Baroness Finlay of Llandaff:

Moved by Baroness Finlay of Llandaff

23: Clause 55, page 35, line 30, at end insert “including, where necessary, alcohol and mental health support,”

My Lords, I declare my interest as chair of the Commission on Alcohol Harm. The commission received evidence from many who had first-hand experience of the relationship between alcohol and domestic abuse. As many noble Lords pointed out in Committee, there is a strong, if complex, relationship between alcohol and domestic abuse. The figure often quoted is that up to half of perpetrators have been drinking when an assault takes place. Alcohol also tends to make violence more serious, doubling the risk of severe violence and rape. Tragically, substance use is a factor in over half of intimate-partner homicides.

It is not only perpetrators who drink. Women who have experienced extensive physical and sexual violence are more likely to use alcohol or drugs harmfully than women who have not. They might do so in an attempt to self-medicate and cope with their experiences, or drink with their partner as a form of bonding. Substances may be part of the abuse itself, and perpetrators may use alcohol to control victims. ONS figures show that around 10% of those accessing domestic violence support services have an alcohol use need, many times higher than the rate for the general population. Around 6% have a drug use need and around 40% a mental health problem. Given the difficulties people with additional needs have in accessing domestic violence support, these figures may well underestimate the scale of the problem.

Indeed, survivors may have been forced to choose which of their needs they are able to get help with. Alcohol treatment is desperately underfunded, and there simply are not enough alcohol treatment services set up to help domestic abuse survivors. For example, female survivors of male violence may not feel able to receive treatment in a mixed space; yet less than half of local authorities in England and Wales have provision for women-only substance use services. Women may also find that their drinking can prevent them accessing a safe space, with some turned away from refuges due to drinking or drug use. Only about one-quarter of refuges in London, when asked the question, stated that they “always” or “often” accept women who use alcohol or other drugs.

Following a very constructive and productive meeting with the Minister last week, she has written reassuring me that this is a priority for the Government. She has agreed to address the issue of alcohol and domestic abuse in statutory guidance and in the domestic abuse strategy, which will set out a comprehensive framework for responding to and supporting victims. I welcome the Minister’s recognition of the seriousness of the problem and her attempts to resolve it. In her letter, she also set out the opportunities created by the new integrated care systems to allow for greater joined-up working between services to better support victims with the alcohol treatment they so often need urgently.

This urgency has increased during the Covid-19 pandemic, making it more important than ever for us to act now. During the first lockdown, visits to the UK’s national domestic abuse website surged by 950% by the end of May. NSPCC Wales reported average referrals for parental substance use to police and agencies were 72% higher in the 10 months to February 2021 than in the first three months of 2020. These figures are frightening, but they go only a small way to illustrate to your Lordships the scale of what people are experiencing right now. I am grateful to the Minister for her letter to the noble Lord, Lord Brooke of Alverthorpe, where she recognised the need for much better sobriety schemes, which we greatly appreciate, but I remind the House of the size of the problems.

I shall finish by sharing the words of a 15 year-old boy who contacted Childline. Speaking of his own experience, he said:

“I’m really scared of my dad, especially when he’s been drinking. Sometimes he gets really angry and throws things at my mum. It’s been getting worse since the coronavirus and I worry a lot. I have no idea what to do as I can’t escape because of the lockdown.”

I hope, therefore, that I will get an even warmer reception for this amendment than I received in the letter from the Minister, and I reserve my ability to divide the House on this very important issue pending the response I get. I beg to move.

My Lords, I want to take a moment to support the noble Baroness, Lady Finlay of Llandaff, in her Amendment 23. I pay tribute to all her work in this field and to the other signatories to the amendment. I want to single out the noble Lord, Lord Brooke of Alverthorpe, with whom I had the privilege of serving on the ad hoc committee on the Licensing Act 2003.

Without any shadow of a doubt, as the noble Baroness, Lady Finlay, set out, domestic abuse is, unfortunately, aggravated and fuelled by alcohol and drug abuse. It behoves all of us to try to limit the damage done in these circumstances. I therefore hope that my noble friend the Minister will look favourably on the modest change to the wording of the Bill that is proposed here.

I know that Scotland has taken a lead, particularly on the unit pricing of alcohol. I initially had reservations about that until I heard the evidence we took on the ad hoc committee. It was always understood, and we concluded that we would press them, that the Government would come forward with unit pricing in Scotland. I think my noble friend the Minister would agree that it has led to a significant reduction in alcohol abuse.

With those few words, I lend Amendment 23 my support, and ask my noble friend to look favourably on the modest additional wording it proposes.

I should have declared earlier an interest as chairman of the National Commission on Forced Marriage.

I thank the Minister very much for listening and for what she said in response to the debate on an earlier amendment on forced marriage. I agree entirely with what the noble Baroness, Lady Finlay of Llandaff, said. I would just add that mental health issues should include people who are forced into marriage, most of whom are very young and some of whom are under 18.

My Lords, it is a pleasure to follow the noble and learned Baroness, Lady Butler-Sloss, who supports this amendment. Like the noble Baroness, Lady Finlay, I acknowledge the helpful letter on this amendment that we received today from my noble friend the Minister.

Accommodation-based support, as proposed in government Amendment 22, is highly relevant because domestic abuse can take place in settings other than the home. Alcohol intoxication increases vulnerability because it makes victims less physically able to get away from an aggressor and more likely to make poor decisions. Likewise, alcohol increases the chances of the aggressor assaulting someone in the home or other accommodation-based settings. We know that the more intoxicated someone is, the greater their chance of sustaining serious injuries.

We should also be concerned about the effects of domestic abuse on children—the hidden victims of domestic abuse, as the noble Baroness, Lady Benjamin, noted in the debate on the first group of amendments. Witnessing domestic violence and alcohol abuse are major events in childhood and may lead to an anti-social lifestyle of offending, truancy and violent behaviour in the years ahead.

As a surgeon, I treated many patients with injuries sustained following domestic disputes, nearly all of them fuelled by alcohol. Some were horrific injuries to the chest and abdomen; others were less serious but, none the less, led to long-term complications—particularly injuries to the face from the assailant’s fists or a blunt weapon. The consequences lead to long-term disfigurement, and the sight every day in the mirror of a broken nose or missing teeth is a constant reminder of the abuse suffered. Children, too, may suffer injuries as part of the collateral damage. Many choose not to admit to the assault outside the home.

I am grateful to Professor Jonathan Shepherd, a surgeon and professor at Cardiff University’s Crime and Security Research Institute, for providing me with his publications in the journals of both the Royal College of Surgeons and the Royal College of Psychiatrists and his position statements on the management of alcohol abuse and the mental health impacts of violence. My noble friend the Minister may wish to consider these in the formal consultation after Royal Assent.

In conclusion, where alcohol is concerned, it is important not to view physical injuries in isolation. All too often, the two are inextricably linked. I would welcome the opportunity to share these Royal College policies with my noble friend the Minister, in the hope that they may influence national policy in providing alcohol abuse and mental health support, as this amendment proposes.

My Lords, we had an extensive and informed debate on this issue in Committee, so there is no need for me to detain the House by repeating what I said before.

The noble Baroness, Lady Finlay, has confined herself to just one amendment this time, to which I have added my name in support. It encapsulates the importance of the issue and uses the modest vehicle of including alcohol and addiction support in the definition of domestic abuse support when local authorities assess the need and prepare their strategies to meet it.

I hope the Minister will agree that the close and complex relationship between what I called in my remarks in Committee

“the unholy triumvirate of substance abuse, domestic abuse and mental ill-health”—[Official Report, 27/1/21; col. 1621.] is intrinsic and deserves to be included somewhere in the Bill. However, I fear that that will not be the case today. The Minister has written to the mover of the amendment, the noble Baroness, Lady Finlay, and I am grateful for the copy she sent me. In the letter, the Minister says that the Government will reflect on the importance of this unholy triumvirate in statutory guidance to be issued under Clause 73 of the Bill. I am not convinced that this will be good enough to get the concerted result we need, so if the noble Baroness, Lady Finlay, decides to call a vote, my party and I will support her.

My Lords, it is important to recognise that domestic abuse does not happen in a neat silo. It is inherently bound up with the wider issues of mental health and substance abuse.

We cannot ignore the impact of devastating cuts to our public services through a decade of austerity. The Royal College of Psychiatrists called for the Government to reverse the cuts and enable local authorities to invest at least £374 million in adult services to cope with the increased need. Indeed, report after report highlights the poor preparedness of our public realm to cope with this dreadful pandemic. It is as a consequence of the austerity decade that council funding has been cut to the bone.

Mental health services have been particularly impacted by austerity, leading to a lack of services and long waiting times. Victims and survivors with mental health problems also face barriers in accessing many other vital services due to strict eligibility criteria and not being able to engage in the way that the services require. Such barriers often lead to people being bounced between different services and having to constantly retell their story. There is awareness of the complex and interrelated needs of those with mental ill-health, but many services are unequipped to support them and few services exist that can care for people with both mental health and substance misuse issues.

The noble Baroness, Lady Finlay of Llandaff, spoke expertly and knowledgably about the close link between domestic abuse and alcohol, with a perpetrator drinking heavily. Of course, there are instances where the victim’s drinking leads to uninhibited behaviours that can trigger abuse. Similarly, the victim may use alcohol and drugs to self-medicate. We know that the level of alcohol consumption has increased during the pandemic, thus exacerbating an already known problem.

This should be part of the Government’s work on community services. They have made a commitment to consult on the provision of community services for victims and perpetrators. Will the Minister give a commitment that the consultation will explicitly include the provision of alcohol and substance misuse services? All this work will be effective only if we look at tackling domestic violence in the round.

In conclusion, the importance of multiagency and holistic working in this area cannot be overemphasised. It is important to recognise that mental health and addiction problems can create additional vulnerabilities which people perpetrating abuse may seek to exploit. If the noble Baroness, Lady Finlay, decides to test the opinion of the House, the Opposition Benches will strongly support her.

My Lords, I thank the noble Baronesses, Lady Finlay and Lady Burt, and the noble Lord, Lord Brooke, for tabling this amendment. I am grateful to have had the opportunity to discuss the issue with them at length. As the noble Baroness, Lady Wilcox of Newport, observed, domestic abuse does not happen in a neat silo. That is a very good way of putting it in the context of this amendment.

In Committee we debated the complex relationship and obvious correlation between domestic abuse, mental health problems and the misuse of drugs and alcohol. Some of us have witnessed the way in which someone who abuses a substance such as alcohol seems to have a switch flicked within their brain and suddenly becomes potentially very aggressive. That is not an excuse for domestic abuse. It is important that both victims and perpetrators have the opportunity to address these issues, and that they get the support they need. To this end, the statutory guidance issued under Clause 73 will reflect the importance of joining up domestic abuse, mental health and substance misuse services.

As I informed the Committee, local authority spending through the public health grant will be maintained in the next financial year. This means that local authorities can continue to invest in prevention and essential front-line health services, including drug and alcohol treatment and recovery services. We want to ensure that people who need support for alcohol and substance misuse issues can access the right services commissioned by local authorities. The Government are working on increasing access, and we have appointed Professor Dame Carol Black to undertake an independent review of drugs to inform the Government’s work on what more can be done.

The overarching aim will be to ensure that vulnerable people with substance misuse problems get the support they need. The review will consider how treatment services can enable people with a drug dependency to achieve and sustain their recovery. These will span a wide range of services with which they might interact across mental health, housing, employment and the criminal justice system. The review is currently focusing on treatment, recovery and prevention. The Government look forward to receiving Dame Carol’s recommendations shortly.

I reassure noble Lords that we intend to reflect the importance of joining up domestic abuse, mental health and substance misuse services. The joint strategic needs assessment produced by local authorities, clinical commissioning groups and other partners should include consideration of the needs of victims and survivors. This assessment informs the commissioning process for the local area. In addition, joint working through local health and well-being boards helps support people who may have co-occurring substance misuse, mental health and domestic abuse issues with more effectively commissioned services in order to improve outcomes and the use of local resources. We want to ensure that, no matter where someone turns, there is no wrong door for individuals with co-occurring conditions, and that compassionate and non-judgmental care centred on the person’s needs is offered and accessible from every access point; for example, people can access via a referral from their GP, or by self-referral. I hope this reassures noble Lords that assessing and meeting the needs of the local population are already integral to the commissioning and provision of healthcare services.

In addition, the Government have announced a total of £25 million in funding for domestic abuse perpetrator programmes. This more than doubles the £10 million funding for such programmes last year. Through them, we funded a number of interventions that sought to address issues such as substance misuse and mental health problems as part of a wider programme of intervention.

I know that the noble Lord, Lord Brooke of Alverthorpe, is pleased that the Bill introduces domestic abuse prevention orders—DAPOs—which enable positive requirements such as attendance at a drug or alcohol programme or a behavioural change programme. The courts will also be able to require the subject of such an order to wear a sobriety tag.

The Government recognise the harm that alcohol can cause and have already committed to rolling out sobriety tags as part of a wider programme to tackle alcohol-fuelled crime. Following two pilots and a successful judicial engagement programme, the alcohol abstinence monitoring requirement was launched in Wales on 21 October last year. This has proved a popular option for sentencers in Wales and we will be rolling out the new requirement in England later in the spring.

We are also committed to our ambitions in the NHS long-term plan for expanding and transforming mental health services in England, and to investing an additional £2.3 billion a year in mental health services by 2023-24. This includes a comprehensive expansion of mental health services, ensuring that an additional 380,000 adults can access psychological therapies by 2023-24.

I would add that the domestic abuse commissioner’s role requires her to adopt a specific focus on the needs of victims from groups with particular needs. She also has the power to make recommendations where she sees gaps in provision. I believe her role will offer independent oversight and the assurance that all issues relating to domestic abuse will be monitored closely.

Finally, it is worth briefly touching on the drafting of the amendment. The noble Baroness, Lady Wilcox of Newport, referred to this. It seeks to add to the definition of domestic abuse support in Clause 55. This relates to a new duty on tier 1 local authorities to provide support to victims of domestic abuse and their children within safe accommodation. As such, the amendment does not touch on the issue of support for perpetrators to help them address problems with alcohol misuse; nor does it deal with the provision of alcohol and mental health community-based support. This is the point that the noble Baroness, Lady Wilcox, was making.

That said, I can assure the noble Baroness that, as part of the new duty in Part 4, tier 1 local authorities will be expected to assess the accommodation- based support needs of all domestic abuse victims and their children. Within the statutory guidance that will accompany Part 4, we describe the support within “relevant” safe accommodation as including support designed specifically for victims with unique and/or complex needs, such as mental health advice and support, and drug and alcohol advice and support.

Again, I thank the noble Baronesses, Lady Finlay and Lady Burt, the noble Lord, Lord Brooke, and other noble Lords for drawing attention to this important issue, and I thank all noble Lords who have raised it during this debate. I hope I have been able to persuade the noble Baroness in relation to the existing provisions and our ongoing ambitions to address the links between substance misuse, mental health and domestic abuse. On that basis, I ask the noble Baroness to withdraw her amendment.

My Lords, I am grateful to the Minister for the detail she has provided in her full reply. I understand from a previous conversation that the guidance to the Bill will be statutory, as will, therefore, the implementation of the many factors to be included in it that she listed in her response. I am also glad to hear that the review of my long-standing friend and colleague, Professor Dame Carol Black, will report soon. I have always held her in the highest regard and I am sure that her report will be very sound.

I recommend that all noble Lords recall that we need early intervention; otherwise the next generation to experience alcohol abuse will become alcohol abusers themselves. The link is horribly real and certainly well documented, and I appreciate the Minister saying that there will be no wrong door. The £25 million for programmes for perpetrators is welcome, but there is a lot of evidence to show that every £1 invested in local treatment services saves £3 in wider social costs. This is indeed a sound investment by the Government.

In the light of the full response I have received, I will withdraw my amendment. I am grateful to all noble Lords who have spoken for their strong support, both now and behind the scenes, for the amendment and the work being done. I hope that the Minister will take back to the Treasury the need to recognise the financial cost to the nation of alcohol-fuelled domestic violence. Measures such as minimum unit pricing, a differential duty on off-sales to decrease drinking at home—which would support pubs and restaurants—and stopping the promotion of alcohol close to checkouts in supermarkets are all needed to make her strategy to decrease alcohol-fuelled domestic violence as effective as she and I would hope. These issues do not come directly into the Bill, but they are of wider concern. In the meantime, I beg leave to withdraw the amendment.

Amendment 23 withdrawn.