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Published for the British Institute of Learning Disabilities Journal of Applied Research in Intellectual Disabilities 2017, 30, 269–282 ‘I Know it was Every Week, but I Can’t be Sure if it was Every Day: Domestic Violence and Women with Learning Disabilities Michelle McCarthy, Siobhan Hunt and Karen Milne-Skillman Tizard Centre, University of Kent, Canterbury, UK Accepted for publication 26 November 2015 Background Domestic violence against women is well Results The violence experienced by many of the women researched in the general population, but much less so was severe and frequent. It impacted negatively on their in relation to women with learning disabilities. This physical and psychological well-being. The women’s qualitative research study interviewed 15 women with awareness of refuges and others sources of help was learning disabilities who had experienced domestic generally low. violence about their experiences, the impact of the Conclusions Healthcare and social care professionals violence on them and their children, their coping have a clear remit to help women with learning strategies and help seeking behaviour. disabilities to avoid and escape violent relationships. Materials and methods Semistructured in-depth interviews were conducted. Data were analysed using Inter- Keywords: disabled women, domestic violence, pretive Phenomenological Analysis. A service user qualitative methodology advisory group helped at particular stages, notably at the formative stage and with dissemination, especially the production of accessible materials, including a DVD. terms of prevalence, US research suggests around 85% Introduction of women with disabilities experience domestic violence Since the 1970s and 1980s, domestic violence against (Feuerstein 1997), with the Canadian research women has been well recognized as both very common suggesting women with disabilities have a 40% greater and very damaging to individuals and wider society likelihood of domestic violence than non-disabled (Dobash & Dobash 1979; Stanko 1985). There is a huge women (Brownridge 2006). body of evidence regarding its prevalence and effects in Whilst the respective fields of disability studies and the general population (Mullender et al. 2002; Walby & violence studies are both well developed, ‘the Allen 2004). Lombard & McMillan (2013: 10) give an intersection of the two fields of disability and violence overview of existing research and state that ‘lifetime has, however, received far less attention’ (Mikton & prevalence rates tend to offer us the most reliable Shakespeare 2014: 3055). Thiara et al. (2011) observe that indicator of the extent of the problem and these suggest in the United Kingdom, despite the Disability one in four women will experience domestic abuse in Discrimination Act 1995 requiring public services to be her lifetime’. offered on equal terms to people with disabilities, there There is also a smaller body of research on domestic is a still a lack of awareness and resources when it violence of women with physical and sensory comes to support for disabled women who have impairments. This is mostly from countries such as experienced domestic violence. They describe disability Canada and the United States (for example, McNamara and domestic violence services as working in ‘“siloed” & Brooker 2000; Yoshida et al. 2009), but also more ways (p. 758), that is in isolation from each other, thus recently in the United Kingdom (Thiara et al. 2012). In exposing disabled women to further risks. © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd. 10.1111/jar.12237 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. 270 Journal of Applied Research in Intellectual Disabilities The concept of intersectionality refers to a way of Domestic violence against women with learning looking at the interconnected nature of social categories disabilities of gender, race, class, etc. and thus at the different layers of oppression an individual might face. It is Whilst there is research on certain forms of abuse occasionally used to analyse the domestic violence against women with learning disabilities, in particular experiences of disabled women; however, this is usually sexual abuse, these studies tend to look at abuse from a in relation to women with physical and sensory variety of different perpetrators. McCarthy 2014a). impairments (Thiara et al. 2011) and not those with Studies looking specifically at domestic violence from an learning disabilities. However, there are exceptions to intimate partner are rare. However, there are a few. this general rule, with the work of Chenoweth (1993, Walter-Brice et al. (2012) conducted a small qualitative 1996) being particularly notable, as well as McCarthy study in the United Kingdom, interviewing five women (2009). The concept of intersectionality is also with learning disabilities and found that the women increasingly used to understand the domestic violence experienced multiple forms of abuse from their experiences of other marginalized women, such as older partners, much of it severe, including the use of women (Lombard & Scott 2013), Black and minority weapons; that the abuse, harassment and threats ethnic women (Gill 2013) and lesbian women (Barnes continued after the end of the relationship; that 2010). This literature suggests that all facets of a responses from Police and Social Services were minimal person’s identity are important and need to be taken and the women were left unprotected (although account of. Failure to do this results in a piecemeal children were removed from their mothers). Similarly, approach to the problem of domestic violence, which Pestka & Wendt (2014) also conducted a small can mean that ‘many women “fall through the gaps” qualitative study interviewing five women with learning between policy and practice, rhetoric and disabilities in Australia. They found the women in their understanding’ (Gill 2013: 142). study had all experienced rejection in their childhoods and sought a sense of belonging in adult intimate relationships, even if they were abusive, and that the Literature review women’s low social status increased their vulnerability. As stated above, most of the literature on domestic They conclude that women with learning disabilities violence and women with disabilities focuses on ‘settle with or accept abuse in their lives to gain social women with physical and sensory impairments. As value that has often been missing throughout their life well as establishing the above high prevalence rates, course’ (p. 12). Findings from both these studies the research also makes clear that disabled women strongly resonate with our findings below. (despite their greater need) have less access to Mikton & Shakespeare (2014: 3056) state that ‘among specialist and general domestic violence services the evidence gaps, the exact nature of violence against (Thiara et al. 2012). persons with disability requires more detailed mapping’ In terms of the types of domestic violence disabled and it is this which the research project reported here women are exposed to, the literature suggests that as sought to do. well as what might be termed the ‘usual’ types of domestic violence that any woman can experience Methods (physical, sexual, financial, etc.), disabled women also experience some very specific and unique forms of In this study, we used the UK Home Office definition of abuse, such as perpetrators withholding or sabotaging domestic violence which was current at the start of the needed equipment (wheelchairs, hearing aids, guide research in 2012: ‘Any violence between current or dogs, etc.); withholding assistance, for example leaving former partners in an intimate relationship, wherever women in physically uncomfortable or embarrassing and whenever the violence occurs. The violence may positions for a long time; making threats that leaving include physical, sexual, emotional or financial abuse’. the relationship will result in institutionalization for the woman (Saxton et al. 2001; Hassouneh-Phillips & Curry 2002). Ballin & Fryer (2012: 1085) conclude that ‘Abusive intimate partners exploit the challenges presented by the NB this definition has subsequently been updated to include disability, knowing that this will seriously limit a violence towards young people aged 16–18 and coercive woman’s ability to take action’. control. © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 Journal of Applied Research in Intellectual Disabilities 271 This was a mixed methods study, involving dialogue (Ellsberg & Heise 2002). In anticipation of this, interviews with 15 women with learning disabilities researchers were recruited to this study who had who have experienced domestic violence and an online experience and knowledge of both the learning survey of 717 professionals (police, domestic violence disability and domestic violence fields. workers, adult safeguarding specialists, advocates, etc.). Survey findings are reported elsewhere (McCarthy M., Service user involvement Hunt, S. and Milne-Skillman, K.). This research project worked with an advisory group of women with learning disabilities. They helped at Qualitative data collection various stages of the research, for example, at the Semistructured interviews with women with learning formative stage by helping us to shape the research disabilities were chosen as the most appropriate method questions and towards the end, by helping to for data collection because inquiry into sensitive and disseminate findings. They played a crucial role in personal topics requires a one-to-one method, which helping to make an educational video for women with allows for in-depth, wide-ranging discussion (McCarthy learning disabilities. 1999). The interview schedule was designed by the research team and included the following topics: the Ethical approval women’s understanding and experience of domestic violence; the impact on themselves and their children (if Ethical approval for the study was given by the Social any); their coping strategies; whether and how they Care Research Ethics Committee (SCREC) (Ref. 12/IEC08/ sought help to leave the relationship; and life after the 0028). It received Research Governance approvals from abusive relationship. all the participating Local and Health Authorities and The nature of the topic meant that the interviews unconditional approval from the Association of Directors were often distressing for the women, but none of them of Adult Social Services (ADASS) (Ref. RG12-016). wanted to stop, or shorten, the interviews. No time limit The research project sought, but was not granted, was imposed on the length of interview and most lasted ethical approval to include participants who were still between 1 and 2 h, with some lasting considerably in violent relationships. The SCREC felt that the risks to longer. Many of the interviewees commented on the fact participants did not outweigh the benefits; thus, the that it was the first time they had been able to speak at research could only include those who had left violent length about what had happened to them, that they relationships. This draws attention to one of the main found the interviews helpful, they wanted to talk and ethical issues in researching domestic violence, namely wanted people to hear their accounts. In experiencing the physical safety of participants. Whilst it is, of course, what might be loosely termed as some therapeutic necessary for ethics committees to ensure that all benefits from a research interview, they are far from researchers minimize risk to participants, some unique (Hutchinson et al. 1994; Murray 2003). prominent commentators in the field of domestic Stefansdottir & Traustadottir have described how the violence research are now arguing that some ethics qualitative research process can help women with committees may be going too far; conceptualizing all learning disabilities to ‘face their past and to move on’ research on violence and abuse as ‘sensitive’ and all (2015: 374). Some of the women had keyworkers or victims/survivors as ‘vulnerable’ leads to greater ethical other supporters with them during the interview, scrutiny of these projects compared to others, and although most were interviewed alone. makes ethical approval harder to get (Downes et al. Whilst the participants may have experienced the 2014). They argue that this can prevent some research interviews positively, the researchers found themselves from taking place, leading to a lack of evidence and having to listen to distressing, disturbing and harrowing thus to increased risks to those who experience violence. tales of, in some cases, extreme abuse. This takes an Downes et al. (2014) also argue that some ethics obvious emotional toll and it something that needs to be committees lack an understanding of the ways in which managed by debriefing, supervision and constant Don’t Put Up With It! A DVD on domestic violence for women Copies of the interview schedule are available from the first with learning disabilities is available, free of charge, from the author on request. first author. © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 272 Journal of Applied Research in Intellectual Disabilities victims/survivors competently manage risk themselves. positions the initial “description” in relation to a wider They also claim that ethics committees sometimes lack social, cultural and perhaps even theoretical context’ an understanding of the dynamics of violent (Larkin et al. 2006: 104). relationships and insist on certain protocols which could Initial coding was done by two researchers increase risks to participants, such as written Participant independently, with a high level of agreement. Data Information Sheets and signed consent forms, either of were read and re-read several times, then codes were which, if found by a perpetrator, could endanger a identified from the data content, using inductive woman. A similar situation arose in the research project techniques rather than predetermined categories. reported here, where, in the response to the lead Emerging codes were then clustered into subthemes, researcher saying she would advise women with and finally into overarching themes. Themes were learning disabilities not to tell a violent (ex-) partner identified and given prominence not only because they that she was taking part in the research, the ethics recurred consistently across participants, but also committee stated that it was unethical to encourage because of persuasiveness and extensiveness, that is the secrecy in relationships. strength of feeling and meaning participants conveyed Such concerns, alongside the fact that different ethics when giving their accounts. committees adopt different ethical standards and that those granting or withholding ethical approval may Participants have less specialist knowledge and experience than those wishing to conduct the research, mean that some We recruited a purposive sample of women with mild reforms may need to take place if confidence in the learning disabilities who had experienced domestic ethical approval system is to persist. The goal should violence. No formal assessments of learning disabilities surely be for researchers to embrace a genuine wish to were conducted, but all participants were recruited from have committees help them to conduct ethically professional contacts in a variety of learning disability rigorous research, rather than seeing ‘getting through organizations in London and the South East. ethics’ as an administrative hoop to be jumped through, Eligibility criteria were as follows: as it often is (McCormack et al. 2012). 1. Women with learning disabilities who were willing and able to speak about their experiences. 2. Aged over 18. Data analysis 3. Who were no longer in the violent relationship. All interviews were recorded and transcribed. Data 4. Domestic violence had to have occurred no more were analysed using thematic analysis, and we than 5 years previously. employed some of the principles and practices of Women in same sex relationships were eligible to Interpretative Phenomenological Analysis (IPA) to guide participate in the research, but none were referred to it the data analysis. The rationale for using this approach (Table 1). is that IPA is well suited to a relatively small sample size, as it allows for in-depth exploration of interview Findings data and is deemed particularly suitable for under- researched topics of inquiry (Padgett 2008). There were six main themes emerging from the data: This aim of this method of analysis ‘is to explore in 1. Severity of the abuse. detail how participants are making sense of their 2. Psychological impact. personal and social world’ (Smith & Osborn 2007: 54). 3. Women’s resistance strategies. However, it goes beyond that in that the findings from 4. Perpetrator issues. IPA research are highly nuanced. They seek to offer a 5. Seeking help. detailed understanding of both the themes which have 6. Life after the abuse. emerged across interviews and individuals’ own accounts and in this way build up a picture of the Severity of the abuse general as well as the particular experience of individuals. Analysing data, using an IPA approach, Many women reported very serious assaults and, in involves not only ‘giving voice’ to participants’ some cases, potentially life-threatening injuries, for experiences, important though that is, but also engaging example a head injury from being pushed downstairs, in a ‘more overtly interpretative analysis, which being strangled and being stabbed. The use of weapons © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 Journal of Applied Research in Intellectual Disabilities 273 Table 1 Participant characteristics. It got worse towards the end, because after we split it got even worser. He would say he would kill me, Relationship status at he would say if I can’t have you, no one else can. time of domestic Had Participant Age Ethnicity violence children He would phone and text me and say “I will find where you live. I’ll burn your house on fire with 1 46 White British Had been married No your kids in it” 2 23 White British Never married Yes 3 28 White British Never married No Leaving don’t make no difference.. .they still come 4 30 White British Never married No back for you 5 67 White British Never married Yes 6 49 White British Had been married No 7 23 Bangladeshi Had been married Yes Domestic violence commencing or escalating during 8 31 White British Never married No pregnancy is well established in the literature as a 9 25 White British Never married No common phenomenon (Mezey & Bewley 1997), and it 10 39 White British Had been married Yes was found to be common within our sample. In fact, all 11 27 Indian Never married No of the women who had been pregnant whilst with an 12 36 White British Never married Yes abusive partner reported experiencing physical assault 13 20 White British Never married No whilst pregnant. Two women reported miscarriages 14 41 White British Had been married Yes which they attributed to violent assaults: 15 33 Bangladeshi Had been married Yes When I was pregnant he thumped me, kicked me. I including knives, bottles and heavy objects were also lost one of the babies – and there was two, I didn’t reported. even realise I had twins. I went to hospital, I was bleeding He would normally like push me against the wall, grabbed my neck, I couldn’t breathe... like last time, Sexual violence was common amongst our sample he’s got like a scarf and tried to put that around my and in some of the more extreme cases, happened in neck.. .the worst thing was the strangling front of children or when children present in the home I felt really scared of him. I thought 1 day I’m He raped me in front of my daughters...he gonna end up in a coffin. threatened to cut me with a knife in my private area, he said that in front of my 7 year old. As well as being serious, the violence was often frequent and often happened over long periods of time, The sexual violence was generally harder for the in some cases, for many years. women to talk about than physical or other forms of abuse. It was usually not mentioned in the early I know it was every week, but I can’t be sure if it stages of the interviews, but was revealed later, was every day presumably after a level of rapport and trust had been established. How often did the abuse happen? To put it bluntly, Financial abuse was also reported by many of our everyday sample. As outlined below, many of the perpetrators had drug/alcohol problems and almost all were It was 12 years of abuse unemployed. The men used the women’s money, both their regular income as well as savings, as a matter of Another defining feature of the women’s experience course, using force where necessary and leaving the was that the end of relationship was not always the end women with debts to be repaid long after the relationship had ended. of abuse. As is frequently reported in the general domestic violence literature (Fleury et al. 2000), violence, abuse and harassment often did not end when the He wanted my money always, for the drugs, he’s relationship did. As some of the women in our study left me in a lot of debt which is what I’m still could describe, it often got worse: struggling with now © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 274 Journal of Applied Research in Intellectual Disabilities He would ask me for money and if I said no, he’d I wanted do different things, take my son out on twist my arm. He took a lot, all the money I had days out.. .he made me stop them, he....everything been saving up was always about him Verbal abuse was an everyday occurrence, with the A common form of coercive control was to women being continually insulted: deliberately isolate the woman from her friends and family. The women reported that the perpetrators did He called me a bitch, a bastard and a liar this in two main ways: either intimidating the women into stopping going to see their family and friends or He called me a fat bitch, ugly and a slag using various tactics to ensure the family and friends stopped seeing the women: Psychological and emotional abuse of women by their partners can take many and varied forms (WHO 2012). he was nasty to them outside [neighbours]I lost all One of ways it manifested itself for the women in our my friendships with the neighbours.. .he made it so study (and this was found also to be the case in Hague I didn’t have anyone to talk to and things like that et al.’s 2011 study) was the perpetrators using the woman’s disability itself to taunt her with: my oldest, kindest friends, he accused them of stealing, so they wouldn’t come here again. Because I had learning disabilities and needed support, he used to drive that in my face. Some perpetrators even tried to isolate the women from their own children, particularly where the He used to take the piss out of me because of my children had been taken into care and the women were learning disability. He used to show me up in front desperate to maintain contact through access visits or of his mates if I couldn’t work something out. He’d phone calls. The perpetrators would prevent these visits and calls. Social Services Departments who were say “you’re useless, you can’t do nothing”. unaware of the dynamics of the violent relationship, Women who had additional mental health problems would then infer that the women were not interested experienced similar treatment. For example, a woman in maintaining contact with their children, with all the with depression and suicidal thoughts describes how implications that entails. The callousness of some of her partner would goad her: the perpetrators was evident and shocking, for example: He gave me a wire and told me to strangle myself, he wanted me to suicide myself, he wanted me to die. He wouldn’t even let me see my children...once I’d lost my kids [in care], he said “get rid of their Coercive control (see Stark 2007) is an all- photos, your kids are not coming back” encompassing form of domestic violence that featured strongly in our sample. All but one of our participants experienced having their freedoms curtailed through Psychological impact unreasonable and non-negotiable demands, threats and intimidation: As a consequence of the above, it is not surprising that the abuse the women experienced had a significant When I got up first thing I had to do everything he psychological impact, both on the women themselves wanted. If I didn’t he would hurt me straightaway. and on their children. Many women described feeling I had to bring him breakfast in bed. If I didn’t, I’d humiliated by what was happening and how their self- get a clap round the head.. .I had to just leave the esteem became very low: baby to cry...to sort him out first I felt hatred, towards myself He said not to talk to boys, he told me “don’t wear sexy clothes”. If I did, he would hit me. He I was putting myself down, I couldn’t even look in wouldn’t let me see my friends. the mirror. © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 Journal of Applied Research in Intellectual Disabilities 275 Some spoke of developing mental health problems, learning disabilities was adversely affected by the and for a few, these included self-harm and suicidal experience of abuse. thoughts: Women’s resistance strategies I was very very low, I was on anti-depressants and they got highered and highered Despite the severity of the abuse outlined above and the disadvantageous position of the women in relation to I wasn’t getting any help...I took an overdose, a the men who abused them, it would be wrong to small one, assume that the women were simply passive victims. Resistance to domestic violence can take many forms, I tend to want to take my life...and I have got a although the literature often focuses on physical very bad habit of trying to do that. resistance to a one-off, violent, usually sexual, assault (Cermele 2010). In this study, the women’s resistance The women were distressed about the impact on their strategies included verbally resisting/standing up to children. In particular, they focussed on the effect on perpetrators, sometimes hitting back, rejecting apologies, children of witnessing their mothers being upset, using contraception secretly and reporting animal abuse humiliated or physically hurt: to the authorities. Many women in our study made multiple attempts to There was screaming matches and he used to make leave and of course, the ultimate resistance is to my son [aged 9] believe it was my fault...but my permanently leave the violent relationship, which all son never liked to see me upset, so he always used our sample did eventually. to be on my side Perpetrator issues He was dragging me and hitting me and my daughter [aged 4] was slapping him, saying “Let We did not speak with any of the perpetrators in this mummy go”. He turned around and said to her study, so any information we have comes from the “Shut up, before you get the same” women with learning disabilities, although much of it was corroborated by the professionals who referred He used to call me names in front of the children them to the research project or by keyworkers who and I think it’s something they do pick up on, kids, supported women during the interviews. they don’t understand what the names actually From this information, it was clear that mostly, the mean, but they pick up on it. I thought it would violent partners did not have learning disabilities grow off them, but it doesn’t, it stays with them. themselves but did tend to have mental health problems, sometimes also alongside drug and alcohol dependency Some women were also aware of the social and (a minority had serious physical health problems too). psychological implications for children of multiple They tended to be jealous and manipulative, make threats moves to escape from a violent ex-partner. One woman of self-harm/suicide/murder (including murder of with two young children said ‘I moved 10 times and that’s children). They had a history of abusing previous not right for kids, is it?’ Another, who had experienced partners and would sometimes boast of this to the very extreme and sadistic abuse from her partner, woman with learning disabilities. Animal cruelty described how she struggled to bond with her eldest featured in several accounts of the perpetrators (the link child, because the child physically resembled the between perpetrating animal abuse and domestic perpetrator and said the child was receiving therapy for violence is well established in the literature (Febres et al. emotional and behavioural problems. 2014) and the women stated that the men often had The psychological effects of domestic violence on the criminal records and were known to Police already. women in this study echo those found by Taggart et al. (2008, 2009) in their studies looking at risk factors for Seeking help psychological distress in women with learning disabilities. They highlighted abuse as a key risk factor. An important general point to make here is that a lot of Similarly, the above findings echo those by Conder et al. professionals were aware of the abuse the women were (2015) who found that the mental health of women with experiencing, especially healthcare workers. However, © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 276 Journal of Applied Research in Intellectual Disabilities because the knowledge was gained in indirect ways and that they had not been able to access information in a because the women with learning disabilities did not form that was easily understandable to them. This is specifically ask for help in escaping from the therefore one of the things we have sought to rectify, by relationship, little or nothing was done. This seems to producing some accessible materials. be a common phenomenon with the general population For women with physical and sensory impairments, (SafeLives 2015) and with women with physical and the literature suggests that when accessible women’s sensory impairments (Hague et al. 2011). refuges are not available, disabled women who had On the occasions when the women did report experienced domestic violence would face the domestic violence, as opposed to indirectly letting it be unacceptable practice of being ‘threatened with’ or known, a minority reported good experiences: indeed placed in, institutional forms of care as a way of getting them out of their homes (Hague et al. 2011). My social worker brought me to a safe place where Whilst this was not a common finding in our study, people could look after me and take care of me there were a few such examples, including one woman who was placed in a care home for elderly and people The Police were really helpful, really good with physical disability (she was neither). The staff there appeared to lack any understanding of the However, the majority experienced problems in dynamics of domestic violence: she had not wanted to seeking help, especially those who had children. have any further contact with her abusive partner, but Echoing the findings of Walter-Brice et al. (2012), the she was persuaded by the care home’s staff to do so, women felt unsupported: because he was terminally ill in hospital and had a requested a last visit from her. When she visited him in When we ask for help, there’s no one to help us. hospital, he tried to assault her from his hospital bed. They seem to take your children away instead of helping you [sobbing] Life after the abuse When I phoned Social Services to say that my Ex As stated above, for many women, the end of the had our daughter living with him, even though the relationship was not the end of the abuse and some Court said he couldn’t have her, they said “we faced ongoing harassment, intimidation and, on can’t do nothing about that now, she’s not on the occasions, serious assaults after they had ended the computer no more”. relationship. However, once the women were finally free, then most were able to explain, with some relish, Some women themselves interpreted the lack of help the improvements in their lives: available to them as being due to financial reasons: I’ve got a good life now... Because of all the fundings being cut they wasn’t able to help me...I’ve got low support needs, they I’m very happy now. I’m going up and not down only assist people high... I’ve got no worries now, I’m happy, a lot different, I used to have an advocate, it’s all been stopped best thing I ever done If you get counselling, they’re only six sessions and About half our sample had entered into a new that’s for a normal person as well as a disability relationship, in which they were happy and were well person.. . and that’s not long enough for a disability able to see the contrasts with the abusive relationships: person I’ve got a wonderful husband now.. .I’m so We specifically asked our participants what happy...It’s a lot different...It feels like someone information they had which might have helped them wants me.. .he helps me if I get stuck. He doesn’t leave their relationship, that is about domestic violence take the mickey out of my illness services, women’s refuges in particular. Their levels of knowledge were low, with 11 of 15 women unaware of I can do anything now.. .he’s more loving, he’s what a women’s refuge was, for example. This indicates more caring. © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 Journal of Applied Research in Intellectual Disabilities 277 The other women were choosing not to be in a If you don’t see loving relationships when you’re relationship and saw this as a positive choice. growing up, you’ll get messed up, like I did. I was vulnerable, cos I didn’t have confidence in Discussion myself...cos I didn’t have a great childhood Conceptualizing domestic violence Others had clearly been railroaded into cementing the It appears from our study that a dominant model is relationship too quickly (through manipulation, or to see domestic violence as an individual problem through being easily led): (instead of the widespread social problem that it is, historically and cross-culturally). Thus, a woman who When I started seeing him, he moved in received a text from her ex-partner threatening to kill straightaway, because he was homeless...it was too her, was advised by Police to turn her phone off and easy, I just let people walk all over me, still do get a new one. A young woman who had to have these days. security on the entrance to the Labour Ward to prevent her violent partner from entering while she I was living in my own flat, but I suppose you gave birth, was subsequently discharged from hospital could say I gave into him and let him come over at to go home and live with him, with no follow-up. the weekend and he stayed 2–3 days, then it ended Another woman was advised by her Care Manager up 4, 5, then it was 7 and he was here! that it was ‘her choice’ if she wanted to continue living with her violent partner, otherwise she should I just don’t know when to say no to somebody. I just leave. When domestic violence is seen in this will give things to people that I can’t afford to give way, then the solution is seen as largely in the hands of the woman herself, usually by leaving her home. Like the idiot I am, he gets his foot in the door However, this is a flawed response and one which fails to make links with other, similar, crimes against Some women were indignant about the ways their people with learning disabilities, notably so-called homes had been taken over by the men they formed mate crime (Gravell 2011; Landman 2014). Mate crime relationships with: is where people with learning disabilities are befriended by those who are intent on abusing and I always kept my place really clean and tidy, but exploiting them and its dynamics are very similar to once he come in, he brought all his stuff to my the relationships many of the women with learning place and I had to live in the front room, sleeping disabilities in our study found themselves in, that is, on the settee, cos he’d junked up my bedroom with meeting someone who appears to like them, who then bags of his rubbish and it smelled very quickly inveigles their way into their life and home and starts exerting power and control, through The problem with taking an individualized approach to intimidation and violence. In Gravell’s report (2011: domestic violence and expecting vulnerable people to find 17), this process, whereby so-called friends take over their own solutions to it, is that it is too simplistic. Notions the homes and other resources of people with of ‘choice’ can be masked by people’s lack of, or poor, learning disabilities, is referred to as ‘cuckooing’ and experiences. When people live in poverty, in poor housing it was certainly evident in our study, whereby many and in social isolation, as many of those with mild of the women found their new boyfriends moving learning disabilities do (Money, Friends and Making Ends into their homes at a very early stage of the Meet Research Group 2011), it is not surprising that some relationships, before the women were comfortable seek and maintain relationships which are damaging: with that. As to why, apart from a general lack of ‘Given so few opportunities for relationships that bring assertiveness, the women did not object to this, there warmth, mutual support and validation, then often any were a number of different reasons why they could connection is better than none’ (Landman 2014: 359) not assert their autonomy: Capacity to exert and express choice is also relevant Firstly, some women felt that their own troubled here. When controlling behaviour, intimidation and backgrounds and personal histories contributed to them violence starts very early in a relationship or even before not being able to stand up for themselves: a ‘relationship’, as such, has begun, then the trauma a © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 278 Journal of Applied Research in Intellectual Disabilities woman with learning disabilities might experience can Similarly, staff should be alert to women with compromise her ability to make choices and learning disabilities becoming more isolated (less professionals need to be mindful of this. Whilst all the contact with family, friends, professionals, her children women in our study had mild learning disabilities and (if in care)) after the start of a new relationship and if therefore did not lack mental capacity, per se, it is not the women seem to have less money than before they well understood how trauma arising from violence and meet their partners. abuse affects decision-making abilities, although this is Clearly, any signs of physical injury need to ring starting to be recognized in the literature (Dixon & Robb alarm bells and staff should be aware that there is every 2015). It is also recognized in law: in 2010 a woman with likelihood of multiple forms of abuse will be taking learning disabilities, who had been assessed as having place. Only one woman in our study experienced capacity to consent to use contraception whilst single, physical violence in isolation and all the others was subsequently assessed as not having capacity to experienced multiple abuses and this is typical (WHO consent to this, after she married an abusive partner. 2012). This was due to coercive pressure from her husband and The NICE guidelines (2014: 12) also state that staff in his dominating influence over her (Local Authority vs A a variety of services, including those who work with [2010] EWHC 1549 (Fam)). vulnerable adults, should be trained to ask service users The Mental Capacity Act (2005) states that people whether they have experienced domestic violence and should receive support to help them make their own abuse: ‘This should be a routine part of good clinical decisions. In this context, support could be interpreted practice, even where there are no indicators of such as information about the help that could be available to violence and abuse.. .Ensure people who may be women with learning disabilities if they wished to leave experiencing domestic violence and abuse can be seen a violent relationship. on their own’. Another priority is for healthcare and social care professionals to have a greater remit to work with those Implications for policy and practice with a mild learning disability. Whilst this may sound It is imperative that professionals involved in the lives unrealistic in times of austerity, considering the of women with learning disabilities become more aware significance of public spending cuts on people with of the problem of domestic violence. Indeed, National disability (O’Hara 2014), the context for this being made Institute for Health and Care Excellence (NICE) a priority is that almost 90% of local authorities in guidelines (2014) state that ‘Health and social care England no longer offer social care to people whose service managers and professionals should ensure front- needs are ranked low or moderate (BBC 2014). Those at line staff in all services are trained to recognize the the most able end of the learning disability spectrum, indicators of domestic violence and have effectively been moved outside the social care abuse’(Recommendation 6, authors’ emphasis) system: and this renders them very vulnerable to abuse. This research suggests the indicators or ‘red flags’ They may live their lives in poor homes, in poor that staff need to pay attention to are as follows: communities, socially marginalized and excluded. In Women with learning disabilities in relationships with their ground breaking report, giving a voice to such men people, that is, those ‘with a learning disability who 1. With no learning disabilities. don’t get help and support from formal services’ the 2. With mental health problems. Money, Friends and Making Ends Meet Research Group 3. Drug/alcohol problems. describe their situation thus: ‘We have very few friends 4. Who do not work. who know things and can help us...lots of us have had 5. Who move in with the women very early into the bad experiences with past relationships. We are not in relationship. contact with many people who can support us to stop us getting into difficulties in the first place’ (2011: 23). This is not just an issue in the United Kingdom and This is not to suggest that unemployed men are more likely to Conder et al.’s recent paper from New Zealand (2015) be violent than men who work, but the relevance is that money details how women with a mild learning disability can is likely to be tight and thus the potential for financial abuse of and do become invisible to services and that this women is clear. More significantly, when the men who do not renders them vulnerable, particularly at times of crisis go out to work and spend most of their time at home, the women get no respite from the abusive behaviour. or transition. © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 Journal of Applied Research in Intellectual Disabilities 279 Healthcare and social care professionals have a role in were discussing events more than five 5-year-old, so making women with learning disabilities aware of this hopefully did not have a large effect; nevertheless, relevant laws and how to invoke them. For example, they were relying on memory. knowledge of the Domestic Violence Disclosure Scheme – Finally, the participants were all women who were commonly known as Clare’s Law – could be very useful able to reflect on, and enter into lengthy discussions to women with learning disabilities entering new about, their experiences. Thus, the experiences of those relationships and who are worried about their partner’s at the more severe end of the learning disability behaviour. However, they are likely to need help to spectrum are not included. understand the process of applying for disclosure, as well as the rights and responsibilities attached to it. Conclusion This leads onto the need for joined up thinking and working between healthcare and social care professionals There is nothing about having a learning disability (including domestic violence services) and the Police. which protects women from domestic violence. This The Police response to domestic violence for those in the research, and that of others such as Walter-Brice et al. general population has been officially deemed as “not (2012), suggests that the full range of mental, physical good enough” (HMIC 2014: 6) with only 8 out of 43 and sexual cruelty which is inflicted on other women, is Police forces judged to be responding well to domestic also inflicted on women with learning disabilities. abuse. As the police have little training in responding to In view of this, this paper has argued that healthcare women with learning disabilities who report domestic and social care professionals have a clear role in trying violence (see McCarthy et al. in preparation), confidence to help women with learning disabilities to recognize cannot be high that they would deal with these cases any domestic violence and to avoid or leave violent better. Opportunities for learning from, and with, their relationships. Specific recommendations have been colleagues in learning disability services should be taken made about recognizing indicators of domestic violence wherever possible. This could happen during training and being pro-active in asking women if they need help. and also through joint operations, as sometimes As well as these measures, in a more general sense, happened in mental health, when a nurse will healthcare and social care professionals should seek to accompany police officers when they respond to a call enhance the independence, and improve the lives, of from a person with mental health needs. women with mild and moderate learning disabilities in However, working together across services, when a broad sense, for example through developing their adult social care, the police service and social networks (McConkey 2010) and through domestic violence services are all facing further cuts is a employment (Forrester-Jones et al. 2004) and other very difficult task indeed. The cuts to services which meaningful interests and activities: have already taken place, and further ones planned will “As long as the most, and sometimes only, valued inevitably hinder, not help, responses to women with thing in a woman’s life is her relationship with a man, learning disabilities who report domestic violence. this will leave her emotionally and psychologically dependent and vulnerable to exploitation and abuse” (McCarthy 2014b: 5) Limitations of study In assisting women with learning disabilities with As with all studies, there were a number of limitations regard to domestic violence, there is a clear and strong to this one, which should be borne in mind. For role for advocacy, including self-advocacy and example, the sample was relatively small and specifically women’s groups (Martin et al. 2012). In this participants were all volunteers, which may have research project, we found that some women were keen resulted in unknown biases. Also, within this to get more involved in domestic violence work and to sample, there is a lack of representation of women from offer help and support to each other. Black Afro-Caribbean backgrounds (although Asian Women with learning disabilities also need accessible women are included). This is despite active and information, so that they become aware of the infrastructure which exists to help other women who repeated efforts of the research team to ensure Black and Minority Ethnic women were well represented. are seeking to leave violent relationships. Only four of Another limitation is that because we were not able to fifteen women in this study had heard of women’s include women still in violent relationships, this meant refuges at the time they were in the violent relationship. we had a focus on historical cases. None of the women However, there would be little point in providing © 2015 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd., 30, 269–282 280 Journal of Applied Research in Intellectual Disabilities Chenoweth L. (1993) Invisible acts: violence against women accessible information, if the services do not, in turn, with disabilities. Australian Disability Review 2,22–28. make themselves accessible to women with learning Chenoweth L. (1996) Violence and women with disabilities: disabilities (Hague et al. 2011). This research therefore silence and paradox. Violence Against Women 2, 391–411. offers a clear challenge to those in both the learning Conder J. A., Mirfin-Veitch B. F. & Gates S. (2015) Risk and disability and domestic violence spheres to work resilience factors in the mental health and well-being of together to help women with learning disabilities, women with intellectual disability. 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