Family violence

Rosie Batty has turned her attention to the medical profession’s role on the front line of the battle against family violence. The Australian of the Year wants us to listen and learn.

THE cold hard facts about family violence make for ugly but necessary reading.

Family violence can happen to anyone but, in 95% of reported incidents, it is mainly committed by men against women, children and other vulnerable people. So far, in 2015, two women have been killed every week on average; one woman is hospitalised every 3 hours. The cost of violence against women and their children to the Australian economy in 2009 was $13.6 billion. It’s calculated to rise to $15.6 billion by 2012–22 without the right preventive action.1,2

One in three Australian women has experienced physical violence since the age of 15 and 64% of them did not report it to the police.3

Rosie Batty, the 2015 Australian of the Year, knows those numbers inside and out, not just because she lived them, but because her mission in life is about teaching others the hard facts so they don’t have to suffer the way she has.

If people do not know Ms Batty as the Australian of the Year, they certainly know her for the tragedy of her son Luke’s death, on Wednesday 12 February 2014. He was killed in front of horrified onlookers by his mentally ill father, Greg, at Luke’s local cricket ground in Tyabb, southeast of Melbourne, where the 11-year-old was training.

Ms Batty has been, since then, a fierce advocate for the victims of family violence, for both policy and practical change, for finding ways to keep women and children safe and supported.

Of late, she has turned her sights on the medical profession, keen to let doctors and allied health care workers understand the pivotal role they can play in helping victims through their crises.

“It’s really important that the [members of] medical profession, who are at the front line, and quite often are the first [people] that victims may well visit, are as aware of the problem [of family violence] as the rest of the community”, Ms Batty tells the MJA.

“Engaging with the medical sector, [which is] pivotal, is really important.”

Simple message

Her message is simple — don’t try to fix the problem all by yourself, but know where the specialised services are in the area of your practice and how to connect your patient with the people who can help her, even if that’s as simple as giving her one phone number … 1800 RESPECT.

“Sometimes, it’s the right time to actually ask the question and not be afraid of asking the question, ‘are you in a violent relationship’ ”, she says.

“The person may be so confused that they actually don’t know that they are. Or they may not be ready. They may be too frightened … but certainly having [a doctor with] a compassionate, empathetic manner could be the difference between somebody coming back, and feeling comfortable in coming back, and at a time that’s right for them.”

Family violence, she points out, may underpin many of the issues that bring victims to a general practitioner’s surgery.

“Drug and alcohol abuse, mental illness … in a lot of cases those are underpinned by family violence”, Ms Batty says.

“You’re not a specialist in this space. You’re a referral point. What’s most important is the safety of the victim.

“It isn’t necessarily the right approach to ring triple zero and involve the police. So what is that step? Who are you going to refer [the victim] to? Who are the specialised services in your immediate area? Or do you keep it very simple … 1800 RESPECT does refer them to the correct services.”

Information in waiting rooms is another key area where doctors can make an impact with victims of family violence, she says.

“I would love to see more information available in practices. It may be a key way to introduce the topic to somebody who may not be ready to acknowledge the position they’re in. Pamphlets that describe violence — what is family violence? What are the different forms of violence? What can you do? And what can you do to support someone? It’s a whole-of-community approach.”

Mandatory reporting by doctors is not a solution, Ms Batty says.

“I’m hesitant to recommend [mandatory reporting]. We need the infrastructure to be able to support that, and we don’t.

“What we’ve got to understand is that if people knew that they would be forced to report, it would certainly make a difference to whether I spoke about it or not. It takes away that trust, that confidentiality, and it’s taken out of [the victim’s] hands.

“It’s more important that doctors are better trained, and understand that they don’t have to be experts, but they do need to know how to refer properly, why it is important to link a woman in.”

Guidelines

The Royal Australian College of General Practitioners has its “white book” — Abuse and violence: working with our patients in general practice — which provides clinical guidelines for GPs with patients who are victims — and perpetrators — of family violence.4

In May of this year the Australian Medical Association joined with the Law Council of Australia, to produce a document called Supporting patients experiencing family violence.5

Are guidelines enough?

“No”, says Professor Kelsey Hegarty, an academic GP who currently leads the Researching Abuse and Violence in Primary Care program at the University of Melbourne.

“The RACGP guidelines are excellent, but we need a systems approach.”

Professor Hegarty testified before the Victorian Royal Commission into Family Violence in Melbourne on 12 August about a study in which she and her colleagues taught GPs a first-line response recommended by the World Health Organization once a patient is identified as a victim of family violence.6

The mnemonic LIVES — listen, inquire about their needs, validate their experience, enhance their safety and ensure ongoing support — gave the GPs an easy-to-remember protocol for dealing with patients.

However, Professor Hegarty told the Commission that she did not agree that GPs should identify victims and then just move them on to specialised services.

“There has to be obviously more than that and there has to be a basic safety assessment”, Professor Hegarty said.

“So when we taught GPs that as well, to — under the mental health care plans that exist — see them in an ongoing way, we found that women were less depressed. So we certainly know that we can … and when women are less depressed they take further actions often to keep themselves and their children safe.”

One area of encouragement for Rosie Batty has been the response from medical students to her campaign.

“I have had great interest from medical students”, she tells the MJA.

“I spoke to the students at Flinders University in Adelaide [recently] at the students’ request. It was very powerful. It was really inspiring to me to realise that medical students want to understand the social issues behind the symptoms.

“It’s not just about recognising [symptoms], it’s about what’s happening socially and what communities the doctor’s practising in, understanding different cultures.”

In the end, Ms Batty says, it comes down to trust, respect, no judgement and plenty of empathy.

“Right now, the journey of the victim leaves a lot to be desired”, she says. “That journey needs to be supported by people who don’t judge or criticise or push or give unintended advice.

“If we can unpack some of the myths and misconceptions around family violence and treat it as it should be treated, as violence, as totally unacceptable, then it will go a long way towards the victim being able to feel that they can, not just speak out, but actually feel supported by the community that in the past has condemned them.

“Doctors have to play their part.”