How GPs can break down barriers for rural abuse victims

The close-knit nature of small communities is creating barriers for women seeking help for sexual abuse, according to new research examining revictimisation rates.
 
The La Trobe University study, released on Friday, aims to shed a light on the lives of survivors living outside of Australia’s major cities, in a bid to highlight their unique experiences and obstacles.
 
It found women who experience family or sexual violence when they are young often experience it again in adulthood, and for those living remotely, additional obstacles can keep women trapped in increasingly dangerous situations.
 
For the study, researchers interviewed several female abuse victims living in rural and regional Victoria to paint a picture of their experiences and what services are lacking.
 
‘You can grow to accept or believe that it’s normal, especially if it is within the family unit,’ one woman told researchers.
 
‘You’re conditioned to believe that it’s normal, which really impacts on developing healthy relationships in the future.
 
‘You are growing up being attacked through your life. Is this normal, is it not normal? You can’t tell anybody so you’ve got these deep secrets inside you, and you just want to explode, and you can’t,’ said another.
 
The study’s author, Dr Emily Corbett, said sexual abuse is often exacerbated in rural areas through social isolation, a lack of transport options, and limited awareness and education about sexual or family violence.

‘We found that many regional and rural women face significant structural disadvantage including low levels of employment and income, limited-service sector resources, unsafe family environments, and exposure to community violence,’ she said.
 
This is a situation RACGP Rural Council Victorian Representative Dr Kate Turnbull knows all too well, telling newsGP that with specific services more difficult to access outside major cities, GPs are often the first point of call.
 
‘Working with patients experiencing family or sexual violence is tricky for all GPs, but in small towns it can be made even more complex as perpetrators or other people involved in the “story” will often be known to the GP,’ she said.
 
‘Difficulties with accommodation, transport, employment, and income are important factors that can keep survivors of trauma stuck in vulnerable situations – often these issues are worse in rural areas.
 
‘By and large, healthcare and other social systems are not designed or adequately resourced to help people move through the disadvantage that their experiences have created.’
 
Moving forward, researchers said they hope the study will not only add to the evidence base of family violence impacts, but also prevent and support survivors of sexual violence in regional and rural areas.
 
Associate Professor Laura Tarzia is Principal Research Fellow at the University of Melbourne’s Department of General Practice, as well as co-lead of the Sexual and Family ViolencE (SAFE) program.
 
She told newsGP there are many responses GPs can provide that are already within their realm of clinical skills to help patients going through family violence incidents.
 
‘If somebody is presenting with otherwise unexplained mental health distress, that should really be a cue for a GP to really sensitively ask about the possibility of a history of sexual violence,’ Associate Professor Tarzia said.
 
‘And GPs don’t have to call it sexual violence, they can say something really gentle like, “sometimes I see people who’ve had an unwanted sexual experience in the past and that can still be affecting them now, do you think that’s something that might be going on for you?”.
 
‘In the rural and regional context, people have the opportunity to build up a really trusting and long-term relationship with their GP, and that’s something that can be really helpful for survivors feeling like it’s okay to disclose things if you trust that practitioner and they know you really well.’
 
In Australia, around 20% of adults report experiencing physical and/or sexual family and domestic violence since the age of 15.
 
However, one quarter of survey respondents believe domestic violence is a normal reaction to day-to-day stress, 19% agreed that sometimes a woman can make a man so angry he hits her without meaning to, and 15% agreed there is no harm in sexist jokes.
 
Associate Professor Tarzia said funding for resources and longer consultations are needed when it comes to GPs consulting on family violence, but there are also simple ways doctors can help patients.
 
‘We can offer repeat consultations even if they’re not necessarily longer appointments but inviting the person to come back and check in, then that patient feels like the practitioner is not just washing their hands of them,’ she said.
 
‘There’s still a lot that can be done even in a short amount of time to make the person feel heard, validated, and supported.
 
‘GPs actually have a really important role because people can go to the GP for anything. It’s not stigmatising to go to your GP, and if you need support around sexual violence, it’s a more discreet way to get that support.’
 
To further support GPs, the RACGP released the fifth edition of the Abuse and violence: Working with our patients in general practice (White Book).
 
The college is also currently offering a Family Violence GP Education Program – offering a mix of self-directed and peer group learning. The program will run throughout the year, with participants able to claim five CPD hours upon completion. 
 
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domestic violence family abuse and violence family violence rural