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