Calls for New Zealand doctors to screen patients for domestic violence
With one in three New Zealand women saying they've experienced physical or sexual violence in a relationship, is enough being done to spot the warning signs of domestic abuse? Currently, Kiwi doctors have no mandate to respond to evidence of family or domestic violence. So should GPs now start acting on the symptoms, asks Michelle Duff.
He came home one night, drunk, and punched their daughter in the back as she lay in bed.
Another time, he dropped their baby boy on the concrete.
He would bash the kids in front of his partner, Angela. And when she wasn't watching.
She spent her days in psychological turmoil: Terrified, alone, and trapped. All she thought about was protecting her children.
"You get into a horrible place where you don't know what to do," she said.
"I tried to take the kids but he wouldn't let me . . . I had been with him so long that he had isolated me from my friends and family."
Angela finally felt able to leave Dave* after a hospital doctor asked if she felt safe at home.
"My GP never asked anything along those lines, never ever," she says now.
"I was on antidepressants to cope, and you'd think at that point the doctor would think: 'Hang on, what else is going on here?'"
Angela was at Starship Children's Hospital with her nine-year-old daughter, who was undergoing major surgery for an unrelated condition, when the doctor asked the question.
Her then-husband had been aggressive to their daughter right up until she went into hospital, lashing out at her the previous evening.
After revealing the abuse to doctors at Starship, Angela was seen by a social worker and she and her children were moved into a Shine safe house.
Her ex was eventually jailed for nine months for the physical abuse of their daughter and son - who was by then five years old.
Angela also acquired a protection order against her ex.
THE WARNING SIGNS - ARE GPs DOING ENOUGH?
Angela is speaking out now, four years later and during the coroner's inquest into the death of child abuse victim Moko Rangitoheriri, to join calls for the screening of all women for domestic violence by their GP.
"I feel like that's where a lot of people are let down, at a GP level," she said.
"Even now I'm still on antidepressants and I don't have to tell them much to get my medication. It's like 'Oh, you're depressed? Let's give you something to help you along'.
"They need to be asking all patients questions about family violence, sooner rather than later."
Despite strong recommendations from the World Health Organisation for doctors to respond to family violence, in New Zealand there is no nationwide mandate for GPs to do so.
Instead, advocates said many doctors felt uncomfortable addressing the issue and are unsure of what to do if a patient says they or their children are being abused.
One in three New Zealand women report having experienced physical and/or sexual intimate partner violence in a relationship. When psychological and emotional abuse is included, this rises to 55 per cent.
Ministry of Health Group Manager Integrated Service Design Clare Perry said GPs had an important role to play in a system response to family violence.
The ministry did contract MEDSAC to provide some training for GPs on identifying and responding to intimate partner violence and child abuse and neglect.
Asked if family violence should be a health target, Perry said: "Health targets are reviewed annually to ensure they align with government health priorities."
Christchurch GP Dr Clare Healy is the clinical director of the Cambridge Centre, which works with patients who have experienced sexual and physical abuse.
She is also a member of MEDSAC, or Medical Sexual Assault Clinicians Aotearoa.
"It doesn't take some kind of special skill to be able to ask this question in a way that doesn't cause offence, and GPs do it with all kinds of things from fertility to dementia," Healy said.
"It needs to be linked to a health target, and embedded in primary care."
The Ministry of Health began funding a violence intervention programme in hospitals in 2007, which led to Angela being asked if she felt safe in her relationship.
But there was no equivalent for GPs, Healy said.
"That's where there's a gap. What we really need is for the ministry to provide funding to primary healthcare organisations for education and back-up support."
Even questions like, "What's your relationship like? Are you treated well?" can open up a conversation, she said.
"We need to think about domestic violence as being a driver of ill-health."
A 2016 study found there was no adequate policy, funding or support for domestic violence to be meaningfully addressed in primary health care.
It recommended the ministry create a national health target for family violence, similar to those that exist for faster cancer treatment or immunisation.
Women's Refuge chief executive Dr Ang Jury said a national screening programme for domestic and family violence was overdue.
"GPs do play an important part in this, and it would be extremely useful if doctors and practice nurses were trained to ask. Frequently the experience of living with violence creates mental health issues, particularly depression – so doctors need to ask why.
"It's not going to solve anything, but it would mean people would get help earlier."
Shine national spokeswoman Holly Carrington said her organisation had encountered resistance from some GPs.
"They may feel like it's not their job, or that they're intruding on people's personal lives," she said.
"But if you're caring for someone's health, what is more important than making sure they're not being beaten up and abused?"
The Royal New Zealand College of General Practitioners was unavailable for comment in the timeframe provided.
But in a 2016 submission to the Ministry of Justice, it said: "Family violence undermines all elements of holistic health. The College advocates that the health sector should be leading . . . this work, and that GPs must be included through its continued development."
Funding and support were the main barriers, it said.
If you or a family member need help, contact Shine at shine.org.nz or 0508 744 633.