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Royal Commission Into Family Violence: Report and Recommendations Volume 4

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Royal Commission Into Family Violence: Report and Recommendations Volume 4 Royal Commission into Family into Commission Royal Violence Volume IV Volume IV Volume Report and recommendations Report and Report and recommendations March 2016 Royal Commission into Family Violence Volume IV Report and recommendations The Hon. Marcia Neave AO – Commissioner Patricia Faulkner AO – Deputy Commissioner Tony Nicholson – Deputy Commissioner ORDER TO BE PUBLISHED Victorian Government Printer March 2016 No 132 Session 2014–16 Volume IV Report and recommendations 978-0-9944439-4-6 Published March 2016 ISBN Summary and recommendations 978-0-9944440-1-1 Volume I Report and recommendations 978-0-9944439-1-5 Volume II Report and recommendations 978-0-9944439-2-2 Volume III Report and recommendations 978-0-9944439-3-9 Volume V Report and recommendations 978-0-9944439-5-3 Volume VI Report and recommendations 978-0-9944439-6-0 Volume VII Commissioned research 978-0-9944439-0-8 Suggested citation: State of Victoria, Royal Commission into Family Violence: Report and recommendations, Vol IV, Parl Paper No 132 (2014–16). Contents 19 The role of the health system 1 20 Recovery: health and wellbeing 65 21 Financial security 93 22 R estorative justice for victims of family violence 135 23 A dolescents who use family violence 149 24 F amily violence and the family law system 181 25 R eview of family violence–related deaths 227 Glossary 241 Royal Commission into Family Violence: Report and recommendations iii 19 The role of the health system Introduction This chapter explores the role of the health system in identifying and responding to family violence. Many people told the Commission that health professionals such as general practitioners; antenatal, maternal and child health nurses; as well as specialist health services, such as mental health and drug and alcohol services, are in a unique position to identify family violence and to intervene early. Research suggests that women who experience family violence use health services more often than others, and that family violence and intimate partner violence is linked to poor physical and mental health outcomes for victims. Not all victims of family violence are able to, or choose to seek assistance from a specialist family violence service. Many will disclose violence or sexual assault to a trusted health professional in the context of seeking care for themselves or their children. Therefore, it is critical that health workers are able to respond and help victims to obtain the services they need. This chapter begins with a discussion about the capacity of the health system to undertake effective identification and ‘screening’—the process that seeks to identify people who may be victims of violence or abuse—and how this differs from risk assessment processes. It also describes some of the screening tools used within the health sector. The chapter then explores current health responses to family violence. The Commission heard particularly about the work of hospitals, general practitioners, maternal and child health nurses, drug and alcohol workers, mental health professionals, Aboriginal health services and community health centres. Women’s health services were acknowledged by many as having played a substantial role in family violence reform in Victoria, both in relation to primary prevention and response. Opportunities for a range of health professionals to strengthen and extend responses to family violence were identified; including dentists, ambulance workers and pharmacists. The Commission heard that while there are pockets of good practice and innovation in identifying and responding to family violence within parts of the health service system; there is a lack of cohesion and consistency as a whole. A common theme in evidence before the Commission was the need for health services to be better coordinated in order to guarantee a standard of response to all victims of family violence, wherever they access the health system. This chapter describes some common impediments to health practitioners being proactive in addressing family violence. These included a lack of time or resources to identify and respond to family violence and inadequate referral options. The absence of a safe and private space for consultation can also impede patients’ disclosures. At a system-level, the Commission heard of fragmentation between service providers, which is compromising effective referral pathways and coordinated responses. The Commission also heard of the importance of workforce training and development to assist health workers to identify and respond to family violence with confidence. The Commission makes a range of recommendations designed to strengthen the health system’s ability to detect and act on family violence disclosures from patients. This includes increasing training and development of the workforce, improved screening and risk assessment processes and developing initiatives to facilitate a more joined-up approach to ensure victims of family violence are able to receive the help they need, regardless of where they enter the health system. Leadership, at policy, government and clinical practice levels, is considered essential to promote awareness and change. The effects of family violence on the physical and mental health of women, children and other victims are discussed in more detail in Chapters 2, 10 and 20. Royal Commission into Family Violence: Report and recommendations 1 Note that the Commission uses the term ‘mental illness’ in this report because it is commonly used in the community; it recognises that some people prefer the term ‘mental health disability’ or ‘mental ill-health’. The Commission recognises, too, that other terms, such as ‘psychosocial disability’, might be preferred by people with disabilities. Context and current practice Health professionals have a powerful role in responding to family violence. An empathic response from a trusted doctor, nurse, midwife or other care provider that emphasises the perpetrator’s responsibility, reinforces a woman’s entitlement to a healthy relationship, encourages her to believe that a better life is possible, offers a range of options and respects her decisions is an important step in breaking down the sense of isolation that leaves women and children vulnerable to serious harm. These interventions have the potential to be empowering, may contribute to enhanced health outcomes and are potentially lifesaving.1 The Commission heard the importance of health practitioners developing an understanding of the experience of family violence victims. The quality of response a victim receives from a health service is likely to significantly influence how she manages risk and her pathways out of violence. The Salvation Army stated in its submission: ‘It takes a lot of courage to disclose family violence and a poor response can reinforce the belief that no one will believe her if she says anything or that there is no help available.’2 According to World Health Organization guidelines, an effective response from health practitioners requires them to understand the dynamics of family violence and how it affects victims. The critical role that the health system and health care providers can play in terms of identification, assessment, treatment, crisis intervention, documentation, referral and follow up, is poorly understood or accepted within the national health programmes and policies of various countries.3 In some cases, a woman’s engagement with health services is not in direct response to the family violence she is experiencing, but rather in relation to the effects of the violence: ‘[I] called Lifeline after feeling suicidal after 13 years of abuse, I was taken to hospital and introduced to a social worker there’.4 The Commission also heard that family violence has serious and detrimental effects on victims’ health and wellbeing. Women experiencing family violence use health and medical services more frequently than others because of increased rates of physical health issues that result from the violence.5 A 2004 report from VicHealth, the Victorian Health Promotion Foundation, found that women also present to health practitioners with a range of other health problems, including stress, anxiety, depression, panic disorders, suicidal behaviour, poor self-esteem, and post-traumatic stress disorders.6 Research shows that women who have experienced intimate partner violence are almost twice as likely to experience depression and to abuse alcohol.7 The evidence shows that barriers to victims of family violence who are seeking assistance and help are substantial. Victims can become isolated from social supports, as a consequence of a perpetrator’s pattern of controlling behaviour, and are often overwhelmed by the financial, housing, social and other ramifications of having to separate from the perpetrator. Living in regional and rural environments can create additional 8 barriers, through increased isolation, and influences the pattern of how women seek help. 2 The role of the health system Impact of intimate partner violence on the burden of disease A forthcoming State of Knowledge paper from ANROWS (Australia’s National Research Organisation for Women’s Safety), reviews the findings from literature that investigates the causal evidence on the health outcomes for women who experience intimate partner violence. A second paper in the same series, due later in 2016, will detail the estimated disease burden attributable to intimate partner violence.9 Intimate partner violence has been included as a risk factor in previous global and
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