IRISi is a social enterprise committed to improve the healthcare response to gender-based violence through health and specialist services working together. In 2021, IRISi’s “16 Days of Activism against Gender-Based Violence” campaign is themed as “16 ways for the 16 days of action: how health care settings can improve their response to Violence Against Women and Girls”. Our aim is to reinforce that health care professionals have an undeniable and fundamental role in identifying victims and perpetrators so we can end violence against women and girls.
In order to do this, healthcare interventions such as the IRIS and ADViSE programmes, which were developed by IRISi to enable these professionals to recognise Domestic and Sexual Violence and Abuse, can make a big and lasting difference. The structure behind these interventions is essential, since it provides not only training to health care professionals enrolled in the intervention, but also a clear referral pathway for the women identified as victims of DVA during a consultation. At the other end of this pathway, there is always an Advocate Educator (AE), a professional who is a specialist in supporting all the patients referred by practices and clinics, providing them with emotional support, legal advice and information, and sometimes an onward referral to another external agency where appropriate.
As our IRIS AEs work so closely with health care settings, we invited them to consider the following questions: “In your experience as an Advocate Educator, why is it so important to identify and respond to Domestic Violence and Abuse in health care settings?”. These are the answers of those who responded and joined our campaign!
“Some of the referrals we received through the GP surgeries are women experiencing some of the most awful abuse. These women have found a safe and secure environment where they have felt able to disclose their abuse, and importantly been offered support. The training provided to the clinicians have played a huge role in reading between the lines and accessing the vital help and support needed to stop violence against women and girls.”
“GPs are trusted with disclosing personal/health problems and, as we know, women who are victims of abuse suffer many health issues, which are a direct result of living with repeated abuse and hopelessness. Unfortunately, many victim survivors don’t understand domestic abuse and never are asked about it. Untrained GPs may refer patients to Social Prescribers and Link Workers as patient presenting issues that seem non-medical and, if these professionals also have not had DVA training, they too would miss the opportunity to ask. Hence a woman may be passed around to many services and may never get help with the root cause. Hence whole health sector needs to be DVA trained, and IRIS is the only organisation who is offering that training and support through an AE.”
“In my experience as an advocate educator it is crucial that clinicians and all GP surgery staff are able to identify and respond to domestic violence and abuse. I have worked with survivors who have shared with me that they felt so alone, so isolated and so frightened to speak with the police or any specific DVA organization for fear of being hurt or killed and that being asked about DVA by their clinician gave them the courage to start to speak. Acknowledging that DVA is a health issue has given so many victim/survivors a voice and an opportunity to get support for their situation. That support has meant that they can take back control of their lives, remain safe and most importantly be free from abuse”
“I have been an IDVA for nearly 12 years, a lot of things have changed in that time & I always thought that referrals from GP surgeries to agencies supporting victims of DVA were really low. I became an AE in 2018, after completing the Training that summer. I started training GP surgeries later that year to recognise how patients who have or were experiencing DVA may present at the surgery and how to ask if that patient would like to talk to someone in the surgery who could provide specialist advice and support. Generally, patients have developed a relationship with their clinician, they trust that environment and they feel safe. It is so important that clinicians identify the nature of the issues, many patients are on a variety of prescription medicines to help them cope with anxiety, depression, sleep problems as well as other mental and physical health problems. DVA has a massive physical and mental health affect, therefore it completely makes sense that health care settings are trained leading to the best possible support. Identifying what the patient is coping with at home or acknowledging that they have never been able to process historic DVA will mean responding to what that patient needs in order to fully recover or get the specialist help they deserve.”
“Working as an Advocate Educator for the last 2 years has opened my eyes to the importance of identifying domestic abuse and sexual violence at the first disclosure or suspicion of disclosure. We must aim to support before it is too late and in too many cases, the abuse has gone far too long before the victim received help and consequently, the abuser has had plenty of time to create havoc in the victims’ life and her family. We must train GPs and other professionals so that they ask the right question right at the beginning, validate what has been said and offer support via the IRIS programme. We also need to give them the tools to be able to support their patients once the disclosure is made. I recently did a pitch for the IRIS programme and the GP there told me that her whole team felt unequipped to know what to do, how to ask the question and how to respond or where to refer once they had a disclosure. All these insecurities lead to a reluctance to ask ‘what is going on at home?’. They had to courage to admit that they are letting down their patients. The IRIS programme should be mandatory to all surgeries.”
“Over the last 6 months, I have been privileged to see first-hand how the identification of DVA within health can be lifesaving. Domestic abuse not only impacts the victim/survivor, but it also impacts every thread of that person’s life. Health professionals are in a unique position to identify domestic abuse, time and time again, survivors tell us that they would speak to the GP about domestic abuse if the question was asked… A question that can sometimes be the difference between ending the abuse or it continuing for the next generation.”
“Health professionals are in a very safe and trusted space for victims/perpetrators to share their most intimate of issues. The health professional is in a perfect position to offer confidential support and have been instrumental in supporting patients because of the respect between patient and health professional which is vital in identifying and appropriately responding to patients ensuring the right help is in place at the right time, you can be part of the solution to help women and their children to live a life free from fear and perpetrators to access support to start making the right changes!”.
“In my experience as an Advocate Educator, it is so important to identify and respond to Domestic Violence and Abuse in health care settings because many survivors have developed a trusting relationship with their General Practice over many years, and may not disclose their experience to anyone but their clinician. Clinicians need to be ready to identify health presentations related to DVA and feel confident in responding safely and empathically to disclosures. This will result in patients/survivors feeling listened to, believed and linked in with appropriate services.”
Dionne van den Oever
“In my experience as an Advocate Educator I have found a significant number of women seek help from their GP who will be often a woman’s first, or only point of contact. These women will not always provide an outright disclosure of being “a victim/survivor of domestic abuse” however they will present to their GP (sometimes repeatedly) with clinical symptoms of domestic abuse which can include many health issues. It is therefore essential that health professionals recognise domestic abuse as a health issue and are skilled in being able to identify how domestic abuse can clinically present and recognise when someone is describing the abusive behaviour of a partner or family member. It is vital GPs have an understanding of what coercive control is and feel confident to ask and talk about it, because if they don’t their patients’ health is unlikely to improve, the patients will keep presenting to General Practice, those patients and families will not access the appropriate specialist support that they need, and opportunities to safeguard and protect may be lost.”