSS) with Kent Police. We worked with Kent Police closely throughout 2020 to develop and refine the data we collected. The national RTSS template focused solely on ‘abuse’ as a data collection field. However, we worked with our Kent Police analyst to add in data collection for; abuse (that being the victim, perpetrator or CYP), type of abuse, and abuse history. Our RTSS has highlighted the issue of DA and suicide, unlike no other data we had had previously. We have engaged with many stakeholders to present this work; including our Suicide Prevention Network and central government officials (including the DHSC and the DA commissioner).  

The project has progressed significantly since 2019, and this is fundamentally a result of partnership working and engaging and building relationships with key stakeholders.  

We fund a police analyst to work with us on data analysis two days per week. Our Kent Police analyst is funded by the Suicide Prevention programme budget. The analyst focuses on detailed case reports of suspected suicides within Kent and Medway and inputs these into our RTSS. This data is then sent over weekly to the SP team, and then a member of the SP team will then analyse the data that has been sent across.  

Furthermore, additional activity generated from the project, such as commissioning qualitative research around DA victims and suicidality and funding several DA/suicide related projects (including an academic evaluation of one of these projects), have all been funded through our Suicide Prevention programme budget.  

Three years of real time data showed us the scale of the issue. 30 per cent (114 out of 379) of suspected suicides in Kent and Medway’s RTSS from 2019 – 2021 had been impacted by domestic abuse.  

Further analysis showed there were five main cohorts: 

• Victims who are dying by suicide in the middle of the abuse  
• Victims who are dying by suicide months or years after the abuse has ended 
• Victims who are also thought to have been perpetrators of DA at some point in their relationships or lives  
• Children and young people living in households impacted by domestic abuse 
• Perpetrators of domestic abuse, the largest group. Including individuals who have been convicted, accused or who are under investigation for domestic abuse.

Our local research has encouraged other organisations to look into the link between domestic abuse and suicide. Since 2021 several national articles have been published, further backing up our local findings. We are delighted that the Secretary of State highlighted our work before announcing in July 2022 that the new suicide prevention plan will contain a section on domestic abuse for the first time. 

We have also: 

• Included DA as a priority within our local Suicide Prevention Strategy 
• Funded local partner Oasis to pilot Trauma Impact Workshops for survivors of DA where the abuse has stopped  
• Invested in qualitative research with DA victims who have previously attempted suicide or have self-harmed  
• Funded three new innovative projects with a specific focus on supporting domestic abuse  
• Targeted our MH campaigns to DA audiences 
• Developed a briefing note highlighting the issues and making recommendations for front line practice 
• Continued promotion of suicide prevention training to DA teams and DA training to mental health teams  
• Recommended local DA risk assessments are changed to capture more relevant information 

A challenge for us was to raise the profile of this issue and highlight the link between DA and suicide, while seeing little shift or focus on a national scale. Our findings were the first time nationally that anyone had ever quantified the number of lives lost to suicide after being impacted by domestic abuse.  

Our local research has encouraged other organisations to investigate the link between domestic abuse and suicide. Since 2021 several national articles have been published, further backing up our findings. However, despite good progress being made, there are still several unanswered questions, consequently resulting in us still not truly understanding the scope of this issue on both a local and national scale. We still need to know: 

• How many victims of domestic abuse die by suicide nationally and locally (both during the abuse, or in the months and years that follow)? 
• Are any groups at higher risk (gender? LGBTQ+? Age?)  
• Do any types of abuse (financial, stalking, coercive control etc) pose a higher risk?  
• Are there any high risk points within the abuse cycle, e.g.when a victim is informed the perpetrator is being released from custody, or when the abuse has stopped and services may have drifted away? 
• How many perpetrators of domestic abuse die by suicide nationally? 
• How many children living in households impacted by domestic abuse are dying by suicide nationally? 
• How strong is the link between DA and suicide (correlation vs causation)? 
• What (strategic or tactical) interventions could reduce the risk of deaths by suicide? 

While presenting our work to colleagues around the country, we have come up with a list of points to consider for other regions and local areas: 

• Include Domestic Abuse as an explicit priority within your local multi-agency Suicide Prevention Strategy. 
• Ensure your local Real Time Suicide Surveillance system asks specific questions about DA (Victim, perpetrator, CYP? Type of abuse? Current or former relationship?).   
• Ensure domestic abuse training completed by all mental health staff. (Consider making this a commissioning condition).  
• Ensure mental health and suicide prevention training completed by all domestic abuse staff. (Consider making this a commissioning condition).   
• Ensure provision of recovery (including trauma aware elements) programmes for female and male victims of domestic abuse in the months and years after the abuse has stopped.
  • Ensure provision of perpetrator programmes for both men and women. 
  • Undertake further research 
  • Qualitative research with victims 
• Detailed analysis of RTSS 
• Detailed analysis of data held by secondary MH trust 
• Consider revising risk assessments to ask the following questions of both the victim and the perpetrator: have you self harmed? Have you felt suicidal? Have you made a suicide attempt? (and over different time periods). 
• Ensure specialist domestic abuse councillors are made available for all MARAC victims. 
• Ensure that local suicide bereavement services are trained / experienced in supporting families after the suicide of a DA victim or perpetrator. 

We commissioned independent research to help us understand the experience of suicidal feelings when being victimised by domestic abuse, beyond the data. The research is ongoing (due to be completed end of summer 2022) and will be based on accounts from 15 survivors and professionals. It is important that we hear their stories and share these with professionals and survivors.  

We will continue to fund Kent Police to deliver the RTSS which ensures our database of knowledge is continually expanding. We have added additional data fields (including “type of abuse”, “current or former relationship”, “dependent children?”) into our RTSS data capture to ensure that we gain as much contextual information as possible.  

We have secured funding for a county-wide roll out of Trauma Impact workshops for victims of DA, including an academic evaluation and plan to conduct action research to provide bereavement support to families of DA perpetrators who die by suicide.  

Importantly, we will continue to advocate national scale action and research, as well as inclusion of DA-specific questions on national and local RTSS systems.  

Megan Abbott, Tim Woodhouse  

This case study was done jointly with the National Suicide Prevention Alliance and forms part of our suicide prevention resource.