Getting help from doctors and other health professionals for domestic violence and abuse

Early research showed that women were using health services to address physical injuries as well as the emotional impacts of abuse. It wasn’t until the mid-1990s in the UK however, that the medical profession began to address the issue. Many women in abusive relationships make contact, at some point, with health services, either though routine check-ups, for appointments during pregnancy and child-birth, for help with stress and mood disorders or for treatment of injuries caused by physical abuse. Early research showed that women used health practitioners because the consultation was confidential, thereby allowing them to assess and judge risk, and because it might be the only place a partner would allow them to go alone.

The GP was the first person Alonya talked to about domestic abuse. She said she didn’st know where she would be’s if she hadn’st, and her GP called up exactly the right people’s.

Age at interview 31

View profile

The research in this area has continued since 2000 and we now have a range of training opportunities available for general practice and other staff. The IRIS programme (Identification and Referral to Improve Safety)* is now in operation across the UK, providing training for general practitioners and other health professionals in how to identify victims of domestic violence and abuse combined with a referral pathway to the local domestic violence and abuse services (see also ‘Getting help from counselling & therapy for domestic violence and abuse‘ and ‘What doctors need to know about domestic violence and abuse‘).

*See Resources & Information page

Women we interviewed usually found it hard to talk to doctors or nurses about problems at home, unless the health professional asked them first. They were not sure about confidentiality and worried that other people, including their partner, might find out if they said anything. Women particularly feared losing custody of their children. Tanya, whose back was covered in bruises after an assault did not want to tell her doctor about the cause. She said, ‘You don’t want anyone to know what’s going on, you feel stupid, feel ridiculous’. In most cases women only talked to a doctor after the relationship had ended, for fear of reprisals from their partner if he found out. Tanya was:

‘Terrified of telling [the doctor] ,terrified I’d have the kids taken off me, I was scared he’d kill me if he found out I was telling someone, but I did it because I had to’.

Disclosure for some women happened very gradually as they were often ‘closed down’ or ‘self-doubting’ and found it difficult to talk about abuse. (See ‘What doctors need to know about domestic violence and abuse‘.)

Getting to see the doctor alone

A major difficulty for women was getting a chance to talk to the doctor on their own since their partners insisted on accompanying them. Some women did not seek medical attention at all for fear of their partner’s reaction, and they convinced themselves that emergency treatment was not necessary. Abusive partners did not encourage women to seek medical treatment, such as Jessica’s husband who would not take her to hospital for a broken ankle until she had first cooked tea for the family.

Following a miscarriage, Yasmin endured eleven days of increasingly heavy bleeding before her husband took her to hospital. After a life-saving blood transfusion while Yasmin was still weak, her partner took her home before anyone asked any questions.

Yasmin was shocked that the hospital would let her go in a weak condition following major blood loss.

Age at interview 32

View profile

When Sara became seriously ill one night her husband, after making himself a cup of tea, reluctantly rang for an ambulance. Her check-up was Sara’s first chance to see a doctor alone (read by a professional).

Age at interview 40

View profile

Khalida’s husband psychologically and physically abused both her and their son but she could not confide in the doctor as her husband always went with them. The boy, aged 12, had a chronic bowel problem and had attempted suicide, but he managed to create an opportunity for disclosure.

Khalida reveals how her son took the initiative to disclose abuse and she talks about the repercussions she would have faced if she had tried to visit the doctor alone (read by a professional).

Age at interview 58

View profile

Experiences of talking to a doctor

Women’s experiences of talking about their relationship to a doctor or other health practitioner varied widely. For many it was a crucial first step in accessing specialist domestic violence and abuse services. Others, however, found their doctors to be un-helpful or lacking in the knowledge and resources to help.

Good experiences

Many of the women had good experiences of talking to their GP, particularly if the doctor had known them for a long time or if they were able to choose a particular doctor at the practice that they felt comfortable talking to. Lolita’s doctor ‘always had an ear for [her]’ and ‘referred [her] to everyone!’ The most helpful outcome for women was being referred by their doctor to a specialist Domestic Violence and Abuse Agency.

Mandy, depressed and unable to sleep was offered counselling and medication by her GP who also wrote the phone no. for Women’s Aid on the prescription.

Age at interview 37

View profile

Jane felt that health professionals ‘are a lot more clued up about domestic abuse now’ and the joint working of doctors, police, her children’s school and social services made it possible for her to leave her husband of 20 years.

Jane could not stop crying with relief when she was finally able to say what was going on.

Age at interview 46

View profile

Irina’s GP was really really helpful’s in providing a letter for her to apply for Legal Aid

Age at interview 33

View profile

Sara went to her GP for a check-up following pneumonia, for once without her husband. She ‘broke down’ and talked about her home life, and the GP gave her the telephone number of the domestic abuse help-line. She said her GP was ‘amazing … exactly the right doctor at the right time … a female ….she just listened, let me cry …gave advice, was very proactive… she said I could ring her any time’.

Un-helpful experiences

Some women experienced an un-helpful response from their doctor or had low expectations of their ability to help. Several women, like Stephanie didn’t go to the doctor as they knew they would be given anti-depressants and put in a long queue for counselling.

Initially Kate felt that talking to her GP and a counsellor about abuse made the situation worse as she had to go home and face her husband’s frightening explosions of anger.

Age at interview 44

View profile

Women who went to their GP with exhaustion, sleeplessness, low mood or anxiety often found that the doctor focused on testing for physical illness or simply prescribed anti-depressants. Julia felt that GPs are not trained to ‘go below the surface’. Short appointments were also a problem. As Melanie said, if she started opening up she ‘would be there forever’. Some women found it difficult to talk to a male doctor, or an unknown doctor if they had moved home. Others were mistrustful of confidentiality if they talked to a doctor who also treated their partner.

Several women said that talking to their GP about problems at home was not helpful when no further support was offered. Ana’s doctor was ‘quite nice and understanding’ but ‘nothing happened’ afterwards. Kanya talked to her GP and a counsellor but still felt alone in having to ‘deal with the situation’.

Lindsay was anally raped and damaged internally on her wedding night but her GP and the hospital doctors refused to accept that a woman can be raped by her husband. On another occasion, covered in bruises, Lindsay went to her GP for help with depression and her doctor commented that ‘all marriages go through a rough patch’. She contrasted them with her current GP who specialises in sexual abuse and is ‘absolutely brilliant’.

Lindsay described her contact with doctors who did not acknowledge domestic abuse after she was raped by her husband.

Age at interview 35

View profile

Tanya lived in a small tight-knit community where her partner’s family, his alcohol addiction counsellor and the teachers at her children’s school all knew he was abusive but no-one would talk about it or offer her support.

When Tanya told her GP how scared she was of her husband, her GP responded: Oh, that’s Irish daddies for you’s.

Age at interview 45

View profile

Experiences with other health professionals

Some health professionals suspected domestic abuse and tried to talk to the women concerned who were not always able to respond. Victoria’s midwife asked her directly if there was ‘abuse going on at home’ but Victoria, in floods of tears was not yet ready to admit the real cause of her unhappiness to herself. Ana’s breastfeeding counsellor observed her partner’s behaviour and shared her concerns with Ana.

Ana was petrified’s of her husband’s anger and made excuses for his behavior (played by an actor).

Age at interview 32

View profile

Yasmin had few opportunities to be alone and her health visitor did not pick up on the hints she gave about her controlling abusive partner. Yasmin later found out that her midwife and health visitor had written their concerns about her welfare in her medical notes but no action was taken.
Whilst being assessed in a psychiatric unit, Min was denied access to her seven-week old baby who she was breastfeeding.

Min was not allowed to feed her baby and she was left overnight without access to a breast pump to relieve the painful swelling (played by an actor).

Age at interview 47

View profile

Women’s fears and anxieties about talking to health professionals

Fear of losing their children

Many women were afraid to talk to a doctor about their abusive relationship for fear that the doctor would contact social services and they might lose their children. This view was reinforced by Min’s GP who knew about her abusive relationship and advised her to ‘put up with it because it’s better than having your children removed’.

Min described her GP as absolutely lovely and totally clueless’s. She told Min not to rock the boat’s by talking about abuse (played by an actor).

Age at interview 47

View profile

Anna felt that health professionals and police did not know how to provide support for domestic abuse, and she never lost the fear of losing her children.

Age at interview 47

View profile

Kate described the shocking reprisals following her disclosure of domestic abuse. Her health visitor was ‘a crucial form of support’ helping her accept that her relationship with her husband was abusive but when her GP found out about the abuse she reported it, against Kate’s wishes, to social services.

Kate’s partner blamed her for giving him the label of an abuser’ which she might as well tattoo on his forehead.

Age at interview 44

View profile

Fear of a ‘mental health’ diagnosis

Many women were fearful of talking about how they felt to a doctor in case they received a mental health diagnosis that their partner could use against them in child custody proceedings. Tanya and Min both endured mental health assessments. Jacqui became severely depressed and self-harmed. The doctor prescribed anti-depressants, giving Jacqui’s partner an opportunity to reinforce his suggestions that she was going mad.

Jacqui described cutting her arms with razors in order to release some of the emotional pain she was feeling, and finally approaching her GP for help.

Age at interview 59

View profile

Despite her partner using her depression as a rod’ to beat her with, Jacqui eventually talked to her GP who was supportive and referred her to the local Domestic Violence and Abuse agency.

Age at interview 59

View profile

Min was not allowed to go with her baby and she was left alone overnight and sectioned’s before losing access to her children (played by an actor).

Age at interview 47

View profile

Missed opportunities for disclosure of abuse

Penny took a whole year to talk openly to her GP, as her depressed mood was initially mis-interpreted.

After failed attempts to disclose her situation to doctors at her practice, Penny finally found a sympathetic GP who referred her for specialist support.

Age at interview 62

View profile

There were numerous other examples where signs of abuse were not investigated, like Philippa who was not asked about her severe weight loss. Anna found out that her doctor had flagged up domestic abuse concerns in her notes over many years but had never spoken about it. Linda and Jacqui both gave graphic accounts of how hospital doctors on more than one occasion did not enquire about extensive injuries, broken ribs and bruising on the body caused by physical violence, and accepted the offered excuses.

Linda talked about missed opportunities in hospital when she made excuses about her bruising and was afraid to talk in case her husband arrived and could over-hear.

Age at interview 59

View profile

Going into a women’s refuge

Need help now? Need to cover your tracks online? CLICK HERE To exit the site CLICK HERE For some women experiencing domestic violence and abuse,...