Nicki you’sve been working for quite some time I think in this field

Yes I have been working directly, one way or another with survivors of abuse for about 25 years, and I think if there was one message that I was going to give to women experiencing abuse it’s that it’s not your fault, absolutely it’s not your fault. Women often internalise the abuse they’sre experiencing, they often question whether they’sre actually experiencing domestic abuse, particularly as the rhetoric is it’s about physical abuse, when often actually the physical abuse won’st necessarily be their day-to-day experience. There might always be the threat of it there but women experience other forms of abuse as well within a relationship so sexual abuse, financial abuse, control of everything they’sre doing. So coercive control was recognised as illegal in the law last year, which is a really positive step forward, particularly because many women don’st necessarily seek the help that they need or deserve because they don’st recognise that they’sre experiencing domestic abuse.

And there are services available, so Women’s Aid has a network of member services, in most area there is a domestic violence service that might provide refuge for safe accommodation to escape from the abuser. There is, there are outreach services, there are advocacy services and there are helplines and we also run the National Domestic Violence Helpline which is 24 hours a day, seven days a week. Women can just ring and get support with anything related to their experiences around domestic abuse. It can be anonymous and we won’st judge them but what we can do with our online database is identify exactly where they can get the help that they need in the country.

OK and what would be your message to say a friend of family member or someone if they were concerned about a woman that they knew?

I think it’s really hard when you see can someone that you care about in an abusive relationship and you feel helpless to be able to make things better for them. My advice to them would be to not to try to pressurise her to leave the relationship or take action that she doesn’st want to do because ultimately you’sll probably just drive a wedge between yourself and her because she’s not able to do that and its very important to recognise what the barriers to her seeking help might be.

Two women a week are killed and often that’s after they left the abuser so it’s a really, really risky time so what I would say to them is to not judge her, to provide information about where she can get support and to let her know that you’sre always there for help and support if she needs it.

And I gather family members and friends themselves can actually ring your the national helpline?

Yes the helpline is available for anybody that’s concerned about domestic abuse whether they’sre a professional or a family member or a friend or a woman experiencing abuse themselves.

And if you’sre a professional working in the field you might come across through health care professionals or other areas, you might come across women who’sve experienced abuse, what would your be your advice to them do you think?

My advice would be to always, always attempt to see the woman on her own because often if she’s in a controlling relationship the perpetrator will make sure that he’s by her side when she’s seeing professionals, not giving her an opportunity to disclose the abuse. So to see her on her own and actually to question her about whether there’s anybody in her life that she’s worried about or she’s fearful of at the moment. So actually ask the question and give her the opportunity to tell you. And if she does tell you, again not to be judgmental but to listen to what she’s telling you about the risks that she’s facing and what support that she might need and how you can help he, rather than running away with your own agenda and being um, attempting to make her decisions for her. It’s really important that you provide her with the information to enable her to make the decisions that are right for her.

Nicki perhaps you could finish by just actually telling us what the helpline number is and for anyone that is on this website there is a link here but you might just like to tell us what the National Helpline is.

The National Domestic Violence Helpline we run in partnership with Refuge’s is open 24 hours a day, seven days a week. It’s staffed by female, trained experts in domestic abuse. Anybody can ring and get support, whether it’s first time disclosing or whether it’s an emergency refuge today and we’sll help them. The number for the national Domestic Violence Helpline is 0808 2000 247.

My name is Gene Feder, I’m a GP in Bristol and I lead a research group that has for the last more than ten years been investigating how best doctors, nurses and other healthcare professionals can respond to women who experience domestic violence. The reason I think this is a kind of crucial issue for doctors and other healthcare professionals is because there is a direct connection between the abuse that women experience and their health. That connection, it’s a nasty connection, it’s about increased problems with mental health so if you’sve been abused in your lifetime you have a much higher likelihood of depression, anxiety and post-traumatic stress disorder. It doesn’st stop with the impact on your mental health, if you experience domestic violence, it can also affect in the long-term your physical health, for instance gynaecological problems are much more common in women who’sve experienced domestic violence, particularly if they’sve experienced sexual abuse.

Domestic violence traditionally has been seen as a problem of physical assault but it turns out that really that’s just a small part of what we mean by domestic violence. So there’s sexual abuse that’s part of domestic violence, there’s emotional and psychological abuse and often a broader coercion and pressure on women living in abusive relationships for which these other forms of abuse are often used as a means of control. This doesn’st mean that in all instances of physical or sexual abuse there is this wider coercion but in health terms it’s the domestic violence which is coercive which has the biggest impact.

So an argument for why doctors and other health professionals need to pay attention is firstly because domestic violence impacts the health of their patients, but the second and I would say equally strong argument is: that’s what women who are experiencing domestic violence want. We know from research interviews, including some of the really eloquent interviews in Healthtalk, that women want to disclose and want to let someone know what’s happening but find it very difficult. And doctors are at the top of their list of professionals, particularly their GPs, that they could trust with this very difficult disclosure because, after all, saying to someone that you’sre being abused by the person who is supposed to look after you and love you the most, is incredibly difficult.

One of the problems is that doctors themselves, at least historically, have not seen themselves as being in a position to receive that disclosure and to respond appropriately, and that’s changing. So one of the real messages of this Healthtalk module is that general practice particularly, the healthcare setting should be a place where women can disclose but we also know from some of the interviews that that’s not going to happen for most women spontaneously. It’s going to happen for most women if they’sre asked by their doctor or by their nurse.

And now we have a training programme nationally to give doctors, nurses and other healthcare professionals the confidence, because it does take some confidence, to ask women if they are experiencing domestic violence. They won’st necessarily ask it with the term domestic violence’s, they may ask are you having any problems at home?’s or are you scared of anyone at home?’s, is anyone forcing you to do things at home that you don’st want to do?’s Those are the sort of questions that we’sre now training doctors and nurses to ask and the goal is to, particularly in general practice, and GPs have the most contact with the population of any other healthcare professional, particularly in general practice, for that to become a safe place for women to disclose.

Now, if all the doctors were doing was making it a safe place and possible for women to disclose, there would be a problem because the question then would be well what does the doctor do next once a woman discloses, other than to be supportive and validate her experience. Well the crucial part that we’sre doing in addition to that is linking doctors, and nurses, and other healthcare professionals to the very professional domestic violence services, unfortunately currently very threatened by cuts, but still very much out there within the UK. And in those services there are the professionals, called advocates or support workers, who have the skills to support women in making decisions about what they want to do next about their safety and, crucially, about their children, because the impact, for those women who have children, on their children, of domestic violence in the home is… can be devastating, and women who are experiencing domestic violence are concerned not just about their own safely but about the safety and the impact on their children.

Within these services, there is the expertise to provide that support. It doesn’st mean that if a woman discloses she should be asked by the GP why don’st they leave?’s and she certainly won’st be asked that by the services that support her. The issue of leaving, as we know from some of the interviews on Healthtalk, is difficult and it may not be a solution for the woman, it may in fact be unsafe for her to leave in an un-planned way. That’s not the be-all and end-all of the support that healthcare professionals or the domestic violence services should give. The point is to start from where the woman is and look at what the woman wants and support her in doing that. And I’m convinced that’s what doctors, nurses and other healthcare professionals should do. And I know that that expertise and capacity exists within the domestic violence sector.

Hello I’m Alison Gregory and I work at the University of Bristol and there I research domestic violence but in particular I look at the way that friends and family members interact with women who’sve experienced domestic violence. And part of the reason that I research this is because we know that women might tell friends, family members and within that group I include perhaps their neighbours and also their colleagues, people who are around people that are experiencing abuse… and if even if women don’st go to professional services they may well speak to the people around them or those people may notice that something’s going on. And often friends and family members say they’sre not quite sure what’s happening but they realise that the relationship perhaps isn’st a healthy one or they see some behaviours from the partner towards the woman and think I’m not quite sure about that, I’m not quite sure what’s happening’s…

And those people can be a really valuable resource if the friends and family members do understand what’s going on then communicating with the woman and encouraging her to think about the options that she may have, and providing practical solutions or offering to support her if she’s like to seek help from one of the professional organisations like the National Domestic Violence Helpline or the local agencies in the area where the woman lives, those can be valuable things to sort of encourage a woman to do to seek help.

But we know that friends and family members don’st respond well. If you listen to some of the talks on Healthtalk’s you’sll hear that actually sometimes friends and family members were confused, they didn’st know what it was they could do to help or they gave lots of advice or they suggested the woman leave when perhaps she wasn’st at the stage where she was able to leave. And we know from what women say that actually those kind of things are quite un-helpful. Women want to be believed, they want to know that they’sre going to be supported in the decisions they’sre making and they are quite complex decisions to make about whether to leave, when to leave, how to go about doing that, how to stay in touch with the person who’s been abusive, particularly if they’sve got children, that’s something that has to happen. They want to be able to continue to communicate with their friends and family members but perhaps not to be obviously asked about what’s going on and to be reminded of the situation. They just want to kind of have that support in a very normal and natural way from that group of people, to not be shunned by them because they don’st know what to do but actually to continue interacting, that’s the really important thing to keep the lines of communication open.