Support after Shipman: the role of Victim Support and the Witness Service - Tameside Victim Support and work arising from the Shipman case
Like most people in the Ashton/Hyde area, the co-ordinator and volunteers in the Tameside office of Victim Support imagined that there must be some mistake and that the allegations being made against a highly respected local doctor in the late summer of 1998 were unfounded. His surgery was in Hyde, a thriving multi-cultural market town not far from Manchester, and on the edge of Cheshire. A previous and notorious case known as "the Moors murders" had been associated with the Ashton and Hyde area in the mid-1960s. Without doubt, some of those affected by the Shipman investigations will have had some memories of that previous case. The thought that another such nefarious case could possibly have occurred was horrifying to many.
"Every so often, you are reminded of what Hindley did up on the moors, ...it's horrible to think that something as unthinkable has happened again on the doorstep..."
However, fears were raised further as exhumations continued and press speculation became more vocal. By the end of September 1998, it was clear that there was a case to answer, and that investigations would continue.
Tameside Victim Support began to receive referrals of families from the police as early as September 1998 and followed the normal Victim Support policy in relation to relatives of victims of homicide. The policy is that a trained volunteer will take responsibility for helping a family cope with the aftermath of the homicide and help liaise with the police, police Family Liaison Officer, and the family so that procedures and processes are better understood. The following is the specific policy statement (with personal details omitted) issued by Tameside Victim Support at the beginning of the Shipman case regarding referral procedure, and it is still being used as further cases come to light:
Referrals continued to arrive as more cases were investigated. However, as initially the build-up was gradual and the co-ordinator had a group of ten core volunteers, the Scheme was able to cope.
Whilst the actual size of the task before the co-ordinator of Victim Support Tameside was not immediately known, the existing good relations between Victim Support Tameside and the police led to the co-ordinator being invited to visit the police incident room to meet the investigation staff. She was privy to the discussions regarding the Shipman investigation and the Senior Investigating Officer agreed to share as much information as possible so that families could be helped. Anything not understood could be questioned, and only information that could compromise the investigation would be withheld. The co-ordinator became very conscious of the white board on the wall with names of possible victims which gave a sense of the enormity of the possible work ahead in supporting the families. It rapidly became apparent that the work could not be accomplished fully by Victim Support Tameside alone, as there were only two staff trained in supporting families bereaved through homicide - the co-ordinator and one volunteer. Extra help would be needed from other nearby Schemes.
At this stage, the issue of confidentiality of information received from the police investigation unit needed addressing. The co-ordinator felt she could not immediately discuss the details of what she knew with her own colleagues as the information was not public and she needed to reflect on the implications of handling a multiple homicide. But because news of the possible murders appeared in the media the next day, when a scheduled meeting of the Greater Manchester Federation of Victim Support Schemes was taking place, the co-ordinator was able to take the problem there. While it was possible on this occasion to share the magnitude of the situation with colleagues at the Manchester meeting, the issue of what confidential information can be shared and with whom, needs in future to be clarified on a case-by-case basis. The recommendations made in this report might assist this process.
At the Greater Manchester Victim Support Federation meeting in October 1998, the situation in Teeside was explained and discussed. Subsequently, a group of 30 volunteers from local Schemes outside the Tameside area volunteered to help. Within this number there was a group of 13 who had been trained to help in cases of homicide. Because the co-ordinator at Tameside did not have personal knowledge of the skills of this group, she had to take on trust the fact that they had been trained well and could take on this high-profile work. The value of the existing national standards and national training pack for this type of work cannot be overstated. On this occasion the training was backed by extra information packs put together by Victim Support Tameside. This meant that the volunteers could confidently offer help quickly and efficiently. In only one case, the worker did not feel personally prepared and confident, but supervision sessions were in place to help.
The information packs were given to the volunteers, who were to contact the families. The packs contained information and maps of the area, plus details of how the Tameside Scheme normally operated, how this particular case would be handled, and reminders of the need for confidentiality of information at all times.
As agreed with the police, and following normal referral procedures, details of the families involved in the police investigation were given, with their permission, to the co-ordinator by the police. The co-ordinator then contacted the family and explained how Victim Support could offer help. The help was described as:
- someone to talk to face-to-face
- someone who could act as a conduit so that information could be gained quickly
- someone who could help with practical and financial matters including Criminal Injuries Compensation forms
- or simply a telephone contact that could be used at any time to discuss anything.
Once the contact was agreed in principle, the co-ordinator selected the most suitable volunteer. Geographical location was a major consideration, as volunteers were drawn from outside the area and would have to travel. The family was given the volunteer's details and information about Victim Support Scheme contact. The volunteers were then given some basic information about the families so that a first approach could be made as soon as possible.
Contacts made with families varied. Some people were happy just to know that Victim Support was available as and when they felt it necessary. Others wanted face-to-face contact in a more regular form. The fact that the deceased were mainly elderly meant that in some cases families were spread out and more than one member wanted contact. Those families living away from the area still preferred to deal direct with Tameside Victim Support and eventually as the case went to the Crown Court, having met with other families, they formed a loosely knit support group.
"It was good to know that we could always phone and if she (the Victim Support volunteer) wasn't there she would be in touch quickly and help us think and talk through anything that bothered us. Nothing was too trivial. ...Even though we may seem intelligent and coping, there are times when some outside support is crucial to keep your sanity..."
Having family members spread out over a wide area can cause problems, especially when people live abroad. Others in the family may wish to shield them from hurt, not realising that modern technology means that news travels very swiftly. As the police are the first to make family contact, this is really a police matter. However it may be helpful to remember that even though family may be far away, immediate members need to be told about the death and the support possible through the local Victim Support Scheme, before the investigations become public knowledge. They can then make an informed choice about what they want to do. In one case where this did not happen, general information regarding the criminal enquiries was first reported on television and caused discomfort, then concern, about a parent.
"When the TV news showed film of the surgery and pictures of Dr Shipman, I don't know why, but I felt I had to write... to get a copy of her death certificate. Her diaries mentioned visits to the doctor but no name. ...When it came, the signature on the certificate was that of Harold Shipman. My first reaction was horror. This was the doctor my mother had trusted and liked so much..."
This family member felt great distress, followed by depression and frustration at the lack of information or any early contact that could have helped.
It may be helpful to note again the several features that were specific to the Shipman case and which made it different from other homicides for the families involved.
For most, the death of their family member had been some years before. They had buried their loved one, mourned and managed their grief. They had also, in most cases, appreciated the care of the doctor. Now everything had changed. The cause of death was a possible murder, and possibly committed by the very doctor they had known and trusted.
"The death from natural causes was hard to bear, but death caused by a doctor who was trusted and who was seen as caring was unbearable in the extreme..."
This knowledge in turn increased normal feelings of anger, helplessness, and grief especially when it was discovered that Shipman might have collected "souvenirs" of jewellery from his victims. As one family member put it:
"I was amazed at the number of pieces that were on file. The ring I was looking for was not among them..."
The exhumations and coroner's inquests led to more involvement by Victim Support than would normally occur after a homicide. Although it is usual for help to be offered during the coroner's court hearings following homicide, these would normally be fairly short and causes of death given briefly. The presence of the press would also be minimal.
The uncertainty surrounding the deaths was such that families were left for some time not knowing if it could be proved that homicide had been committed - unlike in normal circumstances where it is certain. The number of deaths involved in the case (15) proved to be the tip of the iceberg. But whilst it is now thought that over 300 deaths may be suspicious, it is only these 15 which went to the Crown Court. In this case, therefore, there are many families who will not have their day in court, nor can they state for certain that a particular person was responsible for the death of their family member. Nevertheless, many have needed help from Victim Support to talk through their disappointment and anger. At the time of writing, over 300 individuals have approached the Tameside Scheme for such support.
All these factors mean that greater support was given to all families from the coroner's hearings onwards. Indeed those hearings have continued post-trial leading to much work with subsequent families. One fact that has caused comment is the fact that the family doctor who had signed the death certificates was serving a life sentence for 15 murders. These would be used to claim compensation - a disturbing factor for families to deal with.
Support and supervision
It should be noted that during the early stages of investigations, local people still could not believe that anything criminal had happened, and thought the police had got it all wrong. The surgery staff were still in place, and flowers and cards for the families were left with them. It was extremely difficult for Victim Support to work within this scenario, and the co-ordinator's role was one of sustaining volunteers who were trying to assist families who were not sure what had really happened to the deceased.
As the investigation moved on, the co-ordinator felt that she was constantly trying to keep her head above the water. Her 13 years work at Victim Support helped her, but she herself needed support and the chance to think through and discuss her work goals and tasks. Any volume of work that cannot be evaluated cannot be managed. The management committee of the Tameside Scheme recognised this and obtained the help of an outside independent supervisor who had counselling experience. Her work with the co-ordinator was considered invaluable. The cost of this work was borne by the Scheme. The co-ordinator considers her own main strength was that she learned to manage the Scheme rather than become over-involved in the personal work with the victims' families. Her first contacts with the families helped her to personally key in to the issues, but to have become involved in individual family matters would have narrowed her focus to the detriment of the total work necessary.
The volunteers were seen regularly and gradually given information as the case proceeded, rather than overwhelming them with too much information. They completed worksheets so that the co-ordinator could keep in touch with their work, and so that issues about the quality and quantity of their contacts could be raised during supervision sessions.
In the main, the work of the volunteers was supporting through active listening in the same way as with other victims of crime. After a homicide, family members will deal with the death in an individual way. We know from earlier work (Brown & Christie, 1990) that some need to talk it out time after time, in order to make sense of something that seems to have no sense. Others will use quiet reflection. Feelings regarding the circumstances and the perpetrator also need to be expressed without fear of condemnation or horror on the part of the volunteer. However, helping families who are sure that a murder has occurred but where charges are unlikely to be brought is another matter. This may mean that the process of helping them to live with the uncertainties may take much longer.
Supervision of the work was regular. Where the volunteer was from outside the area, some of the supervision was carried out by their own Scheme's co-ordinator, with regular contact with Tameside's co-ordinator.
No particularly difficult issues were noted during supervision, although contact with families needed sustaining over a long period of time. This was done mainly through regular updating of volunteers regarding the progress of the investigation and then the court hearing details.
Crown Court and beyond
Once the date and venue were set for the Crown Court case, the main issues for families were the long distance to travel and the means to travel. Those who are not called as witnesses are not given any financial help, but may wish to be present at court. This can become a financial problem when a trial is lengthy.
In line with good practice, families were offered a familiarisation visit to the Crown Court before the trial. Families appreciated this opportunity to see the layout of the court and know where the key people sit. While this could be achieved through video, the actual visit was considered more appropriate as families could look around the court precinct and see where they could sit privately, what facilities were there, and meet with the Witness Service workers who would be with them throughout the trial.
An issue arose regarding accompanying the families to and from court. There could have been a problem of case discussion between those travelling together; also later, among those who had given evidence and those who had not. There was some suggestion that the volunteers travelling with the families should sign a declaration saying nothing had been discussed. This came to the notice of Victim Support National Office and the reaction was to strongly advise against the signing of any document, as it was thought that this could change the status of volunteers to witnesses. However, it is normal good practice of Victim Support not to discuss details of any case, and families are made aware of this. It was therefore agreed, following a great deal of discussion, that the volunteers accompanying the families would not be required to sign any documents.
At this stage, while some telephone contacts had been helpful, both co-ordinators felt it would have been more helpful if a visit from the National Office by a field officer had been paid to them both.
Both Tameside Victim Support and Preston Crown Court Witness Service had established sound contacts with Manchester Crown Court Witness Service during the early days of work. Following the confirmation that the court hearing would be in Preston, a one-day course was offered by Manchester Crown Court Witness Service and was attended by all who would be involved so that court procedures and etiquette would be understood, plus any legal issues pertaining to Victim Support and Witness Service contact during the trial. This helped to bring both services closer together so that each understood the other's role. And the volunteers subsequently said they felt "included" even although they did not sit in the court, and very welcomed by their counterparts in the Witness Service.
Families were personally introduced to the Witness Service through the court familiarisation visits or on the first day of their court hearing visit. The majority were prepared in the knowledge that, in the court setting the Witness Service would take over their care. The Tameside co-ordinator's practice was to be at the police mini-bus departure point and the accompanying Victim Support volunteers were given a special "care" bag containing drinks, biscuits, sweets, tissues and a mobile phone. It was also the practice for the co-ordinator to telephone the Witness Service co-ordinator when the bus had left and give any necessary information about specific families that might be helpful - for example if anyone was not feeling well, or was particularly upset. The Witness Service co-ordinator met the bus each day as it arrived at the court. These practices were reversed when the bus left on its return. It should be noted here that journeys to court for actual witnesses ended after they had given evidence in court. This dealt with any suggestion that there could be contamination of those yet to give evidence.
Care of families continued throughout the trial period and when the verdict was expected, the Tameside co-ordinator attended the court. The six days' wait was extremely difficult for the families. Volunteers were also affected by the wait. They had already waited over the Christmas break until 6 January for the closing speeches to be made. The verdict was delivered on 31 January. The naming of each victim was important to each family and to the volunteers who supported them outside and within the court. Although this court case was one of multiple homicide, for every family it was their one murder.
Families were assisted greatly by the deputy court manager who helped them prepare for the huge media interest. This extended to helping them with what they wanted to say at a press conference arranged by the court press office.
During the six days' wait, an inter-denominational memorial service was arranged for the evening after the verdict in Hyde. It was led by one of the witnesses and both co-ordinators and their families were invited. Both were saved seats by the families that had been helped, and were also given flowers. This gesture was greatly appreciated, and demonstrated "caring for the carers." The service itself also gave an opportunity for families to have some sort of conclusion together. The ongoing investigations and the public inquiry may well keep their experiences alive.
While that memorial service was mainly for the 15 families and those involved with them and the court, a "service of hope" was also arranged later for those touched in any way by the Shipman killings. However, those who are left knowing murder has definitely been committed without charges being brought against anyone, and those who still do not really know what has happened, will require help and support with the emotional and practical implications in the aftermath of the investigations. The long duration of the public inquiry and the subsequent coroner's hearings will add to this work. This has great implications for the workload of Victim Support volunteers and is still under review.
The part played by others
Tameside Victim Support Scheme
Thanks to efforts of the deputy co-ordinator, the Scheme's clerical assistant and the office volunteer, work other than that on the Shipman case continued to be covered efficiently and willingly. Without this, it would have been impossible for the co-ordinator to concentrate on the processes necessary to support the families affected by this case. The co-ordinator had regular sessions with all workers, so that they did not feel their work was of any less value than that done on the high-profile Shipman case.
On a local level, for Victim Support, the management committee played a vital and supportive role. Issues regarding the support of the co-ordinator, the care of the volunteers, and the financial and resource implications were quickly understood. On reflection the management committee thought that it would have been helpful if the National Office had keyed in earlier to the problems. Through this, financial help would have been clarified earlier, and support given through "comfort" contacts both through visits to ensure the workers were coping, and also telephone enquiries about how they were progressing. When the latter calls came, all, including the management committee, appreciated them.
The National Office
It is always difficult for a parent body to know when help is needed by the local group. If, however, there are means of informing designated people quickly when special circumstances arise, then pathways are cleared and the appropriate support given. Face-to-face contact in the local area is also helpful. Financial issues are particularly important, as many local Schemes exist on very small margins of cash.
While it is difficult in the early stages of this type of case to gauge the amount of extra financial burden to be borne, an early emergency grant would alleviate the worry for the local Scheme. However, this means that the National Office needs to be involved from the very beginning, and it would be helpful if a named member of staff, and in their absence a deputy, is assigned by the National Office to act in this capacity.
The National Association made a number of awards totalling £84,473, the first award being made in September 1999. This money was used on short-term employment of extra staff, equipment needed to deal with the extra work, postal costs, and expenses for extra travel and subsistence. Money was also used to provide extra office accommodation needed for family contact visits. Without the financial help from the National Association, the work could not have been done.
Adjoining Victim Support Schemes
As already acknowledged, Greater Manchester Victim Support played a great part in helping the Tameside Scheme to cope with the volume of work that suddenly arose. In another area, this type of support may not be available. Rapid response teams based regionally and who could be on call would answer the problem. However, they would need financial backing. With training, such teams could be called on for any Victim Support work of large volume that needed either longer-term or short-term work. Such teams, whilst specialising in such quick response work, would still have the basic skills of being good listeners and communicators, have knowledge of the legal procedures, and be able to share information and knowledge with co-workers and families appropriately.
The Witness Service
The part played by the Preston Crown Court Witness Service is set out in detail below. The importance of establishing good working relationships between Tameside Victim Support and Preston Crown Court Witness Service cannot be over emphasised. The co-ordinators, with the backing of their management committees, shared knowledge, created useful training packs and guidelines, and agreed the work to be done by each party. The handover of families from one to the other was achieved smoothly and without stress for the families. Families were clear regarding the work of each of the services and due to the ongoing updating of all concerned, everyone worked well together.
Police and other officials
The Shipman case demonstrated very good practice regarding information exchange, co-operation in helping families, and professionalism at all levels. The good relationships already in place between the police and Tameside Victim Support Scheme had been nurtured over the past years. The relationships between the Witness Service, the Scheme and the police were the result of the early and positive contacts between the co-ordinators who previously had not known each other. The help families needed to get them through a difficult and painful time provided an obvious focus.
In this particular case, the coroner's court became a focal point. Good contacts were formed between the coroner, his officers, and the Victim Support co-ordinator and volunteers. This was achieved through focused and fruitful meetings, which resulted in families being helped to deal with a painful and difficult experience played out in public and before the press.
The Shipman court case is now over. But work continues and families are being supported during the public inquiry. The original families still need support, as the inquiry will again raise issues surrounding the death of their family member.
Other initiatives arising from work with the families bereaved by this multiple murder include: input to the senior police investigation officer's training course regarding bereaved families; more regular contact with the self-help group, Support After Murder and Manslaughter (SAMM) locally and nationally; and closer connections with the probation service.
To support all the families affected in this case, a newsletter (without photographs) is distributed on a regular basis to the families by Victim Support Tameside. E-mail is also used, and telephone contacts remain at a high level. This work is likely to last a further two years. As the public inquiry continues, families will also need support at significant times for them.