As a child, Claire* experienced “extreme and repeated and prolonged trauma” as a result of being sexually abused by a relative.
The pain was so great she suffered traumatic amnesia, only recovering memories of the abuse in her early thirties when she sought psychiatric help. She can pinpoint the exact moment the first memory returned: 2pm on January 2, 2006. And with it came overwhelming anxiety.
“When you are experiencing a traumatic crisis you just feel so helpless, overwhelmed, everything is out of control. You need someone to calm you down and remind you that you’re safe. Because you re-experience the trauma, you feel as though it’s happening to you again,” she says.
For the 1 in 5 Australian women who have experienced sexual violence, getting the right kind of support is incredibly important. But when support is spread over different institutions and practitioners that don’t communicate or are insensitive, these vulnerable women are at risk of being re-traumatised all over again.
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“If you get a grumpy receptionist, or a practitioner who doesn’t call you back when they say they’re going to, or if anyone doesn’t follow through or doesn’t treat you with kindness and respect, it really can feel like you’re very alone and isolated,” Claire explains.
But it’s not just at times of crisis that these women need appropriate professional support. Surviving sexual violence often brings with it a lifetime of challenges, chief among them being mental illness. For women in this situation, every encounter with the healthcare system needs to be sensitive to their background.
“Women told us that having to repeat themselves was exhausting and re-traumatising,” says University of Melbourne health research Dr Laura Tarzia, part of the team behind a recent study of how ‘trauma-informed care’ is delivered for women who have experienced both mental health problems and sexual violence.
“They said there needs to be more information sharing between services so they don’t need to start all over again every time.”
“Trauma-informed care is fairly well-established. It responds to the possibility that the patient might have experienced trauma as a guiding principle,” says Dr Tarzia.
“It’s things like asking people if it’s OK before conducting an examination on them. We need to keep people informed and make sure they have control over what’s happening to them.”
However, she says the study found that it was difficult to deliver this kind of care at a system level, where survivors may be seeing more than one service provider or practitioner.
“For women who are experiencing multiple issues it can be quite hard for them to receive a coordinated system model of care,” says Dr Tarzia. “Even though sexual violence services and mental health services are often seeing a shared group of patients, there appears to be little information-sharing between the two.”
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At Claire’s GP practice, for example, there is a note on the database that she should only see either of two specific doctors with whom she is comfortable.
“They know my history and I have a relationship with them – they understand my needs and how to work with me,” she says. “Knowing you’re in the hands of people who understand your situation and the issues that might arise is just so reassuring. It’s like someone speaks your language.”
Funded by Australia’s National Research Organisation for Women’s Safety (ANROWS) and led by Professor Kelsey Hegarty, Chair of Family Violence Prevention at the University of Melbourne and the Royal Women’s Hospital, the study consulted with more than 60 sexual violence survivors, as well as practitioners and managers from service providers, including a hospital, two sexual assault centres and a mental health service. There were also sexual violence survivors on the research team.
No two experiences are the same, says Dr Tarzia, so women require different types of care. Some need to be prescribed medication to help them manage their mental health, whereas others benefit more from counselling. Often both are required at different times, and many women try a number of services and approaches before finding one that meets their needs.
“We know that women who have experienced violence do access health services far more than women who haven’t, so there is this pressing issue about the demand on services,” she explains.
“Ideally there is ‘no wrong door’ - whatever service a woman accesses first, she should receive appropriate care. The challenge is to ensure the services work together and there are appropriate referrals.
“It’s also very important women are treated sensitively at their first port of call, whatever service it may be. It’s a big decision for them to seek help, and if they are not treated appropriately at that point it can really set them back.”
The report’s recommendations focussed on a hospital setting. They included:
- strengthening staff connection within care teams, the hospital and external services through opportunities to communicate and develop a shared understanding of different roles;
- clearly defined roles and referral pathways for staff, implementation of policies that support trauma-informed care and establishing staff ‘champions’ within the hospital;
- regular reflection for staff, including prioritising feedback from women about what they would like changed in the system, input into strategies, policies and resources and auditing how women flow through the system on their pathway to safety;
- regular assessment of the environment and workplace, including ensuring there are spaces to have private and confidential discussions, allowing sufficient time to engage with women on these sensitive topics and assessment of culture, values and beliefs within the workplace.
For Claire, participating in the project as a research assistant has been empowering and an important step in her road to recovery.
“Having been involved in the project has been a massive step forward for me in terms of my healing. To be part of the process and be able to speak directly to the people in whose care I have been, was a real privilege and a massive confidence boost.
“I’ve been able to use a series of horrific experiences in a positive way that will help and support other women. It’s a really key point in anyone’s healing, to be able to make a contribution to others in the same situation. I’m incredibly grateful and fortunate to have been involved.”
If you or someone you know is impacted by sexual assault, domestic or family violence, call 1800RESPECT on 1800 737 732 or visit 1800RESPECT.org.au.
*not her real name
An exhibition of the project’s findings is currently on display at the Royal Women’s Hospital Melbourne.
Banner image: Unsplash