Supporting victim-survivors of family violence

What can primary health care teams do? 

Melanie Irwin, Primary Times writer 

We’ve recently seen a shocking rise in the incidence of deaths caused by gendered violence in Australia. High rates of violent crimes against women and intimate partner violence have caused a public outcry, with Prime Minister Anthony Albanese describing the situation as a crisis.1,2 Victim-survivors of family violence will often present to their local primary health care (PHC) service. So, what can PHC teams do to recognise signs of family violence and provide care for victim-survivors? 

 

What is family violence and who does it impact? 

Family violence, also known as domestic violence, is any kind of abusive behaviour towards a family member or intimate partner (including a former partner) that makes them feel unsafe.3 Physical abuse is the most widely recognised form of family violence, but the abuse can also be sexual, emotional, social, financial, spiritual, or (quite often) a combination of these forms.4 

People of all ages and from all backgrounds can be impacted by family violence, but the victims are predominantly women and children.5 Some groups of people are more likely to be impacted by family violence, including people with disability, those with culturally and linguistically diverse backgrounds, LGBTQIA+ people and Aboriginal and Torres Strait Islander peoples.6 Children who witness violent behaviour within the home or family context are also victims of family violence.3 

The impacts of family violence are varied and can be severe and long-lasting. Adult victim-survivors can suffer from physical injuries, chronic illness, mental illness, substance abuse and self-harm. Family violence can also create long-term disadvantages for its victims, such as low self-esteem, low income, unemployment, housing insecurity and homelessness. Children who are subjected to family violence can suffer from harmful impacts on their physical, neurological and emotional development, on their mental health and on their cognitive and behavioural functioning.7 

Recognising and responding to signs of family violence 

Trusted PHC settings are often a point at which victim-survivors can first disclose. This position of access and trust can be key to beginning the longer pathway to recovery. High-quality primary care can be a core component of the coordinated approach. Thus, it’s important that PHC professionals recognise the warning signs of a potential family violence situation. These signs can include a patient or client with: 

• a domineering partner 

• anxiety, depression and/or low self-esteem 

• lack of financial independence 

• unexplained injuries 

• multiple cancelled appointments.8 

If you start to suspect that something isn’t quite right with a patient or client, you might consider asking them – in a safe and private environment – if they feel safe at home.8 You don’t need to be a specialist to have this conversation. What’s most important is that you take a sensitive and compassionate approach. This will ensure that the individual feels safe and believed, which will encourage them to seek further support, if needed.9 

A trauma-informed approach to care recognises the difficulties that an individual may have experienced and seeks to empower them in their journey towards recovery.10 Some recommendations for how to navigate these conversations include: 

• Listen carefully and without judgment. 

• Thank the individual for trusting you. 

• Reassure them that the violence is not their fault and that it’s never justifiable. 

• Don’t ask too many questions (this can be re-traumatising). 

• Respect their choices for how they would like to proceed. 

• Encourage them to consider specialist support, such as 1800RESPECT, the national domestic, family and sexual violence counselling service.9 

 

Understand your responsibilities 

It’s important that you understand your responsibilities as a healthcare professional. The organisation you work for may have policies and procedures for recognising and responding to family violence. Some workplaces may require staff to refer victim-survivors to an internal specialist or supervisor. Depending on your jurisdiction, you or your organisation may be legally required to report known or suspected cases of abuse. Mandatory reporting mainly relates to the abuse and neglect of children and in some jurisdictions a child’s exposure to family violence falls under mandatory reporting. For more information about this, refer to the Australian Institute of Family Studies Mandatory Reporting Resource Sheet.

 

Remember to look after yourself 

It’s important that you understand your responsibilities as a healthcare professional.8 The organisation you work for may have policies and procedures for recognising and responding to family violence. Some workplaces may require staff to refer victim-survivors to an internal specialist or supervisor.8 Depending on your jurisdiction, you or your organisation may be legally required to report known or suspected cases of abuse. Mandatory reporting mainly relates to the abuse and neglect of children and in some jurisdictions a child’s exposure to family violence falls under mandatory reporting.11 For more information about this, refer to the Australian Institute of Family Studies Mandatory Reporting Resource Sheet.12 

 

Creating change 

We have a serious problem of violence against women and family violence in Australia. However, this violence is preventable, and there are some important initiatives that are working to create change. The National Plan to End Violence against Women and Children (2022–2032) has been developed and supported by the Commonwealth, state and territory governments as an overarching framework that aims to end gender-based violence. The plan highlights how all parts of society must work together to achieve this goal.14 The Department of Health and Aged Care is funding a range of measures under the plan to support PHC services to recognise and respond to family violence, including educational and professional development opportunities.15 Find out what support is available in your jurisdiction at www.health.gov.au. 

The plan is also fostering an increasing focus on prevention of violence against women. Change the Story is a framework developed by not-for-profit organisation Our Watch that considers the broader social, political and economic context of violence against women. The framework outlines key actions for working with men and boys and seeks to address the underlying societal factors that contribute to violence against women so that this violence can be prevented.16 

 

Conclusion 

PHC teams are well placed to create a safe environment for victim-survivors of family violence. A sensitive, compassionate and trauma-informed approach to care can help survivors navigate their journey towards safety and recovery. By spreading awareness and working together, we can all contribute to building a healthcare system – and a society – that not only protects but also empowers those who need it most. 

Keen to learn more about creating a safe environment in your workplace for victim-survivors of family violence? Register now for APNA’s continuing professional development (CPD) online course: ‘An introduction to family violence awareness for nurses who work in primary health care.’ 

For more CPD options, including advanced training, visit: www.1800respect.org.au/training-professional-development. 

 

References

1. Wendy Tuohy, ‘A woman is being violently killed in Australia every four days this year’, The Sydney Morning Herald, 25 April 2024, accessed 20 May 2024. 

2. Kate Lyons, ‘Almost 30% spike in rate of Australian women killed by intimate partner last year, data shows’, The Guardian, 29 April 2024, accessed 20 May 2024. 

3. Safe and Equal, ‘What is family violence?’, Safe and Equal website, accessed 20 May 2024. 

4. Safe and Equal, ‘Forms of family violence’, Safe and Equal website, accessed 20 May 2024. 

5. Australian Institute of Health and Welfare (AIHW), Family, domestic and sexual violence in Australia: continuing the national story 2019, AIHW website, 5 June 2019, accessed 20 May 2024. 

6. Safe and Equal, ‘Who experiences family violence?’, Safe and Equal website, accessed 20 May 2024. 

7. Safe and Equal, ‘Impacts of family violence’, Safe and Equal website, accessed 20 May 2024. 

8. Safe and Equal, ‘Identifying family violence’, Safe and Equal website, accessed 20 May 2024. 

9. 1800RESPECT, ‘Introduction to responding to people who have been impacted by domestic, family and sexual violence’, 1800RESPECT website, accessed 20 May 2024. 

10. NSW Health, ‘What is trauma-informed care?’, NSW Health website, accessed 20 May 2024. 

11. 1800RESPECT, ‘Mandatory reporting’, 1800RESPECT website, accessed 20 May 2024. 

12. Australian Institute of Family Studies (AIFS), ‘Mandatory Reporting Resource Sheet’, AIFS website, accessed 20 May 2024. 

13. Safe and Equal, ‘Prioritising your wellbeing’, Safe and Equal website, accessed 20 May 2024. 

14. Australian Government, Department of Social Services (DSS), The National Plan to End Violence against Women and Children 2022-2032, DSS website, 2022, accessed 20 May 2024. 

15. Australian Government, Department of Health and Aged Care (DHAC), Improving health system responses to family and domestic violence, DHAC website, accessed 20 May 2024. 

16. Our Watch, Change the story, Our Watch website, accessed 20 May 2024.