Coronation Street viewers were left in disbelief as 18-year-old Betsy Swain was rushed to hospital and told she had suffered a stroke. Doctors said the stroke was caused by a blood clot, which resulted from neck artery damage after a temporary loss of circulation. Asked about the cause, Betsy had to tell her mum that her boyfriend, Dylan Wilson, had strangled her during consensual sex – despite both believing the pressure applied was minimal.
Home Office data shows recorded non-fatal strangulation and suffocation offences against under-18s in England and Wales increased from 2,130 in 2022–23 to 4,888 in 2024–25. Anyone who has experienced non-fatal strangulation should seek medical attention as soon as possible, even if they are unsure whether they wish to report the incident to the police. Serious internal injuries can occur even where there are no visible signs of injury.
Consent is not a defence in law
The storyline also carried a striking legal implication. Under the law in England and Wales, an individual can consent to being strangled or ‘choked’, but cannot consent to being seriously harmed or killed by strangulation. So if a person is seriously injured during strangulation, the strangler cannot use consent as a defence. Dylan could have faced charges if Betsy were to provide a statement.
IFAS: 'There is no safe way to strangle'
The Institute for Addressing Strangulation (IFAS), the UK’s leading authority on non-fatal strangulation, said: "The Strangulation/'choking' is not an assumed part of sex. Everyone has the right to say 'no' or change their mind if they want to."
Working with Coronation Street on the storyline, Professor Cath White, Medical Director at IFAS, said: "We are grateful to Coronation Street for approaching this storyline with such care and a commitment to medical accuracy. Non-fatal strangulation can result in life-changing injuries, including stroke, even where there are no visible external signs. There is no safe way to strangle. We hope this storyline helps increase understanding of the risks, challenges, and common misconceptions and encourages anyone affected to seek advice and support."
First UK guidelines for children
This week, IFAS published the UK's first clinical guidelines specifically for the management of non-fatal strangulation in children and young people under 16. Building on IFAS's previously published adult clinical guidelines for emergency and acute care settings, the new guidance responds to the clear need for dedicated recommendations for paediatric patients. It closes a significant gap in clinical practice, providing dedicated recommendations for healthcare professionals for the first time. Previously, clinicians caring for children after suspected or confirmed non-fatal strangulation had no dedicated UK guidance and often had to rely on protocols developed for adults.
The new guidelines were developed by a UK-wide Intercollegiate Working Group convened by IFAS, bringing together more than 60 senior clinicians, Royal Colleges, specialist societies and frontline professionals. Professor White said: "There simply wasn't a UK guideline for managing non-fatal strangulation in children, so clinicians were doing their best with guidance written for adults. We brought together more than 60 clinicians from across the UK – including Royal Colleges, specialist organisations and frontline professionals – to build something better. We listened, challenged one another and developed guidance that addresses a real need. These are the first UK guidelines, but they won't be the last. As the evidence grows, we'll continue to learn and refine them to ensure children receive the best possible care."
Survivor's story: 'I truly believed I was going to die'
Julie experienced a violent assault during the course of her work. She was attacked by a service user in her home, and for part of the assault was throttled. "Being strangled was a terrifying experience. I truly believed that I was going to die," she said.
Julie was involved in a struggle before managing to escape and get a neighbour to raise the alarm. Police and ambulance attended, and she was taken to hospital for treatment, having received a blow to the head that required stitches. "After hospital I gave a statement in the police station, but didn’t report that I had been strangled. I wasn’t able to recall it. It wasn’t until later on that night, whilst at my sister’s home, that I remembered, and it was terrifying. I screamed to her that I had been strangled and I was shaking."
Julie was able to offer an updated statement. "The CID visited me the next day to update me on events (his arrest) and to take this additional information," she recalls. "I still couldn't understand why I didn’t report it initially, as it was a hugely traumatising aspect of the assault. How could you forget something like that? It really upset me. I now understand that when we experience trauma, parts of it can be blanked out, acting like a protective feature, as it is so distressing. This is important knowledge, as an inability to recall doesn’t mean that it didn’t happen."
The physical impact was severe. "The next day, I could hardly physically move," she said. "My neck ached, my head hurt, and my whole body was so stiff. To this day, I struggle with headaches/migraines, neck and shoulder problems. The doctor home visited me and prescribed me medication to manage physical and emotional symptoms. I lay on the couch for about 3 weeks, unable to move, which was more psychological than physical."
Julie was later diagnosed with post-traumatic stress disorder (PTSD) and underwent EMDR (Eye Movement Desensitisation and Reprocessing). She said: "From sharing my experience, I want to let others know how traumatic the experience of strangulation is. It often ends with death, but when you survive it, you are left with the physical and emotional impact of having to fight for breath, which is a terrifying experience."
"By understanding how life-threatening strangulation is and the lasting physical and emotional impact of it on those who survive is important knowledge for professionals as such knowledge can influence how they support/respond to survivors, knowing the impact. I also feel that strangulation is an uncomfortable subject to talk about, as it is so violating. I don’t think it is an easy experience to share, let alone expect others to understand. My family and friends were affected too as they saw what I went through but I have never shared the depth of hopelessness and terror I felt. I don’t want them to hear that, hence how professional support can provide an outlet to share that family and friends can’t. Also, as the ability to recall strangulation may be delayed, because it is trauma, can provide further comprehension of it from a trauma perspective which can also inform professional responses. As I mentioned earlier, if it isn’t recalled immediately, it doesn’t mean it didn’t happen and being believed is important for recovery. Professionals can be a crucial part of recovery when they respond in the best way at the right time. When they know how and when to respond to such trauma, this can help you to recover."
What to do after non-fatal strangulation
Strangulation can potentially lead to a stroke, which is a medical emergency. The FAST test can help recognise the most common signs: facial weakness – can the person smile? Arm weakness – can the person raise both arms? Speech problems – can the person speak clearly and understand you? Time to call 999 if any of these signs are present.
IFAS has also developed a Victim Information Leaflet to help victims and survivors understand the potential health impacts, what symptoms to look out for and where to access support. Where non-fatal strangulation has occurred as part of a rape or sexual assault, individuals may be referred to a Sexual Assault Referral Centre (SARC), which provides specialist healthcare, forensic examination and emotional support. Where strangulation has taken place in the context of domestic abuse or gender-based violence, IFAS encourages individuals to seek support from specialist domestic abuse organisations.
For support: in an emergency, call 999. SARC services in England and Wales are listed on the NHS website. SafeLives: safelives.org.uk. Freephone 24 hour National Domestic Abuse Helpline (England): 0808 2000 247 (run by Refuge). Women’s Aid live chat service (open 8am-6pm weekdays, 10am-6pm weekends): chat.womensaid.org.uk. Northern Ireland: 0808 802 1414. Scotland: 0800 027 1234. Wales: 0808 8010 800. Men's Advice Line: 0808 801 0327. Respect helpline, for anyone worried that they may be harming someone else: 0808 802 404.
