- A lot of my clients say,
all these professionals tell me
that they will do anything they can to help me.
And then when I ask them about housing,
or about a bus pass,
or about medication,
they say, "Oh, that's not something we help with."
It's not our job to do everything for everybody.
It's our job to do the thing
that is within our scope of practice
and then to advocate and connect people with other services
that can do the same thing.
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- What do you see first responders
and health professionals doing wrong
when they spot the signs and then go into the next step?
- So I think especially with underserved communities,
or marginalized communities,
we have a tendency to impose our own values
of what relationships are supposed to look like.
And so we kind of erase cultural norms.
And for example, if we think about gender equity
in relationships,
that's not the case for so many traditional
or cultural groups.
And so just because a woman's role is in the home,
and usually is a more quiet or a subservient role
doesn't necessarily mean that she's being controlled
by her partner.
And so we as health professionals and as first responders
need to hear people as they're saying it,
as opposed to assuming that relationship dynamics
are problematic.
So that's number one.
I think the other thing is to really think about
how do we get information from our clients
in a way that we're building that trust?
And it's hard
for both first responders and health professionals
that have a very minimal amount of time.
And so being careful to not come across as judgemental
or to really just not be judgemental,
because usually we come across as judgmental
when we are being judgemental.
And so being able to recognize
what exactly we're trying to ask someone
and being thoughtful about the words
and the language we're using,
and not making commitments
that we can't follow through with.
- Hmm, big one.
- A lot of my clients say all these professionals tell me
that they will do anything they can to help me.
And then when I ask them about housing,
or about a bus pass,
or about medication,
they say, "Oh, that's not something we help with."
And so if you're going to commit to helping someone,
make it clear what that context is,
what the limitations are and help them find other services
that can help with the things that you can't help with.
It's not our job to do everything for everybody.
It's our job to do the thing
that is within our scope of practice
and then to advocate and connect people with other services
that can do the same thing.
One of the tricky things is because I'm human,
and because we're all human,
is we, again, impose our expectations.
And so if someone is not ready, or willing to admit it,
or acknowledge it,
then it's my role to call it out or convince them.
And so instead it's about working on the things
they're coming in with
and continuing to build that relationship.
And maybe at some point they will feel safe enough
to say something about it,
but if they're not saying anything about it,
that is a way that they are protecting themselves,
and that is the way that they are exerting their urgency.
For me to take that away,
or make assumptions about them
is to continue to perpetuate the same kind of violence
that their partner is perpetuating.
- What is their next step?
- One of the most important things is to find out
what the person sitting in front of you needs from you.
And so it might be, get me out of here.
Usually it's not,
unless someone is explicitly telling you that.
Usually it's not get me out of here.
And so the first thing
that any health professional or first responder can do
is recognize their own bias,
recognize their own need to save people,
or get them out of bad situations.
And so being able to take a step back
and really hear what that person needs from you right now,
and be able to serve them in that way.
- So how do we do that?
How do they do that?
- Ask. - Ask.
- Sometimes we're so afraid to ask the questions-
- We are, aren't we?
- And if we suspect intimate partner violence,
or even if we don't,
we should just be asking
the same way we ask people about suicide and self harm,
we should be asking about whether intimate partner violence
is a part of their relationship.
And so if we ask the question, we get an answer.
We might not always get a straightforward answer,
but we might.
- But what is the exact question to ask?
- Are you experiencing intimate partner violence
in your relationship?
It can be as simple as that.
You're not going to offend anyone.
- And when you've asked that to people,
what are some of the responses you've gotten?
- They come in all shapes and forms.
And sometimes it's, "No,
my partner is this and this and this,
but we work well together,"
or, "I love him and he loves me,"
and that's kind of the end of it.
And sometimes it's I've often wondered about it,
but I'm not sure.
And I've heard other people have had much worse experiences
so I don't think mine is actually abuse,
or mine is not a big deal.
And there's a lot of that that comes up.
- Do you get the people who say,
"No, and for you to ask that is so insulting and so rude?"
- Absolutely not. - No!
- I've never heard that before.
- Wow!
That's I guess good news.
- It is.
And I think that is the fear.
It's the- - That's the fear.
- Fear that someone is going to come at us
with that answer, even if they do, life goes on.
But the likelihood of someone
actually having that kind of response is minimal.
- Right.
Especially if you've taken the time to look at the signs,
get the education that you've provided
in the previous sessions,
you're coming from a space of education
and compassion as well.
So when they ask that question and they're,
I'm kind of looking at their responses in two buckets.
They'll say, I'm fine, I don't need anything.
Or they'll say things aren't great,
and I could use some help.
Would that kind of be accurate
on the two generalized buckets?
- Yep.
- So if they answer from the first bucket
of "everything's fine, thank you for asking,"
what should a healthcare worker respond or do then?
- What the person came in for?
- Okay.
- It's fine to ask at a later date as well.
But if the person came in for a physical, a checkup,
a vaccination,
do the thing that they needed you to do.
If someone is looking for housing,
help them with housing,
we don't know the repercussions
of helping someone find housing.
- Now, if they come from the other bucket
of, "yeah, this has been really bad.
And I just don't know what to do."
- Then asking them what you can do for them.
What kind of support to do they need?
Do they need to find a lawyer?
Do they need to talk to a police officer
to understand the laws around reporting and charging?
Do they need someone to help them find housing?
Do they need a bus pass
so they can go to appointments
without being watched all the time?
Whatever it is that we can help.
Usually these things are more practical in nature.
Usually it's not about counseling,
or mental health at that point,
because if people are in survival mode-
- That's right.
- They're not ready. - You gotta get 'em safe
before you start asking about their childhood.
- Exactly. - Right.
So are you asking, what do you need,
or are you suggesting, do you need this?
- Asking what they need.
- Asking what they need. - Yes.
And it can be a conversation.
So it might not necessarily be that they say,
this is the plan as I need to do all of these things for me,
but it might be, I don't know,
and then it can be a conversation.
And so we don't need to be afraid
of having those conversations,
and we can't expect people to know
exactly what they need to get them out of a situation.
If they knew how to get themselves out of the situation,
whatever that ends up looking like,
they would have done it themselves. (chuckles)
- You know what's so interesting to me.
You're absolutely right.
And what's so interesting is I learned through MedCircle
that it is completely not only appropriate,
but beneficial to ask somebody blatantly,
are you thinking about killing yourself?
If you believe they're in that space,
because you're not gonna put the idea in their head
and you often get a very truthful response,
and you can save somebody's life
just by asking that question.
But I didn't take that same methodology or thought process
and apply it to something like domestic violence
or intimate partner violence,
where I wouldn't have felt comfortable asking that
until you just told me it was okay to ask.
If I had a friend who,
if I believe that, then not,
if it was a close friend, I would probably ask,
but if it was an acquaintance or something,
we were in that space, and I got the vibe,
I don't know if I would have been comfortable asking that
until you just gave me permission.
What else can people do besides asking that question?
- Asking about safety,
asking about respect in the relationship,
asking about whether the person feels they get
what they need from their partner,
and then being able to kind of process that with them.
And it's not about embedding our own values
of what a healthy relationship should look like.
And I think that that's something that
we all run the risk of doing.
Well, if he says that to you, that's disrespectful
and you should probably think about
not being with him anymore.
That's not our job.
Our job is about understanding the person
in front of us perspective
of what they need from their partner,
and then helping them figure out
whether they're going to be able to get that
from their partner,
and if they're not, what are they going to do about it?
- Final words on what to do
after you've spot the signs of potential IPV,
and those next steps.
- One thing is safety planning.
And so that's figuring out
what the individual needs to feel safe
in this situation.
And depending on what types of violence are occurring
within this intimate partner relationship,
that can include things like who do you call
when things escalate,
and you don't think you're going to be able
to get yourself out of the situation safely,
or it could even be things like,
where do you go when you just need some time to calm down
and get your mind
in a way that you can go back to that relationship
and deal with the escalated problem.
And so safety plans can be just as diverse
as the people who are surviving intimate partner violence.
- And who creates these safety plans with them?
- It should be a collaborative effort
between either the first responder or health professional,
and the survivor.
- So anybody? (chuckles) - Anybody, yes.
It's something that someone doesn't have training
and they should probably get training in it,
there are lots of templates online though, consults,
and have a good understanding,
have a solid understanding.
And also knowing risk factors is really important
because if you don't know the risk factors,
your safety plan is probably not gonna be
where it should be.
- Do you see a lot of patients
who now are struggling with post-traumatic stress disorder
because of this ongoing violence?
- Absolutely.
So most of the individuals that I work with right now
who are surviving intimate partner violence,
or who are survivors of intimate partner violence,
that violence started
from way before their intimate partner relationship.
So lots of childhood trauma,
neglect,
lots of substances,
trouble with the law.
And so that PTSD is not just PTSD
due to that single incident of violence,
or that single relationship.
It's a history.
And so again, what that ends up looking like
and how ingrained that is in a person's perception
of themselves and the world around them is so deep.
- Really great conversation today.
Thank you for being here. - You're welcome.
- All the way from Canada,
our international doctor, Dr. Taslim, thank you.
Thank you for watching this series.
I hope it's been enlightening and insightful.
I'm Kyle Kittleson,
and remember whatever you're going through, you got this.
Thanks for watching.
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