Epidemiology and Psychiatric Sciences

Original Articles

Linking abuse and recovery through advocacy: an observational study

K. Trevilliona1 c1, S. Byforda2, M. Carya2, D. Rosea3, S. Orama1, G. Federa4, R. Agnew-Daviesa5 and L. M. Howarda1

a1 Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK

a2 Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK

a3 Service User Research Enterprise, Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK

a4 School of Social and Community Medicine, University of Bristol, Bristol, UK

a5 Domestic Violence Training Ltd, Surbiton, Surrey, UK

Abstract

Aims. High numbers of psychiatric service users experience domestic violence, yet limited interventions exist for these victims. We piloted a domestic violence intervention for community mental health services to explore the feasibility of a future cluster randomized controlled trial.

Methods. Quasi-experimental controlled design within five Community Mental Health Teams (three intervention and two control teams). The intervention comprised domestic violence training for clinicians' and referral to domestic violence advocacy for service users. Clinicians' (n = 29) domestic violence knowledge, attitudes and behaviours were assessed before and 6 months post-training. Service users' (n = 34) safety behaviours, unmet needs, quality of life and frequency/severity of abuse were examined at baseline and 3 months follow-up. Process evaluation data were also collected.

Results. Clinicians receiving the intervention reported significant improvements in domestic violence knowledge, attitudes and behaviours at follow-up (p < 0.05). Service users receiving the intervention reported significant reductions in violence (p < 0.001) and unmet needs at follow-up (p < 0.05).

Conclusions. Interventions comprising domestic violence training for clinicians and referral to domestic violence advocacy may improve responses of psychiatric services. Low rates of identification among teams not receiving training suggest that future trials using service user outcomes are unlikely to be feasible. Therefore, other methods of evaluation are needed.

(Received October 30 2012)

(Revised March 14 2013)

(Accepted March 18 2013)

(Online publication April 30 2013)

Key words

  • Community mental health services;
  • Domestic violence;
  • intervention studies

Correspondence

c1 Address for correspondence: Dr Kylee Trevillion, Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: kylee.trevillion@kcl.ac.uk)