On Wednesday 17th May, as part of Domestic and Family Violence Prevention Month, the Department of Child Safety, Youth and Women and Brisbane Domestic Violence Service, Micah Projects partnered to present the Forum: Site Unseen. This included a panel of experts convened to discuss and analyse the impacts of domestic and family violence related trauma on a woman’s help seeking behaviour. Of particular note was the concern that if trauma remains unseen, a misdiagnosis of her mental health status is likely. This workshop was attended by government agency representatives, health workers, child protection and family support providers, generalist support workers and domestic and family violence support providers.
Domestic and family violence survivor Natasha opened the Forum and spoke emphatically about her belief in trauma informed care. She spoke of being pregnant and experiencing domestic and family violence and reaching out to mental health services because she thought something was wrong with her, she was the problem. She felt blamed by the Queensland Police Service and the Department of Child safety for not recognising what was happening to her. She noted that when you’re doing your best and you have those in authority pointing fingers at you as opposed to offering assistance, shame reduces help seeking behaviour. “It is also incredibly difficult to ask for help when your perpetrator is watching your every move. Help seeking is a huge risk” she said. “In interactions with Doctors and other professionals, those I confided in were intent on ‘dobbing’ rather than offering assistance.”
Natasha added: “It’s not about what is wrong with someone, it is about what has happened to them. We need person centred responses. This is what is needed alongside trauma informed care.” Site Unseen Facilitator Kirri De Marco noted that women continue to be diagnosed with mental health issues when there is trauma involved. This noted concern was the platform for this discussion. She asserted that we all need to invite generosity and curiosity in coming from a partnership perspective in order to have these complicated conversations and find ways forward that impact holistic change. She outlined 3 sentences that highlight how perpetrators become invisible in patterns of control that include coercive control and abusive behaviour. This demonstrates how easily the perpetrator of violence becomes invisible in the broader system:
Bill abuses Jane
Jane is abused by Bill
Jane is a victim of domestic and family violence
Bill becomes invisible.
Belinda Cox, Brisbane Domestic Violence Service; Ria Wong, Brisbane Integrated Response Manager, Department of Child Safety, Women and Youth; Ruth Wall, Brisbane South Primary Health Network; Catherine Walsh, Domestic and Family Violence Coordinator at Princess Alexandra Hospital and Shelley Elliot of Micah Project’s Partners In Recovery Team joined with those in attendance to discuss the issue of help seeking behaviours in clients impacted by domestic and family violence and systemic responses to those impacted by this trauma.
The question was posed as to whether services and the wider community view domestic and family violence as a trauma. Overwhelmingly the response was no. Most significantly the on- going nature of domestic and family violence and the accumulated trauma is not recognised overall. Often the violence is seen as an incident or incidents with the resultant trauma rarely being recognised.
The importance of asking the ‘right’ questions was highlighted. If we’re not asking the ‘right’ questions we’re potentially going to miss the domestic violence and the trauma. Victims may be seen as angry, depressed and unwilling to engage. The trauma response becomes confused with mental ill health then the cycle of trying to find solutions begins in mental health services instead of looking at the bigger picture.
Natasha spoke about the involvement of victims of domestic and family violence in the mental health system being used as leverage by the perpetrator in continuing acts of control. “He can use this in the family court system to denounce your capacity as a parent when the perpetrator has contact with children. Also handover with a perpetrator of your violence when dropping off children can be very triggering.” It was highlighted that handovers are going to be re-traumatising for victims of abuse for years of their lives. When domestic and family violence is understood as a mental health issue as opposed to a trauma issue, the professionals involved treat these situations very differently to how they’d respond to trauma. Practitioners present concurred that in our family court system, perpetrators use the whole system as a further extension of coercive control using mental health records of misdiagnosed trauma and costing the mother thousands of dollars she often doesn’t have to defend his claims. Dad is invisible, noted the panellists and we need to change the rhetoric and make him more visible.
It was noted that repeated trauma was likely to lead to the development of Post-Traumatic Stress Disorder (PTSD). However as this is a difficult diagnosis, many other diagnoses are given before PTSD. In Emergency Departments, for example, the focus is assessments – not comprehensive assessments – but those intended for client and community safety. An incorrect diagnosis is common but it stays with the person who has been misdiagnosed. PTSD is often misdiagnosed as borderline personality disorder. This is problematic as those with borderline personality disorder are often seen as manipulative and dishonest. Such a diagnosis impedes the capacity of trauma survivors to receive the treatment and responses they need for recovery. Victims of domestic and family violence often have a long history of trauma and are aiming to have their needs met. Trauma is physical and physiological. Physical issues are understood in primary care settings. However, everyone experiences trauma very differently and they can relive it every day. “If we were better at trauma informed care and understanding all the factors then we would know what to do at the time of presentation or shortly after” noted a panellist.
Those partaking in this conversation recognised that health outcomes of victims of domestic and family violence are often poor. The health system can re-traumatise victims through judgements being made even before they report their abuse. This occurs through examples such as having a mental health issue noted in their file. “It’s someone else putting her in a box and taking her control away” noted one participant. Furthermore, trauma training is offered for Emergency Department’s staff upon request but isn’t delivered to every staff member so often staff are unaware of the presenting complexities for victims they’re aiming to offer a response to.
Domestic and family violence and trauma needs to be outlined and spoken about in University studies pertaining to all relevant qualifications for those working with domestic and family violence victims. This includes the importance of primary care education for General Practitioners (GPs). GPs are a really important resource for support in domestic and family violence. It is important to educate all involved in local GP sites.
A panellist noted that: “Women fall through the gaps and men crawl through the gaps. Those who benefit from misdiagnosed trauma are the perpetrators and the system. There are unintended consequences in the current climate of working with victims of domestic and family violence. One being that that the privacy rights of perpetrators can impede the safety of victims. Women not being informed when perpetrators are released from prison is an ongoing problem.”
The importance of joined up systemic responses to ensure the safety of domestic and family violence victims and the accountability of perpetrators was clearly articulated: “The difference between integration and coordination is the degree to which responses are consistent” noted a panellist in her quotation of a Duluth practitioner.
How do we go from conversations about the courage of victims of violence to seek assistance to then discussing whether she is worthy enough? This was a conversation about the manner in which women seeking assistance are treated by the systems they reach out to. It talks to the culture of systems and dismissal when clients are not always engaged, are fearful and silent. In the health system written notes may reflect a patient who did not engage, is not compliant with medication or non-responsive to treatment. Similar comments are evident in other sectors. This takes responsibility from the practitioner and places blame on the victim of domestic and family violence.
It was recognised that the way in which our roles are organised permit us to do this. Each practitioner in their role has forms to fill in and information they require of the victim. Those partaking in this discussion agreed that instead of being beholden to the system, we need to acknowledge we are all the system and have the capacity to change practice that is harmful to clients and triggering of their trauma. We can ask questions in respectful ways to understand the reasons for blockages to engagement. “In our fixation with the need to complete the paperwork we can forget there is a person on the other side” said a participant. Hence, those in attendance were reminded about Natasha’s initial statements about the importance of client centred practice that is trauma informed.
We need to record the questions we ask and not just fill in forms and tick the boxes. We need more fulsome conversations and we need to note when victims of abuse don’t respond, why they don’t respond. What are they saying? Women often won’t respond to specific health initiatives in their vulnerable stages because they fear the consequences. As such they will go for support elsewhere.
Resistant violence and trauma was discussed in terms of victims sometimes being seen as perpetrators as well. It is important to understand how trauma impacts resistant violence. It is often difficult for women in trauma to tell their story. The Key is understanding and acknowledging the context. “Context and the story is where the gold to intervention and support lies” noted one participant. “We need to continually talk about the context of this violence to make what he did visible. We all have a role to play in individual and in systemic advocacy. We focus on women’s safety rather than empowering them. We need to consider our interventions and processes more holistically.”