Just before the pandemic hit, I worked as a domestic abuse support worker in an NHS hospital in London. I had been volunteering on a London-based sexual abuse helpline for three years and also co-founded the charity My Body Back, that supports survivors to reclaim their bodies after sexual or domestic abuse. In early 2019, I was hired as part of a pilot scheme to trial if having domestic abuse services in hospitals would be an effective way of reaching and supporting survivors. Here are some of my learnings about collaboration and building better community support systems – though they taken from this particular project, I hope they can apply to other settings and situations.

Learning #1: Meet people where they’re at

Domestic abuse services, and our movements generally, could learn a lot from meeting people where they’re at. I’m talking about all frontline services and grassroots groups, from migrants rights to drug and alcohol services. Big charities are also often the furthest removed from where people are at, while simultaneously running the biggest services. I feel a great example of meeting people where they’re at, done well, is The Outside Project, London’s first LGBTQ+ homeless shelter, that is run by LGBTQ+ people and centres guests wants and experiences.

Frontline services are not always so in tune. This often isn’t down to a lack of good intention, but the constant hoops we have to jump through for funders, endless bureaucracy and paperwork and just general limitations on what we can achieve in the current system can sometimes overshadow how we offer support, particularly how we outreach to people. Those facing multiple oppressions are often at the highest risk of being isolated due to domestic abuse – and if our services aren’t reaching them, then what’s the point?

We broke down a barrier by bringing domestic abuse services to a community setting that the majority of people access at some point – an NHS hospital. As researched by SafeLives, 80% of women in a violent relationship seek help from health services, usually GPs, at least once and this may be their first or only contact with professionals. 1 in 4 women in contact with mental health services are likely to be experiencing domestic abuse while accessing that service.

In the hospital, we saw an increase in self referrals from migrant women, women who spoke little or no English and women who were local sex workers. Many of them had no idea they could get domestic abuse support and advocacy before they saw it available in the hospital. We were available to meet people right before or after hospital appointments, meaning no one had to make a second trip for us – we fit into what was already scheduled in people’s days. In an evaluation of all the hospital pilot projects in the UK, it was found that 36% of clients were Black, Asian or Minority Ethnic compared to the National Average of 18.5%. By meeting people where they were at, we broke down some of the barriers that had been stopping marginalised groups getting support.

Learning #2: We could all do better at centring the needs, wants and experiences of survivors

Even for specialist organisations who do a lot of work around centring survivors’ needs, wants and experiences, there is always more to be done. In the hospital we made some further steps – we had access to the hospital network of in-person interpreters, which many survivors preferred to having a phone interpreter, and we made our service access safer by booking our sessions as “hospital appointments” to minimise suspicion from abusers. The hospital had step free access, which should be a given for any building, but is unfortunately still often a barrier for many when looking to access services. We worked closely with different wards – including the maternity ward, where we regularly sat with survivors who had just given birth. This made it possible for them to get support when otherwise they might have been worried about childcare, time or ability to approach a service. Considering that 30% of domestic abuse starts/escalates during pregnancy, being able to be on the maternity ward was vital.

There are definitely things we could have done better – for example there were very few available rooms in the hospital, so we often met with survivors in whichever space was available. This was far from the specially catered counselling-style rooms that domestic abuse support work is often done from. In this situation we had to do the best with the space that was available – having tissues on hand, offering tea/coffee/water and trying to bring calm into the space as best we could.

No service is ever perfect, and so it’s vital we continue to keep asking survivors what works best for them – collectively, and individually.

Learning #3: Knowledge sharing is key

Part of our work in the hospital required providing training NHS staff about domestic abuse, mostly focusing on how to spot signs and support survivors. This training is crucial as 72% of survivors do not think health services have an adequate understanding of the trauma impact of domestic abuse and only 15% feel confident that their local health services are providing an adequate level of support for survivors of domestic abuse.

I designed and regularly delivered our training to different teams, from receptionists to nurses to senior leadership to janitors. Whatever room I was in, there were always people who would have challenging questions or make upsetting remarks about domestic abuse. Some examples of things I heard time and again – “Domestic abuse happens more in certain cultures” or “But he could still be a great father despite abusing his partner” or “Well they should just leave”.

Our training was all about dismantling these damaging, but often very commonly held, beliefs. But often, before I had the chance to step in and reply as a trainer, others in the room would challenge. Domestic abuse “experts” aren’t simply those who work in domestic abuse charities. My role in the hospital was never to impose as if I was an expert, it was to facilitate spaces where people could be challenged by people they already knew and respected.

Likewise, I learnt so much from NHS staff – we all come to situations with different experiences and the knowledge sharing and learning we gain from each other makes services so much more effective. If our team or NHS teams had tried to impose, the collaboration never would have worked – instead both teams made space for each other, both teams learnt a lot, and ultimately we did the best we could for survivors from that knowledge sharing.

Learning #4: All our services are interlinked, we shouldn’t treat them as separate

Usually we see hospitals and domestic services as operating in two entirely different spheres, but why should we? Survivors approaching hospitals because of domestic abuse injuries, poor mental health due to abuse, or for health reasons unrelated to the abuse, should always have the option of further domestic abuse support. And survivors who approach domestic abuse services often need healthcare.

By breaking down a barrier between these services, we created a more holistic approach to what survivors needed – if survivors had been sexually abused they could see us and the sexual health clinic on the same day, if they were struggling with their mental health we could liaise directly with hospital mental health teams, and if they had come into A&E after a bad injury and they feared for their lives, they could have domestic abuse support in minutes – with safety plans put into place and accommodation arranged for that day if they wanted to leave. Not to say that there aren’t already connections between services – but by being in the same building with a conscious partnership, we were collaborating more effectively for those who came to us for support.

In our movements, we are often so focused on single issues or projects, that we don’t always see the benefits and strengths of recognising and utilising our interconnectedness.

Learning #5: The need for togetherness

I would argue that we could take this one step further, and start building domestic abuse services more into the fabric of our support networks. If domestic abuse services become a part of people’s general service radar, like GPs and dentists, then we could all be more aware of their remit and our options if we ever do face abuse. An example of how this is already happening is through the IRIS project – an effort to train GPs about domestic abuse and have domestic support workers present in GP practices. In 2018, the IRIS project found that 86% of survivors felt safer after getting domestic abuse support from a GP referral and 83% felt more able to cope.

I’m imagining domestic abuse services working further alongside health services, schools, libraries, parks, to be more present in our community consciousness. This would require another collaboration still – one between abuse support services and healthy relationship services. If we all had regular appointments with sex educators and healthy relationship experts, like we have regular GP appointments, then we would all be more aware of our relationship health. These appointments could be crucial for children – to start learning from a young age about boundaries and consent. And teenagers and adults – to have questions answered, or air concerns, about healthy relationships and sexuality. This could also be a space where we could talk about abuse, and get referred onto further support if needed. And as well as this, it could be a space for abusers to have their unhealthy relationship ideas challenged and enter into abuse rehabilitation programmes. Organisations like Respect are already doing work with perpetrators, but I don’t recall ever seeing these programmes advertised anywhere. Imagine how much we could change culture if perpetrator programmes were advertised in hospital waiting rooms, community cafes, universities.

I see the hospital work as a starting point for looking at how we can collaborate, share accountability and responsibility for abuse, and move towards safer and healthier futures for survivors. There is still a lot to be done.

About the author

Yas Necati (they/them) is a domestic abuse support worker, sexual abuse helpline worker, writer and campaigner based in London. They co-founded My Body Back and helped run a successful campaign in 2013 to update the UK’s sex and relationships education guidelines to include more information about digital media. They are passionate about consent education, creating better services for marginalised communities and in particular developing domestic and sexual abuse services that better serve trans people.

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