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Working together to support survivors

Imagining domestic abuse services, working further alongside health services, schools, libraries, and parks, to be more present in our community consciousness.

Yas Necati | 28 Apr 2021

Image of a hospital surgery.

Image credit: Greg Rosenke.

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. Also, I co-founded the charity My Body Back, which supports survivors to reclaim their bodies after sexual or domestic abuse. In early 2019, I was hired as part of a pilot scheme to see 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 were taken from this project, I hope they can be applied 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 often the furthest removed from where people are while simultaneously running the most extensive 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, which 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 intentions. Still, 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 reach out 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 connection 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 open to meeting 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, we broke down some of the barriers that had been stopping marginalised groups from 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 still often a barrier for many when seeking 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 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 open. This was far from the specially catered counselling-style rooms that domestic abuse support work is usually done from. In this situation, we had to do the best with the available space – having tissues on hand, offering tea/coffee/water and trying to bring calm into the space as best we could.

No service is perfect, so we must 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 to NHS staff about domestic abuse, mainly 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 a proper 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”,  “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 commonly held beliefs. But constantly, before I could step in and reply as a trainer, others in the room would challenge me. 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 were 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 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, 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 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. 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 collaborated more effectively with 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 imagine domestic abuse services working further alongside health services, schools, libraries, and parks to be more present in our community consciousness. This would require another collaboration 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 to further support if needed. 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 working with perpetrators, but I don’t recall seeing these programmes advertised anywhere. Imagine how much we could change culture if perpetrator programmes were promoted in hospital waiting rooms, community cafes, and 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.