From hoping to help: Identifying and responding to suicidality amongst victims of domestic abuse
| Author | Vanessa E Munro,Ruth Aitken |
| Published date | 01 January 2020 |
| Date | 01 January 2020 |
| DOI | http://doi.org/10.1177/0269758018824160 |
Article
From hoping to help:
Identifying and responding
to suicidality amongst
victims of domestic abuse
Vanessa E Munro
University of Warwick, UK
Ruth Aitken
Refuge, UK
Abstract
This article analyses findings from a large-scale study conducted in England and Wales into the
prevalence of, and mediators and moderators of risk in relation to, suicidality amongst victims of
domestic abuse. The authors tracked (disclosed) experiences of suicidal ideation or suicide within
a sample of more than 3,500 domestically abused adults and explored factors that appeared to be
correlated with a presence of suicidality amongst this constituency. This analysis was triangulated
with a series of 20 semi-structured interviews which explored on-the-ground challenges in relation
to the identification of, and support provision for, this vulnerable group, and which also included
reflection on the difficulties experienced by staff as a consequence of the emotionally demanding
nature of their interactions with such clients. Based on their findings, in this article, the authors
underscore the need for more effective multi-agency cooperation, for greater priority to be given
to self-harm and suicidality in risk-assessment processes, and for sustainable resourcing of
domestic abuse service providers. In a context in which suicidality was correlated with experiences
of isolation and hopelessness, they also emphasise the importance of appropriate and effective
engagement by state agencies and those professionals tasked with intervening to help victims of
domestic abuse.
Keywords
Suicide, domestic abuse, risk-assessment, psychological well-being, VAWG strategies
Corresponding author:
Vanessa E Munro, Warwick Law School, University of Warwick, Coventry CV4 7AL, UK.
Email: V.Munro@warwick.ac.uk
International Review of Victimology
2020, Vol. 26(1) 29–49
ªThe Author(s) 2019
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0269758018824160
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Recent years have seen an increased commitment on the part of many national governments and
international organisations to address ongoing concern regarding rates of suicide. In England and
Wales, for example, this has translated into a commitment by the government to reduce suicides by
10%by 2021 (Independent Mental Health Taskforce, 2016; Department of Health, 2017), through
– amongst other things – the development and implementation of local, multi-agency suicide
prevention plans. The success of any such initiative depends, of course, upon a multiplicity of
considerations. One key factor will be the adequacy of the resources and training that are made
available, not only to mental health professionals, but also to the wide range of personnel in
agencies spanning social services, criminal justice, immigration, housing, health and addiction
counselling, as well as the voluntary sector, who may play a role in identifying and supporting
those individuals who are ‘at risk’ of taking their own lives.
While reliable data regarding the prevalence of, and precursors to, suicidality are not always
readily available, previous research indicates that death rates from suicide are consistently higher
for men than for women, especially in high-income countries (Nock et al., 2008; WHO, 2014).
This has been reflected, in turn, in the priorities of contemporary suicide prevention programmes,
where the focus is often on increasing support for ‘at risk’ males in particular. Without under-
mining that imperative, it is important to note that what this often sidelines is the reality that
women – across all ethnic, racial and age groups – are significantly more likely than men to make
suicide attempts (Freeman et al., 2017; Kaslow et al., 2005; Welch, 2001). Responding to women’s
suicidality ought also to be a priority, even though the challenges involved may be substantial in a
context in which, as a recent UK report acknowledged, many women experience ‘multiple mor-
bidities, as well as complex social factors, substance misuse and domestic abuse, illustrating the
importance of a coherent whole public service approach to prevention’ (Department of Health,
2017). The role of traumatic experiences, such as being subjected to domestic abuse, as a precursor
to suicidality has already been formally recognised at national (Department of Health, 2012) and
international (WHO, 2014) levels. However, the scale, dynamics and complexity of this intersec-
tion, and the ways in which positive interventions may be secured, remain significantly under-
researched, particularly in the UK.
Against that backdrop, this article analyses a subset of quantitative and qualitative casework
data collected by Refuge (a nationwide UK charity that advocates annually for thousands of
victims of domestic and sexual abuse, and other forms of violence against women) regarding
suicidality amongst its adult clients. Our research explores disclosed experiences of suicidal
ideation or suicide attempts within a sample of more than 3,500 domestically abused clients, who
engaged either with Refuge’s residential or community outreach services. Using clients’ responses
to suicide questions asked by caseworkers during routine risk assessments, as well as answers to a
series of standardised measures of psychological well-being, and information shared by clients
regarding their personal experiences of abuse, we explore the prevalence of, and mediators and
moderators of risk in relation to, suicidality amongst victims of domestic abuse. We situate this
analysis alongside semi-structured interviews with 20 practitioners with significant experience
working with Refuge to conduct risk- and needs-based assessments, safety planning and frontline
client support. These interviews provide a broader perspective on victims’ experiences of abuse
and suicidality, and enabled the authors to explore more fully the challenges currently encountered
by practitioners in providing support to this often vulnerable constituency. While our analysis
relates to England and Wales, our findings regarding the experiences of clients and caseworkers, as
well as the procedural and funding challenges posed to timely and effective intervention, resonate
beyond national borders.
30 International Review of Victimology 26(1)
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