Domestic violence as a women’s health issue— panel discussion

Abstract

I work as a freelance trainer in the U.K., focusing on domestic violence. I feel extremely privileged to be able to dip into the lives and reality of a number of different kinds of agencies. I train many professionals; for example, police officers, social workers, and probation officers. I also work with Women’s Aid.In the last couple years, I’ve been training midwives and health visitors, and that’s given me some insight into what it’s like to be a practitioner trying to deliver a good service around domestic violence. I’m going to talk about what practitioners say they need from their management, from their colleagues, and from other agencies within their geographical area, to enable them to carry out and deliver a good and safe service to survivors of domestic violence.Following a comment that Robert McAfee made, in terms of historical images of domestic violence, how about Henry the 8th for starters? Just think, there’s the first form of really institutionalized domestic violence that was publicized and legitimized.I want to reflect on some of the things that Dr. McAfee said and give you a little information about some of the things that we’ve been doing in England that are often inspired by what’s been done in the United States.I was impressed by Dr. McAfee talking about the strategic approach that the AMA took to domestic violence as a health issue in terms of accrediting, training, and establishing formal interagency procedures. The message that seems to be coming from such an important body is that it’s not optional for frontline workers to address and be trained in responding to domestic violence. It has to be compulsory, and it has to be done in a way that the organization is saying to workers, we will support you when you ask these questions of survivors of domestic violence. We will be there to recognize that you, as workers, have needs as well; when you ask the question, it may lead to disclosure, and the backup support that you need will be there. Health workers need to know what they will be able to offer to women after that first screening question.Dr. McAfee mentioned bringing together the work on health and justice, and I’d like to tell you very briefly about something that we’re doing in England. As part of my voluntary activities, I work in the Hammersmith and Fulham Domestic Violence Forum. This was one of the first multi-agency forums set up in the country, with very little money but quite a lot of support from the local Borough Council, and very active involvement from many different organizations, including Women’s Aid, which was a key organization in that development.That Forum has gained a reputation nationally for some innovative work. Very recently, we’ve received money from the government under the Crime Reduction Program to do some development work with health workers in accident and emergency departments and also in GP’s general surgeries. That program is going to offer women who go into the hospital emergency department or into the walk-in GP surgery with injuries caused by domestic violence, the chance to speak to one of our advocates. This advocacy service is quite unusual in England because it works with women who are not necessarily living in refuges. Our advocacy service helps women use the criminal justice system more safely and is intended to take some of the onus off these women in holding their perpetrators accountable.As a woman goes into the emergency department, she will have a chance to speak to an advocate who will assist her if she wants to go ahead with a criminal prosecution and help her access many other kinds of services. It’s a program that, for the first time in the U.K., is linking advocacy work and criminal and civil justice work to the health service.Another issue raised by Dr. McAfee that is really inspirational and not something that we’ve done very much of yet in England is viewing domestic violence as a workplace issue. Raising the awareness of employees, training personnel officers and human resources staff, and working with trade unions in Britain around domestic violence as a workplace issue has not gotten very far. As far as I know, private sector companies are not yet involved. There are a few local authority organizations and a few government departments that have acknowledged that domestic violence is a key issue for their employees. It’s a key health and safety issue, but we’re just starting to develop policies and training in the U.K. The inspiration from the Family Violence Prevention Fund work and the work that Dr. McAfee spoke about certainly inspires me to go back to the U.K. and talk with people from other agencies to try to get that work taken forward.I’d also like to speak briefly about some of the things health practitioners, such as midwives or health visitors, say they need in order to be able to deliver good service on domestic violence.Many health workers need recognition that they themselves may be survivors of domestic violence. We are talking about women who, as all the statistics have shown so far, are very likely to have experienced some form of physical or emotional abuse from their partners or ex-partners. One of the difficulties for people such as midwives, for example, in asking patients questions about domestic violence is the lack of support from management to deal with the issues that working on domestic violence throws up for them. When we ask the health visitors and midwives we train what they need, they tell us, “written guidelines.” They say that it’s not enough to have a few well-trained staff. Responding safely to domestic violence requires a properly codified and well-planned response by management.They also want clarity about what to expect from other agencies. As we know, no one agency can meet the needs of all survivors of domestic violence. Most women are going to need to access a whole range of different services. Midwives and health visitors are part of that complex jigsaw puzzle, but they’re only a part. I’ve heard a number of midwives, in particular, say how frustrated they feel when they’ve wanted to offer a good service to a woman, knowing she’s in danger, but when they refer her to Social Services, for example, they haven’t felt they’ve had the good response that they wanted. I’m not picking out any particular Social Services Department here, but this is a message that’s come from a number of midwives and health visitors with whom we’ve worked.Health workers also want very practical things to offer women who are fleeing abusive partners. Sometimes it’s money for food. Sometimes it’s personal hygiene materials. Sometimes it’s a way of getting the woman to a place of safety, and they haven’t got the cab fare unless they put their hands in their own pockets and give money to the woman to get her to that refuge.Many workers don’t feel that it’s enough to have just themselves and their colleagues trained. It’s also very important that their managers are aware of the issues and are able to deal with the subtleties and the complexities of domestic violence.I want to leave you with a question that’s meant to be provocative. We’ve focused, as we should, on the needs of survivors of domestic violence. I’m very interested in how we can get institutional change that takes the onus off the woman of holding the perpetrator accountable, and the role that the health system can play in that. I want to ask you to think about how you in your various roles in the health service, along with those of us who are not in the health service, can help to hold perpetrators of domestic violence accountable.I liked what Dr. McAfee said about having a notice about domestic violence on the wall in the hospital or doctor’s surgery. I think this puts the message across to perpetrators, who are also going into the surgeries, that this is unacceptable, inexcusable behavior.What are other ways in which we can hold those perpetrators accountable? Certainly, health visitors, health workers, midwives, accident and emergency staff, and general practitioners have a key role. They are able to document information that might lead to prosecution, which would hold the perpetrator much more accountable to the criminal or civil justice system.I want to leave you with these questions: How can we prevent ourselves from being part of the problem? How can we become part of the solution? How we can we help to empower those who are experiencing domestic violence and the agencies to whom they come? I work as a freelance trainer in the U.K., focusing on domestic violence. I feel extremely privileged to be able to dip into the lives and reality of a number of different kinds of agencies. I train many professionals; for example, police officers, social workers, and probation officers. I also work with Women’s Aid. In the last couple years, I’ve been training midwives and health visitors, and that’s given me some insight into what it’s like to be a practitioner trying to deliver a good service around domestic violence. I’m going to talk about what practitioners say they need from their management, from their colleagues, and from other agencies within their geographical area, to enable them to carry out and deliver a good and safe service to survivors of domestic violence. Following a comment that Robert McAfee made, in terms of historical images of domestic violence, how about Henry the 8th for starters? Just think, there’s the first form of really institutionalized domestic violence that was publicized and legitimized. I want to reflect on some of the things that Dr. McAfee said and give you a little information about some of the things that we’ve been doing in England that are often inspired by what’s been done in the United States. I was impressed by Dr. McAfee talking about the strategic approach that the AMA took to domestic violence as a health issue in terms of accrediting, training, and establishing formal interagency procedures. The message that seems to be coming from such an important body is that it’s not optional for frontline workers to address and be trained in responding to domestic violence. It has to be compulsory, and it has to be done in a way that the organization is saying to workers, we will support you when you ask these questions of survivors of domestic violence. We will be there to recognize that you, as workers, have needs as well; when you ask the question, it may lead to disclosure, and the backup support that you need will be there. Health workers need to know what they will be able to offer to women after that first screening question. Dr. McAfee mentioned bringing together the work on health and justice, and I’d like to tell you very briefly about something that we’re doing in England. As part of my voluntary activities, I work in the Hammersmith and Fulham Domestic Violence Forum. This was one of the first multi-agency forums set up in the country, with very little money but quite a lot of support from the local Borough Council, and very active involvement from many different organizations, including Women’s Aid, which was a key organization in that development. That Forum has gained a reputation nationally for some innovative work. Very recently, we’ve received money from the government under the Crime Reduction Program to do some development work with health workers in accident and emergency departments and also in GP’s general surgeries. That program is going to offer women who go into the hospital emergency department or into the walk-in GP surgery with injuries caused by domestic violence, the chance to speak to one of our advocates. This advocacy service is quite unusual in England because it works with women who are not necessarily living in refuges. Our advocacy service helps women use the criminal justice system more safely and is intended to take some of the onus off these women in holding their perpetrators accountable. As a woman goes into the emergency department, she will have a chance to speak to an advocate who will assist her if she wants to go ahead with a criminal prosecution and help her access many other kinds of services. It’s a program that, for the first time in the U.K., is linking advocacy work and criminal and civil justice work to the health service. Another issue raised by Dr. McAfee that is really inspirational and not something that we’ve done very much of yet in England is viewing domestic violence as a workplace issue. Raising the awareness of employees, training personnel officers and human resources staff, and working with trade unions in Britain around domestic violence as a workplace issue has not gotten very far. As far as I know, private sector companies are not yet involved. There are a few local authority organizations and a few government departments that have acknowledged that domestic violence is a key issue for their employees. It’s a key health and safety issue, but we’re just starting to develop policies and training in the U.K. The inspiration from the Family Violence Prevention Fund work and the work that Dr. McAfee spoke about certainly inspires me to go back to the U.K. and talk with people from other agencies to try to get that work taken forward. I’d also like to speak briefly about some of the things health practitioners, such as midwives or health visitors, say they need in order to be able to deliver good service on domestic violence. Many health workers need recognition that they themselves may be survivors of domestic violence. We are talking about women who, as all the statistics have shown so far, are very likely to have experienced some form of physical or emotional abuse from their partners or ex-partners. One of the difficulties for people such as midwives, for example, in asking patients questions about domestic violence is the lack of support from management to deal with the issues that working on domestic violence throws up for them. When we ask the health visitors and midwives we train what they need, they tell us, “written guidelines.” They say that it’s not enough to have a few well-trained staff. Responding safely to domestic violence requires a properly codified and well-planned response by management. They also want clarity about what to expect from other agencies. As we know, no one agency can meet the needs of all survivors of domestic violence. Most women are going to need to access a whole range of different services. Midwives and health visitors are part of that complex jigsaw puzzle, but they’re only a part. I’ve heard a number of midwives, in particular, say how frustrated they feel when they’ve wanted to offer a good service to a woman, knowing she’s in danger, but when they refer her to Social Services, for example, they haven’t felt they’ve had the good response that they wanted. I’m not picking out any particular Social Services Department here, but this is a message that’s come from a number of midwives and health visitors with whom we’ve worked. Health workers also want very practical things to offer women who are fleeing abusive partners. Sometimes it’s money for food. Sometimes it’s personal hygiene materials. Sometimes it’s a way of getting the woman to a place of safety, and they haven’t got the cab fare unless they put their hands in their own pockets and give money to the woman to get her to that refuge. Many workers don’t feel that it’s enough to have just themselves and their colleagues trained. It’s also very important that their managers are aware of the issues and are able to deal with the subtleties and the complexities of domestic violence. I want to leave you with a question that’s meant to be provocative. We’ve focused, as we should, on the needs of survivors of domestic violence. I’m very interested in how we can get institutional change that takes the onus off the woman of holding the perpetrator accountable, and the role that the health system can play in that. I want to ask you to think about how you in your various roles in the health service, along with those of us who are not in the health service, can help to hold perpetrators of domestic violence accountable. I liked what Dr. McAfee said about having a notice about domestic violence on the wall in the hospital or doctor’s surgery. I think this puts the message across to perpetrators, who are also going into the surgeries, that this is unacceptable, inexcusable behavior. What are other ways in which we can hold those perpetrators accountable? Certainly, health visitors, health workers, midwives, accident and emergency staff, and general practitioners have a key role. They are able to document information that might lead to prosecution, which would hold the perpetrator much more accountable to the criminal or civil justice system. I want to leave you with these questions: How can we prevent ourselves from being part of the problem? How can we become part of the solution? How we can we help to empower those who are experiencing domestic violence and the agencies to whom they come?