Domestic Violence - What Can Paramedics Do?

[Music] Paramedic Insight Podcast from the College of Paramedics [Music] Paramedic Insight Podcast brings you interviews, discussion and public data analysis, important topics from around the world of paramedic practice from the College of Paramedics. Hello and welcome to another edition of the College of Paramedic Insight Podcast, my name's Gary Strong. I've got a difficult subject to talk about today but one that's really really important for paramedics and all those who work with them to be aware of. We're going to be discussing the issue of domestic violence and so I think I should say up front that if this triggers any concerns for you then during the podcast my guest Michelle O'Keefe will be telling us giving us lots of good information really about how to raise these concerns and address them. So without further ado I would like to introduce Michelle. Michelle is the service improvement coordinator for the safeguarding and domestic violence team in Leeds in Yorkshire. She's spoken to paramedics before and does some great teaching for us. Michelle it's great to have you along today. Thank you for your time. Tell us a bit about yourself and your role. So I have been working in the domestic violence field for around 20 years. I started out working in a local domestic violence support project and then in 2006 I qualified as an advert which is independent domestic violence advocate working with high risk victims and at that time the Marack the multi-agency risk assessment conference. And we're just beginning to emerge so areas were developing and setting up the Maracks which I supported in our area across Bradford. So I did lots of work in the Marack I was Marack coordinator for a short period of time I supported the development and delivery of the specialist domestic violence courts that were set up around about the same time. And also I developed and delivered group work programs to vulnerable young women and worked with the children's coordinator around that. In 2009 I went to work in Newhall Prison which is a women's prison that I think houses about maximum 400 women. And I set up a project called the Athena project which was the first of its kind in a women's prison and it was there to support victims of domestic and sexual violence in custody women in custody. Lots of really really vulnerable women with complex needs in prison so it was a really useful project it was really rewarding but it was really difficult and sometimes really distressing. So I was there for five years and then I moved on after 15 years I think a frontline work I decided that I want you to take a step back and work at a more strategic level. And a role came up within lead city councils safeguarding and domestic violence team. So I got that and my my roles vary and our team are really flexible around what we cover and kind of initiatives that we work on. Some of the key things that I've worked on in this role so far have been we have introduced implementing routine inquiry in GP practices across leads. So working with the CCG safeguarding team in leads we are rolling that out and supporting GPs in any way we can to introduce screening for domestic violence and abuse into practice. And with some really positive you know initially it was difficult trying to get GPs engaged but we've had some really positive results so we're rolling that out across leads. And then I also do some work with the four other area leads across West Yorkshire and so there's lots of work joint work that we're doing across West Yorkshire as well. Thanks Michelle and thanks for sharing your experience with us. One of the things I you've wondered from the perspective of paramedic whether they're working in a GP practice or you're driving around in ambulance. It's just thinking about how widespread the problem of domestic abuse is because you know it is when we're out on the road as it were driving through the streets of leads or anywhere else. We're probably not aware of how often it's happening. Can you say a bit about how common it is. Certainly more common than people actually think the statistics are kind of warning for women will experience domestic abuse at some time in their life and wanting six men. Actually we're now looking at the figure is almost one in three women and that's really current from the office of national statistics and that is more of a true figure I would think because domestic violence and abuse is hugely under reported. So we kind of go with the statistics that have been reported. Two women a week are killed by a current off on the partner in England and Wales alone. The police on average will receive over a hundred calls a day. Sorry every hour relating to domestic abuse and that's across England and Wales. And the year ending March 2019 the police recorded 746,000 domestic abuse related crimes. Now this was an increase of 24% from the year before and it's it's really difficult to establish why that might be but one of the things is they may be that there's an improved recording system within the police forces across the country. And also an increasing reporting so victims feeling that they're able to report to the police. And just one of the things that I want to highlight though is that domestic violence and abuse is a gender issue and women are disproportionately affected by it. So women are more likely to experience more serious harm on homicide and that is absolutely reflected in domestic homicide reviews across the country. What I will say is that we absolutely do recognise that men can be victims and it's important to highlight that all specialist services will offer support to both men and women. And the nice guidance does state that it can happen to both men and women but it is more commonly inflicted on women by men. Quite often when I'm talking about the issue and they say women are affected are female victims, you know, but that's not to say that I absolutely do accept that men do experience domestic violence and abuse. And I think anyone who's read any of the sort of serious reporting that's done in the papers will we aware of that. It's quite shocking for those of us that don't think about it all of the time, which of course you have to do in a professional capacity. I'm interested in sort of upping it to thinking it's more likely to be one in three women. I'm picking from what you said that that was before we had COVID. And I should add perhaps for anyone who's listening to this off in the future that it's the 22nd of May 2020 and we're in the middle of the response to COVID in the UK. So any thoughts on that Michelle? Yeah, I think there's always been a feeling that the number was higher and that it would be one in three women and not one in four. But in terms of COVID the impact there has been a significant increase of calls into the National Domestic Violence Helpline. There's an increase of 49% since COVID, since lockdown. And whilst locally initially we didn't see such a huge increase in such a short space of time tracking the numbers. There is a steady rise in the number of people calling local domestic violence helplines and that's reflected across all areas. But there's also an increase because what what organizations, especially its organizations have had to do is change the way in which they can communicate with victims. So lots of them have created live web chats and there has been a steady increase in web traffic and live chat with victims that are using more discrete technology to access services. So the other kind of side of the impact is that the availability of refuge spaces has been significantly impacted obviously by lockdown. And that's quite often refugees are full when we're not experiencing such difficult times. Lockdown has made it very difficult to move families on because the knock on effect of lockdown is that houses have not been made available and repaired in the normal way. yw i'n gweithio'r gweithio amdwys i'n gweithio. Mae'r gweithio'r gweithio'r gweithio amdwys i'n gweithio amdwys i'n gweithio amdwys i'n gweithio. Mae'r gweithio'r gweithio amdwys i'n gweithio amdwys i'n gweithio amdwys i'n gweithio amdwys i'n gweithio. Mae'n gweithio amdwys i'n gweithio amdwys i'n gweithio amdwys i'n gweithio. 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But I guess it's really important to think that in some aspects, what you're describing with domestic violence situation, it's a long-term condition. You can't fix it all, seeing. No, no. Domestic violence isn't a one-off event, it's a process. So, you know, what you might kind of be confronted with, a situation, is very often not the first time that that has happened, you know. So, it is a process. I think it's important, before I kind of move on to what should they do with this aspect and this person's not disclosing, it's important to understand why somebody might not disclose. And I won't spend too much time on this, but there are some key kind of factors. The fear of retribution from the perpetrator. So, if they disclose, is this going to make their situation worse and they will know better than anybody else? There's a real fear that if there are children involved, those children are going to be removed from that victim. And quite often what you've got is a perpetrator constantly telling that victim that this is what's going to happen. And I think when we look at our processes, certainly it leads if the police attend a domestic incident and there are children present, they will then contact the duty and advice team and say, we attended a domestic incident, there were children present. And then the duty and advice team within children's social care will contact the victim. Now that's too often for support and to see if they can provide any kind of support and guidance, but what that victim will think is they're going to take my children away if I don't leave him. Not in all cases, but it's a very real fear. So they may not disclose for fear of the fact that the kind of consequences of them disclosing will lead to children's social work services getting involved and then ultimately what they're kind of fear is that their children will be removed. And so having said that, it's really important to talk to somebody if that's what you're going to do and say, children's social work services are there to support, yeah, you know, and kind of getting them on board with that. So cultural issues. So you may have a victim who can't disclose because they've not got indefinitely to remain in the country and that they have been threatened that they will be deported by their partner or sent back if they talk about what's happening. Fear of causing family breakdown and bringing shame and dishonor on a family and again, possibly leading to potential on a base to abuse and on a base to kill ins. So not believing that anything can be done for them, believing that the experience is too trivial to mention. And I think if we talk about domestic violence and abuse and it's certainly in my experience when you talk to a victim that I spoke to quite recently, we had gone to do a review. She had been serious as a little bit about her husband and he had tried to attempt to take his own life and they both survived. And she very kindly agreed for us to look at the lead up to that incident and then their relationship in, you know, as a whole. And what the first thing she said to me was, I'm not of it to move domestic violence because my husband never hit me in all the 25 years. But what he did do was control her for 25 years. And all be it was really subtle control. What led to the serious assault was her separating from him. And separation is a really high risk time. So most homicides take place when somebody has said they're leaving or they're just left. So there's lots of balancing and juggling and kind of safety kind of mechanisms that need to be in place for people. And for me, the people who are best place to do these are the specialist domestic violence support projects, which, you know, I'm going to give you lots of kind of information around what paramedics can do. But ultimately, if they are aware of who the specialist support projects are in their area, they can contact them and discuss concerns and with the safeguarding needs and so on. So I've digressed a little bit Gary, I'm sorry. So in terms of if they won't disclose, what I would always say is that professionals can take the initiative, particularly health professionals and ask direct questions. And so there is, I think there is a reluctance for people, for practitioners and health practitioners in particular, are reluctance and a lack of confidence to directly ask somebody about domestic violence and abuse. And actually, what research shows is that victims of domestic violence and abuse want to be asked. So we've got kind of two things going on. We've got professionals that don't want to do it in case they kind of upset that person or that person is, I think the word, if that person is not sure what word you're looking for, but it's a fascinating insight because it reminds me of something we've learned in recent years about, you know, personal and suicidal ideation. And historically, there was always this fear of asking people whether they ever thought about taking their own life, which I think we've overcome now because we realise that actually you're not going to proffed by asking that question. And it seems to me there's a bit of a parallel layer that if you say it outrightly to somebody, you know, are you being abused or worse that effect? It creates a much more honest situation rather than just sitting towing around it, hoping they might say something. Yeah, I think it's particularly important how that's asked. It should always, always only be done if that person is alone and not in front of anybody. And the thing is, the greater the level of comfort of the person asking. So if they feel really comfortable asking that question, the greater the level of comfort of the victim, you know, so again, we deliver lots of training to midwives and health visitors who do routine inquiry and we will always say, please don't start by saying, I'm really sorry to ask you this because what you do in it, you're making that question into a negative and that person may feel really embarrassed to say, well, actually, I am. So the greater your level of comfort, always when that person's alone. And the question I was going to ask you around, what's the position with paramedics around interpreters, Gary? So if they go to an incident and they suspect that an injury has been caused by domestic abuse, but this person can't speak English. So we have access to language lines, which is one level. It's not in a sensitive situation like this. I don't think that's going to provide all the answers by any means. I think we find that it would be interesting here for my listeners, but different ambulance trusts will have different levels of resources and access to interpreters. And I guess it also depends on how common the language is. I guess I'm saying the answer may vary around the country. Yes. Yes. And so I suppose it's something to bear in mind and something to think about if that situation did present itself. Just in terms of, so we would always encourage health practitioners in particular to ask somebody about domestic violence and abuse, if it's safe to do so, if that person's on the run, and if that practitioner is comfortable doing that suggested kind of questions, particularly around paramedics, how's your partner cause these injuries? Are you afraid of your partner? Does your partner or someone at home bully you or insult you? And there are stuff around control. So it's all you could do. Does your partner try to control you, for example, not letting you have any money or go out the house? But more recently, we had a conference in November, a co-assembly conference where we had a chap who came to speak and he made a fantastic point around instead of asking, does your partner try to control you? Ask them what the partner prevents them from doing or what are you not allowed to, other things that you're not allowed to do. And because then that gets them thinking about the restrictions that have been imposed on them. So it might be they're not allowed to go to the shops on the run or they're not allowed to see family and friends. And that gives you a bit of a clearer picture of whether there is an element of control in the relationship. The other thing I did just want to touch on and it's really too long a subject to be able to kind of. yIS, tua pla r glalu o ten os. 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Mae'r gwaithio'r ddewyn ni'n ames i'r gwaithio. Iündeg ei pethissio haw Euch. M顯 wydeth gytpau o fwy hwnnod ddarau. Y fŵnod o gyffrwych chihru吉blygu yn eu gwneud yda pethissio holl. Gydiau neu sy'n gwiaeth a clym tuu Domch afryróginu sut wael alumnaid yn ym pan hynny i Franewydd hostingo feth псdwysio fy hun. Mae'r tanc na weithud welfydd entirely ydyn nhw godatwn roedd yn aynguaeth rycedden. ¿Rydw'n gael metwanyledd? Yes,ک进, yn y d challenging. Un bod sy ddimald ei uneu adh jaką. Droma bat yn y bod Nina Dodna, unwyd yn y ffropiot arall ar ரonwyr gofneud. Ngtw, onboardig fetna. Yw'n nicodol hygen fastenau'r neu sut' 50 Starshwy. Ond i'n mae y unadol moddiol a'r fநement, mewn fenau, yn gywaithанияu a'r grwy rhois ofaracol. ac jou wneud ei naw o ffordd oedd fel ac mae'r rhwylands o tai a blateglwylifoli, taisар sifen�� £60,000 o wahili, o de cilantro Mirfysfa Wys Augusti. it a long time. So it's about reassuring somebody that thank them for telling you, you know, because it's very, very difficult for, you know, it's very difficult for victims to talk about their experiences for lots of reasons, shame, fear, embarrassment and whether they'll be believed or not or whether they'll be blamed or so if somebody does disclose thank them for doing it and acknowledge how difficult that must be for them, acknowledge that you believe them, what they're saying, that it's not their fault and that they're safeed it and their children's safeed it is your priority at that point. You know, it kind of all goes down to those basic human, basic human kind of its kindness in it and how we respond to people, but I have had, you know, and people that have worked with other the over the years who've said that they had a really negative response and then didn't speak to anybody about the abuse for years, until years later. Yeah, it's a critical moment, isn't it? And I guess we would be remiss of us not to talk about the current situation as well because those critical moments are made much harder, certainly for ambulance-based paramedics and that they're likely to be wearing PPE of some sort, you know, maybe a mask over their face, maybe a full-blown hood and you know, that just just makes communication all the more difficult and we've in some of our other podcasts, we've heard some great tips and tricks for working in PPE and trying to improve on that, but it's hard, isn't it? It's going to be hard for me to respond to you when you're dressed in a bit of a strange costume coming into the room. And you've got somebody who's already distressed with a situation that's happened. I think for me it just go back to how somebody's, it's difficult to see somebody's face, isn't it, when they're kind of have PPE equipment on, but if they're kind, if they appear kind, if they're, you know, kind of reassuring, that makes a huge difference, how that would be done and how that would be interpreted with somebody with all that equipment on. Yeah, I think you're dead right, I think in one of the many things we've learnt during the last eight or nine weeks is that, you know, the empathy that we have to have as a health and care professional, if you're wearing all this funny gear, you've got to turn that into overdrive somehow and then turn it over more so that it's really obvious that people are in the environment that you're in, big challenge for people on busy shifts. And equally when you've got, if this is a domestic incident and paramedics are called out, what you've got is a really distressed person who is trapped 24 hours a day, seven days a week with that perpetrator. In a really, you know, it's a really distressing time for everybody, isn't it? So it is about ramping up that kind of empathy and general kind of kindness and reassuring somebody in that way. I think one of the things that I did want to kind of mention was that if somebody, if somebody does disclose or if somebody's reluctant to disclose and you are transporting that person to hospital, it's always worth speaking to hospital staff saying, you know, this person's not said, but I am really concerned that there's domestic violence and abuse because then they may have the opportunity to have a conversation with that person. Yeah, and equally with the reporting procedures and tell me if I'm wrong if anything's changed, but I'm understanding around safeguarding has always been that if you've got suspicion, it's better to report because nobody's going to take drastic action on the basis of one report if you've got it, if you happen to have got it wrong. But usually there's a gathering of concerns around somebody, isn't there? The paramedic might report something which has been reported by a care worker of some other sort in the situation or a neighbour, you know, the picture bills, doesn't it? Yeah, and I think never assume, as you're saying, that somebody else is going to report this. Yeah, yeah, because that happens quite often. Never assume that another agency do it, you know, we would much rather have three agencies refer a case into our OMA RAC than everybody else thinking somebody else has done that. Yeah, yeah, absolutely, and I think this also is getting at that historically, there's been a bit of a fear of what if I get it wrong, but it's better to think, to get it wrong and have a low threshold for reporting, than to miss something that's significantly a miss in a domestic situation. Yes, yes. Yeah, so now that's helpful. And the safeguarding team that's there, you know, are there to talk to around any concerns or, you know, an hour door with. I don't think it's really important to get across to paramedics, safeguarding isn't just about filling in a form on your electronic patient record or your paper record. It's not just about the paperwork, you really do need to talk to somebody and make that referral. Yes. So just going back to if somebody, if somebody does disclose domestic abuse and you believe them to be at high risk of harm, the kind of advice would be always call the police, particularly if there's a high risk of serious harm or death. If somebody discloses and they're, I mean, it's difficult to assess risk in those situations, but if you, if they're saying, I'm absolutely fine, it's always good to encourage them to contact support agencies within their area, who can support them, who regardless of what the decisions they're making, or if, I know we kind of suggested paramedics that they have leaflets and we've got some Z-Cards in leads with all the numbers on, but certainly around infection transmission, they're not able to kind of carry anything like that. Are they? It's really difficult at the moment, but what might be helpful, actually, Michelle, if you want to send me some links to some of the national sources of help afterwards, we can put them on the website with the podcast, because I think it's important for paramedics, so just have that awareness that you, gosh, yeah, and maybe 30 miles outside my usual area, I'm not quite sure who to phone, but I do know that such and such a charity deals with domestic violence and I can just have that kind of thing. Having the knowledge and having access to the people is critically important. So if we can offer that a few links to the forecast, we can do. Yes, absolutely. And the other side of that is that don't, you know, especially Storganisations, domestic abuse organisations, will provide guidance to practitioners and professionals. So if as a professional you just think, I need to speak to some of you about this, you can ring those help lines and they will provide guidance and support as practitioners. And I think that's not used enough. So that's always useful to know that it's not just for victims, you know, professionals can call. That's really helpful to know actually, I mean, just in preparing to have a chat to you, I had a look at the refuge website and it's a mind of information, isn't it, that can make your awareness really, really help stuff on encouraging or projects to have a look around there. Yeah, and there's also a website, Safe Lives website, who do work with organisations across the country and I'll provide you with a link to that. That is the the break it down into, I think there may be links for health practitioners and what to do and what to look out for and the signs and what supports are available. So yes, I mean, certainly 20 years ago we didn't have the internet, so we used to print off leaflets and have them up to victims, but you know, we've got all range of information at our fingertips somewhere. Yeah, that's right. And so we've covered a lot of ground and I'm conscious that we could talk much more, but what you've shared with us has been incredibly helpful, I think, for the paramedic world, both in our current strange lockdown, PPE type responding situation, but also beyond that, you know, this problem's not going to go away, and I firmly 100% know that paramedics can be part of the solution if we're well educated around this. So thank you ever so much for your time and input on this. I wondered, as we finish, if there's any sort of couple of top tips you want to offer, and also I believe, you know, if any, because it's potentially somebody could be listening to this and thinking actually I have been a victim, you know, never mind whether I'm a paramedic or a paramedic student or whatever I need to do something about myself. You know, what should they do? I've kind of jumbled two things into one there, sorry Michelle, but it's, you know, your experience has been really interesting and useful to listen and learn from. So yeah, and any sort of final tips for paramedics or for anybody who might be listening, who's a victim? Yeah, I suppose one of the things that I always kind of try and, and we're remembered, actually, have gotten with this podcast is that when we talk about the victims of domestic violence and abuse and when we're in the context of myself talking to you as another professional, we tend to think of people out there experiencing it, so the people that we're going out to, the people that we're going, you know, to provide a service to and actually there are people around us every day, you know, who we work with, next door neighbors, family, friends, who could be experiencing domestic violence and abuse and certainly there are the services out there are, you know, I would always encourage people to contact support services if they're experiencing it. It's really difficult to do initially, where it's really rewarding once it's done because what you do is get people who understand your situation and can help you through that. The other thing I would always say is that that if there is a situation where somebody needs to call the police do so, and we certainly in leads we come at one of our campaigns was around because neighbors hear things and people come into the house, messy or hear things and if you are concerned about somebody's welfare, ring the police, because we wouldn't, we could ring the police and have the person fall out with us but the still alive, we could not ring the police and have the person next door towards killed by the partner, you know, it's not our responsibility but we need to get better at being confident in, in a talking about it, in supporting people and being aware of the services that are available out there. Thank you. I can't say thank you enough really that you've given so much insight into a situation that's bigger and more challenging I guess than many of us realise but the good news is that with services like yours in leads and joining up with what those of us working in the community can spot and observe, you know, we can bring hope to the victims and that's that's kind of the best thing we can do is we're paramedics because we want to make a difference and I believe from everything you've shared Michelle we can make a huge difference to somebody's life by saying doing the right thing at the right time. Yes, absolutely. So thank you. This has been another paramedic insight podcast very grateful to Michelle O'Keefe for your time. We'll finish by encouraging everybody to stay safe and stay in touch. If you have any comments or questions or concerns about anything we've talked about you get in touch by the College of Paramedics website. Thank you for listening and thank you, Michelle. Thank you. 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