Savitri Hensman, the NIHR Applied Research Collaboration (ARC) South London's patient and public involvement coordinator, reflects on issues of safety, control and health. The disappearance of Sarah Everard, on her way home in south London in March, and subsequent discovery of her body, has led to an outpouring of sadness for her, her family and friends.

Since then, many women have shared their own experiences of sexual or physical harassment, attacks or threats. 
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A court hearing for the Blackheath man alleged to have murdered two sisters, Nicole Smallman and Bibaa Henry, whose bodies were found in a Brent park, has further highlighted the issue of violence against women and girls. In both cases, serious questions have arisen about the action of police officers, which tie into issues of power and accountability.

In addition, widely-aired concerns about a south London school have recently highlighted alarming levels of sexual harassment and violence faced by schoolgirls more widely. Reportedly local girls and boys tried five years ago to draw attention to a “culture of misogyny”, along with use of homophobic and racist slurs The same year, a parliamentary committee pointed to major problems in schools nationally, yet this too did not lead to adequate action.

There is now extensive evidence of the connections between safety and health, especially of those facing social and economic inequalities. Sometimes violence results in serious injury or death. A wider number of people who are attacked or menaced may undergo trauma, while others may be left with a lingering sense of insecurity or humiliation.

Public spaces are not always welcoming to all the public: sexism, racism, homophobia and transphobia are still all too common. Lack of access may leave disabled people feeling yet more unsafe or excluded. Even the home may not be a safe space, as the surge in domestic abuse during the pandemic has shown. Poverty makes it harder to escape from risky situations, while hostels, asylum centres, care homes and other places with multiple residents vary greatly in how secure they feel. Yet health research which is not specifically about such issues often fails to take on board the wide-ranging effects, including drawing on findings from other disciplines.

For instance, studies often focus on encouraging people to lead healthier lifestyles, yet with little recognition of the hugely different ways in which people might experience their physical and social environment. For many, a walk or run may offer a welcome boost to their mental and physical health – but for others, it may be stressful because they are, or feel, unsafe. And some people may have experienced such disempowerment at critical times in their lives that they may have little confidence that their choices can make much of a difference. Or they may not trust advice from the authorities, after bad experiences.

People from all backgrounds can find themselves on the receiving end of violence, harassment or intimidation, which may affect their health in varying ways. Yet often lack of safety reflects and reinforces existing inequalities, as well as getting in the way of seemingly simple ways in which people could improve their own health. This is not to say that those on the receiving end are just victims – many have played a key role in raising awareness, caring for others and bringing about change.

Being more consistently aware of the complex ways in which safety (or lack of it) may influence health could enrich research. Greater involvement of diverse people and groups, including those addressing violence or its aftermath, and valuing lived experience are important. The death of Sarah Everard and other recent events are a reminder of the value of listening to a range of voices and recognising the injustices which complicate the work of improving health, as well as valuing the initiatives within communities to try to keep more people safe and well.

This blog was first published by the NIHR Applied Research Collaboration (ARC) South London. Original link here.

Have a read below to see what our ECR bursary winner Nicole Renehan did with her award money. To find out how you can apply to our ECR Bursary Scheme click here.

I was delighted to be awarded the Early Career Researcher grant from VAMHN to attend the Autism and Mental Health Conference on 11th March 2021, hosted by the National Autistic Society. The purpose of the conference was to explore the specific adversities and needs of autistic people in relation to their mental health and how services have responded to them before, during, and thinking beyond the pandemic. There were four sessions including several speakers and presentations covering the broad topics of: 1) Understanding and meeting the needs of autistic people; 2) The impact of covid 3) Evidence based approaches; and a Key Note speech by Dr Peter Vermeulen on Coping with uncertainty – Strategies for well-being. All of the presentations and talks were fascinating and the pre-conference easy read booklet with engaging power point slides was really impressive.

My own interest in attending this conference stems for my research with domestic abuse perpetrators which explored how, why, and for whom UK accredited criminal justice, domestic violence perpetrator programmes work. This was an in-depth cohort study which meant that I was able to ask about the lived experiences of some of the men who attended the programme and follow them through their journeys of change. One of the men I interviewed was awaiting an assessment for autism. ‘Trevor’ had faced many adversities in his life such as domestic abuse, parental violence (by his stepfather) and mainstream school exclusion. He said that he had always felt like an ‘outsider’ and struggled to ‘associate’ with people, which had impacted on his mental health. Trevor also experienced overwhelming feelings within intimate relationships. My research documented many barriers to change. But it was identified that autistic men (certainly evidenced in Trevor’s accounts) will face additional barriers than neurotypical men in regard to programme engagement, understanding and support needs. 

I attended the Autism and Mental Health conference as I wanted to further my understanding about the difficulties autistic people face in regard to their mental health. Ultimately, I wanted to extend my knowledge and research about how multiple adversities hinder autistic men’s capacity to change in the context of perpetrators programmes and how these can be developed and/or adjusted to be more responsive to neurodiversity.

There were many things that I learned. I learned that autistic people commonly experience anxiety more profoundly than non-autistic people; that feelings of (even slight) uncertainty can be compounded by absolute thinking; that anxiety can be driven by a sense of feeling ‘less than’ neuro-typical people; and that masking (to fit in with neurotypical people) can be exhausting and may result in increased anxiety and, ultimately, distress and panic. I learned that self-calming strategies could mitigate anxiety in stressful or unfamiliar situations but that such activities might be inaccessible, forbidden, and/or not socially tolerated. What this suggests, firstly, is the need for much wider understanding of neurodiversity in society. But, crucially, it suggests that much more can be done to reasonably adjust domestic violence perpetrator programmes so that they are more responsive to autistic men’s sensory, emotional, and relational needs and learning. There is no ‘one size fits all’ and so responses should be individualised. It might also involve simple messaging rather than complex programme material and concepts, and flexible programme structures for those who are unable to engage in group work environments. I would add that the needs of the whole family should be central to any intervention involving autistic people, particularly when families chose to stay together and/or child contact will be the motivation for programme engagement.