Chapter 6: Strengthen the role and impact of ill health prevention

Changing Lives is an organisation that supports people who experience multiple disadvantage. 
Their focus consists of four pillars of practice - 

• Women and Children 
• Housing 
• Recovery 
• Employment

Changing Lives' work with women falls into three sub areas:

• Adult women who have been groomed for sexual abuse through exploitation and women who exchange sex for money 
• Women who have experience of the criminal justice system 
• Domestic abuse - refuge, IDVA and ISVA services and family services, supported by an experienced domestic abuse workforce for those who are refused other provision because of complexity of need.

In regard to inequalities experienced by women, an important aspect is the premature deaths of women who experience multiple disadvantage, which was highlighted in a recent report, 'Make The Link: The premature deaths of women experiencing abuse and exploitation' (November 2022).
(Changing Lives. (2022). Make the link: The premature deaths of women experiencing abuse and exploitation. A briefing by Changing Lives.)

The data from this report showed how 61 women with multiple disadvantage had died before age of 40 - many of these deaths were recorded as drug related deaths or unknown cause.

Some of the deaths have been linked to domestic homicide reviews, where huge inequality and lack of understanding were shown for the women - all of whom were exposed to domestic abuse and had a history of trauma and/or violence. All of this points to the fact that services collectively are not meeting the need of these women in the right way to stop them dying prematurely. And though this is not intentional, we must do better as the life expectancy for this group is far below average.

Another inequality that is experienced by the group of women that our services work with, is the access to justice. Many of the women have been repeat victims of sexual exploitation and yet the perpetrators are not held to account for this, as the cases are not referred to the CPS and most often never get to trial. Women with complex issues are viewed by the criminal justice system as unreliable witnesses, and as a result the crimes against them go unpunished. Although there have been some high-profile cases that have had more traction within the criminal justice system, for the majority this is the picture. 

For this to change it is important that the women are understood from a safeguarding perspective. They need to be fully understood by services to get the help that they need and that requires services to be trauma informed. It is difficult for these women to reach out for help and support if their previous experiences of engaging with services have been negative. If services do not have a positive response and come across as judgmental, this is just not good enough. We recognise that doing things in a different way can be really challenging, but we have to find the right way to do this, otherwise we are letting down the most vulnerable women in our communities The message that a different approach is needed has been highlighted through Safeguarding Adults Reviews, Domestic Homicide Reviews for example.

An example of this is letters for appointments. They just don't work for women who are experiencing complex issues. Personal engagement and persistence (with boundaries) are much more effective and building the kind of relationship that will make a difference to the women.