In the first of our 16 blogs for 16 days, Miranda Pio, Caitlin Webb and Elizabeth Jones explain the importance of the Pathfinder Project. Together they make up the Pathfinder team at Standing Together Against Domestic Violence (STADV).
“I found that when I went to go the doctors…. there were so many hints and bits of pieces, but nobody ever asked me if I was alright, was there anything underlying? Nobody triggered a question or something that even got me thinking about it, right down to the fact that when I was aged 32 and had a hysterectomy my ex-husband forced me to say I wanted my ovaries out too because I would be put on hrt and he thought I’d be more likely to have a physical relationship with him. And they never asked… I pushed and I pushed, and nobody ever asked me. I just felt that people thought that I was neurotic. Nobody asked me why I was going in so often.” Annie, DVA survivor
Annie’s experience highlights the desperate need for healthcare professionals to pick up on the signs of domestic abuse and enquire when appropriate. There is an alarming body of evidence that has been presented over the last decade that points to health settings being the key places to offer support early and to the broadest range of domestic abuse survivors, particularly those experiencing multiple disadvantage.
At Standing Together, through our work on Domestic Homicide Reviews, we have found that health professionals have a unique role to play in intervening earlier and help prevent a homicide from happening. In some cases, health professionals may be the only statutory agency to have contact with the victim and perpetrator and will hold critical information around the risks to that family.
We know that there is both a human and economic cost to domestic abuse.
Each year an estimated 1.9 million people in the UK experience some form of domestic abuse.1.3 million of these were women (8.2% of the population) and 700,000 men (4%). The cost of domestic abuse to health services has been estimated at £2.4 billion.It is clearer than ever, that there is a pressing need to find cost effective and safe ways of supporting survivors.
‘They diagnose and then you are on your own. And it’s like, until you are on the waiting list for stuff, you’ve got nowhere to go to…you’ve just got to fight to live.’ (Alexa, survivor)
Due to the prevalence of domestic abuse within our society, we know that NHS staff willbe in contact with adult and child survivors (and perpetrators) across the full range of health services. The mental and physical health consequences of domestic abuse mean that the NHS spends more time dealing with the impact of domestic abuse on women and children than almost any other sector and is often the first point of contact for women who have experienced abuse.
The high prevalence of domestic abuse also means that a high proportion of NHS staff are likely to have experienced domestic abuse. It is therefore paramount that NHS staff are provided with the appropriate support from their employers. We can only expect health professionals to respond appropriately to domestic abuse if a supportive system is in place to enable this work.
What do survivors tell us they need?
‘Sometimes it’s so exhausting. You have so many memories of how you’ve been told that you’re worthless that you are still taking on board those things. So, when somebody in authority tells you or doesn’t believe you or doesn’t ask the questions, you go away feeling worse than when you went in.’ (Sarah, survivor)
Survivors have told us that they want health professionals to understand how abuse plays out and be able to recognise signs that it is occurring.Survivors want to be believed, and for their experiences to be taken seriously, with an appropriate response taken.When a survivor discloses abuse to a health professional it may be the first time they have disclosed to anyone. Health professionals need to be trained to respond appropriately by validating their experiences and reassuring them that everyone has the right to live free from fear, violence and abuse.
‘I am an asylum seeker, and I have some other trauma, and this woman is not able to understand that. When I tell her things, she goes ‘oh really’. I felt like she doesn’t believe me… like she doesn’t understand me.’ (Aisha, survivor)
Survivors want to be treated with dignity & respect. They have articulated the need for services that understand their experiences of multiple disadvantage and are able to meet their particular needs rather than providing a one size fits all approach. Some feel that the services available to them are not sufficiently specialist, or able to understand their specific experiences.
(It’s) ‘Difficult to answer as people don’t have time to talk to you as they are so busy. (We) need specialist workers/information available.’ (Helena, survivor)
The survivors we spoke to as part of our consultation recognised that health professionals are often under-resourced and have limited time to appropriately respond. This is why it is so critical to have specialist workers such as Health IDVAs on site to provide specialist support, information and guidance for NHS staff.
Pathfinder – the solution?
Pathfinder is a pilot project funded by the Department of Health and Social Care and the Department of Culture Media and Sport until March 2020. It aims to establish comprehensive health practice in relation to domestic abuse and wider issues related to violence against women and girls in acute hospital trusts, mental health trusts and community-based IRIS programmes in GP practices.
We are working with 8 sites across England that we identified as already having a good response to domestic abuse in at least two health settings. We are learning from this good practice, sharing examples across the sites and plugging the gaps with our expertise to create a more robust response where necessary. This includes updating domestic abuse policies and training strategies, bridging relationships between health partners and local specialist services and embedding specialist intervention roles (IRIS in GP settings, co-located health IDVAs & DA coordinators).
The learning we get from the Pathfinder pilot project will inform a Toolkit which will be free and accessible to any healthcare provider from March 2020. The Toolkit will provide resources to support healthcare organisations to assess their response to DA and implement policies and a range of interventions to bridge the gaps that they identify.
To learn more about the Pathfinder Project, our events and our upcoming Toolkit please visit our website: www.PathfinderToolkit.org
Miranda Pio is the Project Manager for Pathfinder. Caitlin Webb is Pathfinder Project Manager and Elizabeth Jones is Pathfinder Project Officer.
The team work together at Standing Together Against Domestic Violence (STADV).