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Costing the mental health harms of sexual and physical violence in adulthood

The Global Burden of Disease (GBD) Project showed that mental health disorders account for the greatest share of disease burden among survivors of intimate partner violence against females and of sexual violence against children. Economic costings of sexual violence in adulthood is often not costed and tends not to address the longer-term mental health harms despite the strong associations.

In the study, Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England, VISION researchers Sally McManus, Ladan Hashemi, Anastasia Fadeeva, Niels Blom and Estela Capelas Barbosa, with Sylvia Walby, estimated the annual cost of experience of violence throughout adulthood, in terms of reduced quality of life and health service costs.

Data were analysed from multiple sources, including the probability sample Adult Psychiatric Morbidity Survey and service delivery costs. Results showed that the estimated cost of long-term reduced quality of life adults in England experienced because of violence during adulthood was £3767 million in 2019, with associated healthcare costs in that year of £4130 million. Costs of long-term lost quality of life and healthcare were evident in both women and men, although higher in women. Costs associated with combined sexual and physical violence were particularly high, the great majority of these costs resulting from experience of violence in women. Combined sexual and physical violence in women was associated with the highest cost per victim.

Both sexual and physical violence have sizeable and independent associations with long-term mental health and treatment and service use. Violence reduction has potential to reduce health service costs and increase population level quality of life.

Research Highlights

  • Economic costings rarely quantify long-term mental health harms of sexual violence in adulthood.
  • Both sexual and physical violence are associated with sizeable costs.
  • The costs result from long-term mental health harms as well as treatment and service use.
  • Most of the mental health related costs of violence fall to women.
  • Interventions that reduce violence have potential to reduce health service costs and improve quality of life.

To download the article:  Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England

To cite: Sally McManus, Sylvia Walby, Ladan Hashemi, Anastasia Fadeeva, Niels Blom, Estela Capelas Barbosa, Costing the mental health harms of sexual and physical violence in adulthood: A prevalence-based analysis in England, Public Health, Volume 258, 2026, 106400, ISSN 0033-3506, https://doi.org/10.1016/j.puhe.2026.106400.

For further information: contact Sally at sally.mcmanus@citystgeorges.ac.uk
 
Photo by Nik Shuliahin on Unsplash

New VISION Policy Briefing Series on ethnicity inequalities and violence

In collaboration with Imkaan, the UK’s only national feminist umbrella organisation dedicated to addressing violence against Black and minoritsed women and girls, VISION Research Fellow, Dr Hannah Manzur, wrote two policies on the intersectionality of ethnicity, sex, gender, and violence focussing first on access to specialist services and second, through a systems theory approach.

The first policy briefing, Ethnic Inequalities in Violence Series: Specialist Services, is based on VISION research on ethnic inequalities, gendered violence, and specialist services. The research team finds critical inequalities in Black and minoritised women’s access to support and emphasises the need for a sustainably funded ‘By and For’ Sector.

The second policy briefing, Ethnic Inequalities in Violence Series: Systems Response, also uses VISION research on ethnic inequalities but looks at violence risks, harms, and service responses from a systems theory approach. This briefing identifies compounding disadvantages, intersecting inequalities, and critical gaps and disparities in victim-survivors’ services access and treatment.

 

Supporting Specialist Services for Black and Minoritised Women Victims of Violence: Access, Impact, & Resources

Specialist services provide life-saving support to people experiencing domestic and sexual violence, including trauma-informed and VAWG-sensitive care, counselling, legal and medical support, safety planning, advocacy, and crisis interventions delivered by trained caseworkers and practitioners. Led by Black and minoritised women, specialist ‘By and For’ services[1] are particularly important in offering essential holistic, wrap-around support, including intersectional advocacy, tailored to the specific needs and experiences of Black and minoritised women victim-survivors. Despite this, specialist services, particularly the ‘By and For’ sector, are constrained by chronic underfunding, limited inclusion and recognition of their expertise, and increased demand for services in an increasingly hostile political landscape for Black and minoritised communities and victim-survivors of violence.

Key Recommendations

  1. Funding: adequate, secured, and sustainable funding for specialist services with increased and ring-fenced ‘By and For’ funding.
  2. Recognition: formally recognise ‘By and For’ services as a distinct and essential model of VAWG prevention.
  3. No Recourse for Public Funds (NRPF): urgently repeal the NRPF condition.
  4. Data: introduce a data firewall for migrant victims, improve national ethnicity data, fund specialist services’ data-infrastucture projects, and engage ‘By and For’ expertise.
  5. Accessibility: evaluate national accessibility to specialist services, especially ‘By and For’ closures and reductions.
  6. Training: statutory services training in service provision tailored to Black and minoritised women victims.
  7. Collaboration: investment in collaborative partnerships, training, and referral protocols, led by ‘By and For’ expertise.

 

Ethnic Inequalities in Violence: Addressing Compounding Disadvantage and Institutional Engagement through a Systems Response to Violence

From data to policy to services, the systems designed to address the complex needs of violence victim-survivors of violence often fall short. Disjointed services, difficult pathways to support, and critical gaps in service provision create a complex system which victim-survivors, particularly those experiencing domestic and sexual violence, are expected to navigate to access support. For Black and minoritised victim-survivors of domestic and sexual violence, violence  causes and contexts, risks, harms, and support needs are shaped by both intersecting inequalities and compounding disadvantages. The combination of existing social disadvantages, under-funded and non-specialist public and specialist services, and disjointed and complex systems[2] requires urgently addressing from an intersectional and systems-based response to violence prevention and victim support.

Key Recommendations

  1. Systems-level responses: Targeted interventions and support provision must be integrated into a systems-level approach through cross-sectoral and multi-agency collaboration. Include funded advisory roles for specialist ‘By and For’ services representatives as systems leaders, not only referal partners.
  2. Build data and evidence linkages and expand cross-sectoral comparative research.
  3. Remove cross-sectoral barriers to support, including repealing the NRPF, introducing data-sharing firewalls, and enhance statutory duties.
  4. Invest in comparative and intersectional research which integrates multiple social contexts and axes of inequality.
  • [2] VISION’s systems theory approach was led by Dr Olumide Adisa. See for example: Adisa 2024, 2025.

 

To download the briefings:

To cite the Specialist Services briefing: Manzur, H. 2026. Supporting Specialist Services for Black and Minoritised Women Victims of Violence: A VISION Research and Policy Briefing in collaboration with Imkaan. London: VISION, Imkaan. https://doi.org/10.25383/city.33524527

To cite the Systems Response briefing: Manzur, H. 2026. Ethnic Inequalities in Violence: Addressing Compounding Disadvantage and Institutional Engagement through a Systems Response to Violence. A VISION Research & Policy Briefing in collaboration with Imkaan. London: VISION, Imkaan. https://doi.org/10.25383/city.33527260

For further information: contact Hannah at hannah.manzur.4@citystgeorges.ac.uk

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Sexual violence along migration routes: A qualitative systematic review and evidence synthesis

While all types of violence happen in the context of migration without state authorization, states have no directly tangible and clearly articulated incentives to protect migrants who travel in this way from violence. Migrants in transit, particularly those who travel informally without documents, are exceptionally vulnerable to exploitation from criminal gangs and smuggling networks, abuse by border forces, corrupt policing, and exposure to petty crime and violence during the journey.

The systems and structures that govern international migration without state authorisation create conditions of vulnerability for migrants, and sexual violence requires separate attention. Sexual violence in any context has unique causes and consequences and reporting follows distinct patterns, linked to different social meanings and gender dynamics. Thus, there is good reason for treating sexual violence differently from other more general forms of violence.

There is little or limited incentive for states to prevent sexual violence against migrants who might be travelling without authorization or be in the process of escaping adversity in their home state. These individuals who are not part of citizenry cannot easily call upon available mechanisms to report and seek support and retribution for crimes of sexual violence perpetrated against them. Yet, there is precedent to consider sexual violence an international ‘wrong’ and to advocate for the consolidation of action against it (for example in United Nations Security Council Resolution (UNSCR) 1825, which established sexual violence in conflict as warranting consolidated international action).

VISION researcher Alexandria Innes and Merili Pulleritis (City St George’s, University of London) conducted a systematic review and evidence synthesis to systematise and synthesize qualitative evidence of sexual violence experienced by migrants travelling without state authorization, during the course of their journeys. 

Their article, Sexual violence along migration routes: A qualitative systematic review and evidence synthesis, finds that sexual violence is widespread in the context of migration without state authorisation, and structurally embedded feature of undocumented migration. Findings were grouped around the six themes of agency, economics, climate of violence, normalisation of violence, perpetrators, and gender.

Data showed that migrant women expressed agency by adopting preventative or protective measures against expected sexual violence, at times including engagement in unwanted sexual contact. Economic deprivation intersected with sexual violence during migration journeys, increasing risk of sexual violence. The most severe cases of sexual violence were not mitigated by money. In some cases sexual violence victimisation was considered to be the only available way to prevent deportation or death.

Sexual violence was severe and indiscriminate, and included forced witnessing, and forced sex act perpetration on other migrants. Sexual violence along migration routes is executed by various types of perpetrators, including organised and systematic perpetration by state agents such as border guards and police, and by smuggling and trafficking gangs. Sexual violence is also carried out by opportunists who are often migrants in transit, or people who reside along the route. Sexual violence is used against men, women, trans and non-binary migrants, and people of all ages, but there are important gendered differences in the experience of sexual violence before and during a migration journey.

Sexual violence along irregular migration routes is an urgent issue demanding a response. Sexual violence is structurally embedded in the governance of international migration, suggesting the need for significant systemic change. This problem requires dedicated attention and resources directed towards prevention and protection.

To download the article: Sexual violence along migration routes: A qualitative systematic review and evidence synthesis

To cite: Innes, A., & Pullerits, M. (2026). Sexual violence along migration routes: A qualitative systematic review and evidence synthesis. PLOS ONE, 21(8), e0355474. https://doi.org/10.1371/journal.pone.0355474

For further information: contact Andri at alexandria.innes@citystgeorges.ac.uk

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5th VISION annual conference: Presentations and illustrations now available

The fifth VISION annual conference was held on 7 July at The Light Auditorium in Friends House. The theme was Violence prevention in dialogue: Research and Policy.

After five years of research looking at violence prevention and the resulting health inequalities and focusing on improved measurement, policy, and practice, and delivering through a strong cross-sector partnership, we showcased our research in partnership with stakeholders Refuge, High Trees, Migrants’ Rights Network, Gloucestershire police constabulary, and Revolving Doors. In addition, we invited those working in violence prevention to critically assess our contributions and identify where further research and prioritised focus are required.

Jo Todd of Respect and Professor Gene Feder, VISION Director, reflected on 25 years of working in violence prevention as frontline practitioners and researchers. Drawing on their extensive experience, they highlighted both the progress made and the challenges that remain. While collaboration between government, academia, and the third sector has improved, longstanding silos—particularly across the health and criminal justice sectors—persist. Overcoming these barriers requires sustained commitment to relationship-building and cross-sector working.

They noted that significant progress has been made in violence prevention policy, including the publication of the government’s Violence Against Women and Girls (VAWG) strategy last year. However, there remains considerable interest in how the incoming Prime Minister will take forward the Labour government’s commitment to halve violence against women and girls within a decade, and what this will mean for future policy, practice, and investment.

Professor Liz Kelly from London Metropolitan University was our 2nd keynote speaker and shared her thoughts on the language and naming of violence in the 21st century. Liz highlighted that  language changes not just what we say but what we know and recognise. The words we use in the field as researchers, analysts, policymakers, officials, and practitioners matter and should be clear and grounded in victim / survivor agency and freedom.

VISION research was highlighted in three symposiums:

  • Insight: Key findings on definitions and measurement within violence prevention
    • Dr Vishal Bhavsar (Kings College London) and Professor Miranda Horvath (University of Suffolk) presented on intimate partner violence perpetration.
    • Dr Madeleine Janickyj (University College London) and Emma Pickering (Refuge) presented on technology facilitated abuse.
  • Inclusion: Violence prevention research with marginalised populations
    • Dr Alexandria Innes (City St George’s UoL), Aya Khedairi (Migrants’ Rights Network) and Professor Gargi Bhattacharyya (University College London) presented on insecure migration status. Andri and Aya discussed their project, Understanding Violence: the risks for migrants with rising far-right fascism and the resulting output, Workbook: Migrant Community Insights on Building Safety. Gargi highlighted how the far right is misusing genuine work and research and that media discussion of VAWG frequently descends into racism and incitement.
    • Dr Annie Bunce (City St George’s UoL) and Lauren Bennett and Anthony Donohoe from Revolving Doors presented their work on developing principles for co-analysis with Lived Experience.
  • Involve: A look at two ongoing, impactful pieces of VISION research with partners
    • Dr Elizabeth Cook (City St George’s UoL) and Harry Jenkins (High Trees) presented their collaborative research developing Built on Trust, a report with youth from Lambeth in London on the role of youth spaces and trusted adults in reducing young people’s exposure to violence.
    • Dr Ruth Weir (City St George’s UoL) and Sophie Jarrett (Gloucestershire Police) presented on their system-wide partnership with central and local government, police, education trusts, and the third sector to understand and prevent teenage relationship abuse (TRA). This work has resulted in the establishment of a national group on TRA and a local group wtihin Gloucestershire.

VISION co-Deputy Directors, Professor Sally McManus (City St George’s UoL) and Dr Estela Capelas Barbosa (University of Bristol) closed the conference by reflecting on the achievements of the VISION consortium and outlining priorities for the future of violence prevention research, policy, and practice. Sally highlighted the wide range of datasets, tools, resources, and publications developed by VISION over the past five years. Looking ahead, Estela emphasised the need for further research on violence affecting LGBTQI+ communities and minoritised women and children. She also stressed the importance of breaking down the persistent silos between the health and criminal justice sectors, noting that the impacts of violence extend across both systems. Effective prevention and support therefore require joined-up services, coordinated policies, and cross-sector collaboration.

Visual artists, Abigail and Chloe Baldwin, from Buttercrumble, beautifully captured the day in a series of illustrations which can be downloaded below along with the keynote and symposium presentations.

To download the presentations:

  1. Insight Symposium: Insight Symposium_Perpetrators of IPV; Insight Symposium_Tech Abuse
  2. Inclusion Symposium: Inclusion Symposium_Insecure migration status; Inclusion Symposium_Co-design of analysis principles
  3. Involve Symposium: Involve Symposium_Partnering with young people; Involve Symposium_Teenage Relationship Abuse
  4. Professor Liz Kelly, 2nd Keynote: Keynote 2_The language and naming of violence
  5. Professor Sally McManus, VISION Achievements: VISION achievements

To download the illustrations:

  1. Conference Summary
  2. 1st Keynote – Jo Todd and Gene Feder and 1st Keynote – 2nd illustration
  3. 2nd Keynote – Liz Kelly
  4. Insight Symposium – Data and Definitions
  5. Inclusion Symposium – Marginalised Populations
  6. Involve Symposium – Partnerships
  7. VISION Achievements
  8. Violence Prevention in Dialogue

Violence is a risk factor for adverse clinical outcomes in severe mental illness

A longitudinal study investigating the experiences of violence suffered by those with severe mental illness (SMI) was recently published in the British Journal of Psychiatry. VISION researchers Vishal Bhavsar, Angus Roberts, and Robert Stewart worked with lead author Ava Mason and others and found that people with SMI and who experienced violence are more likely to need future emergency and inpatient mental care.

The aim of their research was to understand whether violence recorded early in someone’s contact with mental health services could help predict these later outcomes. Anonymised electronic mental health records from approximately 6,000 adults who received care from South London and Maudsley NHS Foundation Trust between 2007 and 2022 were investigated.

By applying Natural Language Processing (NLP) to records of those diagnosed with schizophrenia or related disorders, or bipolar disorder or mania, the researchers were able to determine whether any current or previous physical, domestic or sexual violence had been recorded in the first three months after someone first came into contact with services.

Results showed that people living with SMI who had violence recorded in their mental health records early in their care were at increased risk of crisis service use, hospital admission and detention under the Mental Health Act in the years that followed. This highlights the importance of identifying and responding to experiences of violence as part of routine mental health care.

In conclusion, experiences of violence, to the extent to which patients report their experiences and these are recorded, are risk factors for worse outcomes in severe mental illness, only partly accounted for by clinical status around the time of presentation. More systematic ascertainment and recording of victimisation needs to be considered if interventions are to be appropriately targeted.

To download the article: An investigation of recorded physical, domestic and sexual victimisation as risk factors for adverse clinical outcomes in severe mental illness: longitudinal study

To cite: Mason AJC, Bhavsar V, Roberts A, et al. An investigation of recorded physical, domestic and sexual victimisation as risk factors for adverse clinical outcomes in severe mental illness: longitudinal study. The British Journal of Psychiatry. Published online 2026:1-8. doi:10.1192/bjp.2026.10648

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Intimate partner relationship abuse between men: An interdisciplinary seminar

 

Wednesday 17 June 2026, 13:00  – 16:45, in person only

This event is in the past.

This free, interdisciplinary seminar brings together leading voices from research, lived experience, performance, and specialist practice to examine intimate partner violence in relationships between men and consider implications for policy, research, professional practice, and wider system response.

Register here: Ticket Tailor

Despite increasing recognition that abuse within intimate male relationships is a significant public health, social justice, and service delivery issue, it remains under recognised across many systems and disciplines. Survivors frequently encounter barriers to recognition, disclosure, and support, while policy, professional training, and public discourse have historically paid limited attention to these experiences. 

This event will explore the dynamics, impacts, and structural challenges surrounding abuse in this context, and consider how research, policy, practice, and public understanding can evolve to better respond. 

The programme combines research presentations, creative performance, lived experience testimony, and expert commentary to offer a multi-dimensional exploration of the issue. The seminar will include catering and: 

  • A brief research presentation on prevalence, dynamics, barriers to recognition, and current evidence gaps from Dr Steven Maxwell 
  • A monologue from He Kept Me Safe, a research based verbatim play developed from survivor narratives exploring abuse within intimate male relationships by Dr Edgar Rodriguez-Doran 
  • A keynote contribution from broadcaster, comedian and survivor advocate James Barr, reflecting on his lived experience through comedy and the role of storytelling 
  • A talk from Tanaka Mhishi, writer and researcher in masculinity, trauma and sexual violence, exploring masculinity, trauma, violence, and engaging men in conversations about healing 
  • Brief facilitated interdisciplinary discussion on implications for research, policy, education, commissioning, service design, and practice 

This event aims to stimulate critical interdisciplinary dialogue and contribute to wider thinking on inclusive responses to domestic abuse and sexual violence. 

 

Intended Audience / Invitees 

The seminar is intended for a broad interdisciplinary audience including: 

  • Researchers and academics across social science, health, psychology, gender studies, criminology, law, public health, and related disciplines 
  • Policy makers and strategic leaders working in domestic abuse, sexual violence, health, justice, equalities, LGBTQ+ inclusion, and public policy 
  • Health and social care professionals 
  • Mental health practitioners and psychological therapists 
  • Domestic abuse and sexual violence services 
  • Policing, criminal justice, and legal professional 
  • LGBTQ+ and community sector organisations 
  • Sexual health and public health professionals 
  • Education and professional training providers 
  • Students and trainees with relevant academic or professional interests 
  • Wider stakeholders with interest in trauma, masculinity, violence prevention, and inclusive service/system design

 

Programme 

1.00 pm: Registration and Lunch 

1.30 pm: Welcome and Opening Remarks 

1.40 pm: Research Presentation: Understanding Intimate Partner Violence in Male Relationships: Prevalence, Dynamics and System Challenges 

2.00 pm: Monologue: He Kept Me Safe 

2.40 pm: Facilitated Discussion and Audience Reflection 

3.00 pm: Break 

3.15 pm: James Barr: Lived Experience, Comedy, and Public Discourse 

3.45 pm: Audience Q&A 

4.00 pm: Tanaka Mhishi: Masculinity, Trauma and Engaging Men in Conversations About Violence and Healing 

4.30 pm: Panel Discussion / Closing Audience Q&A 

4.45 pm: Close 

Join us at this free seminar, 17 June, Northampton Suite, City St George’s UoL, Clerkenwell, London, 1300 – 1645. To book your place please register here: Ticket Tailor 

Photograph provided via Adobe Stock subscription

Webinar: Risk of sexual violence along migration routes and the implications for current asylum policy in the UK and Europe

 

Sexual violence along migration routes: A systematic review and synthesis

Thursday 29 January 2026, 2  – 3 pm, online

Email VISION_Management_Team@citystgeorges.ac.uk to register for the Teams link

This event is in the past.

VISION Co-Investigator, Dr Alexandria (Andri) Innes and PhD student Merili Pullerits will outline how sexual violence is a pervasive and structurally embedded feature of undocumented migration journeys. It is often associated with economic status, and economic need or destitution and often expected along the routes. Some migrants who plan to travel without documents take action to prevent unwanted pregnancy before travelling, or seek protection by travelling in mixed sex groups or in couples of convenience. 

This review found that some routes situate sexual violence in an intense climate of violence and brutality, and at times sexual violence victimisation is considered to be the only available way to prevent deportation or death. Many irregular migration journeys take place in hostile landscapes where guides such as smugglers and traffickers are the only means of transport, and refusing sexual contact would result in abandonment and death. 

The worst forms of sexual violence are brutal and indiscriminate, involve forced witnessing, and forced sex act perpetration on other migrants. It is used against men, women, trans and non-binary migrants, but there are important gendered differences in the portray of sexual violence and the expectation of sexual violence before and during a migration journey. 

Finally, Andri and Merili will highlight how sexual violence along migration routes are executed by various types of perpetrators, including organised and systematic perpetration by state agents such as border guards and police, and by smuggling and trafficking gangs. It is also carried out by opportunists who are often migrants travelling the irregular route, or are people who reside along the route and take advantage of the vulnerable populations transiting through.

There is very little, if any, form of accountability for perpetrators and very little protection from violence available to migrants. There is also no protection offered by receiving countries to prevent removal directly into contact with perpetrators along migration routes in locations that are often considered ‘safe third countries.’ 

To register and receive the Teams link, please contact VISION_Management_Team@citystgeorges.ac.uk