 Welcome to the Mental Health Professionals Network webinar for this evening, which is working together to support the mental health of people who have experienced family violence. We're delighted to let you know that there have been over 2,000 people registered to participate in this, which I think is just an indicator of how important this topic is. And we've got a really expert and lively and interesting panel tonight, so it's going to be a very useful discussion for you. So far online, there are 558 people. So welcome. I'm Mary Emma Layes. I'm a GP and psychotherapist based in Cairns in North Queensland, where it's about 30 degrees. And we're thinking of you in the rest of Queensland and the Northern Territory with cyclones bearing down on you or rain from the post-cyclone period. So I work at Headspace with young people, and I've been doing it for seven or eight years, and I've facilitated a number of mental health professionals' webinars. So I'd like to welcome our panellists for this evening. So you've already had the biographies of the panellists, so you know a little bit about who they are. So first of all, I'd like to introduce Kelsey Heggarty. So Kelsey's a GP and an academic from Victoria. Hi, Kelsey. Welcome. Hi, everybody. Now, you've developed a measure of domestic violence, which is called the Composite Abuse Scale, and it's the first validated multi-dimensional measure of partner abuse. I understand. Yeah, that was from my PhD. It was particularly to include emotional abuse and harassment. So thank you very much. It's great to have you on our panel. I'd like to welcome Carmel. So Carmel's a psychologist also from Victoria. Carmel, I was just wondering, what first brought your interest in family violence? Well, I think that I started thinking about it in my child protection days because I so often was working with women who are impacted by violence, and I have a fascination with the whole recovery process for women and children after family violence. So thanks very much, Carmel. I understand that people might be having a little trouble hearing me. I'm also reading some instructions I'm talking to you. So, Jack, you're from South Australia. Hello. What's it like down there tonight? It's been a beautiful day, about 35, and it's a nice family evening. That's lovely to hear, and you've worked with lots of people who have been impacted by family violence as well. What would you say are some of the best changes or improvements that have been made that support people better than when you started working in this field? There's been some good law reform. I work in South Australia, so in December 2011, we introduced new intervention order legislation which actually supports women and children being able to stay in the family home and removing the perpetrator. So that's been a significant improvement, and I think also just the increasing awareness across services in relation to domestic violence, trauma responses, and the consequences of it that's providing better support. Yeah. So that's great improvements, and I'm sure that we'll be hearing more about that through our discussions this evening. Now, I'd really like to welcome Amy. So Amy's someone who's had lived experience of family violence, and we just appreciate so much of being with us. It's a real privilege for us, and it's very courageous of you. And I know that you're really involved now in work educating other people about family violence, and one of the programs that you've been involved in is in high schools. So could you just tell us a little bit about that one? Sure. Hi, everyone. So a few years ago I developed a respectful relationship program and delivered it to high schools. Basically developing resources as well for schools handling disclosures, understanding what local services are in their area geographically and talking to kids and giving them resources about respectful relationships, what a healthy relationship looks like, the framework of that, and doing their dating rights, the bill of dating rights. So looking at what their rights are and their choices and going through the cycle of domestic and family violence, touching on sexual violence as well. So having a real interactive discussion with the kids and really supporting them and supporting the school. And we've had a lot of disclosures come from that. The kids are being really well supported by the school. So it's been a really life-changing program and it's something I enjoy doing. Thanks so much. And look, we're going to just cover a couple of ground rules just about the program. And the first one is actually in regard to Amy. So a pseudonym is being used for Amy. And if you are talking about the case amongst colleagues, please make sure that you use Amy as the name for our lived experience panel member, even if you know her other name. Now, also remember that this is like a face-to-face activity. So anything that you write in the general chat box can be seen by 618 now, other people. And if you have questions that you would like the panel to discuss, please post them in the chat box. We've also received several hundred questions submitted when you joined in. So please be understanding that we're not going to be able to cover every single question that was submitted, but we've certainly picked up some themes and we will try to make sure that that's covered. And I think you'll be quite pleased with what our panelists are covering together. If you want to hide the chat box, you can click the little arrow at the top of the chat box and then you can just watch the webinar without the chat box. And there will be resources posted up on the MHPN webinar afterwards. So if resources come up for discussion, you'll have access to them later. So now what I would like to also do is just give you a little... Well, the learning outcomes you've already seen and I just want to describe the session outlined to you. So we're hoping that we'll be able to understand mental health indicators better in the context of family violence, identify the key principles of the approach of each of the disciplines represented tonight, and what we find with MHPN webinars is often that there's more similarities than differences. And also to explore some tips and strategies for how we can collaborate well together and improving the provision of care for individuals experiencing family violence. Now, you've all read the case beforehand. What will happen is that each of our panelists will respond for five minutes with how they would receive... how they would work with Amy if she came to see them, and then Amy's going to respond from her perspective as someone with lived experience. And so I'm just waiting because we have... OK, so just so that you know, the cameras come on and off. I looked after by reading back conference things to do a great job. So to save bandwidth when people are not speaking, the cameras are going off, but they will come back. They're still on the telephone. So what I would like to do is welcome our first responder, which is our GP, Kelsey, and she's going to just respond to us as she would to Amy. So Amy is the mother of an 11-year-old girl called Libby. Amy endured significant physical, emotional, and psychological abuse at the hands of Libby's father both before, during, and after their relationship. So, Kelsey, I was wondering how you would go about... how you would think about helping Amy when she came to see you? Oh, thanks very much. And I'd like to begin, really, after reading the story and energising on behalf of my profession, because the CP certainly did not respond to Amy in any way that we would like them to. And I also like to start by saying that as we're all thinking about how we would respond, sometimes we know for sure that there'll be people out of the 641 who are listening who've actually experienced this themselves as a health practitioner from their partners. And so I hope whatever I say is empathic to their experience. And I thought we might just start by making sure we're sort of on the same wavelengths about what we talk about. We, you know, we can talk about family violence, but it's actually involving a lot of other members of the family. But this case is really about by a partner and obviously has greater effects on the children, too. And certainly Amy's case does reflect the breadth across physical, psychological types of intimidation and controlling behaviours. And from work I've done, we know that one in ten women attending general practice will have this sort of experience. So if you're a full-time practitioner GP out there, then that's five women a week, mostly who aren't identified in any way. And so, really, I just wanted to make that point that in fact, GPs aren't responding. And so, but I obviously, in my own general practice, am very well aware that often need to ask. And often we ask when there's a whole range of presenting symptoms, and I try and ask in all these sorts of situations. Again, Amy has experienced many of these things. But what I see is that it's mostly the mental health presentation that results in presentations to general practice. It's less likely that the injuries, as in Amy's case, they're going more to the emergency department sometimes. And of course the reproductive health. So for us as CPs, you know, anybody listening, we really have to be aware of this, particularly with people presenting depression or anxiety or post-traumatic stress. And I have to try and remind myself on a regular basis that, you know, the children in these families are experiencing a lot of things when part of our illness is going on, including bedwetting and sleeping disorders and other things and then in that relationship. So it's great that Amy's going in and doing this work in school. So how should people ask? And, you know, I do a lot of teaching on this, but this is the sort of things I do. I start general and move into more specific things about whether they're afraid of their partner, do they feel safe at the time? Has they actually been physically threatened or hurt? And often I normalise it by saying, but it's very common in the home and I frequently ask my patients. So that's sort of how I go about asking and I find that works. And we know that women are, you know, almost three times as likely to tell if they directly ask. And this is a whole, you know, I use this because it's what qualitative studies have shown and it's sort of what Amy's saying as well, that they really want to be asked. They want some posters up to give them an idea that it might be helpful. And then it's really basic good communication skills which weren't present in the GP's and Amy's story. But it's taking some time to listen and non-judgmental validation and understanding that this is a chronic problem and it's not going to be solved in one or two sessions. But GPC people for a long time, so it's actually, you know, quite able that they can follow up and the key to it is respecting what they want. And I have the privilege of being involved in the World Health Organization Guidelines for Health Professionals, generally, not just GPs. And this really emphasises women-centered care that we all need to be trained, that we need to case find, as I just said, written information. There was no evidence that we shouldn't use zoom-antry reporting for domestic violence. And it is that psychological treatments that treatments for depression and others do work for women who have a partner violence and that mother-child interventions, which we have a real lack of, I think, in Australia for being able to refer to also work. And so I think people would be aware of women-centered care. But the extra pieces I talk to GPs about when I do myself is assisting her to increase her safety and her children's safety and providing or mobilising social support because women are very isolated from what they need. And I taught GPs in an intervention called WEAP, which Carmel's talking about a different WEAP, but in the WEAP study. And that actually showed that GPs could be taught to do this women-centered care. And women were asked more about the safety of themselves and their children and had less depression in a large, randomized control trial. So I think it can be done and I think a lot of GPs can do it. And I like this mnemonic that WHO got, FES, which is live, live, whatever. Listen, inquire about needs, validate, enhance safety and support. And I ask about safety in a very simple way. I mean, these are obviously complex risk assessments. But this is the way I do. And I really base it on what the woman feels and how safe she is, whether she's afraid to go home. And most people in general practice aren't afraid to go home that day. They've been dealing with it a lot. Has she been threatened with weapons as far as being escalating? And I go through a safety plan with women. Maybe not on the first visit, if they're safe to go home, but on top. And so I just want to flag that, in fact, we're trying to reach out to more women and this is from my job as a university person. We're trialling, taking some of the elements face-to-face, similar to mental health interventions, on to an internet-based safety, decision-aid and healthy relationship tool. And we're currently recruiting volunteers. So if you could all recruit one person, they have to be under 50. And really, this is, you know, an extraordinarily... The pilot feedback has been fantastic about this. I decide about my relationship. So I'd love people to do that if they could. And really, for resources, the College of GPs I've been involved have got a lot of resources about, and the main one being the White Book. And I just thought I'd flag those because we've been getting a lot of feedback that mental health practitioners would like that. And finally, just, you know, I think every GP has a role. They have to be ready to be open to recognise the symptoms, to respond to disclosures, address the risk and safety issues, review the patients who follow up on support, refer, reflect on our own attitudes and management of abuse and violence, and finally respect our patients, our colleagues and ourselves. If we don't do that, we can't hope to do the work. So that's how I approach it, respect all these other things that I've been involved with. Thanks so much, Kelsey. And the RAC GP resources are really good, and I would encourage any GPs online to look at those. Just for the participants, we have a technical issue which is why we haven't been able to see Kelsey. Rebecca working behind the scenes to fix that, and hopefully we'll be able to see our other panellists. So I would very much now like to welcome Carmel to give us a response from the perspective of a psychologist. Hi, Carmel. Hi, Mary, and thank you for having me on the panel. I've just started off with a couple of quotes because they kind of underpin how I approach the work. I love this quote from Colin Ross, that trauma is to psychological medicine, what bacteria is to physical medicine, because I think that the trauma of domestic violence is often underrated, and people present with depression or anxiety or some physical symptom, and it's often not explored enough. And the other is the quote from Alan Wade, that violence is always about humiliation and resistance is always about dignity, and in fact recovery, I think, is about reclaiming one's dignity after the experience that people have been through. I think that the broad range of how we respond to trauma often applies to domestic violence, but many of the trauma work too also is based on a traumatic experience, and yet domestic violence is a series of traumatic experience, and often people are struggling to survive on a daily basis, if not physically, certainly psychologically. So I've just put up what some of the symptoms are, only because there are all kinds of ways in which it might present, and sometimes people just deal with the symptoms in the same way that sometimes the police just deal with domestic violence as if it's a single incident when it's part of the pattern. So it's not that everybody, of course, who's suffering from insomnia or has eating difficulties is going to be someone who's also living with or has lived with violence, but the other way round, that often people who have lived with violence or are still living with violence find that it affects them in all kinds of ways, such as leading them into medication abuse, substance abuse, sometimes gambling. Certainly there are a number of ways in which people's thinking is affected, and we often have people who have trouble concentrating, planning, getting to their school, kids to school on time, problems in the workplace that are related to the fact that they're basically trying to survive psychologically. And certainly depression and anxiety are very common presenting issues for people who are living with violence. A number of women I've seen who've presented with depression and would often not even identify themselves as being victims of domestic violence. I find within a few sessions, if not the first one, that I'm saying, look, I'm not sure whether you're suffering from depression, but you're certainly suffering from oppression. And problems with anger and irritability are not as common because with most people who are living with violence at home being women and children, often the symptoms are inward looking, if you like, but somebody can develop a problem with irritability and anger because of it. Certainly domestic violence affects you socially and in fact there's deliberate attempts by perpetrators to isolate people socially so that it means that they lose friends they've had and they've been peer-revealed for new friendships. And in fact, unfortunately, often the perpetrator in the worst instances becomes the focus of their lives psychologically and sometimes what a councillor is in the first place is a bit of a reality check of somebody who can say to them, well, that doesn't sound like a very good space that you're in at home. Something as simple as that. The real problems and the lasting problems, I think, are the existential problems where people suddenly, sorry, gradually, more than suddenly lose a sense of their own self-efficacy and they start to feel that they're useless people, bad mothers, they'll never recover, they can't trust people or that it's all their own fault and they've brought it on themselves and you need very careful, sensitive work to help someone rebuild their lives afterwards. We do also do the work that's related more directly to post-traumatic stress symptoms, such as dealing with panic attacks and people who become either emotionally labile or emotionally numb and very much often in survival mode. I wanted to just mention, look, it's very hard to put into a single slide everything that you might need to think of in working with someone, but I guess it's these kinds of areas of activity in counselling that I think are really essential and the first is to really believe what you're hearing. It fascinates me that if somebody says that they've been, you know, mugged as they were leaving their shop or they've been, you know, some crazy person has attacked their car or themselves, they're usually believed. But often when women talk about their experiences and in terms of domestic violence, they're not believed. Why the owner suddenly becomes a common man, if you like, to be believed is awful and has quite a reputation for them. And if you read Amy's story, she certainly had examples of how she felt not believed and judged. Relieving of symptoms is very important. Grieving for what people have lost, not just in terms of... in terms of their relationship, and sometimes they grieve in different ways for that, but they're also losing the kind of parenting they wanted for their children or they've lost relationships they've had with other family members. They've lost future hopes and dreams. There's all kinds of grief. And then, of course, part of the work is the achieving, which is basically looking at new perceptions of the story, I think, and a renewed sense of self. And it's a capacity, I think, on the part of councillors and other support workers to be able to help them set small achievable goals together. And I call it the Weave Model because all of those four aspects happen in and out of each other. They move backwards and forwards. So the four tasks of the model keep being revisited and it requires a great deal of patience often working with someone. And I noticed a lot of the questions are about why do women keep going back and why do they stay, et cetera, et cetera. And so you do need a fair bit of patience in this work. I absolutely believe that with appropriate support, people will make good decisions for themselves. It may not be at the pace you'd hope. And the best practice elements really I've taken from the APS guidelines for working with women which is about being respectful of women and attending to their safety and making sure that your language indicates that the perpetrator is accountable for the violence that's not being mutual. So being non-judgmental and I'm sure reading Amy's story, she experiences quite a bit of judgment and not enough validation often. I've included this kind of new cycle of violence that we've developed in my workplace because we felt that the traditional cycle of violence that's often talked about has quite mutual language. I'm not quite sure how a honeymoon phase got into a cycle of violence because there's nothing more mutual really than a honeymoon, hopefully. And so we don't talk about a gradual build-up and an explosion as if it's some kind of pressure cooker. We talk about intimidation and standover and an assault and we don't talk about a honeymoon phase. I talk about it as a false remorse phase and I know that sometimes remorse is often seen as quite genuine and experienced as genuine but in my book if it was real remorse it wouldn't be a cycle because something would be done about it so that it didn't happen again. So that's it for the time being for me and I'm hoping a bit later to be able to talk a little bit about changing the language in the way that we work. Thanks so much, Kelsey. And Carmel, sorry, I'm distracted by... We're sorting out a technical issue, which is fine. What I wanted to also say, Carmel, was when you were talking about believing there's been a lot of comments in the general chat about male victims of domestic violence and while it is a lot less common it does still happen and I think sometimes men feel even more that they disbelieve, perhaps even more than women. Yes, I absolutely agree with that. I mean, I take the view that violence is not okay, that it's a choice people make to be violent and that if you're experiencing violence whether you're a man or a woman or a child then there ought to be a response that is respectful and hears you. Yeah, so I did want to just acknowledge that for the people in the participant box who've been commenting about men because we do care about them as well. Yes, I think the reason that we mainly use the female pronoun is because of the statistics. Yeah. So I'd now like to welcome Jack and Jack, you're going to speak to us about how a social worker might respond to Amy's situation. Thank you. Thank you and it's really good to be here. I want to talk about... I want to start by talking about the dual focus with which social work utilises. As Schwartz said back in 1960, we recognise that private troubles are public issues so that what might be impacting on the individual before us can be a socio-political issue. And I think it's really relevant to domestic violence because domestic violence, as Carmel has been saying, is about experiencing trauma, what can be known as the symptoms of abuse that have been listed very clearly so far in this webinar, but it's also a form of oppression. And so, for me, it's really important as social workers that we recognise not only the support to the individual herself, but also what we need to do to advocate for social change. Social work views the person in their environment and so therefore for me, we need to move away from looking at what is asking ourselves what is wrong with AME as some sort of individual pathology and asking ourselves wondering about what has happened to AME. I think the prevalence of domestic violence in women's lives means we need to be alert to the reality so that whatever area of social work we're practising in, we need, when we're supporting women particularly, we need to be aware that domestic violence is part of her lived reality so we need to be open to that. We need to be able to receive that information from a woman so she can feel able to disclose and we also need to be willing to explore this. And for me, what's really important about that is that it's done in a really safe and appropriate environment where the worker is aware, where is the perpetrator? You know, is he in the waiting room? Is he outside? What does that mean for her if she discloses now in regards to her safety? And I totally support what Kelsey said earlier in regards to the sorts of questions and how to introduce that conversation. Responding. How we respond to a disclosure is critical as AME has indicated in her case study, Feeling Blamed and Judged. In my experience of supporting women over many years, that is a really common experience. I think, you know, the good old-core conditions of social work, empathy, positive regard, genuineness, we need to believe, support and advocate. One of the things I find really important and this goes to Carmel's point in regards to some of the questions in the... that participants are asking about trying to understand why she may stay in a relationship or why she may return is for me when I first started working in this area to understand I needed to work out what her response to her partner's use of violence, what that meant for her and how she had managed that. What I've learned over my years of practice is women do respond to the violence, they learn, they manage it, they learn strategies and there are acts of resistance, as Carmel's alluded to, and those acts of resistance are particularly important. So as social workers, we work from a strengths-based model, we need to really listen carefully and look at what we can pull out from what can be a really horrible story to see where her strengths are and what she's done to survive and really challenge that notion that women are passive recipients of violence. One of the key aspects, of course, is utilising risk assessments and conducting safety planning. Risk assessment tools have developed considerably over the years and I think, you know, certainly in South Australia, we have a family safety framework which is across all agencies. I don't have time to go into details about that at the moment. But in regards to both risk assessment and safety planning, what I want to say is that the starting point needs to be that we respect Amy or the woman as the expert of her life. She may not have called it safety planning but she has been doing it. She will do all sorts of resourceful things to keep herself and her children as safe as she can. So for me in safety planning with a woman, I will always work out, you know, find out from her first what she's already doing. I might be able to give her some information that's useful but it is very much a mutual exercise. Which comes back to a fundamental point and one I think that fits really well with social work, that we walk side by side with the woman. We are alert to the power imbalances in the relationship in domestic violence that's particularly crucial because of course he has been abusing his power over her. So it's been a really disempowering experience. I think this work is the worst thing we can do is to use disempowering practice. And so that's something to be really crucial of and really respecting her autonomy. The final point I want to make is just in regards to the importance of recognising the impact of DV on the relationship between mother and child. It's a very common tactic that perpetrators use and she is often feeling like she's a terrible mother that if only she'd done things better, etc., etc. So I think workers need to be really aware of what they can do to strengthen the mother-child relationship and pay strong attention to that. I work from a trauma lens and I have to say when I first read Judith Herman's Seminal Work Trauma and Recovery first published in 1992 it was a bit of a life-changing moment. There's a particular chapter in that entitled Captivity which I feel gives a wonderful explanation in regards to understanding the trauma responses of the experience of DV. So if you want to understand why women do what they do read that chapter. I also find using a narrative therapy approach can be very effective in working with women. Narrative therapy, it fits really well with social work values, principles and practices. It externalises the problem from the person which is crucial because so often a woman will feel that she used the problem because he's told her that for a very long time so just that externalisation can be a really useful starting point. It also has a strong focus on what meaning she's made of her experiences which I think really works in this context. And what narrative therapy is interested in is exploring that problem saturated dominant story of her life which is very much the story that the perpetrator has got into her head. But it's seeking out what we call unique outcomes which are those acts of resistance I've mentioned to build up the woman's alternative story. So you start with this really horrific problem laden story where she feels horribly responsible to blame, her self-esteem is extremely low and you can work with her over time to recognise her strength, her acts of resistance to build another story that actually has meaning for her life where the perpetrator's held accountable and she's free from that sense of blame. My last comment is in regards to collaborative practice. I want to make the point that domestic violence is a pervasive epidemic issue. It's a political issue. It is not an issue that one worker or one agency itself can attend to. So we need to work together. We need to work across agencies. And to do so we need a shared understanding of domestic violence. We need to understand it is an abuse of power and what that means that it is an experience of trauma and working from that trauma-informed perspective. And we need to have a shared purpose which I think needs to be about the woman's safety and autonomy and about the abuser's visibility and accountability because he often gets ignored. Advocacy is crucial both in regards to directly for the woman herself but also in regards to systemic advocacy to improve laws, to improve service responses. There can be times when it's frustrating and so I think something that we call institutional empathy can be important to let so that you know where the worker from that other service is coming from and that can help build some trust and rapport. And just one quick mention, to experience domestic violence is to almost inevitably involve legal processes. They're really intimidating. There's huge power imbalance. It's very hierarchical. So I think it's crucial that the woman is supported through to navigate those processes. Thank you. Thanks so much, Jack. Look, I'm really pleased to note that the panelists are covering a lot of the topics which people have submitted in their questions before the webinar. So I'm going to spend a little bit longer. I'm not making people hurry up in this section because you're actually answering a lot of the questions people have and this is just so useful. So thanks so much, Jack. And finally, I would like to welcome Amy to speak to us about how things were for Amy. Hi, everyone. I've just been trying to answer lots of questions there. So thank you for all those brilliant questions for the panel. That's fantastic. I guess my first slide we'll go into is understanding the dynamics. But obviously Kelsey's covered this off. Thanks, Kelsey, for that. But obviously understanding the dynamics and the background to what is domestic and family violence and knowing that it comes from a perpetrator's desire for power and control. It's not just a one-off incident where someone's been angry or the woman has said something to make him angry in those kind of victim-blaming conversations that we'll discuss on the other slide. And it covers psychological, emotional, social, physical, cultural, sexual and financial abuse. So we've got on the next slide the Duluth Model Wheel which some of you will be familiar with, I'm sure, the Power and Control Wheel. Do I have to come over here? Thank you. Okay. There we are. So I won't obviously go through all this right now but with the Power and Control Wheel and I love what Carmel had up as well, obviously using intimidation, emotional abuse, the isolation, using the children or pets against them, threatening children and pets, economics of financial abuse. And it's that walking on eggshells as part of that as we explore the honeymoon cycle before but also walking on eggshells, so using the Power and Control. Sometimes for women in GD it can just be a look. So women might present without physical injuries at the time to a GP but it might be the emotional abuse that's happening in the psychological breakdown, psychological abuse and just a look that the perpetrator gets to indicate that that cycle of violence is coming. Next slide please. Yeah. I'll see you up here. This is quick. Sorry. Okay. So real time stats. With DV homicide, DV is actually the leading cause of death and injury in women under 45 in Australia and that's pretty full on and two birth cancer, variant cancer and other illnesses. Currently one woman in Australia is murdered each week by her counter-former partner. We've actually got that at 13 deaths in seven weeks in Australia. So when are we at two deaths a week as a result of DV homicide? And obviously we've had children dying at the hands of a perpetrator as well. So we need to really address this and take these stats quite seriously when it comes to assisting and supporting women and children through this pathway to safety. Again with safety planning, a lot of refuges and DV services and emergency hotlines will help with safety planning, which is really important. A lot of people think it's easy for women to just get in the car and leave but there needs to be safety planning around that. The most dangerous times for women are actually when she's pregnant and when she tries to leave. One in three is shown women with physical violence since the age of 15. One in four is shown women with experienced emotional abuse since the age of 15. Hence why it's so important to go into schools in my opinion and start addressing these issues quite early. One in four is shown children who witnessed DV against their mother or their mother. And again, these are only reported statistics. So in my opinion of the children and the women I've worked with over the last nine years, I believe it's a lot higher than one in four children. DV actually counts for 40% of police time and the cost here is shown economy is $13.6 billion per year as they're getting worse. So let's talk about some helpful interaction and responses. So the first point I want to talk about is treating holistically. So for example, if a woman presents at a GT's office for a broken arm, it's not just about treating the physical. It's also about addressing emotional trauma sustained and then not adding to the financial stress but also perhaps dealing with the patient if she's requested to be bulk-billed because then again that impacts on the financial abuse. It can impact on perpetrator knowing that the woman has access to the GP as he can see on a bank statement that she's perhaps done an F-Post transaction at the GP to pay for the consultation then he will say that she has gone and got medical treatment and that will then lead her back into the cycle of abuse. So I guess addressing all aspects of DV affecting the victim and seeking to refer to other health professionals and maybe onto a community service agency or onto a police, onto a DV service to completely engage her in that system so not just treating that broken rib or arm. The biggest one for me and I really need to drive this time is avoiding dialogue that victim blames and shames. So I know beforehand Kelsey touched on some really helpful and positive dialogue. So people in general, family, friends, people at the shop, doctors and anyone in any sort of industry can see someone with an arm that's hurt and say, what did you do to yourself? What happened? But when you've got a woman where you suspect DV is the case to actually say to her, what did you do to make him angry is really inappropriate. A lot of women are going through victim blaming and shaming themselves and feeling that they've done something to cause his behaviour but taking that away from her and not saying, why don't you just leave actually using phrases that allow exploration of her decision making and choices which she hasn't had to this point. So perhaps asking, would you like support to make an appointment with a legal service? Would you like me to ring a DV service for you here? Do you have a trusted GP? You can see if you're injured. Fulfilling your role in the present with a future focus. So as a GP, you might treat a physical injury and address emotional trauma with a referral or any depressants. But think ahead to the evidence that police might need for a possible criminal charge and making sure you take comprehensive notes but those notes are legible that you've outlined exactly what you've seen. You know, supporting her if she wants to report to police ensuring that perhaps she has one of her friends or family member or someone taking photos of the injuries. Ensuring that in a timely manner like supporting her to see the police so they can get evidence again of those injuries. So thinking about the future and what is it you can do now to help her to ensure her safety and shorted that the perpetrator is held accountable. A boarding dialogue that minimises the impact of DV on the victim during your disclosure. So again, not sort of saying you'll be right, that'll heal or I've known John Say it is. He's a good bloke. He just gets like this a bit when he's drunk. So not minimising the behaviour of the perpetrator. Maybe saying to him, have you talked to a DV service for information to ensure you and your children are safe? Using dialogue that helps support them to get to safety. Also ask the victim what is it that you need right now like how can I assist in helping you and listen to what they say. Sometimes it's all they need is just to talk and they need someone to believe them. Who's going to receive the information and help them to do something about it. So really encourage them to seek support. Mental health. So care plan or plan to deem the victim an unfit parent. So obviously there's a mental health care plan. There's a little difficulty in consistency of engagement to the victim. So if I've only got sort of 10 visits within that frame, it can be difficult if they're actually navigating their way at the time through the legal system. They're actually going through property settlement. They're in a refuge or getting back out in the community. They're trying to relocate their children to a new school. They're looking at DV orders at criminal. The criminal legal process can take up to two years to get to court. So a DV order civil law if they breach it or the police actually take enough action in the first instance and there's enough evidence to support a criminal charge then that will still take two years to get to court. So it's a long time as a woman to be going through that process. And so if she's engaged in mental health care plan a lot of the time to the historical context you'll be dealing with the issues here and now that are presenting. Also the affordability around the mental health care plan. So many psychologists are still charging a big gap which is really unattainable for victims who've experienced financial abuse and having to perhaps relocate or be re-employed and seek seek employment. And it's also difficult for them to get to appointments if they are on a job full time. So also finding the right counselor or psychologist for them. The reason I bring up here is that if you're dealing with a victim and an unfit parent some of you are probably thinking what's she talking about. But when we talk about mental health I think we're talking about it here obviously from two perspectives. We've got a perpetrator that might claim mental health in a court environment as a defense or justification for their behaviour and for their abuse. And so then when you've got a victim who's been diagnosed with mental health they might find that they're not comfortable with that diagnosis. They don't accept the diagnosis because they've got a perpetrator in court stating that they've got mental health and that's why they're abusing their victim. So they don't want actually to link with that. There's also the issues around perpetrators using the patient's mental health against them to intimidate them emotionally and physically. So if they're still residing together it can be that the perpetrator knows that the victim is taking prescription medication perhaps so engaging counselling can start using emotional abuse and calling them a psycho and telling them they need to take their meds and making all these sort of derogatory comments to further continue that emotional abuse. There's also society's misconceptions around mental health and the victim feeling weak and also concerned and doubtful how they live with mental health conditions not having it completely explained to them and also for practitioners to look at the reason of why is the victim presenting with a mental health issue because they've been traumatised and victimised. And also with the perpetrator seeking access to the children in court they will often try to then use a mental health against the perhaps the mother who's the main primary caregiver for the children in order to gain access to make her look like she's an unfit parent. So that's why victims will often really avoid continuing on participating initially in mental health programs. So we've talked there obviously about why the photo flight response and if any of you get some. And there we go. I have heaps more to say so I can't wait to ask me anything else. I think I'll get back to the general chat box. Thanks, Mary. Thanks so much, Amy. Now I know that you had what do we invite Kelsey back in because we weren't able to see her before but we should be now. So I know that you had a question for Kelsey around the way that professionals train their workers and that you're quite passionate about the training that goes into professionals. So I wondered if you wanted to address that question to Kelsey. Oh no, we've lost Kelsey on camera again but she's still on the telephone so please just ask her and she'll be there. Okay. Hi, Kelsey. Hi, how are you? Good. Someone will be able to see me eventually. Kelsey even said that she combed her hair. Yeah, I did. So anyway, Amy, please go ahead. Kelsey, my question's quite lengthy but here it is. In a changing world where society deals with increased substance abuse, unemployment, Stevie-related deaths and disability coupled with a very weak justice system, how do we encourage the university, the medical bodies and the medical fraternity at large to commit to annual and ongoing domestic and family balance training and to recognise the pivotal role they play and the responsibilities they have as frontline responders in the treatment of victims? It's a great question and one that I am obviously passionately trying to address. I think there's an interesting thing to think about that the College of GPs has done amazing work. I've surveyed all the medical schools to try and see how much they do on domestic farms and it's on average less than three hours in the whole medical course. The nursing course and the psychology courses and some of the social work courses and some of the psychiatry courses are exactly the same. My experience of all mental health professionals and general practitioners is that the vast majority of them have not had specialist training. Maybe not the people who are online tonight but generally. We have a major problem that child abuse tends to be taught but confronting domestic violence safe to safe does not seem to be. And I think that there are ways of doing it. I like the UK system where child safeguarding training is mandatory rather than mandatory reporting and people are making mandatory domestic violence attached to that child safeguarding. So it's us joining together and lobbying but the problem is different people control a different training program. So certainly as I said the College of GPs we're doing an enormous amount of training. So we are trying it's just hard to make it mandatory. May I actually ask another question Mary I'm sorry for this one to me of Kelsey. So I understand when we talk about mandatory reporting and child safeguarding and I have obviously my sense I'd like to see mandatory reporting but okay so tell me this thing if a woman's pregnant and she's presenting to the hospital and she's got evidence and I've got a history case file of DV happening why is it not reported then because there is a child involved when she's pregnant? Yeah so some of the law includes that the unborn child and some don't and they vary across the state and I completely agree with you I think the issue is also our child protection services and that's the great difficulty they child protection services tend to ignore the fact that if the father's being violent towards the mother that that's detrimental to the child. You know it's drowning but it's the fact that when I try and say report to child first here in Victoria and then to child protection because of emotional abuse and neglect because of what has been happening with the mother and the father and then they separate and then the father uses the children as pawns it's just not seen as able to get up to the limit where it will be taken notice of compared to severe physical and sexual. Kelsey thank you both for that I'm just going to continue with Kelsey there is a lot of discussion in the general chat and in the questions that came in before about how do we help children in this situation and there was one specific question we've got some lawyers participating as well so there's some lawyers that are really passionate about trying to do the right thing by victims of domestic violence as well and how can courts sometimes grant the father of the child has access to the children as part how can we support women who have to release their child to the person who harms them for custody I mean it's perhaps a bit specific but Kelsey if you have any general comments about protecting women yeah yeah look this is this is this is something that is passionately an issue for me because I have to support the women and the children can people see me now support the women and the children when the child is having to do webcams with a father on a regular basis have to go to the father comes back very behaviourally disturbed and I think that you know the current Royal Commission in Victoria needs to really fix the family law system where any dads are good enough dad even one who's abused the mother I think that this is an area that breaks my heart the most is watching women have to send their children off to perpetrators of violence against them but often perpetrators of abuse against the children and it gets suppressed in court the women are told not to bring up the family violence thanks Kelsey they really are told by lawyers not to bring it up because they will look like an alienating parent yeah and so I'm not a lawyer you know I'm sure the general sats going mad but it's a really major issue so look Jack I think this has been an appropriate point to bring you back in as a social worker if you had any comments about children and justice it is I've spent several years actually working in women's shelters and so I've seen firsthand as well as the research what happens to both women and children through family law processes and for me I can only agree with what Kelsey has said when a woman and children you know they would come into our emergency accommodation they would be housed we would see I mean the first step to any recovery the first step in any trauma process is safety and without safety healing and recovery is very very difficult when a mother and children are required to continue to interact with their perpetrator that really difficult we also need to appreciate that separation is the most dangerous time for women there are more fatalities DV deaths shortly after separation than at any other time so just because a woman has left the relationship does not mean she's safe the number of times that I've worked with women who have been told by child protection they must leave or they will be failing to protect their children they leave they come to a DV service he goes to the family law court they then have to on their own as it's a civil matter try to to present why they have concerns around further contact and interaction with him they are told by lawyers not to say and there's a lot of research evidence to support that and we've got a long way to go before we make that safe and that is detrimental to women and children so I'd like to bring you to Carmel as a psychologist how can we support women and also children who for GPs psychologists social workers we'll see children as well and adolescents I just wondered if you wanted me to talk about about yeah happy to do that we have some programs that support children and children inevitably are impacted they can feel sad helpless guilty frightened and in fact a family court sometimes one of the issues is they're not believed and often not heard in family court and so as Jack says they have to keep on having contact with someone that is frightening and often dangerous so I think that safety is certainly paramount we can't always ensure their safety depending on what the family court orders are we can do our best I absolutely believe children have a right to be involved in decisions often when they're quite young and also that assessment and support of children needs to change over time because level of risk changes over time and their capacity and ways of responding change over time children vary a lot in what they well they will say who they will tell what they will tell and to whom and so I think probably what's best is for as many of us we can to what we're hearing from children and be as gentle as we can in exploring what are often just labelled as behavioural difficulties and in many instances our parents behaving badly so where possible we check safety and assess the risk and try to do that often with the help of the child and with the protective parent it's often useful to find out who else is involved with the child and whether you need to talk to them it's important to be clear about your role I think some workers are mandated some are not some are able to put some things in place and other workers can do other things basically I guess if you're giving children a message the messages are that violence is wrong that it's not their fault that there is not an excuse for a grown up to hurt them there may be an explanation but an explanation is not an excuse and whatever people say to you if someone in your home is hurting you or hurting someone else in your home it is not your fault and the other message is that they're not alone that there are people who can help and to what helps encourage that is really the sorts of things that Amy was talking about in terms of being non-jumped mental really hearing not being afraid to ask the exploratory questions in a non-threatening way and empowering kind of way children often need reassurance that what they're feeling is normal it's very common for children to believe that violence is their fault in the same way that even with separation where there's no violence children often believe they've had some part in the breakdown of their parents' relationship so saying something to a child like well you seem to be looking very sad or this is a really hard thing to talk about isn't it even to say you know I'm a bit worried about you would you like to talk about it I care about you I'd really like to be able to help children know better than anyone often whether it's safe or not to talk and who too and so it's about keeping the door open if you like to their conversations they might be willing to have even if they don't disclose to you if they've had a positive conversation where they haven't felt as if they've been shut down or judged or whatever it may mean that you can't do something but they will be more likely to talk to someone else in the future when they feel a bit braver or are more able to do that often there are enormous threats made to victims and to children about what will happen if the truth is told and so it's just a matter of trying not to react if you like to the bad behaviour children's bad behaviour is like a barometer of what's happening for them in their life Thanks so much Kamala what you were just saying then about there was a lot of questions from the participants about other groups not just children but adults who are in other ways disadvantaged so deaf people culturally and linguistically diverse people transgender people Aboriginal and Torres Strait Islander people and I think that being able to say even you know is anything happening to you at home that makes you frightened and they might say no everything's fine and then you can say as you just talked about for the children to say look if anything like that does ever happen to you you are really welcome to talk to me about it and you will not be judged in your safe here and I think just making people know that you're a safe person to talk to and giving those messages that is never okay may even be new information to some groups you know some of the behaviours that we know and not okay might even be acceptable in some of the environments that people have come from to just giving that good health information so important Kelsey I wanted to bring you back in because I know that you had something more that you wanted to say about working with children and I think you might have your camera welcome I don't know where the people can see me but I think I've been working with Anita Morris who's a social worker and she's done a PhD where she's worked very closely with mothers and children and talked to them about it and the things that assisted their agency or their ability to feel more empowered the children is obviously some of the things Carmel's been talking about but also there needs to be not just talking about it between the mother and the children and I've just put a resource by Kathy Humphries on the general chat particularly but some awareness of you know that there's something wrong that seems to actually be a prerequisite for the children getting agency secondly I think it's a distance from the perpetrator and that might be emotionally or physically like if people move states or whatever but also if they can be helped to emotionally distance themselves from the perpetrator and the third thing is having a sense of family resiliency so encouraging such as you know just rituals and meals and co-constructing of families so you know many of these things are then used in a trial of between the practitioner the GP she was looking at and the child and the mother for so many times we only get the mother's perspective on the child rather than looking for the child's support Thanks Halcy Amy I'd like to bring you back in we're sort of progressing on from children I wanted to talk about what's been in high school and particularly around promoting respectful relationships I have been really alarmed in my work with adolescents about what kind of behaviours young men and women think are okay and I think that personally I think things have gone backwards since I was at high school in the 80s in regards to what women think is okay young women so I just wondered if you'd like to comment about adolescents and violence in relationships I guess we've got it and similarly when I was in school in the 90s we're showing at age now you know we've got now so much more desensitisation to violence so we've got online video games you know everything's online we've got iPads we've got mobile phones we've got billboards all around us at bus stops and we're driving along and there's so much more sexualisation there's so much more violence on TV every TV show you turn on the news there's more violence and when you've got children who are being unsupervised it's up to them to make their own decisions about what they're watching on TV and what sort of online media they're engaging in and what gaming they just become really desensitised and we're living in a very different age when you and I went to school and so again you know we've got even books that say that this is what boys want or this is the attention and you know trying to talk to them about self-worth and self-respect and that no sets and boundaries nobody ever taught me about boundaries and it wasn't until after I went through my experience in working actually for a TV service that one of the workers actually started speaking with me about boundaries and that was so imperative and for me to take that and develop one of these shibble roots and one to support those lovely things and then they're sort of not knowing they don't have a great role model you know with a lot of broken families now I mean one of them so you know children if they only have one gender of a role model it's important to engage children with other role models of the opposite gender so they can develop qualities do you want in someone that you start dating and do you think there's a time when it might get dangerous so when would you raise a red flag and you know come and talk to you know your best friend or maybe not mom that it might be somebody else they trust and really having a discussion with them because things have changed immensely and you know as a parent myself I've got a preteen you know I guess even out of those basics that have still been around since you know 60s and 70s but we've now got to handle a really violent society and also where the violence is basically if I can use the word tolerated because our justice system isn't that it's a legal system so it's not actually holding perpetrators accountable it's not it's demonstrating that you can do that and get away with it and so then there's no repercussions for these children to see that they're not actually seen that that behavior is bad but they will face repercussions for that and Amy how can schools help convey those healthy relationship messages and how can they support young people who are experiencing violence well I mean there's quite a few online resources I should have actually tried them in the resource sorry but you know they can look up respectful relationships and look up different there was a Love Bites program actually just looking at resources and getting someone in to speak you know who's doing respectful relationships and delivering that program I think it's a lot to rely on teachers to specifically deliver that Mary I think when perhaps they may have had their own experience and not comfortable talking about it they may not be really aware of what DV looks like and you know may not feel comfortable having the time to plan a lesson around that so getting a guest speaker in to deliver that and getting some resources online you know it's even talking to the local police station to a DVLO a domestic I was an officer and asking them what sort of you know resources they've got as well but online safety about you know personal safety because that all forms a part of it you know with now a CV and dating relationships you've got online bullying and cyber bullying as part of the stalking so they're not treating you right or you worried about your friends you know come and talk to someone or find someone you trust to talk to and just encouraging them to have just have an open door I always have an open door whether it be the teacher or the chaplain or the school council just keep an open door for those kids to come and talk to someone Thanks so much Amy I know Karma I wanted to bring you back in because I'm aware that your organisation has just launched an app exactly on this issue so I just wanted to we're going to give you the opportunity to talk a little bit more about the language that we use and I'm we're sort of in the last few minutes but Karma if you want to talk about the iMatter app and maybe something about language just waiting for Karma to come back on to the in Yeah you have Wiles Aurora and in Victoria Live Free the iMatter app is an interactive app that has a library of images and video clips and articles and quizzes and it was designed for young people and we consulted with a lot of young women and it's really to encourage them to have positive conversations about relationships and to have a good sense of self-esteem so that they will understand boundaries know when they're crossed be able to know how to get out if they're being hurt in a relationship not be mistaking and protective behavior and where it is in fact controlling and moving towards abusive behavior so iMatter's that's what that app is about and briefly about language I think really if I had to make one point it would be about following on from the domestic violence cycle it's about being aware of the mutual language that's often used in relation to violence and when I was reading the paper last week there was a report of a murder that had been the result of the domestic dispute which is a ridiculous thing to say a dispute is a mutual thing and should certainly not end in murder and all those examples that Amy was giving like you know what do you think was your role in the violence for instance or how long have you had these kinds of marriage issues that sort of thing is very mutualizing so I think that what it does is it lets perpetrators off the hook so mutual acts entail consent nobody can sense to being a victim of abuse even though they may be still there they don't want the abuse to happen and that's why the language of resistance is so important and I think we often underestimate resistance and we have more and more included that in our group programs and in our individual work with women on the lines that Jack was I guess referring to so that we kind of assume if you like that to resistance will occur and what it does is it's an indication of an inner strength it's an indication of a capacity for resilience and tapping into that can help women realize that what they were doing although they appear powerless they actually were standing up for themselves in some way we don't mind if it's spitting in some way of I don't believe what you were saying about me I'm not taking on that assault on my sense of myself so I know we're running short of time but if you follow on from the you know my first point which is that recovery is about dignity dignity is at stake when there is violence and it is so linked to a sense of self and recovery is linked to a sense of self it's very central to us and our well-being and recovery the other thing is safety I'd just like to make a point about safety I notice in the general chat a lot of people have been talking about that and we probably haven't paid enough attention to it but safety is absolutely crucial and this is one of the reasons why the whole issue of family court placing children with people that have been abusive even if they supposedly only abusive to the one parent it's very difficult for people to recover when they are not safe you know they do recover but it's more slowly they the recovery is interrupted or compromised if you like I don't think that we're very good at drawing the line as to when someone forfeits their right for a relationship with a child because of their behaviour Carmel thanks so much is there just one more comment you'd like to make a couple of minutes over because we started late so just if there's any final point that you would like to make I suppose what I'd like to say is that I'm very gratified to see that there is such a you know an evident shift in terms of the community taking notice of this issue I think that we've come a long way in my career in terms of supporting women and different kinds of services and knowing how to be supporters but where we've still got a long way to go is making perpetrators accountable and I think that we're way way behind on that and that's in a general sense in the community and it's in a specific sense in the courts thanks so much Carmel and I'd like to just invite Jack if there was any final comments that you wanted to make thank you I would just like to reiterate what Carmel said and I think you know at the moment particularly it seems in a political sense that domestic violence has been talked about a lot and absolutely fantastic that Rosie Batty was given Australian of the year but when we drill down there are still you know how the system actually operates there are still so many barriers that women and children face that we need to overcome I think it's fantastic to have this conversation tonight and to look at the general chair and to hear so many people saying similar things so I think you know in regards to social change there's a lot more work to be done thank you thanks Jack and now Kelsey I'd like to welcome you in to say a couple of things and I know you had something specific around perpetrators yes I said in the general chat because people have been saying why aren't we doing or trying to intervene with men and I think general practice in particular and drug and alcohol settings and mental health settings often see both partners and we're developing up an early intervention with perpetrators and I think that this is a direction that we're going globally where you know can we have conversations with men who use violence in relationships to try and turn that around because otherwise you know we're always working with the person that it you know is on the end of this thanks so much Kelsey and I guess it's something that working in early intervention with young people that we're also keeping in mind that people that might be troubled themselves may have grown up in environments where we're always what's happening and helping them to become less likely to be perpetrated in the future is also something that I think we keep in mind as well as helping them to recover themselves. Yeah so and Amy I would like to invite you just to say a couple of final comments. Sorry I was just typing thanks to someone, Holly. Look I'm just really really feeling I've got my little dog who's come to visit I'll pick him up so long as I can see because people mentioned pets before and this is an RSPCA dog who went through abuse so he's he's our little baby. I'm just really honoured to be a part of this panel tonight and I know there's been there's been a lot of questions out there in regards to men and men experiencing violence and I certainly do I am aware of that I have worked with men who've been through DV and it has taken them some years to finally disclose. My biggest concern going forward I believe is the children that we need to do more work to to educate frontline services but also to to really ensure that the next generation you know have a big stance on this and that our judicial system has changed and that we have you know more work is going into the area of psychology and social work but with a DV framework and a DV interest so that we can help them. I think definitely education schools need to continue and again you know my biggest thing is just to help support women just to ask them what is it that you need because for so many years or months have been in that relationship no one has asked them about their needs and their wants and their needs haven't been met and you know unfortunately they haven't been able to think for themselves you know women are psychologically abused for social isolation psychological abuse happens before the physical abuse so when they're worn down and they're feeling weakened it's very difficult to make decisions power and control is exerted by the perpetrator they're not able to make their own choices and sometimes they look to the police to make their choice for them and you know take them to safety or take out an order they look to a doctor to you know to intervene and help them so very often it's they're looking outside of the home for other people to make a decision and take them to safety and I think you know if you've got someone presenting a finding you suspect DV just ask them like how do you know if there's anything I can help you with you know what is it that you need right now that I'm always here and my door's open I think doing that friendship that trust that relationship I'd say friendship if you're a neighbour to someone it might just not be someone you come across in your work but there could be someone that lives next door you might be someone that you work with DV doesn't discriminate there are lawyers and psychologists that go through this every day and each state government do up DV safety cards with local area numbers and also if you ring the you know DV Connecting Queensland or the 1-800 National Hotline which is in the resources that you should all get or even if you know your local police station go and ask them for some DV safety cards and have them there for women to be able to take them if they're not wanting to describe maybe they'll just be able to take them to the police but for your colleagues as well I could talk all night now I'm going to be quiet now Thank you so much and look I particularly appreciate your contributions in the general chat so I haven't actually been able to look at it myself but I know you've been busy and I know that the participants really appreciate it so we had up to 730 people on tonight and I just would like to take a couple of minutes to sum up one thing I wanted to say was we haven't addressed well look a lot of things that people raise we just could not as usual have a discussion and we can't get more in but vicarious trauma is really important to remember so if you're working with people in these situations as any kind of worker in human services or a lawyer or a teacher these can have a big personal impact on you and I really encourage you to know that that's to be expected and it's not okay for it to really distress you and you need to seek support for that but I don't think any of us is immune to vicarious trauma because some of the stories we hear are so awful and we need to be human beings in order to be compassionate and responsive that is going to have an effect on us we do need to seek support for that but please I'd encourage you to seek support from colleagues so I just wanted to encourage you that if you would like to set up your own special interest network around this the MHPM can support you to do that or you can inquire about joining an existing network exploring family violence when you hang up tonight you will get an exit survey or before you hang up which really encourage you to fill out the exit survey MHPM makes decisions about future webinars based on the feedback from the exit surveys and other places please feel welcome to join in future MHPM webinars and also including the iMatter app link will be available in the resource document and our next webinar is working together to manage substance use and mental health issues and that's later on in March so once again thank you all very much for your participation and we look forward to seeing you again in another MHPM webinar good night everyone