In the third of our 16 blogs for 16 days, AVA CEO Donna Covey explains importance of early identification of DVA in healthcare settings.
Health care professionals are often the best placed people to identify and respond to domestic abuse. Survivors tell us that the most frequent missed opportunities are in the health service. As well as being the site lead for three pathfinder sites (Blackpool, Haringey and Enfield and Camden and Islington) AVA are also leading on the survivor consultation work, in partnership with Imkaan. It’s a privilege for me to use this blog to share with you what the survivors have told us both about the missed opportunities, and how services can be improved so that health staff are able to ask about abuse and respond appropriately.
Early identification of domestic abuse is essential. The earlier women feel safe to disclose, then the sooner they can start their journey towards safety and recovery. Survivors want to see health care staff who are able to pick up the signs that domestic abuse might be happening, and are able to tune in to the silent screams of women who are just waiting to be asked.
As one woman told us
“ My situation should have been detected earlier, had it not been for my GP assigned to me, she did not care whatsoever. It just went on, it prolong my agony, all the confusion and everything”
And being asked can mean everything to a woman who feels that no one cares and that she has nowhere to turn:
“If they ask you more than once is everything OK, is everything OK at home and you feel that compassion , that oh they really care about me, you are prompted to open up. For someone that is a survivor, you just need that little window and everything comes crashing down.”
It is essential that disclosure is followed by appropriate action – or the woman’s bravery in sharing her pain is wasted, and this just adds to her trauma and feelings of worthlessness, as the service that is there to support her fails to respond to the abuse she is experiencing at home. And the evidence we heard about missed opportunities is heartbreaking. One woman told us:
“I went to A&E for a broken nose and they um didn’t do anything. They identified it and I said it was my partner but nothing from A&E. They just left it”
Survivors also highlighted the fact that, even when they were able to disclose in a health setting and they received an appropriate response, there was a long wait for services.
“ It’s like you’re jumping through hoops to get there, you’ll get on one rung of the ladder but then there’s always inconsistency ….. When you feel desperate, it feels like you’re hitting a brick wall.”
These experiences, along with long waits and inconsistent referral criteria, need to be considered alongside the evidence from work with professionals that lack of clear referral pathways is one of the main reasons why some health care professionals don’t feel confident to ask about domestic abuse. This creates a perfect storm where health staff don’t ask because they don’t feel confident of being able to give a helpful response that will help a woman onto the next stage of her journey. And at the centre of that storm is a woman who has been let down yet again.
It’s not that the health service does not know how to respond to domestic abuse. For many women, meeting the right health care professional, or being connected with the right service, had been life changing and in some cases life saving:
“ The experience I had with the doctor at the beginning when I was pregnant, it was amazing on the NHS.I had a very, very stressful situation with the father of my child and and without the antenatal counselling I had, I would not have been able to be here to be honest”
The women we spoke to are committed to making the health service better for future survivors, with one woman saying
“ We want as many generations that have passed through it to make it easier for the next generation and educate the abusers and the victim to know that if you’ve been a victim, it’s a long process.”
In that spirit, they had plenty of positive ideas for how the health response to domestic abuse could be improved. These included:
- Continued investment in proven health interventions such as IRIS and hospital based IDVAs
- Stronger referral pathways, that as well as being effective can be explained to survivors so they can understand, visualise and navigate the support they are entitled to.
- Specialist provision for BAME groups
- Interim support for women on waiting lists for mental health services, including check in calls and strong signposting to other services, such as DV services and helplines
- Trauma and gender informed training for health professionals so that they can identify, respond and refer appropriately.
Better resourcing, training and systems are all hugely important , but we must not lose sight that even in a system that is struggling, individual compassion and kindness can make all the difference to a domestic abuse survivor:
“ I’m very lucky that I have a GP that actually does listen to me , and soothes me when I’m having like crisis moments”
Donna Covey CBE is the CEO at AVA (Against Violence and Abuse) and chairs the board at IRISi.