CASE STUDY: GDASS

 

Gloucestershire Domestic Abuse Specialist Services Charity

  • Provide help and support for people who are in an abusive, coercive or controlling relationship

  • Deliver Training to services including Police, NHS and Charities

PROBLEM

  • Training needed refreshing 

  • Old video 'cheesy'

  • Not relevant​

 

SOLUTION

  • A new training video to take to GPs and Health Care Services.  

OUR BRIEF

  • Teach GPs to recognise the signs of abuse so that they can signpost their patients to GDASS for support.

  • Did you know - Most people will only disclose after 11 contacts

OUR APPROACH

  • Met with the team - listen

  • Attended a GDASS training session

  • Listened to people who had used their services - and why they didn't disclose

  • Literature searches, what stops people from disclosing, what is a disclosure

  • Spoke to GPs, Police, Social Workers

  • Understanding

DELIVERY

Film Production

  • Two - Three Films, Teenage - physical abuse, Middle age - controlling relationship, Same sex - signpost to policy

  • 3 scripts, storyboard
  • Created a set (realistic)
  • Casting - Actors

SUSAN

FADE IN:

INT. DRS SURGERY - DAYSCENE  - SUSAN MEETS DR JACOBS

Susan tentatively enters the GP Surgery

DISSOLVE TO:

DR LISA JACOBS, middle aged GP is sitting at her desk....quite tired, but loves her job.

DR JACOBS

Morning Susan. 

(Dr Jacobs gesticulates to the chair and Susan takes a seat )

DR JACOBS

I haven’t seen you for a while, how can I help?

SUSAN

I really don’t want to take up too much of your time doctor, I don’t like to bother you, but my husband asked me to come. It’s my IBS. I feel as though it’s getting worse.

DR JACOBS

It’s no trouble at all, that’s what I’m here for. Have you been taking your medication?

SUSAN

I’ve have... when I need to but it’s just not working.  It’s really bad at the moment I’ve not been myself. 

DR JACOBS

Ok, let’s look and see what we can do.  But, when you say not yourself, how do you mean?

SUSAN

I suppose I have been a bit low and ...well, I feel... anxious most of the time. 

(Dr Jacobs remains silent and looks directly at Susan and waits for her to speak again)

SUSAN

...It’s been so bad that I’ve had to take a couple of days off work.  I just haven’t felt up to going in.  Richard...my husband... had to make me come today.. I didn’t even feel like it. But I suppose he’s right.  

DR JACOBS

Mmm. Sometimes our emotional and mental health does impact on our physical health, and IBS can flare up when you’re feeling out of sorts; especially if you’re feeling anxious. 

Do you think that there is anything that’s making you feel like this at the moment?

(Susan looks down.)

SUSAN

I, I don’t know really 

(silence)

I suppose, well, it’s just...

(Susan pauses and then with a sigh she says)

Everything.

(Dr Jacobs looks sympathetically)

DR  JACOBS

How are things at home Susan?

SUSAN

They’re ok.  It’s just Richard and me now, our youngest left for university.

DR JACOBS

That’s a big change to get used to.  And how are things at work?

SUSAN

Aah I really do love my job. I wish I could work more hours really. 

DR JACOBS

So what’s stopping you?

SUSAN

Well, Richard says he doesn’t want me to.  He says we don’t need the money so he doesn’t see the point in me being at work at all. He just wants me at home with him all the time.  Especially now the children have gone...  he doesn’t really like the people I work with.

DR JACOBS

So how do you feel about that? 

SUSAN

It’s OK... I suppose 

Susan looks uncomfortable and fiddles with her rings more at this point; 

DR JACOBS

Only OK? So how arethings with Richard

when Susan answers the GP, she looks at the floor

SUSAN

... we have been together a long time... there are always bumps in the road; aren’t there?

DR JACOBS

Does he know how you’re feeling  at the moment? 

SUSAN

I think he does.  A little perhaps.  He says that I’m really moody and he’s fed up with it.  He’s a bit annoyed, but I think my IBS is just draining me. He wanted to come with me today, but... I really didn’t want him to.

DR JACOBS

Does he know about your anxiety? 

SUSAN

Mm... not really.  I’m just moody he says. I suppose I am.

DR JACOBS

 

Is there any reason you didn’t want him to come with you today?

SUSAN

I just find it easier to talk...

DR JACOBS

When he’s not around?

SUSAN

Yes.  Richard can tend to talk for me. 

DR JACOBS

Do you feel that he’s supportive?

SUSAN

hmm...I think he is.  When he wants me to do something.  He has my best interests at heart.  Sometimes I feel as though he knows me better than I know myself.

DR JACOBS

What do you mean 

when you say “when he wants you to do something”?

SUSAN

Like... you know, when  he wanted me to take up golf so I could spend more time with him. 

DR JACOBS

Really?

SUSAN

Yes, he registered me at his club and bought me all the equipment so we could spend all our time together.  He doesn’t have many friends since he became semi-retired.  We don’t socialise as much as we used to. 

DR JACOBS

How do you feel about spending all your time together?

SUSAN

Well, it would be nice to have a break sometimes...

DR JACOBS

Have you spoken to him about spending some time apart; pursuing your own interests, that kind of thing?

SUSAN

God no!  Not at all!!  

(Susan looks very shocked at this suggestion – wide eyes, disbelief)

DR JACOBS

That was a strong reaction Susan.  I’m concerned that what you are describing could be an unhealthy relationship. 

(Susan looks at Dr Jacobs and hold back her emotions)

I talk to a lot of women who don’t feel confident or comfortable in their relationships, and some of the things you have said I’ve heard before. Would you say you that is the case?

SUSAN

Well, not all the time. I’ve lost a lot of confidence. But that’s normal isn’t it?  Doesn’t everyone feel like that?

DR JACOBS

It’s not about what’s normal, Susan, it’s about how you feel and whether you are safe and happy with yourself in your relationship. 

Does Richard ever make you feel unsafe?

SUSAN

He gets cross sometimes, you know... at silly things that I have said or maybe if I forget to do something for him.  He’s just stressed, I think. I could be doing more to support him I suppose... I’m probably not a very good wife

DR JACOBS

Oh Susan, don’t say that about yourself. What do you mean by cross?  What does he do?

SUSAN

Well, he doesn’t take it out on me really... he just shouts a lot.  He does throw things sometimes, but only when he’s really upset.

DR JACOBS

That sounds quite aggressive.  It must feel scary for you when things like that happen. 

(Susan looks at the Dr and gently nodds)

From what you are describing, he  sounds like he can be quite controlling; has anyone ever spoken to you about domestic abuse? 

SUSAN

No!  He’s never hit me, he would never touch me – he tells me that he would never hit a woman. He’s always said that. He’s a gentleman!

DR JACOBS

Domestic abuse isn’t just about physical violence. It can be a whole range of behaviours just like what you’ve described. Like making someone feel afraid, or by being controlling.  Or being very jealous... These are all forms of abuse you know.

SUSAN

**DISMISSIVE**

Every man is jealous... it shows he cares doesn’t it?

DR JACOBS

It’s never ok for someone to treat you his way.  I’m concerned that the reason you are feeling anxious and low is because of what you are experiencing at home, and your husband’s behaviour.  

(Susan looks sad)

I’d like to help you to get some support. There’s a local service you can talk to who can provide you with help and advice. They are really good. You are really not alone Susan.

Perhaps I can call them on your behalf, or I could give them your number to let them know that you’d like to speak to them?

SUSAN

Could I just take their number? I wouldn’t want them to ring me when he’s around but, I might call them.  Just to see what they say. You know.

DR JACOBS

Yes of course.  Let’s make a follow up appointment for a couple of weeks time and we can see how you’re getting on. 

Having said that, I do need to ask you if you feel safe going home today?

SUSAN

Course, yes.

DR JACOBS

Ok. As Richard has encouraged you to come to see us today, he may ask you what we talked about.  I would strongly advise you not to tell him that we discussed domestic abuse. 

SUSAN

Ok

DR JACOBS

Maybe you could tell him that we talked about your low mood and that we have a follow up appointment to see how things are in a couple of weeks?

SUSAN

Yes... OK. 

DR JACOBS

I’m glad you came to see me today Susan. This surgery is a safe space for you to come and talk about your concerns, but in an emergency, the police are always there for your safety.  If you do ever feel in any danger Susan.  If you’re scared or feel at risk, then you should call 999.  That doesn’t necessarily have to mean that you’re physically unsafe; if you’re scared or if things escalate in any way – please do call 999, the police will help you.

(Susan takes the GDASS helpdesk number from the GP.)

(She attends a follow up appointment  and tells the GP she has spoken to GDASS and will be meeting with a support worker soon.)

TOM AND MARK

FADE IN:

INT. WAITING ROOM - Day

Tom is sitting in the waiting room – he is looking down at the floor and appears nervous.  Mark has his hand on Tom’s leg – this gesture appears to be an innocent act of support.  On the surface, it would appear that Tom presents as a bit anxious, and Mark is supporting him.

TANNOY:  

VOICE OVER:

Tom Smith to room 2 please

Tom gets up to go to the room – Mark follows him.  Tom looks back to Mark, but doesn’t say anything.  Mark’s hand is on the small of Tom’s back.  

INT. DRS SURGERY - Day

Tom and Mark enter the consultation room where the GP is waiting.

DR (SIMON) ATLEE

Morning Tom, please come in and take a seat

Tom takes a seat

(Dr Atlee gestures to Mark)

DR ATLEE

Who’s this with you? 

(Looking at Mark, Tom opens his mouth to say something but Mark interrupts)

MARK

(Confidently ) 

I’m Mark, Tom’s partner.  Tom gets very nervous so has asked me to come in with him. 

(Tom looks surprised, and avoids eye contact with Dr Atlee)

DR ATLEE

It may be fine for you to come in to the surgery for part of the appointment, if Tom would like you to, but it is our policy that we see patients alone for the first few minutes.  If you could just wait in the waiting room, then if we need you we’ll call you in. 

(Mark becomes irate, voice rises, body language changes to show signs of anger eg fist clenching)

MARK

What do you mean ‘Policy’? I’ve never heard that before! Like I told you, Tom gets nervous and needs me here! I always come in with him !

DR ATLEE

This is a new thing we’ve put in place throughout the surgery for all patient appointments.  It has been advertised on our website and there is a copy of it in reception which you can read while you’re waiting.

MARK

(Huffing)

Tom wants me here, don’t you Tom.  Tell her!

(Tom looks panicked and mumbles something inaudible as he stares at the floor)

DR ATTLEE

It isn’t the choice of our patients, this is our policy within the surgery. I do need to start the appointment now.  

Mark hesitates.

DR ATTLEE

Please would you leave the room.  You can  wait in the waiting room and  I will call you in if you’re needed.

INT.

Dr Atlee stands up and directs Mark out of the surgery

(Mark huffs again, storms out of the room and slams the door behind him.  Tom flinches at the door slamming but looks relieved once Mark has left the room.)

Dr Attlee closes the door and returns to his seat.

DR ATLEE

Is everything alright? 

TOM

...no, not really... no.

DR ATLEE

Do you want to tell me what’s going on? 

TOM

I haven’t spoken to anyone alone in like, 6 months.  I can’t handle it anymore.  I can’t handle him. I’m getting so many headaches.  I feel... I don’t know. I’m not used to talking to people... about this. Sorry.

DR ATTLEE

It’s alright, you can talk here, catch your breath... take your time. Let’s see how I can help.

TOM

...things were already bad, but it’s all started to get... even worse.   

DR ATTLEE

What’s got worse? Headaches? 

TOM

mm yes, I mean no... Worse with... with Mark.  Since I was signed off sick last time after we saw Dr Steadman. I think you were on holiday.

DR ATTLEE

Ah yes ... You were off for a month.

(Dr Attlee nods and looks back through the records on the computer screen)

TOM

He said I was seriously going crazy, I needed to get help! He said I was forgetting everything, my mind was going.  Like I’d put something away, toilet rolls, keys or something, you know, but then hours later, they’d turn up on the kitchen table, or fridge or somewhere totally weird. When I insisted I hadn’t put those things there, he told me it was all in my head and I needed to get checked out.

DR ATLEE

Go on...

(Pause)

TOM

I couldn’t say it in front of the doctor cos he was there, he’s always there... but I’m convinced he was deliberately moving things around to confuse me.   

Why would he do that? I don’t... get it. It’s even worse now. I’ve not been able to tell anyone. He’s just, well... he’s always there.

DR ATLEE

I didn’t realise this was going on... How do you mean, “it’s even worse now”?  Can you tell me a bit more...

TOM

When I got signed off, I was with Mark all the time; he works from home you see. I think he just got used to me being there. If I went out without him, he’d question me, well, more like... interrogate me. If I wore a fancy shirt or something, he’d think I was trying to...  He started looking through my phone. I’ve caught him a few times and he’s now become really funny about me seeing my friends... just seemes to watch everything I do these days.  It’s become so bad that it’s not even worth going out.  The hastle I get. He is so annoyed; all the time.  He just doesn’t trust me.

DR ATLEE

That sounds very... controlling Tom.  

TOM

Yes. Maybe... but last night, he did really scare me. He was so drunk!  His drinking has been worse since his business hasn’t been doing so well.  He started screaming at me.  I mean really screaming. Apparently he’d been at my browser history and seen that I’d been looking for flats. He grabbed my throat and pushed me against the wall... I couldn’t... breathe!  He only let go because one of the neighbours knocked on the door – they must have heard. God knows what would have happened if they hadn’t.  He’s doing my head in!  I just don’t know what to do! I just never seem to make him happy.  

(Tom looks despondent)

DR ATLEE

This doesn’t sound like a safe situation Tom. Do you often feel unsafe when you’re with Mark?

TOM

Mmm... I suppose. I, I... always feel on edge.  It’s like he’s going to explode... at any moment. 

DR ATLEE

I am worried for your safety, but what do you want?  You’ve said you’ve looked for flats, so is leaving him something you want to do?

TOM

Yes... I think it has got to that, but I just don’t know where to go... or who to turn to. How to leave.

DR ATLEE

There are support services that I can refer you to, but I’m worried about you leaving with him today.  Is there anyone we can arrange you to call and stay with temporarily?

TOM

I’ve lost contact with a lot of my friends since we got together.  I’ve fallen out with my parents over him.  A mess! ...I could call my sister I suppose; ask her if she could put me up for a few days...

DR ATLEE

Shall we can call her now? With your consent, I’d like to refer you to GDASS for specialist support as well. They are a local service who help people that are experiencing or have experienced domestic abuse. How do you feel about that Tom?

TOM

Mm... Yes... I’m not sure.... maybe it’s a good idea.  What about Mark though?  He’ll be getting angry in the waiting room.

DR ATLEE

Don’t worry, I will go and speak to him and tell him that I’m filling out some paperwork with you which is confidential.  If there’s a problem, we will handle it.

TOM

(Tom looks worried)

DR ATLEE

Please try not to worry, you’re safe here.

Dr Atlee leaves the consulting room to go and talk to Mark.  She comes back and tells Tom that it is all in hand. 

VOICEOVER

Dr Atlee and Tom put their immediate plans into action and make the phone calls discussed in the consultation.

Dr Attlee completes a DASH with Tom which will be submitted to GDASS (and/or MARAC if she deems Tom to be high risk).

Tom contacts his sister who is happy for him to stay with her.  She will pick him up from the surgery – as an additional safety measure, Tom will leave via the staff entrance to try and avoid contact with Mark on the way out (should he be loitering by the surgery).

If Mark were to become aggressive whilst in the surgery, staff would call 999. 

Tom is given immediate safety advice and is urged to contact the police if he feels at risk.  If he is immediate risk of harm, he should call 999. 

FADE OUT: