Y Pwyllgor Cydraddoldeb a Chyfiawnder Cymdeithasol

Equality and Social Justice Committee


Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Altaf Hussain MS
Jane Dodds MS
Jenny Rathbone MS Cadeirydd y Pwyllgor
Committee Chair
Ken Skates MS
Sarah Murphy MS
Sioned Williams MS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Dr Jen Daffin Seicolegydd Clinigol Cymunedol, Seicolegwyr dros Newid Cymdeithasol
Community Clinical Psychologist, Psychologists for Social Change
Johanna Robinson Cynghorydd Cenedlaethol ar Drais yn Erbyn Menywod, Trais ar sail Rhywedd, Cam-drin Domestig a Thrais Rhywiol
National Adviser for Violence Against Women, Gender-based Violence, Domestic Abuse and Sexual Violence
Lara Snowdon Arweinydd Iechyd y Cyhoedd, Uned Atal Trais, Iechyd Cyhoeddus Cymru
Public Health Lead, Violence Prevention Unit, Public Health Wales
Oliver Townsend Pennaeth Partneriaethau ac Ymarfer, Platfform
Head of Partnerships and Practice, Platfform
Yasmin Khan Cynghorydd Cenedlaethol ar gyfer Trais yn Erbyn Menywod, Trais ar sail Rhywedd, Cam-drin Domestig a Thrais Rhywiol
National Adviser for Violence Against Women, Gender-based Violence, Domestic Abuse and Sexual Violence

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Angharad Roche Dirprwy Glerc
Deputy Clerk
Rachael Davies Ail Glerc
Second Clerk
Rhys Morgan Clerc
Sam Mason Cynghorydd Cyfreithiol
Legal Adviser

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Cyfarfu’r pwyllgor yn y Senedd a thrwy gynhadledd fideo.

Dechreuodd y cyfarfod am 11:59.

The committee met in the Senedd and by video-conference.

The meeting began at 11:59.

1. Cyflwyniadau, ymddiheuriadau a dirprwyon
1. Introductions, apologies and substitutions

Prynhawn da—or it will be in about 20 seconds. Welcome to the Equality and Social Justice Committee. This is a bilingual institution, so we welcome contributions in English and Welsh, and there is instantaneous translation from Welsh to English. I've had one apology, from Ken Skates, for this morning's session. He'll be joining us for the later sessions. Before I introduce our witness this morning, I wonder if anybody's got any declarations of interest that are relevant to this inquiry. I don't see any.

2. Atal trais ar sail rhywedd drwy ddulliau iechyd y cyhoedd: sesiwn dystiolaeth 1
2. The public health approach to preventing gender-based violence: evidence session 1

This is our first evidence session on our inquiry into the public health approach to preventing gender-based violence, and I'm very pleased to welcome Lara Snowdon, the public health lead in the violence prevention unit within Public Health Wales. So, thank you very much, Lara, for joining us. We've got your paper, so we've all read it. I wonder if you could set out what the Welsh Government has done, in its vision and frameworks, to support implementation of a public health approach to preventing gender-based violence.

Prynhawn da, Chair. Chair, sorry, would you mind repeating the question? I had a technical issue at the start. Your voice was duplicated. Apologies.

Don't worry. Obviously, there's a new policy action by the Welsh Government on gender-based violence, and, obviously, you're arguing very strongly for a public health approach. Could you tell us how the Welsh Government has approached the vision and the frameworks to ensure that we are implementing a public health approach to preventing gender-based violence?

Thank you, Chair. We really welcome the inclusion of a public health approach in the violence against women, domestic abuse and sexual violence strategy. I think it will be really key to achieving the goal in the Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015 of ensuring that the Welsh Government implements preventative practice to prevent VAWDASV. However, I think it's fair to say that, at the moment, the approach in Wales is very much in its infancy. So, we have this high-level commitment in the strategy, but there is still a lot of work, really, to do to embed that approach in practice across Wales.

We have the blueprint approach as well, which is one of the commitments of the new VAWDASV strategy, and I think that will be really key in terms of developing multi-agency practice for VAWDASV prevention, which is a key part of a public health approach. It's also a tried-and-tested model that has been used for youth justice and women's justice in Wales, and, I think, particularly to navigate the complexities of the devolved and non-devolved landscape as well. So, I think we have this high-level commitment, I think there's a recognition that we should be taking a public health approach, and particularly focusing on prevention, which is really important, and I welcome the focus of the inquiry on it today, but we still have quite a long way to go in terms of actually developing what that looks like in practice.

So, when you talk about a blueprint approach, you're meaning a collaborative approach, are you?

Yes, that's right. So, one of the commitments in the strategy was to take a blueprint approach, which is an approach that has been developed in Wales, particularly with youth justice and women's justice, and it's really a multi-agency action plan. So, it takes that systematic approach that we look for in a public health approach.

Thank you. So, how well are public and private sector organisations engaging with understanding this public health approach?

As I said, it's really an approach that I think is in its infancy in Wales. So, there is this commitment. I think there's a real drive by a range, particularly, of public sector agencies to understand what this is and to implement it, but there's still a long way to go, I think, in terms of implementing it fully.

I wanted to mention as well the serious violence duty. So, this is another legislative driver that we have at the moment to implement a public health approach. The serious violence duty is an amendment to the Crime and Disorder Act 1998. So, it's central Government legislation, but it puts a responsibility on a range of multi-agency partners to take a public health approach to violence prevention. So, I wanted to mention that, because we have these two drivers, really, for taking a public health approach. They're both relatively new. So, with the serious violence duty, they tend to be regional multi-agency partnerships, which are being set up across Wales, to implement a public health approach. There are two statutory responsibilities: one is to do a strategic needs assessment, and one is to do a strategy. So, I think what will be quite important going forward will be to ensure that, with the commitments of the VAWDASV Act and the commitments of the serious violence duty, we ensure that partners can work together across both of those duties, to ensure there isn't duplication or siloed working, really. So, as I said, quite a long way to go to implement it fully, but we certainly now have some of the drivers to ensure that it can be put into place.


Okay. Just very briefly, what's the difference between the serious violence duty and the 'ask and act' that we talk about, colloquially?

So, 'ask and act' is particularly a duty on health service professionals to be aware of what VAWDASV is and to understand that they have a role in actively asking the question about the experience of VAWDASV, and then taking responsible and appropriate action if they discover that somebody has experienced VAWDASV. The serious violence duty is a piece of legislation that is on organisations to collaborate to take a public health preventative approach to what's termed as serious violence—

So, you're saying that 'ask and act' only applies to the health service, not to the education service, the housing service, or anything else?

Sorry, it's because I'm from public health, so particularly in my sphere of work we're working to ensure that it's implemented across health, but there's a wider multi-agency responsibility on 'ask and act'.

Okay. Just to put some slightly counter views to you: Dr Burrell, of Durham University, supports the public health approach, but says that the gendered roots of violence against women and girls must remain front and centre. Is that something you agree with, or do you think that we need to change the emphasis?

No, I absolutely agree with Dr Burrell, and very much respect Dr Burrell, particularly in his role in engaging men and boys in the prevention of gender-based violence. In terms of gender-based violence, really, the clue is in the title—it's where gender is recognised as a causal factor in what causes that violence to take place. So, we can understand gender as a causal factor, but then intersect it by other risk and protective factors, which may increase or decrease the risk of VAWDASV taking place. So, we quite often would describe gender as a cause and a consequence—. Sorry, we would quite often understand gender-based violence as a cause and a consequence of gender inequality. So, gender inequality underpins gender-based violence, but it also reproduces it as well. It's really important to understand this, because this tells us a lot about what the preventative measures are.

So, again, through a public health approach, we would talk about modifiable risk factors; so, these are factors that can be changed, which is the key part of how preventative programmes are developed. We know that people of the male sex are more likely to perpetrate violence, as well as gender-based violence, but we also know that particular kinds of social norms are harmful—so, those that are rooted in patriarchal norms, misogyny, sexism—and we know that those social norms can lead to violence. So, through the VAWDASV literature review, we really found that programmes that sought to transform those harmful gender norms, and to work alongside men and boys, to really critically think about what those social norms look like, and then how they can engage in them, to change them among their peer group, really, is a really important thing that we can do for the prevention of gender-based violence.

I think the only other thing really to say on this is around intersectionality. So, whilst we have to remember that gender is front and centre, gender is intersected by other intersections, I guess, of social categories. So, that could be something like socioeconomic deprivation, or race, or sexuality, or religion, and some of these things can make women and girls, in particular, more at risk of experiencing gender-based violence. It could also change the nature of the violence that is experienced as well as the response that they get from the services that they try to access. So, sorry, a slightly long answer there, but we can certainly understand gender as a causal risk factor, which is intersected by other factors as well.


Okay. I agree that this is not Daily Mail stuff. [Laughter.] Just finally from me, could you tell me how well you think the VAWDASV strategy understands the complexity of reaching different diverse communities, such as those you've outlined, so that we're confident that it's going to reach all women and girls, and indeed, men and boys?

Again, I think, really, I have the same answer in the sense that it's fantastic that intersectionality is recognised in the VAWDASV strategy, but again, I think there is a long way to go to ensure that the diversity that we have in communities in Wales is represented in VAWDASV prevention and response. So, some examples that we know of research that has been conducted in Wales, such as the 'Uncharted Territory Review', which explored the experiences of women and girls who are migrants, asylum seekers or refugees, wasn't included in the VAWDASV strategy, for example. So, we know that there's a lot of research going on, we know that there's a lot more to do, but having, as a principle, intersectionality, and particularly understanding how prevention programming can intersect with the needs of diverse communities, is going to be really important going forward. 

Thank you very much for being here with us this morning. I'm going to ask some questions now about evidence and data. Public Health Wales's systematic review of what works in preventing VAWDASV was published in September 2021. The national advisers for VAWDASV say that the Public Health Wales review has not yet been included in the Welsh Government's VAWDASV strategy. Do you know what the reasons for this are, please?

Unfortunately, I don't think I can answer your question directly, because that would be a question for Welsh Government. I do—

Okay. If I phrase it differently then: do you think that there is sufficient transparency and accountability in the delivery of the VAWDASV strategy and blueprint?

Yes. Again, really, this is in the very early stages of implementation; the governance around the blueprint has only recently been established. So, I think we will be looking to see, over the next year or so, how this is implemented. The high-level work plans for the blueprint are now just being published, I believe. I've had assurance that prevention has been included, but I haven't yet seen the detail of that, unfortunately. So, unfortunately, I think it's a bit too early to be really looking at that, but I want to say to Welsh Government colleagues, 'Please do reach out and talk to us about how we can ensure that the blueprint plans are as evidence-based and as theory-based as possible.' We do have this fantastic resource of the VAWDASV systematic review that we can draw upon; there's a lot of evidence in there about what works. Where there are gaps, we need to really understand how we can take a co-ordinated response to research and evaluation for gender-based violence prevention. So, I'm really looking forward to working with colleagues on taking that forward.

Thank you very much. Can I ask why the systematic review covered primary and secondary interventions, but not tertiary prevention? And, what are the benefits of developing multi-agency data on gender-based violence to measure the prevalence and trends and to monitor inequalities and track progress in prevention? How feasible do you think it is for it to be able to cover all of this?

To answer the first part of your question, we focused on primary and secondary prevention because, really, they are areas of both research and practice that are generally under-represented, so I really welcome the committee focusing on this as part of the inquiry. There is really a wealth of evidence around tertiary prevention in comparison to primary and secondary prevention, which is why we decided to focus on this. In addition, it would be absolutely huge if you focused on all three areas. So, that was the reason to focus on that, as well as to meet the commitments in the VAWDASV Act around prevention. 

On the second part of your question, around data, I think this answers your former question as well, in a sense, because one of the commitments of the VAWDASV Act is to develop a set of national indicators to measure progress around VAWDASV prevention. That is going to be the kind of key thing that we can do to understand whether the strategy and whether the blueprint approach are being effective, essentially. I know that some work has started on the national indicators, but, again, I think this is going to be really critical to ensure that we're understanding that population-level change towards VAWDASV prevention. It really needs to be underpinned by a robust theory of change that is based on evidence and based on a principle to evaluate all of the blueprint activity to ensure that the indicators match the theory of change. So, I think that will be really key to holding partners to account, but also to ensuring that overall governance, really, for the VAWDASV strategy and blueprint.


Thank you. My last question, then, and you've already touched on this a bit. We've heard that the current 'ask and act' duty doesn't empower professionals to act, often because they are unsure about how to handle a disclosure and the responsibility that they will have as individuals for managing the risk. Do you have details of any reviews into how effectively legislative duties such as the 'ask and act' duty are being delivered, please?

Again, I think I'm probably not the best person to ask that, unfortunately; I'm not directly involved in the delivery of 'ask and act'. I've obviously seen the Welsh Government evaluation of 'ask and act'. One thing I would say about the evaluation that's been done is that it's really fantastic to have an evaluation of the implementation, but it is a process-and-outcomes evaluation; it's not looking at the impact of 'ask and act'. So, I think, going forward, it would be really great to fully understand the impact that 'ask and act' is having in Wales, because, at the moment, we're really working without knowing what the impact of it is, so that's something really important, I think, to take forward.

Thank you. I just want to ask you about some specific interventions. The 'Don't be a bystander' campaign has been run by the Welsh Government for, I think, about six months, and I just wondered whether Public Health Wales was involved in helping to shape that, the procurement of that intervention. What is the evidence base that such an investment is one worth doing?

There was formerly a campaign called 'Don't be a bystander', which was run by the Welsh Government. There's been a procurement process to procure an organisation to deliver bystander training across Wales. So, I believe what you're referring to is the latter, is that correct—or both? 

Well, what was the evidence base for investing money in an advertising campaign and then, obviously, how much has that influenced the procurement of a new bystander training programme?

I wasn't involved in the 'Don't be a bystander' campaign, unfortunately, so I won't be able to talk to that.

I can say, in general, that there is relatively little, or no, evidence, really, that a communications campaign can lead to behaviour change, unless there are additional resources behind that that are supporting that behavioural change. That could be training, for example, to ensure that that kind of initial awareness raising about being a bystander is then supported by action to develop the kind of skills, knowledge and expertise of how people can actually become an active bystander, if that makes sense.

To answer the question about the new active bystander intervention, yes, I've been involved in shaping the procurement for that and developing the specification. I believe that the successful bidder has now been announced. So, in terms of the evidence base, there is good evidence that active bystander training programmes are effective in preventing gender-based violence. What I would say about the evidence base that we found in the systematic review is that the majority of the evidence base comes from the United States, where there really is quite considerable evidence that these programmes are effective. The evidence base from the UK is relatively limited at the moment, but there have been a number of interventions that have been invested in. So, for example, there's the Intervention Initiative, which was funded by Public Health England initially, and is implemented in a lot of universities across the UK. There's also been Active Bystander Communities, which was delivered in Exeter, which is a programme in which bystander training was delivered in community settings, and that has good evidence around changing attitudes and beliefs—negative attitudes and beliefs—that underpin VAWDASV. So, it's an emerging area of evidence in the UK, but I think there's a good case for investment in it by Welsh Government. It's one of the key prevention programmes that we have for VAWDASV prevention. I think, as long as the Welsh Government investment is thoroughly evaluated, which I have assurance that it will be, through being part of that procurement process, then I think we're actually now in a really, really good position in Wales to be at the forefront of developing the evidence base for bystander prevention programmes. 


Thank you for that. Plan International UK is going to be giving evidence at a later session, and they're emphasising that adolescence is a time of elevated vulnerability for multiple forms of violence against girls and young women. I don't think most people would disagree with that. But how well-researched are the interventions aimed at reducing this intimate partner and dating violence? 

So, I would totally agree with Plan International UK. We've worked closely together on a number of pieces of work, but particularly we've recently launched a public health approach to the prevention of violence among children and young people, which I've given as evidence to the inquiry. The framework is called Wales Without Violence, and one of the key things that we found is that children and young people are most at risk of experiencing different forms of violence, but they're also most at risk of experiencing multiple forms of violence as well, which was one of the reasons for looking at this age cohort, really. Some of the other findings that are relevant to this inquiry are that, all of the children and young people who we worked to co-produce the framework with and consulted with, they simply don't recognise the terminology that professionals often use around violence. So, rather than focusing on VAWDASV or on serious youth violence, children and young people often just understand them as, really, an overarching experience, or a different form of the same thing. So, that was why we've looked at the age cohort rather than looking at gender-based evidence or knife crime or hate crime, for example. So, I just wanted to make that point, firstly. 

But then the other reason for focusing on that population group is that, actually, this is where the evidence base is strongest. So, it's interventions, working with children, with adolescents and with people in young adulthood, really, where the evidence is the strongest. We found this in the systematic review. The evidence base is pretty strong here. Again, the same principles apply, about a lot of the evidence that has been developed in the United States, and the programmes that we see that have very robust research are from the United States, so particularly the programmes around transforming harmful gender norms, which I mentioned at the start. Programmes based in schools to develop skills around healthy relationships, to develop critical thinking skills, to develop bystander skills, as well as taking a whole-school approach, are very well evidence based, as well as programmes that specifically look at, as you said, preventing intimate partner violence or adolescent dating violence—different terms used in the literature. So, they could be delivered either in school settings or other education settings, such as colleges or universities, or through—. Theatre programmes was another thing that we found in the evidence. So, there's a range of different modalities of delivery of these sorts of programmes, but, overall, I would say that this is where the evidence is strongest.


Very good. Clearly, there's a great deal happening in our schools and colleges, not least around the new curriculum, which is promoting relationships, values and ethics, as well as the relationships and sexuality education. But, clearly, schools aren't an island, divorced from all the other services that other people need to be supporting them on. So, you've published—Public Health Wales have published—a shared framework for preventing violence amongst children and young people. Could you just tell us a bit more about the action needed to ensure that a trauma-informed framework is fully implemented across all organisations that children and young people are having contact with?

Absolutely. So, taking a trauma-informed approach really is a key principle of the Wales Without Violence framework that we developed. Talking about schools and education settings, there is a really significant role that they can play in violence prevention. It's a slightly complicated way forward, I think, because, on the one hand, for VAWDASV, we have some fantastic evidence of approaches that have worked from the United States, but, in Wales, we also have a number of opportunities about integrating violence prevention into a lot of work that's already being done here.

So, as you said, I think there are a lot of opportunities around the new curriculum, which we started to map out in the Wales Without Violence framework. So, for example, there's a commitment to healthy relationships, there's a commitment to developing critical thinking skills around social norms, which is recognised in the new curriculum. We also have the relationships and sex education curriculum as well. So, I think there's a lot of work that can be done to ensure that we can utilise and maximise the opportunities that are already presenting themselves through those opportunities in Wales.

We also have the Wales healthy schools programme, as well, which provides a kind of support network around developing health-promoting schools in Wales. So, there's a lot that we can do to upskill the staff who are working in those programmes to ensure that schools are fully equipped to take this approach as well.

As well as interventions, though, there are also measures that are evidence based in the literature around actually developing a whole-school approach. For example, committing to leadership around violence prevention from the top down within school settings, upskilling all staff in how to take a trauma-informed approach—so, how to provide a kind and compassionate response if a child or young person comes forward having experienced gender-based violence, to providing safe spaces in schools, developing links with community services, as well as having those more preventative lessons and skill development integrated through the curriculum as well. So, sorry, a slightly complicated answer there, but I really do think that working with education settings is going to be a really key way forward for prevention.

Thank you. Could I now call on Sioned Williams to come in? I think you were going to go first.

Ie. Diolch, Cadeirydd, a phrynhawn da. Dwi eisiau ymestyn tipyn bach ar y dull system gyfan yna o weithredu rŷch chi newydd sôn amdano fe, sy'n mynd i efallai fod yn allweddol o ran yr ysgol. Sut all gweithio traws-lywodraethol gefnogi gweithredu dull system gyfan o atal trais ar sail rhywedd, hynny ydy, cryfhau’r croestoriad rhwng camddefnyddio sylweddau, iechyd corfforol a meddyliol a thrais yn erbyn menywod a merched? Sut y gall hyn gael ei gyflawni?

Yes. Thank you, Chair, and good afternoon. I wanted to look a little further into the whole-system approach to implementation that you just mentioned, and how that could be key in terms of schools. How does cross-governmental working support the implementation of a whole-system approach to GBV prevention, for example, strengthening the intersects between substance misuse, physical and mental health and violence against women and girls? How can this be achieved?


Diolch yn fawr. I agree that the whole-system approach is completely critical, really, to how we can take the next steps in terms of implementing a public health approach to violence prevention in Wales, so, through the Wales Without Violence framework, we've developed a whole-system approach, and I just wanted to mention it here, because I think it gives us some really key clues about what cross-governmental working can look like to support a whole-system approach. So, I won't kind of go through it in detail now, because I've provided it as evidence, but, in the framework, we provide nine strategies for violence prevention, and they range from families parenting and early years through to safe community environments, school and education environments, provision of safe activities and trusted adults for children and young people, as well as societal measures around reducing poverty and inequality, policy and legislation and social norms as well.

So, all of these things are critical in terms of a whole-system approach. We know that one intervention by itself is simply not going to work; we need to increase the overall exposure to VAWDASV prevention messaging in the population in order to achieve population change. So, if we're thinking about cross-governmental working, actually, we need to ensure that we're working with the children and families division and school nursing, health visiting, childcare, through to schools and education, but also through to equality and promoting women's rights, through to programmes that can prevent poverty and actually ensure that the socioeconomic inequality that is currently experienced in VAWDASV is reduced.

So, lots of work to do, but I think not insurmountable in the sense that the answer here isn't necessarily interventions; it's actually maximising the opportunities that we already have in Wales.

Diolch. Ie, fe wnaethoch chi ddweud yn eich ateb cyntaf y prynhawn yma fod llawer o waith i'w wneud i fewngorffori'r dull iechyd cyhoeddus, ei fod e yn y cyfnod cyntaf, mewn gwirionedd—y cyfnod mwyaf cynnar—o gael ei weithredu. Felly, oes achos dros gyflwyno asesiad effaith VAWDASV ar gyfer polisïau neu strategaethau newydd er mwyn cyflawni hyn?

Thank you. And you mentioned in your first response this afternoon that there was a lot of work to be done to incorporate this public health approach, that it's in the first stage, in fact—in the first stage of implementation. Is there a case for introducing an impact assessment of VAWDASV for new Government policy or strategy in order to achieve this?

Diolch. Yes, I think so. I think ensuring that, whenever policy is made, the repercussions in terms of gender-based violence are thought of and understood is really, really important, and I think the work that we've done through the Wales Without Violence framework can potentially provide the conceptual framework, really, for taking that forward. It's not always just the obvious candidates, I think, in terms of policy-making, but, actually, if we can think really broadly from equality through to poverty reduction, through to early years, then, actually, all of these areas of policy have an impact on the prevention of VAWDASV. So, I think that would be a really positive step forward.

Diolch yn fawr iawn, a diolch am ddod i'r pwyllgor. Un bwlch arall mae’r pwyllgor yn cael profiad ohono, tu allan i’r byd cyhoeddus a byd Llywodraeth, yw'r byd busnes—pethau fel yr economi gyda'r nos, y system trafnidiaeth ac yn y blaen. Ac mae hynny'n bwysig, onid ydy, i wneud yn siŵr ein bod ni'n cymryd dull sy'n gryf. Ydych chi'n meddwl bod Llywodraeth Cymru yn effeithiol efo'r busnesau dwi wedi sôn amdanynt, a beth arall allwn ni wneud i wneud yn siŵr ein bod ni'n gweithio dros Gymru i wneud yn siŵr mai Cymru yw'r lle mwyaf diogel i fod yn fenyw yn Ewrop? Diolch yn fawr iawn.

Thank you very much, and thank you for attending the committee meeting. One other gap that the committee has experienced, outwith the public sphere and the governmental sphere, is the business world—the night-time economy, for example, and transport providers and so forth. And that's important, isn't it, to ensure that we adopt a robust approach. Do you think that the Welsh Government is engaging effectively with the businesses that I mentioned, and what else can we do to ensure that we are working on behalf of Wales to ensure that Wales is the safest the place to be a woman in Europe? Thank you very much.


Diolch. Yes, I agree with you. I think the majority of work that has gone on so far in terms of developing a multi-agency approach to VAWDASV prevention has engaged the public sector, whereas actually we know that businesses and workplaces are the places where the majority of the population spend a large proportion of their time, so I really do think that at the moment that's a missed opportunity, really, around gender-based violence prevention.

From the evidence base, there isn't an awful lot of evidence around what works to prevent gender-based violence in workplaces, but we certainly have some clues through the theory of what works around prevention in terms of what could be effective in engaging workplaces and what interventions could be effective in terms of preventing gender-based violence. For example, I've started to hear conversations around whether active bystander interventions could be commissioned by workplaces, and I think that would be something that would be really interesting to explore. I know, for example, that South Wales Police have been developing some work around active bystanders in their workplace. So, there's kind of a beginning to have the starts of conversations around workplace prevention, but as you say, I think this is a really big missed opportunity at the moment. But I think we all have a role to play here. It's not just Welsh Government. It's all of the multi-agency partners involved in the blueprint. Does that answer your question, sorry? I think there might have been a second part of your question.

Sort of. I mean, I guess we're very interested to know what the Welsh Government could be doing more in order to, for example, engage with businesses and public transport et cetera. But it sounds as if you're saying there's not much happening but recognising the importance of it. Is that a quick summary?

Yes. It's a complicated question, because there are probably some pieces of work going on in some sectors, but as a whole I would say there's not very much happening, I believe. I think the example where perhaps there is more happening would be in the night-time economy. This is an area where we do have a bit more evidence around what works to prevent gender-based violence. Particularly, again, through the literature review, I think one of the effective examples that we found was something called the Good Night Out Campaign, which is a social marketing campaign, which is supported by training for night-time economy staff—so, bouncers, door staff, bar workers, as well as people like street pastors, who might be out and about in the night-time economy, and taxi rank marshalls—to be able to respond effectively if they witness VAWDASV taking place. So, there is some evidence in this area, and I know that there has been funding in Wales, particularly through the Safer Streets funding from the Home Office, where some of these approaches are starting to be developed. I think it's a kind of sector-specific answer, really, but overall I think there is still a lot more that could be done in terms of engaging businesses.

Thank you, Chair. Thanks, Lara—it is nice to see you here. I'll take you back to the gaps that you mentioned to Sarah in your answer. In your systematic review, you found significant gaps, especially about honour-based abuse and elder abuse. So, what do you think the Welsh Government and the public sector need to do to address these gaps?

Thank you. Yes, we did find significant gaps in the research in the VAWDASV review. I think this is something where the blueprint, and where the commitment in the strategy to take a public health approach, can play a really, really key role. Ensuring that we're taking a co-ordinated approach to investing in research in Wales to prevent VAWDASV, and also ensuring that everything that goes on as part of the blueprint approach is evaluated, is going to be really, really important. So, I think, having those as general principles is a key part of implementing the public health approach in Wales. 

On those specific examples, we found some evidence of, I think, training for healthcare providers around recognising and responding to female genital mutilation in healthcare settings, but we didn't find any other examples of preventative programming for other forms of so-called honour-based abuse.

When it comes to preventing violence and abuse against older people, we simply didn't find anything at all in the literature. So, that's a huge gap. I think, in Wales, we have some really innovative work going on around responding to and preventing violence against older people. So, I think, ensuring that that work takes a preventative approach, and, perhaps, if we could look to work together to develop the research around prevention in that age group, that could be really, really important and groundbreaking. 


Recent reports highlighted the prevalence of virginity tests among certain sections of the black, Asian and minority ethnic community, with Karma Nirvana reporting they have supported dozens of women in the past couple of years. How can Public Health Wales work with such groups to capture the evidence of such activity, and help eradicate the practice?

Thank you. Before we start talking about research, I think the other really important thing is understanding the data. Looking at FGM as an example, we've just published a report that looks at the prevalence of FGM in health settings in Wales—so, people turning up to health services who have been identified as having experienced FGM. That's been the first time, as far as I'm aware, that that data has actually been collated and reported on in Wales. So, we now have a more accurate picture around what the prevalence looks like in terms of healthcare identification. 

In terms of other forms of so-called honour-based abuse, we have even less of an idea about the actual prevalence of these things that are taking place in Wales. So, I think, before we can even really think about preventative programming, we need to fully understand what the picture is. I think, again, working together between the health services, Welsh Government and the police is going to be really important to understanding what picture of the data really looks like. 

The second point to make is the point around co-production. One of the key principles, really, of taking a public health approach is to co-produce the solutions to violence prevention with the communities where it takes place. I think, particularly looking at these issues, we need to be working with those communities to try to utilise some of the theory and knowledge that we have from the VAWDASV evidence base more broadly, but working with those specific communities to develop the solutions. 

My last question is with regard to any further legislative or policy approaches the Government needs to take to prevent gender-based violence and abuse, and to protect the human rights of women and girls.

As I've said right at the start, I'm really pleased that the Welsh Government strategy commits to taking a public health approach, and I'm really excited now to work with colleagues across the Welsh Government to implement it. I think there's a number of principles that we need to recognise and take forward as part of this approach. We need to ensure it's underpinned by trauma-informed practice, that we're taking an intersectional understanding, that we're committing to evaluation, that we're co-ordinating research, taking an approach in which we co-produce the solutions, as I just mentioned. But then, also, when we're looking at what measures particularly the Welsh Government but also other multi-agency partners can do, it's about thinking about how we can work better together in a multi-agency sense, but also across Government, to ensure we're taking this whole-system approach, working to understand the links between different forms of violence. As I mentioned at the start, children and young people don't experience violence using the silos that we use, I think, as professionals. A practical example of that would be ensuring that local partners understand how they can co-ordinate their responses to the VAWDASV Act alongside their responses to the serious violence duty, for example, as well as looking to maximise those opportunities that we have in Wales to take a whole-system approach. We've talked about some of those already, about integrating violence prevention into the new curriculum and supporting education settings to take that approach as well.


Thank you. And finally from me, I just wondered if you could tell me who were the stakeholders who were involved in developing the four-step model that you've outlined in your paper. Is this three organisations or 30? How many stakeholders were actually engaged in developing this model, which is pretty clear, really?

The four-step model was originally developed by the World Health Organization in 2002. What we did through the Wales Without Violence framework was actually just look to adapt that model and modify it to the experiences of practitioners in Wales. We consulted with over 1,000 people through the development of the Wales Without Violence framework. That was, I think, about 450—. I can provide these numbers to the committee on request afterwards. But a large number of children and young people. And then also with multi-agency partners working in violence prevention across Wales. So, there were many organisations in Wales who were involved in developing this.

Is it possible to just send us a note of who were these stakeholders?

Yes, of course.

I don't need to know the names of individual children, obviously, but if 450 of the 1,000 were young people, that's great, but if you'd just give us a list of either the organisations or sets of individuals who were involved, that would be really helpful. Thank you.

Absolutely, yes.

Thank you very much indeed for your evidence, which was very clear on what is quite a complex framework that you're setting out. Very ambitious. We will send you a transcript of your evidence, so if there's anything that we've not heard correctly, please do ensure that you correct it to ensure that we have a correct record of what you were saying. Thank you very much indeed for your time.

The committee will now break until 13:30 when we'll be taking further evidence on this very important subject.

Gohiriwyd y cyfarfod rhwng 12:48 a 13:31.

The meeting adjourned between 12:48 and 13:31.

3. Atal trais ar sail rhywedd drwy ddulliau iechyd y cyhoedd: sesiwn dystiolaeth 2
3. The public health approach to preventing gender-based violence: evidence session 2

Prynhawn da. Welcome back to the Equality and Social Justice Committee. We are resuming our inquiry into gender-based violence. This afternoon, in this session, we've got Dr Jen Daffin, community clinical psychologist for Psychologists for Social Change—welcome—and Oliver Townsend, head of partnerships and practice at Platfform. So, thank you very much. Welcome to both of you.

If I could just start you off by thanking you for your written papers; you don't need to repeat what's in them, we've all read them, but I just wondered if you could give us some analysis as to whether the Welsh Government has a clear enough vision for implementing a public health approach to preventing gender-based violence, specifically around the impact of stress and trauma in perpetuating violence for women and girls. So, which of you would like to go first? Okay, Jen—is that right?

Yes, that's fine. Thank you for having us. So, I think, from the evidence that we've presented, we'd say that a public health approach is absolutely the way to go, but like with everything in this field at the moment, we're seeing an evolution in understanding, and I think our trauma-informed approach to society is an example of that; that's a really new piece of work that's being conducted that needs to go through its own evolutions and developments itself. We'd say that the same thing applies here. The breadth of complexity that's involved in these topics is complex, so it's a task to pull together all the different moving parts that need to be aligned, and I don't think it would be fair to say that we've done that already. We're looking to do that, and we're moving in that direction, but more needs to be done to be able to do that. And, if we're going to get to creating a trauma and relationally informed approach, that's the journey that we'll just need to go on. So, there will always be more, I think, to do, because the task at hand is complex in itself. And because of that complexity, it will need revisiting time and time again to ensure that it is still fit for purpose and fit for Wales in the direction that Wales wants to go, but for people and our understanding of how trauma and distress manifest. 

Relational health as a concept itself is new, so I think we've got lots of understanding of what 'trauma-informed' means, but trauma-informed is just the deficit end of the relational health continuum, so there's some work to do to connect those dots together, really.

Thank you for the clarity of that answer. Oliver, how does applying a trauma-informed and relational health lens change how we prevent and respond to gender-based violence, in your experience?

Just to build on the first question, if I can, briefly, as well, I think one of the areas that is really worthy of attention is the focus that Welsh Government has placed on trauma-informed approaches. The trauma-informed framework for Wales, which was produced by Traumatic Stress Wales and the adverse childhood experiences hub, the ACE Hub Wales, is a really good statement of intent at a policy level.

I think what you will have seen from our response initially is the need to focus, I suppose, on those three levels. So, the individual level—and that is something that Welsh Government is very good at—looking at how we change practice and how we create the conditions for changes in practice at an individual level is very, very strong. I think the area where we'd like to see more development is a greater understanding on community responses to trauma. So, ensuring that communities are given the resources, the spaces, the language, sometimes, to understand what's happened to them. And then, thirdly, the idea of society—a societal understanding of trauma-informed approaches. And, to go into that, I suppose, the second question was: how will that work around the response to gender-based violence? I think that's about giving communities the language and the tools to make sense of what's happening to them and around them—and we'll probably have space to expand on that further in this session—but actually understanding that the people at the centre of this aren't just individuals; they are part of a wider community and part of a wider society. So, I think creating those conditions from Welsh Government is our key priority to see, really, from this inquiry.


Thank you. So, is there anything you want to add about how we respond to and prevent gender-based violence in the way we're applying that trauma-informed and relational health approach?

Yes. So, I suppose from our perspective, it's understanding the conditions that have often created or contribute to a lack of relational connection. So, Jen was talking about relational working—that's really important to understand that a lot of the people who cause harm have themselves been victims of harm. And I suppose this is not meant to sound flippant, but there is a line in which society determines that someone is a perpetrator versus, up to a certain age, they're a victim, and that line will be different for everyone. But, if we accept that children are victims of harm, there may be a point at which, as an adult, they start perpetrating harm—they may; it's not causal. There is a link, but it's not causal. So, at which stage do they suddenly stop being a victim and become a perpetrator? So, I think shifting the language so that we can understand some of the conditions that have created that harm is really important in how we respond to gender-based violence.

Thank you. Is there anything you wanted to add on that, Jen?

Only that our current approaches, what I would say in practice, point the fire hydrant at the fire alarm rather than at the fire, and what we mean by that is that, if we think of the fire alarm as the behaviours that we see across the top, what we're not doing is getting to the unmet need underneath that. And we have great work on looking at behaviour and taking a behaviour-based approach that works in some settings, in some situations, but when we're talking about trauma and distress, when we're talking about relational needs, we need to go deep and we need to understand what's underneath that distress that's not being met, what's the need that's not being met. So, we need approaches that cannot just get to that surface level but can get deeper and can meet those connection-based needs that people haven't got, which is why, when we're talking about breaking the cycle, we need to focus on creating the right conditions. But, when we see that those cycles get played out across generations, those generations then lose the skills and the opportunities to have relational skills on top of that as well. And so, just directing them to behaviour-based approaches or information isn't getting deep enough to unpick some of that trauma and distress that's occurred, and so we need to go alongside those people and help them re-establish what it is that was missing from their own experiences, or what experiences they have had that have led them to lose those relational health skills, and how do we add those on top of it as well.

And our most vulnerable people in society will not be able to just take up information or take up a behaviour-based approach; they'll need individuals to come alongside them to role model and co-regulate and co-create with them the conditions for relational health as well, and that is as true for children as it is for adults.

Okay. It's quite—. It can be disempowering to think of—. It's so complicated, and so many issues are interrelated, how do we develop that community cohesion and connection to each other in framing a public health approach when society is so fragmented, so isolated, there's so much agoraphobia, people are far too much on their phones and not talking to their next-door neighbour?


Yes, you're right, It's complex and it's a task. The first thing is to recognise that, and to recognise that those things are impacting on us, but that, first, we're social beings and that connection is important—I think we don't have a good coherent narrative at a public level, but that is important. We've seen that through loneliness and we've seen that through the pandemic, and I think people have now an experience of that but maybe don't have the language yet to fully make sense of that, which is where a trauma-informed, relational health and public health approach to this is really important, because it's about setting the tone for the right conversation. And if we understand what our basic needs are and that connection is really, really important, and then understand some of the basics of how we do connection—so what are the things that get in the way of some of that—then we can start to think about solutions and interventions that can target some of that.

So, for example, when we don't have our own relational health needs met, or attachment needs met, so when we don't have our own experiences of secure base, then we can find it much harder to regulate our emotions. If we're not able to regulate our emotions, then we're not able to stay out of fight, flight or freeze. If we're in fight and flight, our response is going to be more dysregulated and it's going to be more aggressive. But if we just see those people, as Oliver was saying, as perpetrators and we put the problem on them and we blame them, then we're missing the opportunities for connection, and we're missing the opportunities for healing, through relationships and through connection, by coming alongside people to co-regulate or to provide them the opportunities to learn that those things are important and that those things are what are causing a dysregulated fight, flight or freeze, or fawning response, rather than it's because you were born bad and there's little or nothing that we can do about that.

When somebody is in a dysregulated state, or they haven't learnt—so, they're in a fight, flight, or an anxious state or an aggressive state a lot of the time—then it's much more difficult to have connection with others as well, and so, it becomes a self-fulfilling prophecy: so, you're disconnected, you believe that you're not good enough, therefore, you stay disconnected and you believe that you're not good enough, and then responses like violence and shame-filled responses just become the norm. And people internalise those narratives as part of the stories of who they are, whereas, what we'd really like to see in the approach is the alternative to that—so, a compassion, human rights-based, social justice-based approach that recognises these things and can share that story with people, so that they can find healing in themselves as much as we can find then collective healing and re-establish social cohesion at a population and societal level as well.

If it's okay just to add one thing: I was just going to say, rather than it being disempowering, I actually find it incredibly hopeful. So, generations of people have often had a very individualised approach to either the support they've had, the experiences that they've made sense of, or the medicalised system-led responses, which have made it about the individual. Actually having conversations that identify that there are weaknesses, vulnerabilities within communities that the system has created—so, endemic poverty, trauma that hasn't been addressed—having people being able to say, 'We have heard you and we're going to help build the conditions that allow you to thrive', is actually incredibly powerful and hopeful. And I think that's where our submission today comes from.

Thank you for explaining that very clearly. Sarah Murphy, can I ask you to come in at this point?

Thank you very much, Chair, and thank you both for being here today. So, I'm going to ask some questions around gender inequality and social cultural norms, which you've already touched on, but, specifically, Dr Burrell of Durham University is supportive of a public health approach but says that the gendered roots of violence against women and girls must remain front and centre—so, gender inequality cannot simply be seen as one among many factors contributing to gender-based violence; it is the central factor. Could I get your thoughts on this, please?

So, that's a central question, and it is definitely something that I think people—certainly in Wales and across the western world—have been fighting for for a long time. So, I suppose, just to make this really clear from the outset, we recognise that violence predominantly impacts women and children, so that is not under any doubt from certainly what we're saying. I suppose, for us, what does a gender-based approach mean? I think understanding that gender is a social construct in terms of the roles that are often attributed to women or men. I think understanding the weaknesses that that hard-wires into the system is really important. So, in our submission you will have seen us talking about a shift in the language that we’ve started using, from ‘toxic masculinity’ towards ‘restrictive masculinity’, and I think that’s a really helpful way of explaining what we mean.

We’re not saying that there isn’t a gender-based element to this at all. That’s not under doubt, really, in our minds. But actually, there is a lot of shame in the discussion around gender-based violence that stops or prevents or reduces the possibility of men challenging their behaviour, of understanding their behaviour, understanding the roots of their behaviour, and also seeking help and support with that behaviour. That’s why, in the submission, we’ve talked about people who cause harm. So, we’ve avoided the word ‘perpetrator’ because, although we are not making excuses for people who’ve created significant levels of harm, what we are recognising, I think, is that there is a spectrum of behaviour, and if we can intervene early enough by removing the shame from that behaviour, recognising where that behaviour comes from, we might be able to prevent gender-based violence much earlier on by tackling those behaviours and thoughts that lead to that.


Thank you. My next question is to you, Dr Daffin. You emphasise the importance of supporting men and boys to equip them with the appropriate skills and experiences to understand and regulate their emotions healthily. Could you talk to us about—? What do successful interventions look like, then?

Yes, sure. And, if you don't mind, just picking up on your last point as well, it absolutely needs to be front and centre. What we're trying to highlight is not changing and challenging that, it's if we re-think about the conversation and we broaden out the conversation then it has a knock-on impact in the solutions that we seek. So, rather than thinking about the causes or where we're rooting it, in broadening out what we're able to bring to the conversation then we can think of other and additional solutions rather than discounting any of those.

For helping boys and men in terms of their emotional, relational health skills, there are many programmes that we could go through, and that’s not our area of expertise or experience to comment on, although we have flagged some ones that are important. What I think is more helpful to focus on is: programmes will only go so far. There is a conversation to have around cultural shift and cultural change, and bringing a relational health awareness and understanding—so, emotional health understanding—to everything that we do, taking a whole-system, whole-family approach to that, which moves us way beyond programmes. They’re important, but if we’re going to get it right for women, and we’re going to get it right for everybody, then we need to be thinking across all of the different ecological layers that intersect across a person’s life. School, and the culture and systems, the culture of a school, are as important as the community conditions that boys and men are exposed to as well. Having those programmes will only go so far.

We need to also be thinking about: how do we create cultural shift? And largely that’s about getting our heads around the complexity, and being able to communicate that, and having a confidence to articulate our own relational health needs and tune in to, 'When am I responding from a dysregulated state? Do I have good relational health skills, what are those, how do I pass those on? Are they embedded strongly enough in our curriculum at the moment? And are they embedded strongly enough then in our public health approaches as well?' I think if we could go there and take that holistic approach to it, we’ll gain more and we’ll do boys and men a better service in taking that holistic approach, too.

Thank you very much. And my last question, then, is: you've also said that interventions are needed to help break the cycle of intimate partner violence, and violence towards women more generally. Is there sufficient clarity regarding the drivers behind IPV, and understanding among the public services to address them, do you think?

It's an interesting question, because if we look at the evidence—and I think Public Health Wales submitted some of this evidence—if you look at same-sex relationships, there is a stat out recently that suggests that same-sex women couples, for want of better language, sorry—I think those are the terms that they used—46 per cent of those identifying couples expressed having experienced intimate partner violence, compared to same-sex male couples, who, I think, were at about 26 per cent, and then the rest are in between now. So, if we are going to think about what really drives that and what are the conditions for that, already the picture gets complex. Do we really understand what some of those driving factors are, when we're talking about discrimination and its intersectionality? Maybe that's, perhaps, what we're seeing there, in a double loading of discrimination.

But, what I think it clearly portrays is that there is complexity at play, and that maybe the solutions for those different groups are going to be different because our understanding of what gender is and the layering of that against culture and those individual experiences, and their broader ecological systems around them, are all going to be different and unique. Taking a binary gender-based approach in its strictest sense is not necessarily going to help us get to some of those answers and solutions.


Yes, sorry, just to say that, very simply, no, I think the awareness across public services is not that great, and I think that, in turn, exacerbates the problem. So, if awareness isn't that great, then people tend to turn to very black-and-white, quite binary views about domestic abuse, which is really where our challenge around the use of the language around 'perpetrator' came from, because what it doesn't allow is any of that space in between for people to raise concerns about their own behaviour, or for people to be alert to some of the very early red flags in a relationship. Often, that perpetuates that cycle of shame, which means that people don't come for help with their own behaviour or ask for help with their own relationships. Actually, we're missing a whole range of early intervention stages, I suppose.

Critically, why is that? Why do the public services in Wales and more widely not have that awareness and understanding? If I can be controversial for a moment, it's probably because of the lack of time, space, resources and funding in services, but also our inability to take stock and really challenge the system that has been built around us, which is very much individualised, rather than community based. If we can actually get out and work in communities in a well-resourced, trauma-informed way, I think we'd be able to unpick a lot of these challenges and that understanding would grow. But, at the moment, no, I don't think that that understanding is very prevalent.

Thank you very much. Thank you, both, and thank you, Chair.

Thank you very much, Chair, and thank you. Let's talk about the role of schools and social media. You say that relational health knowledge must be part of the Curriculum for Wales and allow teaching staff the space and time to provide safe and nurturing relationships. What does a whole-school approach to healthy relationships mean?

In a nutshell? [Laughter.] There's a journey, I think, for us to do there, because there is, yes, 'create safe, secure, nurturing relationships', but if you don't have the language to understand that, as a teacher who's been in the system for a very long time and dedicated your career to that, and now we're throwing these new words out there, there's a catch-up that needs to occur. We need to allow teaching staff across the board time to really understand that for themselves.

These are not easy concepts to grasp. They're deeply personal concepts to grasp, and they mean shining a light and a mirror on ourselves and our own behaviour, and our own responses, and sometimes that is really uncomfortable; sometimes, people just have never considered that that's a thing. So, if we're going to do a whole-school approach, we need not to forget teaching staff and education-setting staff—anybody employed in a school, right from the people who would take children to school on buses all the way to the teachers themselves. It means everybody; it doesn't just mean what is delivered to the children. So, it's across—as Oliver has already said—all of the layers.

We think of the individual levels, so, 'A whole-school approach: what are we going to do for you, as the individual children?', but it means thinking about the teacher in the context of their environment. So, that teacher has a relational experience with every single pupil in that classroom, multiple times a day. That's exhausting in itself, but then they have that in their broader context with their teaching colleagues. They then sit within a context of their management and line management structures, but their policy and their practice as well, which sits within the broader profession of education. So, when we're talking about whole school, whole system, that system is quite large, because they're a public service who sit in the public service realm as well. And so in order for them to do it right in that classroom, they need all of those other things to line up too. So, this conversation here is as relevant to the conversation the teacher has with the child in the classroom as well, if we're really going to do a whole-school approach.


That's right. Oliver, did you want to add anything? That's fine.

Can I just interject before you go on? Clearly, our experience of addressing domestic violence in the health service tells us that unless we address the personal experiences of the health professional they're not going to ask the question, and that must also apply to teachers. So, how is that being approached?

At the minute? 

Or how would you propose that it is approached? Because, clearly, if individuals are traumatised from their past experiences or their current experiences, they are unlikely to deal effectively with the narrative coming from the pupil.

It's a big ask, because nobody goes into teaching necessarily, nobody goes into the mental health world—where I am—openly, at least, to say, 'I want to deal with my own traumas.' That's not what people sign up for. They want to help and they want to be there for others. There is a consent issue to first address in how do we bring people along with us and how do we make sure they're in the right space to be able to do that, and how do we look after them if they're saying, 'No, that's not what I signed up for.' So, there's a really detailed conversation to have there to ensure that we're looking after the workforce as well. It's exposing and it can create vulnerabilities when you're first learning to understand. We're going through this in Platfform. Platfform is going through this. When we first raise consciousness, it can be shame inducing, and it can be shame inducing for many different reasons, because either you've perpetrated this stuff, you've been the one that's done that—we're not void of that, we're all included in this, as a society, we all have a role in how these things play out—or we may also have our own experiences that we need to deal with. And there's a lot of moral guilt and moral harm that I think we have to really think about in creating the right support around all of the professions. It's not just education, but policing and mental health professionals and everybody that's involved as well—creating that layer of support for the workforce, before we then ask them to go and do that delivery. But you can't force people to go there; it's a tentative dance.

Thank you, Chair. Can you outline any effective interventions that are currently being delivered in secondary schools and colleges to help prevent dating violence? What more can be done? What more is needed in this area, really?

I can start, if you like? One of the examples we've submitted in our evidence—I've just forgotten the name of it, but it's in there—is from a college campus in America, which has essentially created a space where men are able to articulate how to act in ways to, essentially, recreate or create a healthy masculinity. So, we use the term, like I referred to before, 'restrictive' masculinity, rather than 'toxic'. So, that is a space for men to actually speak about, understand, process, share their emotions, talk about what's happened to them, talk about maybe things they've done as well. Some of those models, which I'm sure exist in the UK as well, really helped to break down some of the barriers that masculinity essentially traps us into. It's things like—they are clichés, but they still hold true—it's not okay for men to cry, it's not okay for men to struggle with their mental health, it's unheard of, for example, for men to have eating disorders, all of these things that men have consistently been told that they can't feel or don't feel or shouldn't feel. By making the space for them to share those vulnerabilities, it's really powerful.

I think that, plus, more broadly, general relational health education and support within schools, colleges, universities, amongst apprenticeship placements, because we mustn't forget the vocational training as well, because a lot of our focus ends up being on college and university. Actually creating spaces for men, women, non-binary people to articulate how and who they are is probably the best approach. Fundamentally, that will help in two ways. One is it will help us make sense of our own behaviours, so if we are causing harm ourselves, we’ll be able to understand that, start processing that, start coming to terms with that and addressing it. But also, it allows people to understand what is okay, and, critically with that, it’s about allowing people to assert their own boundaries, their own ability to take control of their own lives and their own relationships. So, I think some of the hope for the future that I have is that we might start doing that more.


Thank you very much. My last question, Chair, is: how do we ensure social media is not impacting upon our children’s relational health, well-being and, increasingly, their exposure to abuse and violence? And, knowing about Andrew Tate, what’s your opinion?

Social media, generally, I think, is a topic that we need to cover for children as much as for adults. When our adults are on their devices all of the time, they’re not emotionally available for their children, which is storing up relationally health-related problems for the future. If we understand that mental health is about nervous system regulation and connection to ourselves, others and the world, social media is causing problems with that, in that if children aren’t getting enough contact with adults, then they’re not going to have those experiences to learn how to regulate their own emotions—that’s a physical as well as an emotional experience—which means we’re going to store up issues in terms of our ability to connect, and, like Oliver was saying, knowing our needs and understanding who we are authentically, and knowing how to relate and to connect with others. So, yes, it’s important for children, and we need to protect children, but it’s a broader thing that we need to tackle in terms of how we rebuild social cohesion and social connection. The obvious would be regulation and finding ways to have those technologies support growth and support relational health, rather than compromise them.

If we think about addiction and if we understand that addiction is connection seeking and that our devices, in all of their different forms, are a means of addressing our overwhelm—so, they’re a form of addiction—we may think about our use of them slightly differently if we put them into that category, and observe their erosion of our ability to do social connection.

Great. Thank you very much. Is the Welsh Government doing enough in this regard, and what do you think about the UK Government online harms Bill? Is it enough to protect our children?

Sorry, I was just going to build slightly on that, and then go into that second question, because it segues quite nicely. You mentioned Andrew Tate. People seek simple, straightforward answers, especially in times when our individual dysregulation is growing, but also our community dysregulation. So, if you look around at communities that have been blighted by poverty, by decades of structural inequality, whether that’s racism, gender-based inequality, whether it’s income-based inequality, homophobia, transphobia, any of that will create disconnection between that community, individual communities and the rest of the world. So, to me, and us I suppose, it makes perfect sense that people will reach out to people who have got very clear, reassuring, straightforward, simplistic messages, because you can get some comfort from that.

On the idea that online or social media are entirely harmful, I think I just need to push back a little bit on that, as well, because, actually, there are whole communities who find a great deal of comfort from that: the LGBT community, of which I'm a part; a lot of our mind spaces where you can make huge amounts of connection with people; the disabled community, of which I’m also a part, you can reach and access a lot of support. So, I think part of the complexity of the issue around online harm is the fact it's serving a positive need for connection, building communities that are online rather than physical, but also, as Jen was saying, it's addictive and can be overused differently. 

I think it’s not in Platfform’s purview to have a full view on the online harms Bill. But, I think, for us, we would say quite clearly that focusing on disconnection and overwhelm within communities—and however you define community is really important—is probably the best way of insulating people and individuals, whether they're young people or adults, from the harm that people can witness online. If we move into the online harm discussion without addressing the weaknesses within communities that we've allowed to build up over decades, then we will just be having the same conversation in another 10 years, in another 20 years. We've got to get right back to relationships within communities and find out what's causing that disconnection and work with people themselves to address that.


It's probably an example of pointing the fire hydrant at the fire alarm, that we could do that and that would probably have a positive effect, but if we're not going under and meeting the unmet need that drove that in the first place, then the problem will still pop up somewhere else, and then we'll have another avenue to take care of, or to protect against. We could keep doing that and keep moving, whereas if we get to what is the underlying, unmet need that means people seek that stuff out—so, a loss of sense of connection, and a lack of emotional regulation and feeling connected and grounded into our communities and our societies—and if we haven't got that, then it's obvious that people will turn to a myriad of different things, some legal, some illegal. 

Diolch, Cadeirydd. Byddaf i’n gofyn y cwestiynau yn Gymraeg. Cwestiwn i Dr Daffin i ddechrau. A allech nodi’r ffyrdd y mae anghydraddoldeb rhwng y rhywiau’n ymddangos mewn gwasanaethau iechyd meddwl, a sut mae hyn yn gwaethygu trais yn erbyn menywod?

Thank you, Chair. I will be asking my question in Welsh. This is a question for Dr Daffin to start. Could you outline the ways in which gender inequality shows up in mental health services, and how this perpetuates violence against women?

So, in mental health services, we see that women are more likely to present with particular things, so they’re three times more likely to be diagnosed with a mental health problem, and they are more likely to have experiences of self-harm and have particular exposures to particular diagnoses, including the diagnosis of personality disorder, and subject to particular treatments such as ECT, and there is no underlying pathological, biological rationale for this. But, in the way my colleague Dr Ahsan articulates in her recent article in The Guardian, what we’re seeing is that doubling of discrimination against women playing out in mental health services, where the views that society has of women are manifesting themselves through the means that are available within mental health services. So, the diagnosis of personality disorder is a very controversial one. Women are 75 per cent more likely to be diagnosed with it, and it has a long history of being related to diagnoses such as hysteria.

We could go into more broadly the diagnostic system and its use against persons generally as a system that causes oppression, and so women aren’t the only ones subject to this, but it does play out particularly strongly for women. Lots of my colleagues and experts across the profession would say what we have been doing is focusing on chemical imbalance, but what we actually need to be looking for and focusing on is power imbalance. And it is through the use of harmful diagnoses, but also harmful interventions, or interventions that then become harmful, that women are doubly discriminated against. So, the evidence base suggests that they are more likely to present with particular mental health problems, but then when they reach out for support, the same loading of stresses that may have caused those in the first place—so, the lack of adequate policy for childcare, lack of inclusion, and lack of access to equal work and equal pay, and all of those societal things that we could think of—play themselves out then in the mental health system as well.

Historically, there’s a narrative around the use of diagnosis, particularly use of the diagnosis of personality disorder to obscure some of that social harm. So, you could argue that the use of the diagnosis of personality disorder causes diagnostic overshadowing of child abuse, social injustice and neglect.


A beth fyddech chi'n dweud wedyn yw perthynas hynny gyda thrais yn erbyn menywod?

And what would you then say is the connection between that and violence against women?

Could you elaborate on the question a little bit more?

Ie. Rŷch chi wedi disgrifio yn fanna sefyllfa lle mae menywod, oherwydd yr anghydraddoldeb rŷch chi wedi darlunio, yn derbyn diagnosis sydd efallai yn masgio pethau eraill cymdeithasol. Felly, beth yw perthynas y ffaith yna, sef fod hynny'n digwydd, gyda lefelau o drais yn erbyn menywod? Gallaf i jest meddwl, er enghraifft, fod pobl yn sôn nad yw menywod yn ymddwyn yn rhesymol ac felly fod hynny'n gallu bod yn gyfiawnhad dros y ffaith eu bod nhw wedi dioddef trais domestig, er enghraifft.

Yes. You've described there a situation where women, due to this inequality that you've outlined, accept a diagnosis that perhaps masks other things, other social aspects. So, what's the connection between that fact, namely the fact that that happens, and the levels of violence against women? I'm thinking, for example, of when people talk about women not behaving in a reasonable manner and that that could perhaps justify the fact that they've suffered domestic abuse, for example.

I think I follow. Thank you for elaborating. I suppose it's chicken and egg, almost. If we have that idea that women are more emotionally unstable and can't do emotions, or you could flip it and say that women are more connected to relational health, depending on which side you'd like to come at that from—. Sorry, I can't listen and hold those at the same time. Sorry, I'll start again.

Yes, it's a bit chicken and egg, in that is it the messaging from society that traps women in those ideas and then leads them to experience mental health services in that way? Is that the bit that causes harm, or is it that we need to root out those ideas first and then mental health services will follow suit and then not cause harm? It's kind of, where do we start and where do we stop with that? But once women are in that system and those ideas are then being perpetuated across the mental health system again and across health services as well—it's not just mental health services that do that—there is a double loading in harm that occurs, because then those ideas follow them through, so then women are often—. Those ideas are then formalised in diagnoses and those diagnoses can then be used against women to perpetuate that harm the other side. That could result in them not being viewed as fit to have their children and their children may be removed from them, and if we backward-chain that to if we'd have taken a different approach to understanding the distress that women were going through before they went through the mental health system, then maybe we would have arrived at a different set of circumstances and a different set of interventions and outcomes.

So, what you have is people that, through the way those diagnoses are organised, internalise that shame. So, the system says to you, 'There is something wrong with you. It's not what's happened to you, it's not what's gone on around you; it's something that's innately wrong with you and therefore not fixable', that idea then gets applied to everything across the system, and organises the system in a way that is not helpful towards supporting that woman to have addressed whatever it was that was the thing that caused the distress in the first place, which we know is correlated to experiences of adverse childhood experiences, or abuse and childhood neglect, or just social injustice, depending on how much of that you get layered across your particular experience. Yes, I guess it's a trap, then, that can become really, really difficult to get out of, and so that shame that you first experience by having it internalised as a problem that's wrong with you gets replayed out and the person can experience retraumatisation across the different parts of the system that keep perpetuating that message, making it extremely hard, then, to move away from that narrative to support keeping that family together or keeping that mum with her children.

One of the things we touch on in our responses is around Professor Jane Monckton-Smith's work on the homicide timeline, and one of the things we haven't talked about a significant amount in our contribution is the secondary or tertiary prevention, because it's not what we do. However, we have talked about emotionally unstable personality disorder in our submission. There's an element around the need to believe survivors, believe women, and often diagnoses such as emotionally unstable personality disorder are used as an excuse not to take action, to not believe someone when they're saying that they're at risk of serious harm. One of the things we've talked about is the need for more services to be aware of the homicide timeline, and I think there's an element—I'd agree with everything Jen has said, incidentally, but there's another element—which is, when women are at significant risk of harm, say if they're just leaving a partner, or if the violence has started escalating, a diagnosis of EUPD could potentially be harmful, if not fatal, if it's used as an excuse by police and other services not to take action.

So, I think there is a longer term harm—loss of children, loss of longer term security and safety, but, initially, it could be physical harm or loss of life as well. 


Could I add to that as well? So, that's right, Oliver, and when we just see it through the lens of, 'There's something wrong with you; you have a personality disorder', we're missing those relational health patterns that play out, that may keep somebody with somebody that's causing violence to them or causing a threat. And we as a system aren't paying enough attention to that, and we also just put that blame back on to that individual as well, and we say, 'Well, you just leave them' or, 'You just do this', when everything in their life experience probably goes against that, and their experience of having the relational skills or the threat-based responses to address that in a healthy way just aren't there. So, people may then fawn or tend-and-befriend as their threat response, meaning that they draw that threat in so that they can keep an eye on it, which means, then, women may stay in situations, or anybody may stay in a situation, that's more harmful to them long term, as a protective coping mechanism. 

Diolch yn fawr iawn, a phrynhawn da i'r ddau ohonoch chi. Diolch yn fawr iawn am ddod i'r pwyllgor y prynhawn yma. Dŷch chi wedi sôn lot, dwi'n meddwl, am y cwestiynau roeddwn i am eu gofyn. Felly, mae gen i jest un cwestiwn, os yw hynny'n iawn, yn canolbwyntio ar brofiadau plant, os yw hynny'n iawn. A hefyd mae gennym ni ddiddordeb yn beth mae'r Llywodraeth yng Nghymru yn ei wneud neu ddim yn ei wneud; dyna beth sydd yn bwysig i ni hefyd. Felly, ydych chi'n gallu dweud wrthym ni a yw ymateb Llywodraeth Cymru i gefnogi plant sy'n profi cam-drin neu'n dyst i drais domestig yn ystod plentyndod yn ddigonol? Diolch yn fawr iawn. Dwi ddim yn gwybod pwy sydd eisiau mynd yn gyntaf. Felly, Oliver, efallai.

Thank you very much, Chair, and good afternoon to both of you. And thank you for attending this committee meeting this afternoon. You've talked a lot about the questions I wanted to raise. But I just have one question, if that's okay, focusing on the experiences of children. We have an interest in what the Welsh Government is doing or not doing; that's the important thing for us. And so could you tell us whether the response of the Welsh Government, for those who experience abuse or witness it during childhood, is adequate? Thank you. I don't know who wants go first. Oliver, perhaps. 

Yes, I can make a start, and, then, hopefully, Jen after. Sorry, I just want to make sure I don't miss—. So, I can't speak to whether or not Welsh Government's response is adequate. I suppose what we can say is that there are—. What we see within Platfform at the moment is increased levels of distress of people across the age range that are accessing any of our services. And one of the phrases we often use within Platfform is, 'When you see people falling into the river, we need to start asking ourselves why they're falling in rather than keeping on trying to pull them out.' And in the years that Platfform has been going—over 20,30 years—those numbers have only increased. So, logic would suggest that we're not getting the emotional support around young people right at this stage.

I think that's not for lack of trying. I think the Welsh Government talks about young people and children's mental health and emotional health a lot. I think the whole-school approach is a really positive step forward. But how do we address the, I suppose, lifelong experience of the impact of witnessing or experiencing domestic abuse in the home? And I think we've all got to do more on that. I know that feels like a fudge of an answer, but we do. We have to understand what it is we're dealing with. We have to understand and face up to, I think—. We were talking about that some people draw the line at 18, some people at 16, some people at 14, 21. There is a point, a cliff edge, you fall off in our society, at a UK level, but a Welsh level as well, where you suddenly stop becoming a survivor, or a victim, or a young person who's experienced harm, and you suddenly switch over into a perpetrator or a criminal or someone who’s a violent, repeat offender. And that's in the acute end, I suppose.

So, what I would really like to see—. And, again, most of my answers to lots of these questions will be talking more about the social understanding we need to have around mental health and trauma, but also the community support, and I suppose—. One of the things we've put in our submission is the need to create healthy, trauma-informed communities. So, what you tend to see is communities where these experiences are clustered. So, they are gathered over generations, they build in, they become entrenched, and it's really hard then for any public service, particularly schools, to work in a relationally-informed or a trauma-informed way, because everything becomes so overwhelming and concentrated. So, what we need to see—and this is the area where I think we haven't seen much from Welsh Government—are the links between our community approaches and our community responses and our education settings. I know, probably, Jen will talk about the Bettws project that she was part of, but, in the areas where we see the community becoming involved in their local education settings, there's a huge amount of positivity that can come from that.

So, for me—. Is the response adequate? People are trying, but I would like to see it much wider so that, actually, we can start addressing the causes of emotional dysregulation amongst young people and children so that we stop seeing people coming through as adults in homelessness services, in mental health settings, in prisons as well. So, at the moment, that isn't happening, the numbers are increasing, distress is increasing, and that's what we need to get right very quickly, I think, in Wales.


I think the response is probably reflective of the complexity and disparity that's playing out across the sectors and the way that different professions think about these things. So, it's then not a surprise then that our interventions haven't gone far enough yet. So, for example, there is no—. And we can talk about the validity of the diagnostic system, but, if we just focus on it for a minute, there aren't adequate child diagnostic criteria and categories within that framework itself. So, there's not an appropriate evidence base yet. It's developing, and colleagues in Traumatic Stress Wales and other areas are doing really great work on that, but it isn't routinely available to children in the same way that it is to adults. We don't have a developmental trauma diagnosis, we don't have a post-traumatic stress diagnosis, and intervention packages that go alongside those, for children.

Now, if we're talking about whole systems and taking a holistic, social justice based approach, we're going to need way more than that, and we’re going to need to be thinking outside of child and adolescent mental health services provision, and we're going to need to be thinking outside of one-to-one, individual counselling based approaches to solving these problems. And those ideas are in development. As Oliver said, we're piloting a project on what does it look like to embed community-based provision, what does it look like when we move away from clinic-based provision, what does it look like when we don't work in silos, how do we work together across the different public sectors, how do you get education, health and the police in the some room, what are the cultural, contextual, organisational difficulties and cultures that we need to shift and change to allow that to happen. And there's a whole conversation around funding and how things are organised and things that will need to go with that. And until we've got those things right, we're not going to be meeting children's needs, and we're not going to be able to get it right for children.  

Diolch, Cadeirydd. Dyna i gyd oddi wrthyf i. Diolch.

Thank you, Chair. That's all from me. Thank you.

Before I bring in Ken Skates, I wondered if—. Oliver, you mentioned the Bettws project, and I wondered if you could both just tell us a little bit more about that, because, Oliver, you've mentioned that in your written research, and I think it sounds very interesting and it enables us to not get totally depressed about the size of the problem. If you could just tell us what you've learned so far from the Bettws project—. So, I don't know which of you wants to start.

If it's okay—not to take it from you.

So, it's a piece of work that colleagues and I started as part of Aneurin Bevan University Health Board community child and family psychology department. We were looking to do things differently. If you remember the 'Mind over matter' report, where you talked about the missing middle, within that, evidence was submitted by colleagues from that department that suggested clinic-based interventions are limited. We never see the most vulnerable, because they can't get there. In Newport, for example, you have to take two buses to get to the clinic, but you obviously need the financial means and an adult or someone, especially if you're really young, who can get you there. So, we never see the majority of people who need the support the most.

So, how do we do that differently? How do we move out of the limitations of clinic-based settings, and how do we embed what we know is much-needed psychosocial intervention in settings alongside people? It started with the idea that that means we need to come alongside other professionals that have got relationships with families already. Because there's no point also, if we're understanding that this is about threat and loss of connection and safety with anybody—. For lots of people, lots of children, especially those in the care system, they just wouldn't have had those experiences. How do we trust them, how do we—? Sorry, not trust. How are we suggesting that we would expect them—that's the word I'm looking for, sorry—to be able to get into a clinic and speak to a professional they've never met before? We know from the evidence base that it can take, I think, sometimes, eight to 10 sessions of 50 minutes once a week for somebody to feel safe enough within a room, and lots of our interventions are six to eight weeks. It doesn't stack up. But they'll have lots of people within their lives that are with them within the community that they'll have ongoing relationships with—why are we not utilising those?

So, it started with a consultation-based model to go out to communities, into communities and alongside other workers—so, workforces such as Flying Start, Families First, youth workers, as examples—who already have the resources and abilities within their practice to be alongside families—community development workers who are just there, they're there almost continuously, not in a clinic-based way, where you come in for your referral and then it's closed. And then we advanced on those ideas. So, not just coming alongside consultation, but handing over and co-producing spaces with communities.

So, it's part of a broader systems change project run by Save the Children. Save the Children have a number of these across the UK, but there happens to be one in Bettws, where one of the primary schools in the local area was looking to be a community-embedded school, but they realised that school ends, and school is only part of a child's and family's life. What about the rest of it? What about the community? So, the Save the Children early learning community was a model that was tried in the area to bring all of those parts of the system together—so, we've got education in the room, but you've got your Flying Start, Families First, youth workers, health visitors, other health professionals and other stakeholders within the local area, including housing and the police—bringing them together to try and work with and co-produce solutions with families.

We have a small arm of that specifically looking at bonding and attachment, or a trauma-informed approach to working with communities, where, rather than, 'You're experiencing distress. Go to your mental health professional', if we understand that our mental health is largely determined by our circumstances, and that at the community level as well we're seeing disconnection, then how do we reconnect members of the community? So, we started with the idea of working with a block of families, who were all individually being seen by different health professionals. So, we'd have a number of different referrals going, and nobody was kind of connecting it back together and thinking, 'Well, actually, this referral here is interlinked with this family here', and, 'This toxic stress situation here is causing adversity for this family up here. How do we work together with them as a holistic community to reconnect them and address the adverse community experiences that were perpetuated across the community?'

In a nutshell, what we did was we got groups of families together. So, the funding was for under-sevens, so the parents had to have a child under seven. We got them together alongside the school, who was their trusted relationship, and we worked through the trusted relationship to start to explore and share with them relational health information and a relational health understanding of trauma and distress and mental health and to come alongside them and help them then make sense of their circumstances, and help them make sense. So, not to internalise it—'There's something wrong with me. I have a problem. I'm just not good enough. I've got this diagnosis, that diagnosis'—but to help them understand, 'Well, what does that really mean in terms of my relational health and my ability to thrive?', and, 'What do I need to do differently, then, to thrive?' So, to help them make sense of that information but then to be alongside them to put it into action. So, what changes do you want to make to create a more cohesive, integrated community. And that might've been, 'Yes, we just want to meet on a regular basis', because it's co-produced, it's determined by their needs, or it might've been that they wanted to go and have, in the way the GP surgery was approaching counselling, which was an example given—to do that differently. But we'd be alongside them in that journey as well, and use the broader mechanism of the stakeholders from the local area around them to feed that back in and have them feed their experiences and the things that they felt were important to them back in. Is that making sense? So, it's kind of like a learning-based model where we're providing information, helping people make sense of that in a different way—so, not just going for antidepressants, not just going to a GP. That might be useful as well, in addition, but not just doing that. Because if we're sending people for that, but then sending them back into communities and their own little places that they live, their microcommunities, without any change there, then almost what's the point? It's not a prudent use of intervention, because if we're not changing anything that was causing the problems in the first place, and we're just sending people back to it, the chances are it's likely to perpetuate itself. So, we need change and we need more in-depth support for some people, but we also need to be going in and changing the environments and the living circumstances and the communities that people live in in order to make sustainable, prudent use of those resources. The Embrace project is trying to pilot how we do that.


Thanks, Chair, and thanks so far for the evidence that you've given today; it's been fascinating. I'm conscious of time, so I'm going to ask one question directed, first of all, to Oliver, if I may, and that concerns the evidence that we've heard from a number of witnesses regarding perpetrators and whether victims prioritise prosecution and retribution over an apology and acceptance and acknowledgement of what has happened. Dr Fox and Dr Miles at the University of Manchester have said that, for many victims, prosecution of the perpetrator is low down on the list of priorities, or not even there at all. And, Oliver, you've made a similar point that, whilst some survivors do seek retribution, the vast majority actually just want that acknowledgement and to be believed, and an apology that is genuinely held and meant. What's the impact on policy and in terms of practice in preventing gender-based violence of having an approach that places the greatest emphasis on being acknowledged and believed?

That's a nice last question to have. I suppose the first thing I would just really make clear is, in all of that, it's about listening to survivors as individuals. So, yes, that tracks with what Judith Herman has written about in her recent book, which talks about how do survivors conceptualise justice, what justice do people see. All too often I think we do get very focused on punishment, and, yes, from what I've read, that tracks with your quotation of Dr Fox and Dr Miles talking about retribution being quite low down, but justice remains high, as a need.

Sometimes we can talk about apology as almost an asinine, ad hoc something you do. So, I think it's really important that, when we talk about apology, we mean redress, we mean acknowledgement of harm caused. And the redress that people talk about as being more important is to recognise that harm was done to someone, to an individual, and often, that harm was perpetuated by either inaction or structural inequality from a community, if not wider society. So, apology and redress and acknowledgement and accountability are really important to see that from a societal level. So, do we do enough as a society to ensure that the voice of survivors is heard? Do we do enough to ensure that an apology can be meant genuinely and heard? And, for me, it's about the accountability. So, sometimes, whole families, whole communities will shut down when they see accusations or evidence of domestic abuse. So, there's something about the justice of hearing and people acknowledging that you are telling the truth.

In terms of the policy responses, I believe there's lots of evidence, or lots of really interesting ideas; unfortunately, lots of them are held back by the lack of powers that the Welsh Government have. There have been some brilliant examples of diversionary activities. There's been research—I can't quote the study at the moment—that has shown that the vast majority of criminal activity engaged with by women is actually caused by their experiences of domestic abuse—so, either conducting crime to fund lifestyle choices of, say, a partner, or desperation caused by lack of means that has been created by their relationship. So, I think that, a lot of the time, we could do something really special within Wales, and there have been pilots around that diversion scheme, but, actually, if we were able to have control of our own criminal justice system, we could actually intervene much earlier to address the harm caused by our society's approaches, and critically, I think, giving us an alternative within Wales. We've talked in our submission about the idea of a survivors' court, where, actually, we could create a space for people to make an argument for redress rather than retribution.

The final thing I would just say is in the sense of the safety element, because I would split that out: there is a safety element there for people who have caused harm, and it may be that a custodial sentence is the only way, for example, certainly in the short to medium term, to keep someone safe from that individual. In that sense I would defer completely to the views of the experts in that field—so, Welsh Women's Aid and other organisations—to work out what is the safest response. But certainly, in terms of what survivors want to see, offering that space for redress is something that would be brilliant to see within Wales, but I think is currently limited by our devolution settlement.


Thank you. Just a final thought—from either or both of you—on why it's proving so difficult to prevent gender-based violence, and what the priorities should be for the Welsh Government. Do you think that the approach that's taken, the thinking that's adopted, is perhaps a little too traditional and that we need more radical approaches that place a greater emphasis perhaps on psychological intervention, psychological healing, not just of the victims but also of the perpetrators, and children as well who have witnessed it?

Absolutely. I think you may have just summarised it there—thank you, Ken. I would agree; it's about taking a trauma-informed and relational health approach to understanding violence and aggression, which will be key to breaking the cycle of violence and aggression—that's gender based, but all violence and aggression—and the intersectionality of that; they have underlying mechanisms, some of which are social, some of which are how our relational health stuff plays out. But it's about violence and abuse more broadly as well. And if we're going to do that, our current approach to gender-based violence points the fire hydrant at the fire alarm and misses the fire. So, if we're serious to root out violence from our communities and to make them safer, happier and healthier, we must start pointing it at the fire. And to do this, we must take a public health view that understands that toxic stress, trauma and not having our material needs met, which causes stress and toxic stress, but importantly our relational needs met, contributes to perpetuating those cycles, and that children are at the centre of that. If they're exposed to that, then those are the things that they're learning, or they're not learning—they're not learning how to regulate their own emotions and how to engage in relationships in a healthy way, and they will have that role model to them in terms of their exposure to the way that that is done, but it will also have a biological level physical cost to their sense of self, as well as a psychological cost. And it's working with those two in tandem that's going to help us really progress tackling violence and aggression at a societal level.

I would just add as well that I think one of the greatest interventions we could continue to develop is tackling poverty. But what we've seen, I think, in the Bettws model is that tackling poverty can't really be done successfully as a large-scale, centralised, top-down approach—it has to be hyperlocal, it has to be place based, it has to be built on a block level, from the ground up. And in terms of the overwhelm that people are experiencing, both across generations but also individually, if you're asking people to understand how they react to systems, react to stress, if you do that and you're surrounded in an area with no green space, with no sustainable or long-term work, if the child you were experienced toxic stress and vulnerability, all of that becomes kind of layered into our communities. So, yes, a new approach to tackling poverty is absolutely needed, which listens to people and trusts them with the expertise of their own areas, and a new approach to community building that, again, listens to local people.

And very much, I suppose, the thing I would conclude with saying is that, yes, I think we do need to think differently about future generations. Some of the things we've said today might be quite difficult to hear for people who are currently locked into that situation, and I think we almost have to develop a two-stream approach so that we can make sense of this. One is how do we tackle and break that link intergenerationally in a way that isn’t shaming, that isn’t stigmatising, so that we can talk about this and create a safe space to discuss it, at the same dealing with the very real distress and trauma that survivors are experiencing. And until we break that link, we might never progress, because it’s really hard to look people in the eyes and say, ‘Let’s adopt a healing approach to people who have harmed you.’ It’s really hard to do that, so I think we need a two-track approach to take it forward. 


There's a great book by John Bradshaw, 'Healing the Shame that Binds You', which looks at this sort of issue. Committee may do well to have a synopsis of that.

Thank you. I just have one final question, because we have overrun, which goes back to what Jen Daffin was talking about in her response to a question from Sioned Williams, and that's the link between the perpetrator and the victim, and the sense really about the most acute problems that we see, which are around child deaths in domestic scenarios, and why didn't social workers spot this. So the social worker is getting the blame for something that they didn't cause, but for not being able to properly see the level of danger to the child. So I just wondered if, either verbally or in writing, you could tell us what work you're doing with the heavy end of children's social work to support your argument that we need to be seeing perpetrators in the context of them being victims, and that the rational response that we think we'd like to expect from a mother wanting to protect their child won't necessarily occur. 

I can definitely provide more detailed evidence in writing, but I think an example that comes to mind is when colleagues are working with small children—five-year-olds, four-year-olds—and you can see they're in situations where, around them, they're experiencing violence, either because their parents are still living together or because they're not, and it's still perpetuating itself. You can see the child on a trajectory for perpetuating those cycles themselves, but when you look at that child, they’re a child, and they’re not responsible for the circumstances that they’re in. That’s the kind of conversation, I think, we need to be having when we’re thinking about this. Yes, there are people that are going to have suffered. That little boy is equally suffering in this, which will just go on to perpetuate more suffering. So, how do we have a conversation that can hold all of those voices, and hold them all compassionately, and think about the different levels of healing that are needed? The quote we put in our submission from the compassionate prisons project is that an inmate in a prison in America says:

‘I’m a traumatised child raised by a traumatised child.’

And of course, it’s not going to work if we keep perpetuating that cycle. So there is something for us to focus on there, at that acute end of children and families that are in that. Because it didn’t start with them. It didn’t start with their parents. It’s not that the mother is bad, it’s not that anybody is bad. It’s that the circumstances just weren’t there for them to be able to thrive.

There is something else that we haven’t mentioned yet in terms of how trauma travels intergenerationally. Neuro researchers are looking at the epigenetics of that, and we do see more men in prison. Is that just a social construct, or is there something else that’s maybe socially constructed, but also plays out at the level of the body as well, that’s playing out? And we see more, anecdotally, boys in foster care and in social services up for adoption than we do girls, and we can see a similar trend in learning disability services of autism and things that affect boys in a different way than they do girls. What’s the broader conversation that we need to be having and the thinking we need to be doing there?

There is some research that suggests that, down the male line, a propensity to distress or a propensity to be ready in an environment, which we might think of as attention deficit hyperactivity disorder, does travel in a particular way. So, what are the things that we need to be adding to the conversation in order that we can catch some of these things before they play out? Safe, secure, nurturing relationships are shown to be the key, so it's absolutely about getting it right for families. In particular, that means getting it right for mums who we don't get it right for now, in terms of the policy context there, if we're thinking about rates of post-traumatic stress disorder from birth. So, we're not setting people up, either mums or their children—we're not setting either of them up for the best outcomes.

But, I do think we need to take that holistic approach and think about it across all of its different layers—the social construct, the impact on people when they have been harmed, but then also, how this stuff is perpetuating in a way that didn't start with us and is just going to continue unless we can break that cycle.


Could I just—? I know we're overrunning, but just around the high levels of risk around children in particular, one of the resources we quote, which is how to engage with perpetrators of domestic violence—the evidence there shows that, if you go into that work without shaming, by having a relationship-based conversation, people are more likely to disclose that there are troubling behaviours or real senses of risk, because if you create that sense of trust, then, actually, the survivor, but also, often, the person who's causing the harm, will lower their guard and they will not perform in those roles as much. So, actually, it means that people in child protection roles will be able to make those connections much easier, whereas, often, if you go into a family home and you meet that high level of resistance, and you go in with, I suppose, a binary perspective of what's going on, you can often miss things. So, you go in holistically, you work relationally, and you actually see a much more detailed picture. But, I think that's such a big question; I wanted to leave with that answer, just so that you know that that is something we've considered. But, yes, we can offer you evidence on that as well.

By all means; we're happy to receive additional evidence, if you wish to provide it. I'd like to thank you both for your very important evidence today. We'll send you a transcript so that you can correct anything we've not captured correctly. Thank you very much. The committee will now break until 14:55 to enable us to hear from our final witnesses.

Gohiriwyd y cyfarfod rhwng 14:47 a 14:55.

The meeting adjourned between 14:47 and 14:55.

4. Atal trais ar sail rhywedd drwy ddulliau iechyd y cyhoedd: sesiwn dystiolaeth 3
4. The public health approach to preventing gender-based violence: evidence session 3

Prynhawn da. Welcome back to the Equality and Social Justice Committee's inquiry into gender-based violence. Our final session this afternoon is with Johanna Robinson and Yasmin Khan who, jointly, are the national advisers for violence against women, gender-based violence, domestic abuse and sexual violence to Welsh Government. Welcome, both of you.

I suppose my first question has to be: how adequate is the understanding of the drivers of gendered violence and how we could prevent it? How effectively is this reflected in the Welsh Government's VAWDASV strategy and blueprint? A small question. [Laughter.] Perhaps you could just summarise it because, obviously, other Members are going to go into some of the detail.

If I could start—

Thank you. I think we all accept, don't we, that violence against women, domestic abuse and sexual violence in Wales, and across the globe, is very, very complex. It's an area that, in some parts, is not as widely understood as it should be and I think that there's so much evidence and research in this area that cites the fact that there is a complexity of drivers, all communities are affected and that this is a societal problem, and a societal issue that we really need to focus on, looking at the prevention model, so that we eliminate and we minimise the risk to vulnerable women, girls and communities from a whole-Wales perspective.

I think we understand some of the perpetration of violence against women, domestic abuse and sexual violence and how that has an impact on health and well-being. But I think we need to do more, actually—a lot more—to understand the complexities for children and young people particularly, for victims who have disabilities, neurodiversity, and we also need to understand the specific barriers and the root causes for women from marginalised communities, particularly migrant women, who aren't afforded the same rights and services in Wales, and in fact in England.

I think that the effectiveness of the provision that currently exists in Wales, working across England and Wales, I can say with confidence that the pace and the understanding in Wales is quite well understood and I think that that is demonstrated in the blueprint approach, which has really gathered pace, momentum and engaged key stakeholders. Because this is not a Welsh Government issue. This is a societal issue, this concerns stakeholders, this concerns specialist services and, of course, public services, as we relate back to the legislation in the Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015.

So, in Wales, we have, it seems, a coherent model of delivery now with specific work streams that look at and connects some of those drivers. But what we need more so in Wales is to have a national plan of adopting a public health approach that isn't being implemented in siloes, but is actually being delivered across Government in all of the policy areas—education are working with health—so that, actually, on the front level and the front line, survivors can have the services that they need and we understand what those root causes are.

I think where it has worked well in Wales, and across the globe, is when we've looked at the examples given within the pandemic, how there was that cross-Government planning and co-ordination, and I think we should learn a lot from what worked really well because we did look at it from the root cause, which is the whole kind of notion around the public health approach. So, we did have some great examples of working with our providers, our public bodies. It was very cohesive because we had particular attention in an environment where we had a pandemic, and that pandemic has been escalated in the violence against women and girls agenda, and I feel that we can learn a lot in terms of understanding the root causes, but also what Welsh Government needs to do, with its partners, in ensuring that victims get the service that they need at the right stage of abuse and vulnerability.


So, if I could come in, I would add that—. So, you asked a question about understanding the drivers. We do understand, but do we understand to the level at which we should? No, we don't. And I think evidence in point of that would be the shock that we have of all the recent incidents, becoming aware of the situations that we've had in police, in fire and rescue, in the Welsh Rugby Union, most recently, obviously, with Plaid Cymru, that people are surprised at those things, when we know that the drivers are inequality, misogyny—and when we talk about inequality, it's gender inequality, but it's inequality across strands as well—and that we still have those views about that power imbalance between men and women and that, whilst we have some things that address that, we're not having that in that concentrated approach. So, we know that a public health approach—and I know that you'll have heard earlier around what that means in primary prevention terms—and that understanding of the individual, the community, society, we're not at that place yet. So, that we need to have more women in positions of leadership across all of our society, that we still need to push for that, would indicate that we're not quite clear on what all of the drivers are.

And there have been initiatives, haven't there, in Welsh Government, as we put in our consultation response—initiatives around having equality of representation in Government. But also there are things going on that we haven't pulled the strands in. The increased representation and recognition of the power of women in sport, for example. That furthers that understanding of women as women of power, women of strength, and all of that will make a difference. That we have things in the poverty agenda—we know that violence against women, domestic abuse and sexual violence is more present in areas where there's deprivation, in communities where there's deprivation. It's not only there—of course not—but those are factors that contribute to it. They are drivers, to an extent, of it. We need to understand those layers. We need to understand the different cultures within Wales. And that can be the diverse cultures, but it's also in rurality, isn't it—what does that present as? So, all of those things layer on that base kind of inequality stance, that whole kind of gender divide and those stereotypes around that, and when we see where we've most recently had things appear, we can see that very present, can't we? We can see that that's where there's male hierarchy, there are men in decision making, there's male of dominance of that, and that's where we get that kind of sexism, sexual harassment and all of those kinds of things. We need to be encouraging, then, around that whole-system education approach that we have in some senses, but we also have a lot of fear around this stuff. We see that people don't want to have some of those conversations in their schools; there's been the whole debate around, 'Do we talk about Andrew Tate or don't we?' So, there's that response.

As you've asked how is it reflected, it is reflected in the strategy. The strategy is very ambitious. It talks about eliminating violence against women and girls, and we have the blueprint structure, we have the work streams, but we don't have—as Yasmin has said, we don't have that cross-Government response. So, within those work streams, we don't have the kind of linkage necessary at the moment—I think it will happen—to that wider gender equality stuff, to the wider equalities issues around LGBTQ+, because we also know people across protected characteristics are more likely to have experiences. So, where are we intersecting in our work with the other areas of work that are doing things around equalities for disabled people and so on and so forth? And we need to have more of that approach and bringing that together. 

As you say in your evidence, two women are killed by their partners across England and Wales every week, so there's clearly some urgency to this matter. How are we going to make progress on adopting the public health framework to gender-based violence, which our earlier witnesses today have already coherently explained is necessary in order to not simply repeat what isn't working?

So, in terms of the two women a week, it's just simply something that we shouldn't accept in today's society. In Wales, one of the areas of considerable work has been around single, unified safeguarding reviews. So, there was a murder in Gwent many years ago, where there were eight separate reviews for that particular murder. The impact and the aftercare for the family involved was absolutely horrific. So, actually, Wales took a very bold step to work to streamline homicide reviews and, as such, I'm absolutely delighted to have chaired the training and learning sub-group, and we will now have an all-Wales repository that looks at specific issues around strangulation, for example, and honour killing, which from the UK Government, there is very little guidance in the domestic homicide review guidance nationally.

But it's absolutely right that we shine a light on what more we need to do around understanding what the root causes are. The whole ideology around a public health approach is actually recognising that that particular survivor, that victim, must have been known to some service, whether it was health that she went to for an appointment for feeling low or feeling depressed, whether it was her children who went to school and highlighted some concerns to the teacher. And that kind of highlights where things don't work well in Wales. And what I mean by that is if we had a joint support plan between organisations and policy areas like health, education and local government social care and adult care, there could be a coherent way to look at the root cause of abuse. Because there are several instances, and it's been widely cited in much research, even the domestic abuse mapping report that she conducted last year, that there are a number of incidents before it escalates to a severe risk of threat to life, but it's so complex.

So, for example, honour killings, it's been cited that 12 to 15 honour killings happen a year, but what about women who are transported to other countries, those almost referred to as 'export murders'? There's some real understanding or lack of understanding that we need to address, and only by addressing the gaps in current provision. And if we look at the severe end and the cost of life of VAWDASV, if we actually adopted a public health approach across Wales, what we would then start to see is a primary level of engagement, where we actually adopt a zero-tolerance approach to violence against women and girls, and we also look at the bystander approach, with communities, society, and the training that Welsh Women's Aid provides, Change that Lasts, is really a good example of that primary level of education and intervention around the public health approach. Only when we really understand how we work across agencies, supporting those who are vulnerable at the early stages, can we actually start to reduce and hopefully eliminate that two women die unnecessarily in England and Wales, and we can really see some progress.


Okay. Jane Dodds wanted to just probe a bit further on this.

Thank you. I'm grateful because I know that time is very, very short here. You mentioned there, Yasmin, about a joint support plan, and I just really wonder, as there seems to be lots of joint-agency working, for example, multi-agency risk assessment conferences, and obviously if a child is subject to a child protection plan, et cetera, is it your view that these are just not effective or focusing on the wrong things? Could you just be a little bit more specific in terms of what needs to change? Because that's what we're here to learn. What needs to change in order for us to have a better system? Thank you.

I think, by nature of default, when the cases are heard at MARACs or multi-agency safeguarding hubs or any other children's hubs, they're already at a critical stage, aren't they? Therefore, that co-ordination on the high risks is being co-ordinated, and quite rightly so. But at the early stages of intervention, that cross-support plan, that cross-referral pathway isn't being co-ordinated across Government departments, it isn't being co-ordinated across services. And what tends to happen is those risks then escalate, and only then are they heard at the multi-agency risk assessment conferences. So, what we need to do is almost focus on the public health approach by looking at the prevention. Somewhere along those lines there has been a disclosure made at school, there is inevitably a disclosure made to the GP or when turning up at emergency services, so it's where do you actually intervene at an earlier stage and where is it widely understood across policy that that co-ordination needs to work better at the earlier stages of intervention. Have I made myself clear? Does that make sense?

Yes, that's fine. So, you're talking about a child-in-need assessment being much more focused, and really much more about agencies working together. 


So, earlier intervention. Thank you very much. Diolch yn fawr iawn.

Very good. Unless you have a burning thing that you want to say, I'll move us on to the next—

I feel like there's more to be said about prevention, but move on, by all means if you—

All right. Well, just very briefly, what more needs to be said on prevention? I mean, apart from everything.

We've talked about the drivers, haven't we? And I know that, previously, in the other sessions, you will have heard some things around that. So, we’ve provided evidence of some of what works, and some stuff that’s exciting at the moment is based on behavioural insights. So, previously we’ll have done things because we think they work, but we don’t know if they did. I think Police Scotland recently did something around, ‘Don’t be that man’, and they’d looked previously at campaigns that all focused on consent. What we understand now is that, actually, adult men understand consent, but what they do is have an idea of sexual entitlement. So they changed their whole approach, and they did those things. We need to work in our communities to build intolerance to abuse, to understand that, for communities to feel that it’s important that there’s equality in their community. So, where we have rugby clubs, where we have sports clubs, where we have out-of-school activities, in school, but also in our public spaces, we’re having those kinds of bystander interventions, those male role models, but also strong women as well, and we’re doing that kind of cultural rebuild, really, where we understand that there is equality, but also, there’s an intolerance to the issues. 

Thank you. That's very good information. I'll move on to Altaf Hussain.

Thank you, Chair. Thanks very much. Now, regarding the implementation of existing duties, I'll ask about the 'ask and act' duty, whether it is being delivered. My question is: do you believe that the Violence Against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015 is sufficient to address so-called honour-based abuse? And what more can the Welsh Government, or we as politicians, do to reach out to these communities where so-called honour-based abuse is happening?

So, in terms of addressing all forms of domestic abuse, violence against women and sexual violence, I can speak because, when the UK Government was developing the Domestic Abuse Act 2021, there was considerable work done with key stakeholders to see how intersectionality and inequalities would be addressed. Because I could make the comparison with the Welsh context and the legislation, I was really pleased about the way the VAWDASV Act was developed, and it specifically pays particular attention to honour-based abuse, and that's also been supported by the all-Wales honour-based abuse partnership group, which has done some considerable work, but there is so much more work that needs to be done. Because a victim of honour-based abuse can also be a victim of sexual abuse, can also be a victim of forced marriage, and also female genital mutilation. 

One of the key areas for improvement in Wales has to be the way that risk assessments are conducted, and particularly the way that disclosures are made. So, for example, victims have very rarely come to me and said, 'I am a victim of honour-based abuse'. What they have come to me and said is, 'I'm frightened for my life. There is considerable control in the family, the community. I need protection. My children need protecting, and so do their siblings'. 

So, understanding honour-based abuse is a real challenge across Wales, and one of the things that we really need to do is focus on that greater understanding, because unfortunately, in my experience, people with that experience take that expertise to their new job or their new sector, and what remains is a very sporadic knowledge of honour-based abuse. So, we need really strong infrastructure and frameworks in Wales where we have that real, deep understanding of honour-based abuse.

But for me particularly, I've just completed the super-complaint for the police around how the police respond to sexual abuse victims within the black and minoritised communities, and police forces in Wales were included in that, as well as England. And one of the things that was very prevalent was the lack of understanding for professionals who don't have that cultural competency. They have the training, but when it comes to practice, they actually don't understand how, in policing terms, investigations can be conducted so that we don't further raise risks for individuals who've made disclosures. So, I think across Wales, again, it goes back to the public health approach of how we can have that co-ordinated response, have a really clear understanding of the risks associated with honour-based abuse, and, by doing so, we need to change the way we record the risks, because somebody may have recorded the risks and made the disclosure around honour-based abuse, but they may be a victim of rape, and, therefore, sexual abuse in that vulnerability checklist needs to be acknowledged. That isn't done currently, so it's really important that we have that understanding so that we can provide appropriate interventions and not put victims at further risk because they've made disclosures.

You quite rightly mentioned the communities. We've got to work with the communities to change the attitudes and behaviours. But, also, they want to see change too, and we need to take them along, and have a focus on perpetration, actually, because there are no perpetrator programmes in England and Wales that look at honour-based abuse.


Thank you very much. With regard to recent media reports pointing to an increase in virginity testing, and with Karma Nirvana reporting they have helped dozens of women and girls but that the true number of victims is probably much higher, we simply don’t know the true number of victims of this practice. How can we better capture data about this so-called honour-based abuse and FGM?

On behalf of the Welsh Government, I was part of a department of health and social care in England group with Karma Nirvana and other associated partners, where we actually looked at whether this would be something around legislating virginity testing and hymenoplasty. So, I’ve been directly involved in the change of direction of law. So, it was very important for me to have that insight from the Welsh context. We do need to do much more, but, going back to the example of risk assessments, if the risk assessments are only asking you whether you’re a victim of domestic abuse, whether you’re a victim of sexual violence or coercive control, you need to include that in the data because we need to understand, quite rightly, the prevalence of virginity testing and which communities are at risk. As such, we have had some guidance for professionals in Wales, in the latter part of last year. So, we are already doing some considerable work around this area, but we need to do a lot more with the communities; we need to engage them. In my experience of supporting victims of FGM and virginity testing, it seems that, sometimes, services can play hot potato with who’s got a statutory responsibility for mandatory reporting. That’s simply not acceptable. So, we need to give professionals the confidence to understand the complexities around this issue.

Thank you very much. Thank you, Chair; I’m conscious of time.

Okay. All right, we may come back to that, if we’ve got time, a little bit later on. Sarah Murphy, would you like to come in at this point?

Thank you very much, Chair, and thank you, both, for being here today. Following on from our previous panel, Platfform say that implementation of the trauma-informed framework for Wales is key to preventing intergenerational violence and abuse. So, do you think that VAWDASV commissioners and service providers are fully trained in the framework?

Whether they’re formally trained in the framework or whether they understand trauma approaches and trauma responses I think are different things. I think it’s safe to say they won’t all be fully trained in the framework itself. That’s something that’s being rolled out at the moment, isn’t it, and I understand there’s some testing of different contexts for that to work with. For example, in substance misuse settings and things like that, I think there’s an amount of work being done at the moment. But, yes, they will understand trauma-informed approaches. Whether that practice is happening where we’re talking about cross-community, cross-sector is a whole different thing. If we’re talking about the specialist VAWDASV sector, they’ve been working with trauma for the whole of their existence, haven’t they, so they’re very familiar with it. That’s not to say that people’s practice can’t improve, because it always can; we can always build on our practice. But they’ll be very familiar with working with that, they’ll continue to have training in it, and they’ll do all of the reflective practice and have clinical supervision, which also helps to have that trauma-informed response.

But what we know is that there are chances that that individual won’t have had those experiences up to that point. So, when they’ve come across, in our statutory services—. That will mean that people aren’t identifying the trauma that somebody’s experienced and then they won’t be working in a way that’s responsive to it. So, potentially, people are silenced and also further harmed by that process. We know, for example—again, as we’ve said—if a woman under 40 experiences stroke, it's very likely to be linked to strangulation, be that through rough sex, be that through a domestic abuse setting. She is going to present in a health setting. So, firstly, will that be recognised by that health professional, that that's how she's likely to have come there? There's every chance it won't, but then also, because of that, there won't be that trauma-informed response to it because it will be seen possibly as a physical health condition, won't it? It won't be seen as all of those other things in there. The trauma framework does just that, doesn't it? It's talking about going across professions. But we really need to think about that, about how we're joining up all of our services, because we know that people are not presenting with one thing; they're presenting will lots of things at once, aren't they? Their whole lives are layered and experienced, be that, like we've said earlier, poverty, abuse, any of those things. So, we need to be working together. So, we have 'ask and act', and then we have the trauma framework. How are we going to bring those together better, so that we're providing complete services to people that they might never need any other service once they present in health, but equally that there's a reassurance that they will get those specialist services if they need them?


Thank you. And to bring this to intergenerational trauma, could you talk about what access to counselling and therapy do children who witness domestic abuse have to help them process their experiences and emotions, whether that's individual or family therapy? Are there any support groups that can provide children with a safe space to share their experiences and connect with others who have gone through similar situations, for example?

So, we know that there's an absolute lack of therapeutic services for children and young people. I know that recently, through the Westminster Government's children affected by domestic abuse fund, the Welsh Women's Aid members have been able to get some more funding in this area, but we also know, from our statutory services, that the thresholds for them are really high, so there's every chance—. We heard just last week, when we had the first meeting of the national panel for survivor scrutiny and involvement that's to run alongside the blueprint, and all of the members of that group talked about their children as their priority, and the issues that they'd had during the abuse but also post-separation abuse, the continuation of that, and the challenge they have, particularly in the post-separation context, of getting support.

So, one of them spoke of their child having post-traumatic stress disorder. He's just hit 18, so he can't access many services, and he was referred to a mental health service that doesn't specialise in this. It doesn't specialise in PTSD; it doesn't specialise in domestic abuse-related trauma, but that was the service that the GP referred them to. And across the board, all of the members of the group expressed their absolute concern that children and young people are not able to get the services. So, they are there; they're not there to the extent that they should be, but I think also what that means is that subconsciously, or actually consciously, there's not talk of that service for children and young people because people know it's not available. So, you can't safely talk about something, can you, if it doesn't exist? So, there's a hesitancy to talk about it.

Again, referring to the domestic abuse commissioner's service mapping, counselling was the top thing that was required by victims and survivors but that they also struggle to get hold of, and we know that that's the reality in Wales; we know that there's limitations around that. It's resource intensive and it's expensive. Also, we separate it from our general health services. So, there's counselling for other things, and there's counselling for VAWDASV; it should be an integrated pathway, shouldn't it, because somebody might present with a dissociative disorder, and until you go into that you might not know what the root of that is, or depression, or anything else. So, it's really hard. We're forcing people to navigate systems. We need to stop that now. We need to navigate the systems for those people, and find the best service for them. And we talk about that; we talk about responsive services. That's what it means: it means that we respond and that we engage with that person around their strengths, but around their needs, and really work with them.

That's very true. Thank you. And to follow on with that, do you think there's enough being done to provide safe housing options for families who have experienced domestic abuse to help protect children from that further exposure to violence?

I think that that's something that we really need to understand better, but I think it's fair to say, working with specialist providers and refuge provision, that there is a huge lack of supported accommodation, particularly for children who are affected and victims of domestic abuse. So, what do we need to do about that? We really need to understand the prevalence of their need, and I don't think we have got that quite right in Wales.

I also think there's a whole lot more we can do with education and the curriculum and providing training to professionals within schools and higher education. There was a report done by a national body of students called 'Not on my Campus'. I know that 66 per cent of students had experienced some form of sexual abuse and harassment on the campus. It's so complex and diverse that we really need to understand where those needs are.

For me particularly, in my research and in my understanding of the landscape, where we do have real problems and real gaps in services is actually that transition age, which Johanna just started to identify. The 16 to 19 age group, where that should be the stepping stone to safety, actually is the most precarious age that presents the hugest challenges for services. Because, actually, there are no services, whether you look at supported accommodation, whether you look at interventions, there is no co-ordination there. So, if there's anything that can be presented from today, around children and young people, and the gaps in services, surely this must be one of the key priorities. It needs to be a key priority, because what we are teaching young people who have been failed before is that there are going to be no easy routes to adulthood, and I think this is something that we really need to have a much sharper focus on.

Look, for women and girls affected by VAWDASV, there are not, there never will be, enough refuge spaces. If you look at all the supported accommodation that needs to follow for children who've been affected by intergenerational abuse and then are becoming at risk, in some cases, of perpetrating the abuse they see in the normal behaviours within their families, this is where we can actually prevent that future abuse and that future-proofing across systems and structures and frameworks. We really need to put this focus in Welsh Government, so that we can identify, almost like a series of priorities and actions, that can be integrated into education and supported care, because that is one area that I'm sure Jo will agree on that is really under-resourced.

And it's not always a case of pouring in more money, but if we actually took a cost-benefit analysis approach to this area of work, to the money it cost the economy and services and the Government to provide critical services, if we actually put that money into the front end of primary and secondary prevention, we would actually be making considerable savings. So, I think we really need an overhaul of spending, we need a clear understanding of system change, and we really need to make sure that we have a very clear understanding of the prevalence, the need and the gaps in current provision.


Yes. Chair, I'm aware of time, and I think my final question has been answered, so thank you, both, very much, and thank you, Chair.

Sorry, could I just add? With regards to refuge, we know that women get turned away all of the time, but there are some particular issues that have continued for forever. It's that transition age. If there's a family where there's a boy of a particular age, they struggle to get refuge. And also, we have to acknowledge that, for people who are considered to have so-called multiple complex needs—so if there's a woman who has substance-misuse issues, is involved in some level of criminality, and we know all of these things are more likely to happen to women who experience abuse—it's really, really hard to get them accommodation. Then there's the issue of move-on. So, we're getting clogging in our refuges. But I think we just need to highlight the gaps—specific gaps. There is never enough, but we have particular gaps where we know we cannot accommodate, and I think that needs to be noted. Thank you.

Okay. We can perhaps correspond with you on this, because there are quite a few issues arising out of that. Jane Dodds.

Diolch yn fawr iawn. Mae jest gen i ddau gwestiwn. Y cwestiwn cyntaf yw: mae'r uned atal trais yn Iechyd Cyhoeddus Cymru wedi cyhoeddi adolygiad yn archwilio beth sy'n gweithio i atal trais yn erbyn menywod, cam-drin domestig a thrais rhywiol, a fframwaith ar gyfer atal trais. Sut ydych chi'n defnyddio ei chanfyddiadau i ddwyn Llywodraeth Cymru i gyfrif am gyflawni ei strategaeth VAWDASV, os gwelwch yn dda? Felly, dŷn ni eisiau gweld yn union beth mae'r Llywodraeth yng Nghymru yn gwneud dros strategaeth VAWDASV a'ch barn chi, os gwelwch chi'n dda.

Thank you very much. I just have two questions. The first question is: the violence prevention unit in Public Health Wales has published