Why I Care So Much: Zainab Oshodi explains how two weeks working with IRISi has challenged her perceptions of DVA.

For the last 2 weeks I’ve had the pleasure of working with some really amazing women at IRISi. It’s been an eye-opening experience for myself as a clinician, but also as a woman. Going into this, I had a preconceived idea of the type of woman that is abused. Maybe a woman with mental health or drug addiction problems, maybe a woman whose religion doesn’t support leaving a perpetrator. As ignorant as it sounds, I did not think domestic violence and abuse was a problem that extended to middle class, university educated women like myself. But the figures beg to differ. The figures and facts tell me this isn’t a class problem, hidden in the backstreets of the UK. There is a nationwide female genocide on all women and the country is not doing enough. If 2 women a week, every week, died from some medical condition, we would call it an epidemic. So why is it any different for domestic abuse and violence? 1 in 4 women will experience domestic violence or abuse in their life. This sounds so painfully high to me. To put it into a social context, go on one of your groupchats. 1 in 4 women. A woman you know.

I went to an IRIS training session recently in Cardiff, where local police respond to domestic violence calls every 30 seconds. I couldn’t rack my head around the sheer volume of calls that is. Every 30 seconds, everyday, 7 days a week. Stats show that it can take around 50 incidents before a victim even contacts the police. Which means the calls that are coming in are only the tip of the iceberg. 2,880 calls a day, 19,600 calls a week, is the tip of the iceberg. To ignore that domestic violence and abuse is a gendered issue would be irresponsible of me. A serious conversation needs to be had about male entitlement, patriarchy and misogyny. Nobody is entitled to the body of anyone else. To harm, to control or to invade. So why do I care so much? Firstly, I think everyone should care, it shouldn’t have to affect someone you know for domestic violence and abuse to be wrong. It shouldn’t have to be your sister or you mother or your best friend. Respect for autonomy should extend to all humans, not just humans in your familial and social circle. Fortunately for me, I work in healthcare, this means I see different members of the public every day. I get to chat with them, learn from them, teach them, encourage them, I have to be in their personal space, I sometimes have to tell them off. But for each and every patient that gets in my chair, there is a basic human care that I have for them. I want every person who gets in my dental chair to be safe when they leave my chair. It wasn’t until I did this work that I realised this. I had thought it was a given, but it’s not, the numbers clearly show that. I feel that it is my duty, like all healthcare professionals should, to raise alarm bells when I’m concerned. When women are dying weekly, we can’t sit back idly and hope that someone else will do something because it’s awkward for us. We have a duty of care as humans to support those who may not be in a position to protect themselves anymore.

Author: Zainab Oshodi, 5th Year Dental Student, Bristol

To find out more about what we do and how you might be able to get IRIS in your area, please visit our website www.irisi.orgor email info@irisi.org.

If you would like to write a blog for us about your experiences of DVA and healthcare, please drop us a line on info@irisi.org.

DVA and Mainstream Media: What Lessons Can We Take From Love Island?

It’s the middle of summer and there is nothing quite as fabulously British as Love Island. Social media forms a common ground for all to meet at and rant about the latest twist in the villa at 9pm every day. ITV’s reality romance opened to 3.3 million Brits this year, with Britain being even more interested in the reality romances than they were last year. But with millions of us watching growing relationships on TV every night, it’s hard to ignore some of the red flags present within the show. Working on placement at a domestic violence and abuse social enterprise (IRISi), I’ve read up on the escalation tactics of perpetrators in relationships, and whilst this isn’t attack on the men or women of Love Island, this blog post aims to help us look inwardly on how we behave with our partners, and what affect this can have on them. Whilst most of the examples given in this may have men as the perpetrators (statistics show that in 4 out of 5 Domestic Violence and Abuse incidents the offender is male), it’s not an attack on anyone, but rather a chance for men, women and gender non-conforming people to take a closer look at some of the behaviours exhibited in their relationships.

Whilst it may just be a bit of a reality TV, the people are real and the conversations are (somewhat) real, and therefore the impact they have on those contestants is real. (A disclaimer: We don’t see 24 hours a day in the villa – what we know is based on what has been shown to the public).

In all honesty I absolutely adored Micheal, the firefighter from Liverpool. A fave from the beginning, he had a cool and calm aura about him, and appeared to give the other lads a finger wagging when they needed it. But, in recent episodes, he has given us a textbook lesson in gaslighting. It’s not the first time Love Island contestants have come under fire for gaslighting, and some of the behaviors last year’s Adam Collard exhibited towards Rosie Williams were textbook signs of gaslighting and emotional abuse.

Gaslighting has become a word frequently used in recent times. Derived from the 1944 film (based on an earlier play) called Gaslight, Gaslighting occurs when the perpetrator employs a form of psychological abuse whereby the victim begins to doubt his or her sanity. The victim is told or convinced that they have said or done things that they have not.

Watching Love Island, it’s hard to ignore the clear manipulation tactics exhibited by some of the contestants: Michael deciding not to take responsibility for his actions as an adult and blaming someone else for his behaviour, having the victim think that they have done something to deserve this behaviour even when they haven’t. Instead of accepting responsibility and blame he proceeded to repeatedly call Amber ‘childish’ and ‘pathetic’, going as far as to tell her on national TV not to raise her voice at him when she hadn’t. This is clear gaslighting – trivialising the feelings of the victim and switching blame onto them.

In recent years, a lot of effort has been made by broadcasting companies like the BBC to raise awareness of consent, what it means and what it doesn’t mean. One of the signs of an unhealthy relationship is forcing unwanted sexual advances on to your partner. This wasn’t quite exhibited on Love Island but the disregard for boundaries was apparent. This was highlighted by the 700 complaints made to Ofcom about Maura consistently trying to kiss Tommy after he had repeatedly made it clear that was not something he wanted to do. Whilst it may see like a bit dramatic, respecting our partner’s boundaries is the bare minimum. No means no, and incessant pursuits are not a sign of interest but actually an early warning sign of possible later abuse.

Early on in the season, the public rallied to complain about the controlling language and behavior of former contestant Joe Garratt. Joe, who had been coupled up with Lucie, made it clear that he found it ‘strange’ how much time Lucie spent with some of the other male contestants, though she insisted the friendships were purely platonic. His manner was picked up as possessive and controlling by 302 and members of the public who complained to Ofcom. Joe complained to Lucie that he would rather she ‘get close with the girls’, despite her stating that she just felt more comfortable around her male friends. Whilst it seems harmless enough, coercive control became a criminal offence in the UK in 2015. A red flag in relationships is when the perpetrator seeks to exert control over their victim in a range of ways including telling their partner who they can and cannot talk to. The behavior that Joe is displaying here is an example of coercive control, unintentional or not.

The show offers a learning opportunity for us as a public to analyze unhealthy behaviors and think about how we treat our partners in relationships. Love Island is a great and often humorous watch, but if you or anyone you know feels like you’ve been subjected to any of the warning signs of domestic abuse or violence, reach out; do not suffer in silence. A list of agencies is available below.

To find out more about what we do and how you might be able to get IRIS in your area, please visit our website www.irisi.orgor email info@irisi.org.

24 hour National Domestic Violence Freephone Hotline

0800 2000 247

Womens Aid

0808 2000 247

Home

Mens Advice Line

0808 8010 327

Home

Respect

0808 8024 040

“We dispute that GPs are highly trained, or even trained at all in many cases to recognise and respond to DVA”. A response to todays published findings from Medina Johnson, CEO IRISi.

A University of Birmingham study, reported widely today, suggests that survivors of domestic violence an abuse (DVA) are more at risk of serious mental ill health. You can read the articles here and here.

The study also reports that GPs are highly trained to spot DVA. What it doesn’t mention is that the signs of DVA are well-hidden and often misdiagnosed. The Royal College of General Practitioners, commenting on the report has said that “training for all GPs on adult and child safeguarding was mandatory”.

Medina Johnson is CEO at IRISi, a social enterprise established to promote and improve the healthcare response to gender-based violence. IRISi’s flagship intervention programme, IRIS (Identification and Referral to Improve Safety), is a general practice based domestic violence and abuse training and referral programme. IRIS training provides GPs, nurses, midwives and other clinicians with the training and skills to recognise and identify the signs of a patient who may be a victim of domestic violence and refer them to a named advocate educator who can help and support them through the process of reporting and recovery.

“We know and agree that DVA affects mental health. We dispute that GPs are highly trained or even trained at all in many cases to recognise and respond to DVA” says Medina. “Training on adult and child safeguarding is essential, but it is not the same as focussed training for clinicians to enable them to recognise, ask about, respond to, know where to refer and how to record DVA. IRIS is an evidence-based programme, offering all of this and widely cited as best practice. In the last decade, IRIS programmes have received referrals from over 11,000 women, fully trained over 800 general practices, around 10% of general practices in England and Wales and been commissioned in over 40 areas.”

IRIS is not mandatory training for GP’s. The programme is commissioned and paid for by local health commissioners and local authorities and then rolled out across a specified geographical location. Not all GP’s are IRIS trained.

“By becoming more aware of the signs and symptoms that suggest abuse – long term anxiety and depression, repeat visits to the surgery for minor symptoms, unexplained gynaecological problems – I became much more aware of patients who were living with abuse and the negative effects it was having on their health outcomes. The penny drops and you realise the exact scale and extent of the problem amongst your patient population“
IRIS trained GP.

“We need a systematic approach to training and resourcing this issue in health” continues Medina. “We know that IRIS works – women feel safer, have improved health and quality of life and visit their GPs less as a result; clinicians are better informed, trained and skilled to respond to patient need.”

Professor Gene Feder, OBE, a GP and DVA researcher at the University of Bristol commented

“Safeguarding training does not adequately train GPs (and other members of the primary care team) in asking about and responding appropriately and safely to patients experiencing domestic abuse. That is why we trialled and developed the IRIS programme, which to date has trained about 10% of practices nationally and for which we continue to argue for national funding, rather than local commissioning”

Gender based violence is not recognised as a health issue in the UK. It often goes undiagnosed and hides behind symptoms such as depression and anxiety. The symptoms are not always physical and it can be extremely hard to identify a patient. IRIS programmes provide general practice teams with the training that they need to be able to ask their patients the question and refer them to a named individual, should they wish to do so. This is not only saving women’s lives, it is saving the NHS time and money.

“DVA is an epidemic and should be treated as such” says Medina. “It feels like Groundhog Day when we are told again and again that DVA affects mental and physical health. Solutions exist and offer women choices. When these aren’t prioritised and made widely available, we are not acting in the best interests of patients.”

From more information on IRISi or the IRIS programme, please email medina.johnson@irisi.org

“It is almost impossible to understand how anyone would not recognise domestic abuse as a mental health issue”. Mel Goodway talks about the intrinsic links between DVA and Mental Health.

Domestic violence and abuse often have a devastating effect on mental health, not only for the victims, but also for their children. The links between DVA and mental health deep rooted and far reaching. Our flagship intervention, IRIS, trains healthcare professionals to recognize the signs of DVA, and ask the question to patients who may have come to see them about matters including low mood, depression and anxiety. More often than not, these issues hide a far bigger problem.

To mark Mental Health Awareness week, we asked Mel Goodway, National Implementation Manager for the IRIS project, about her experience of DVA and mental health, and the importance or recognising gender- based violence as a health care issue.

Mel Goodway – National Implementatin Manager, IRISi.

“During my time as a front line DVA support worker I rarely worked with women who were not experiencing a mental health impact as a result of their situation. In fact, I struggle to recollect a single case. Women would frequently use the term “mental torture” to describe the abuse they were experiencing or had experienced. Many women reported anxiety and depression, and unsurprisingly given their daily circumstances. We know that mental health consequences are by far the most common and longstanding health impact on women who experience DVA, with abused women being 7 times more likely to experience PTSD.”

“Recovery from an abusive relationship is not immediate. The emotional and psychological impacts span for months, even years after the abuse has ended. Women report feeling a loss of self-confidence, self-worth, the ability to become independent again and build new relationships, just to name a few. Many of the women I supported referred to ‘emotional scars’ and most women who reported both physical and emotional abuse felt the impacts of behaviours like coercive control lasted with them for much longer and were harder to recover from.”

“It is almost impossible to understand how anyone would not recognise domestic abuse as a mental health issue when we reflect on the repeat physical and emotional trauma that victims go through. Imagine living in an environment where you are afraid of every action you make for fear of physical violence and/or a barrage of verbal battery. Where you are continually living on edge and constantly adapting your behaviour so there are no repercussions. This is what it is like for many women living with domestic abuse and we cannot ignore the impact this kind of environment will have on a persons emotional and mental well-being.”

“At present 3 women a week in the UK will commit suicide as a result of experiencing domestic abuse.”
Mel Goodway

“This figure does not include the amount of attempted suicides per week. Additionally, we know women are likely to use other harmful methods to cope with their poor mental health such as self-harm or substance misuse. These figures are significantly increased in abused women compared to non-abused women.”

“A report collating the data from all our IRIS sites nationally shows that across 2018-19 63% of service users reported experiencing mental ill health, generally experiencing depression and/or anxiety. Several service users reporting self-harm and some reported suicidal thoughts. This number was far higher than those who reported a physical health issue, disability or problems with alcohol or drugs.”

“DVA and mental health are intrinsically linked. As such, we at IRISi, are passionate about ensuring there is not only a health care response to gendered based violence, but one that this is appropriate and safe with a direct route to support.”

To find out more about what we do and how you might be able to get IRIS in your area, please visit our website www.irisi.orgor email info@irisi.org.