The Institute for Addressing Strangulation (IFAS) was established following the introduction of new legislation in England and Wales in June 2022, marking strangulation as a standalone offence.

At IFAS, our aim is to address strangulation in all contexts through the development of resources, training, and the UK research evidence base. An overview of some of our work conducted to date is provided below.

Strangulation involves the obstruction of the airway and/or blood vessels in the neck which can result in decreased oxygen supply to the brain. An overview of the signs and symptoms which could result from strangulation can be found in our paper for the Faculty of Forensic and Legal Medicine. This paper is particularly relevant when considering strangulation in the contexts of physical and sexual violence.

For those victim/survivors who are subjected to strangulation in these contexts, we have published a victim information leaflet which is currently available in eight different languages. This leaflet contains information on the possible physical and psychological impacts of strangulation, as well as how and where to seek support. At IFAS, we are also aware that there are some people who experience strangulation who would not identify themselves as a “victim” and therefore may not engage with victim- focused resources. For those, we have developed a strangulation and ‘choking’ factsheet. We acknowledge the use of different terms for strangulation, including ‘choking’ which is more commonly used in the context of strangulation during sex. Research we have conducted on the prevalence of strangulation during sex suggests that this behaviour is most commonly used in younger (16-34 year old), compared with older, age groups. This is both with regard to those who are strangled and those who strangle others.

However strangulation presents, there can be implications for practitioners in how they might respond to these cases. We have developed Data Capture Guidance for all organisations to consider how to appropriately record and report on disclosures, reports and cases of strangulation in their services. For clinicians, specifically, we have published guidelines for clinical management of non-fatal strangulation in acute and emergency care services.

When cases are reported to the police – and we know there were 39,360 strangulation and suffocation offences reported across England and Wales in 2023-2024 alone – we understand the importance of a specialised response. In 2024, we developed Guidance for

the Police Management of Strangulation which includes relevant material from international guides, and input from English forces.

At IFAS, we work to address both non-fatal and fatal strangulation. Our Domestic Homicide Review Series showed how non-fatal strangulation was reported in the abuse histories of 19% of domestic homicides, and that there are differences in the demographics and

circumstances of fatal strangulation homicides compared with homicides caused by stabbing. Some of these differences included the gender of victims, with 74% of stabbing victims being female, compared with 95% of strangulation victims. Understanding these

differences is important for us to be able to consider the characteristics of cases involving strangulation, so that we can make recommendations for future response and prevention work.

The lived experiences of victim/survivors of strangulation is central to the work we do at IFAS. The ‘Reclaiming My Voice’ project was designed to demonstrate and celebrate the contribution of those with lived experience throughout the work of IFAS since its inception.

From interviews with survivors, a report was produced exploring themes of shame and isolation, showing how sharing lived experience can help both individual lived experience advocates and other survivors. An animation, designed to be viewed and used by anyone,

was also produced from this project.

At IFAS, we continue to address strangulation across multiple contexts, with the aim of sharing learning and developing the UK evidence base. We encourage the development of professional practice in response to, and in the work to prevent the harms of, strangulation.

Anyone wishing to hear more about the work of IFAS is welcome to sign up to our mailing list, or make contact with the team.