(Originally published in Stress Points 2016)
Professor Kelsey Hegarty is an academic general practitioner who works in the Department of General Practice at the University of Melbourne. She currently leads a research program on abuse and violence in primary care. Her current research includes the evidence base for interventions to prevent violence against women; educational and complex interventions around identification of family violence in primary care settings; and responding to women and children exposed to abuse.
Q: What are some of the barriers to women disclosing domestic violence?
At the essence of it is that they have been told that it’s their fault. They feel like it’s not something that is real. They feel guilty about it happening, they have trouble naming it, they also are worried about judgmental responses and they sometimes get them. Often they come from families where it’s been happening so it’s very normalised, therefore they don’t see it as serious as someone else would. And they are embarrassed and ashamed. They fear that perhaps the person they tell may not handle it very well and might break confidentiality and that they might get more physical violence as a result and that does happen.
Q: What can we do as professionals to help facilitate disclosure?
There is a really simple mnemonic from the World Health Organisation clinical handbook and it’s called LIVES. Listen, Inquire about needs and about violence, Validate their experiences, Enhance their safety and ensure Support. It’s very simple. It’s a first line response that every health professional should be doing. Then in addition to that, we know that psychological treatments delivered by people who understand trauma and violence against women is helpful and we know that mother-child work is helpful for people who have already left the relationship. In some areas of Australia, there aren’t domestic violence services, there aren’t sexual assault services, and so the health professional plays a key role walking the journey with the person, on a path to safety and wellbeing. What shocks me is that there is a lack of training for health professionals (including psychologists). Of the women presenting for depression, a quarter to a half will have or will be experiencing partner violence.
Q: Once a client has disclosed domestic violence, how can we best support the client in terms of safety and resources?
In terms of safety assessment and safety planning, the woman is often the best assessor of her safety. As with suicide assessment, you need to ask a series of questions to try and assess, (for example), has the violence been escalating, is there a history of violence outside the home, is there a drug and alcohol history and other risk factors which might make you more concerned. It’s a long pathway to safety and wellbeing, it’s not good to only be advising women to leave, because they are in the most danger when they leave. It may be that staying and navigating what’s happening for her is what she is choosing to do. It’s about working out (the client’s) readiness to action and what action to take. It may be that assisting her with parenting issues or her own mental health and well-being including education, finding a job, mindfulness or yoga, are what she wants to focus on currently. These empowerment and self-care activities may get her to a point where she can enact and action what she thinks is the safe thing for her and her children. In terms of resourses for women and for health practitioners, there is 1800RESPECT website and phone number (www.1800respect.org.au). There is a crisis line for domestic violence in every state and the Royal Australian College of General Practitioners have a White Book for health practitioners to learn more about this complex social problem (official guidelines – www.racgp.org.au/your-practice/guidelines/whitebook/).