Women experiencing abuse are being retraumatised by the systems meant to protect them, says psychiatrist Dr Karen Williams.
Gaps in trauma-informed training across medicine are leaving domestic violence victims at risk, with some women further harmed by the healthcare and legal systems meant to protect them, says an expert psychiatrist.
Dr Karen Williams, co-founder of Doctors Against Violence Towards Women, said many clinicians still lacked the time, training and systemic support to safely identify and respond to coercive control and family violence.
Speaking to The Medical Republic, Dr Williams said the organisation began after she and colleague Dr Anita Hutchison were repeatedly fielding questions from doctors about domestic violence through online forums.
“We could see there was a real thirst for knowledge amongst our colleagues about how to approach it,” she said.
“What I was seeing was a lot of medical notes get subpoenaed in court cases, and they could sometimes be incriminating for the woman.”
Dr Williams said casual references to possible mental illness in clinical notes were often weaponised in family court proceedings.
“A throwaway line like ‘may have borderline personality disorder’ can end up being used by perpetrators and their lawyers to accuse women of being crazy and make their statements appear less legitimate,” she said.
The group, which now has some 750 doctor members and thousands of followers nationally, was established to educate clinicians about trauma-informed care and the unintended consequences of poor documentation and rushed consultations.
Dr Williams said many doctors still failed to ask patients about violence at home.
“There are people who think it’s not their business,” she said.
“They think, ‘I’m a doctor, that’s not my job’.”
But even doctors who wanted to help often faced impossible constraints.
“If you look at the time a GP spends with a person — about six minutes — it’s not enough time to get a trauma history,” she said.
“It’s not enough time to build a relationship with the person to find out why these symptoms are happening.”
She said women experiencing abuse were frequently prescribed antidepressants or sleeping tablets without anyone exploring the underlying cause of their distress.
“Doctors need to be looking for trauma,” she said.
Dr Williams described cases where sedating medications had later been used by abusive partners to perpetrate sexual violence.
“I have so many women whose partners have done that to them,” she said.
The psychiatrist also criticised what she described as superficial screening measures in hospitals and antenatal care.
“Do not ask if you don’t have time for the answer,” she said.
“It is not safe to ask in the emergency department between curtains.”
Asking women whether they were safe at home without offering meaningful support could retraumatise victims and reinforce feelings of shame, Dr Williams said.
“You can’t say, ‘Leave these bad situations and you’ll be better off,’ when leaving could mean ending up homeless, living in a car, or losing custody of your children,” she said.
Dr Williams said coercive control remained poorly understood within both medicine and the legal system, despite growing public awareness and millions of dollars being spent on campaigns.
“The family court continually gives children to their abusive dads because the court doesn’t understand coercive control,” she said.
She said psychiatrists received little formal training in domestic violence despite being called upon as expert witnesses in family court matters.
“It’s not even in our psychiatric curriculum yet,” she said.
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Doctors Against Violence Towards Women was later formalised as a charity with the help of the late Dr Nikhil Autar, whom Dr Williams described as a driving force behind the organisation’s public advocacy and fundraising efforts.
Dr Autar, then a young medical student living with chronic illness, encouraged the group to move beyond private online discussions and become a public voice on domestic violence.
“He was the one who said, ‘You guys need a public page,’” Dr Williams said.
“He’d say, ‘What you say is really important.’”
She said Dr Autar helped establish the organisation as a registered charity, often completing administrative work from his hospital bed while undergoing treatment.
“He just wanted to help,” she said.
Dr Autar passed away earlier this month, leaving huge holes in the lives of his family, friends, the organisation and the community in general.
Dr Williams said he would be deeply missed.
“If there was one thing I would want people to know, it was his extraordinary capacity to hope,” she said.
“He suffered greatly with his health, and even when his body was failing he would hold hope for the future, for himself, but also for the world around him,” she said.
“He was always telling us how we could do so much more, how we could make change, if we just kept talking.”
The organisation now provides peer support for doctors managing complex domestic violence cases, while also assisting clinicians who are themselves experiencing abuse.
“Guess who’s asking for help the most?” Dr Williams said.
“It’s the doctors.”
She said female doctors, many of whom were married to other doctors, often faced additional stigma when disclosing abuse.
“Judges will say things like, ‘You should know this is domestic violence, you’re a doctor,’” she said.
Dr Williams said the long-term goal was to build practical support pathways for clinicians and patients alike, including emergency funding for items such as burner phones, transport and safe accommodation.
“What we want is for a doctor to be able to say, ‘I’m looking after a woman who needs help,’ and for there to actually be something tangible we can offer,” she said.
“We don’t need more tokenistic questions. We need proper care, proper training and real support systems.”
For more information about Doctors Against Violence Towards Women see here.
Anyone wanting to join the group can email info@davtw.org
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