Sue Gedeon (She/Her) - on Wurundjeri Country:
Hi everyone, welcome to this evening’s recognizing and responding to LGBTIQA+ family abuse and violence in general practice webinar.
My name is Sue Gedeon and I’ll be your host for the evening before we get started, I would like to make an acknowledgement of country.
We recognize and acknowledge the traditional custodians of the land and see, on which we live and work and pay our respects to elder's past, present and future.
Just a few housekeeping notes this webinar is being recorded and will be uploaded on the RACGP website.
We have put everyone on mute to ensure the learning will not be disrupted by any background noise, if you have any questions during the webinar, please add in the Q&A box at the bottom of the screen.
You can also interact with the panellist’s and attendees using the chat function, we will try to address questions at the end of the presentation.
If we don't get to your question, we will review these and provide a response offline. If you're not comfortable asking questions during the webinar, please don't hesitate to email me any questions and we'll answer offline. I’ll put my email in the chat box.
I’d like to introduce Associate Professor Ruth McNair and Marina Carmen.
Ruth is an honorary associate professor at the Department of General Practice, University of Melbourne and a general practitioner in an inner Melbourne general practice. She has clinical and research interest in lesbian and bisexual women's mental health, sexual health, LGBT parenting, trans and gender diverse affirmation, LGBT health care and homelessness. She became a member of the Order of Australia in 2019 for significant service to medicine and as an advocate for the LGBTI community.
Marina is the director of Rainbow health Australia, a program that supports LGBTIQ health and wellbeing through research and knowledge translation, training, resources, policy advice and service accreditation through the Rainbow Tick. She is also a Research Fellow at the Australian Research Centre in Sex, Health and Society.
Thanks Ruth and Marina.
Professor Ruth McNair:
Alright, so hi everyone.
Marina, I get to share the presentation so Marina will start with a few slides and then I’ll present a few.
There will have heaps time at the end for questions, so please hold the questions and, if you would like to ask a burning question during the presentation go ahead, just pop it in the chat and Sue will keep an eye on that for us.
So yeah, I’ll hand over to Marina.
Marina Carman (she/her) Wurundjeri land:
Thanks very much, I will just find a way to share my screen.
So yes, thanks, very much for that introduction.
There we go, I’d also like to acknowledge the traditional owners of the land on which we're all meeting and talking on tonight and pay my respects to elder's past and present, always was always will be Aboriginal land.
When I’m giving presentations in this area, I also like to pay tribute to the rich history of the feminist movement and the many LGBTIQ activists who have gone before us and paved the way for us to be in this space today talking about these issues.
As we went through, I’m speaking here today as the director of Rainbow Health Australia, where an expert knowledge translation unit that sits within The Arches at Latrobe University and we've got programs in LGBTIQ family violence that stretch across sort of service, inclusive, capacity building and primary prevention.
So, what I’m going to start talking to you a bit about today's prevalence and reporting what we know from existing research.
But before I move on to talk about that, I wanted to distress that there are many, many positive things about LGBTIQ life experiences, and these are really documented in research.
However, the current social context of stigma discrimination, violence and abuse creates profound harm for individuals and for relationships.
And in addressing these experiences, we need to be careful not to feed into for the pathologising of LGBTIQ people.
So there are a lot of bad things that we really need to do something about, but we also have to look at enhancing and supporting all of the positive things that are listed on this slide.
And we can see it from a range of different studies that LGBTIQ people often have loving relationships really enjoy the experience of building conscious Community connection of choosing family.
And they enjoy the experiences and get a lot out of the experiences of self-discovery and positive experiences of affirmation by others.
A lot of people describe the positive impact of developing empathy through their own experiences and the freedom that comes from, not necessarily conforming to societal norms.
And also the positive experiences of helping others and activism, and that positive feeling of belonging and pride.
But when we're looking now at the issue of family and intimate partner violence LGBTIQ people, one of the main problems that we've got in this area is the lack of population level research partly because, even from the current census in Australia, we don't have a good population level estimate of the numbers of LGBTIQ people in Australia.
And a lot of the surveys that look at experiences of family and intimate partner violence don't necessarily separate out people by gender identity and sexuality, the one population level survey that we do have happened in Victoria.
And this is the really the first piece of research in Australia, that is population level and has actually separated out the experiences of LGBTIQ and non-elevation IQ people.
In terms of their experiences and you can see there that that number is higher, what we can say more generally from international research is that LGBTIQ people experienced similar if not higher levels of intimate partner violence to other parts of the population, and they also experienced significant violence within their families of origin.
So the families or their biological or adoptive families who may or may not be accepting and respectful and affirming of their identity and their bodies and relationships, so the other big and also the other thing to point out is that experiences of violence, a different within different parts of LGBTIQ communities and there's a number of studies that have found higher rates, particularly of issues like intimate partner, violence and sexual abuse amongst particularly bisexual women and trans women and trans and non-binary people.
We also have some current findings that tell us more about the story of these experiences within our database IQ communities.
And these are really the largest ever national surveys of LGBTIQ health and wellbeing in Australia, possibly internationally actually.
And it's really the size of these surveys and the sort of demographic spread that we got in the samples plus that the really clear positive questions that make this the best quality data we've ever had around these issues and there's a whole chapter in private lives, three on the experiences of family and domestic violence, so that's some of the data that I’m just going to show you in a second.
So, in terms of experiences of family violence, Eva, which is what we asked in the survey, this private lives, found that around four in ten participants reported ever having experienced intimate partner, violence and almost four in ten reported experiencing family of origin, violence, so these numbers are really significant.
The other key thing that was interesting from the results that we asked had you experienced these things.
And then we also asked a range of you know, have you experienced X, Y and Z that indicate, you know experiences that indicate that people had experienced family and it or intimate partner violence, even if they said no to the first question, and what we found is that there was a gap of rows from four in ten to six in ten or even if even if in family and intimate partner violence wasn't necessarily indicated by the participant.
That proportion that that we would consider had experienced it rose to six in ten so there's a gap there that tells us something about people's ability to recognize name and name their own experiences as family violence.
The other key issues were around reporting were only around 28% of those who said that they'd experienced family violence had reported it in the most recent case only 2.3% have reported to a domestic violence service and only 4.4% to a doctor or hospital.
I suppose a relatively good news story is that around two thirds felt supported when doing so.
The other things that we asked about where the preferences that people had in the future, if they had experienced it and a significant proportion said that they would want mainstream domestic violence services that were known to be LGBTIQ inclusive and also a sizable proportion said that they would want to access the service that caters only to LGBTIQ people and, again, there were some differences within the different categories were more trans and gender diverse and particularly non binary people or people who had more experiences of verbal harassment and other negative experiences in their lives were more likely and had higher levels of psychological distress were more interested in an LGBTIQ specific service and bisexual and transgender women were more likely to want a mains to be referred to a mainstream service.
One of the really interesting things is looking at, who was most likely to report, violence and I guess the key point that I wanted to make here is relevant to the group is that people with a regular GP were more likely to report, violence and more than twice as likely to feel supported so in amongst these different things that correlate with who reported violence and how satisfied, they were with the response that they got attending a regular GP stood out to us immediately as a factor that was quite important and perhaps not that well known, up until now.
So the implications of this is that we can clearly say that experiences of violence is significant for LGBTIQ people of all genders that it's often not recognized are reported as violence and that there are limits to help seeking and also to Community responsiveness.
So if people themselves are not able to identify a name their own experiences as family violence or intimate partner violence.
And now people around them may also struggle to do that and to support them.
And that they're the gap between the those experiencing violence and those reporting it and wanting to access inclusive services, but then the lower levels that had access those services tells us there's a critical lack there.
So when I go on to talking about the drivers of the causes of this violence and what we can do in terms of primary prevention.
And what I’m really going to be drawing on here is two key resources that my organization has produced in the last couple of years that's really gone on to significantly change, I think the national conversation around these issues so pride in prevention is something you should all download and have a look at and it was a resource that really looked at and summarized existing research and its limitations existing conceptual work and feminist literature.
And also looked at existing policy frameworks and particularly change the story, which is the national framework for the prevention of violence against women and children.
And also looking at existing initiatives and interventions that could be understood and further supported as primary prevention.
So a key outcome in pride in prevention, was the development of a proposed model for the drivers of violence experienced by LGBT communities and it draws heavily on the multi-level socioecological model used in China to the story.
And really what we put forward is that the drivers of family violence LGBTIQ people are the same as the drivers of violence against women, read Agenda norms, but also interlinked so rigid gender norms are closely related to both signal maturity and hetero normative beads and really what we mean by that of the ideas that male, female and heterosexual are the only normal and natural ways to be and that there's something wrong with bodies identities and relationships that's outside of these norms.
So these ideas tell us a lot about what causes experiences of violence for women, and also in a related way causes it experiences of violence for LGBT people.
And it also shows us how to work against these drivers to promote equality and celebration of all our bodies identities and relationships and ways to improve recognition of violence help seeking and Community responsiveness.
So I’m going to hand back to Ruth now to talk further.
Professor Ruth McNair (she/her):
Thanks a lot Marina.
I’ve got to say you know, I was part of the private lives research team with Marina, and you know it's amazing to see it translated into actual benefits to the population, so that we're serving so I wanted to thank Marina for that, because I do a lot of work in informing our Community and the broader community about these findings.
Okay I’m going to share my screen.
I can see, there are a couple of questions there are definitely will come back to that or I’ll talk to them as I’m speaking.
Let me just find my starting slide.
The slideshow yeah.
And so, Marina and I contributed to this, the new edition of the White Book some of you may have seen it already if you haven't the link is there on that slide.
So, for the first time, the White Book included some specific populations that weren't in the previous editions including LGBTIQA+ people so we wrote that chapter together and what we're presenting tonight comes partly out of that chapter and also from our other work and just to remind you, the principles in that White Book around hold systems hold practice systems approach to helping people who present to us with family violence, and I’ll talk a bit about that, and how that applies to our practices in terms of LGBT people.
But also ideas around both recognizing and responding and referral to family violence, because I think these are all really tricky areas for us.
My old colleague and Angela Taft talked a lot about pandora's box, you know, the idea that if we go there with some questioning you know can open up this whole can of worms and we might spend ages and ages, with the person, and you know that's tricky for us in our time limited practices and anyway, I think it's great to have had the opportunity to raise or to add this population group to the White Book.
And, just a brief word about the readiness program, so this is a new program by the Safer Families Centre which is run by my other ex-colleague, Kelsey Heggerty.
So they're now looking at a whole program of training general practice or primary care around family violence so have a look out for that, including this webinar series.
So yeah, as you've heard Marina has covered pretty much the prevalence and correlates there was a question around prevalence in terms of with a homophobic violence from family members is included, and yes that's definitely part of the family of origin violets patents that a lot of LGBTIQ people talk about an experience homophobia or trans phobia or by phobia from families of origin, often parents or siblings and it can make home a really unsafe place.
It does definitely contribute to the higher percentage of LGBT people who are homeless, particularly as young people, because they just leave the family or the family home feeling very unsafe so yeah that's a different part of this group, and what I’ll be talking about is how do we recognize this, how do we help people to disclose family and intimate partner violence to us in practice, and what are the barriers that we've seen and then, how do we respond.
I must say, as a GP I have to really draw it out of people, I mean I see about half of my patients will be lesbian, gay, bi maybe 20% trans gender diverse. This is I mean just as a caveat, I don't specialize in intersex variations like I do have a handful of patients with it in six variations.
But I won’t really touching on that so much tonight it's not in my area of expertise and but yeah, even though I see a lot of this population group, it's not that common for people to tell me upfront about violence in their relationship or from their families of origin, and I have to ask specifically about it, I think that's a lesson to me that I have to be much more aware of this as well.
So, in terms of recognition and the implications for all of that that Marina talked about in terms of the higher prevalence and different patterns, the first thing we need to do is validate and to say that this is a real thing that we're interested in and that we are willing, and able to talk about with people.
We may not have all the answers around a response, but at least we can open the discussion, so you know, I think that’s a really important point around that people themselves don't necessarily recognize their experiences as violence is critical. But also, they're really afraid to tell us in case we don't validate that and that was another question in the chat you know, it is stigmatized to talk about this, and people are really worried that will just say, especially violence between women that will say oh yeah that's not really violence, though, is it.
Or you know women can't be like that to each other, you know there's a lot of that myth out there in the community, there's also a myth in some of the family violence services.
People have told me about that repeatedly when they talk to me in my practice, so I think validation is hugely important.
Yeah, stigma does disempower people. They find it really difficult to raise in the first place, I mean another part of that is also that same sex relationships and relationships between trans and non-binary people are already stigmatized amongst some subgroups of the population, you know it's hard to talk about even that.
So it's even harder to then say well actually I’ve experienced violence indistinct highs relationship so it sort of almost buying into the apologizing of you know or concern that people will respond by saying Oh well see I need these relationships with that good you just told me it's violent, so you know I think this is a huge barrier.
Assumptions around perpetrators, you know big assumption around perpetrators being male and yeah obviously it's a much higher proportion in our population generally, but in the LGBTIQ population, the perpetrator can be any gender, any sex.
And being aware that there's some need to protect perpetrators and again I think this comes back to the idea of protecting the same sex or trans inclusive agenda relationships from harm, protecting them from the stigma that is out there. And so you know, trying to reduce disclosure is one of the issues we have to overcome.
And we'll come back to referrals at the end. So, I’ve heard a lot of people, a lot of GPs, say well you know I’m just pretty open minded I don't mind if people are in the same sex relationship or not, I think it's all same to me I’m just going to treat everyone the same.
And I think yeah up to a point that sort of works, but for a lot of LGBTIQ people that does not work, we have to be very specific, we have to acknowledge their relationship first.
We have to acknowledge that we believe in it that we believe it's happening, and then we have to acknowledge that violence can occur within it for from families, so you know I think all of these things make it very different and make the need for us to be educated in this area, really important so firstly, a lot of people bring internalized five years into the consultation, so they might in inside themselves really believe that being bisexual is an error, is wrong is immoral or whatever.
So you know that's really important to think about and wonder whether a person might be experiencing this secondly, their experiences of discrimination abuse and violence they might be lots of experiences in their life.
Family violence or intimate partner violence might be one of those, but they also might have had experiences of discrimination through workplaces in school from strangers on the street so that's the context that's really important we know that being HIV positive increases stigma and we also see a higher proportion of relationships with someone who's actually positive as having some violence.
High rates of complex trauma, so this sort of feeds back to experiences of general discrimination and violence, and not just one experience, but a lot of people have had multiple episodes of discrimination and violence in their life and certain subgroups of the Community have really present, with the complex trauma so we have to be very trauma informed in our approach.
As right as talked about like a recognition is a really big one, lack of support, so you know let's talk about your average heterosexual women who might tell you about experiencing violence in her relationship she could probably pretty much guarantees you'll get support from her family of origin around this.
Maybe not everyone but you'd hope, most people could, whereas if a person is in a same sex relationship or in relationships with gender diverse people.
They can't necessarily guarantee that support because their family of origin might actually be quite homophobic and against that relationship in the first place.
So I think that's a key point of difference in the service accesses the other big one, come to in a minute so happy to have made the case here that it is very different for this group, for many reasons and being able to talk about that, with people and say you are aware of some of these differences and do they apply to this particular patient or a really good place to start.
I have inserted a few quotations, and these come from various research documents and grey literature in Australia and Rosie did a report, a couple of years ago, looking at LGBTQI family violence, this one quote from non-binary person.
I was using forms of violence interracial relationship like I was getting angry, because they were triggering past traumas for me, and I had to go to counselling to understand what was going on.
So you know, this is a perpetrator who's trying to uncover how their past trauma has influenced their current behaviours.
And intersectional of influence the really important to so I’m just giving an example here the multicultural people and particularly recent arrivals.
Especially if they're from a conservative religious background or come from very conservative countries of origin, so a lot of LGBTIQA people with this cultural background might have experienced family exile so literally being thrown out of home and told to leave the state local area family assault is quite common I mix it in subgroups here, some people have experienced forced marriage to do in their country of origin.
I just heard from a refugee today, who is a gay man, he was forced to marry a woman in his home country to save face for his family which he endured for several years, neither of them were happy about it in that relationship.
Honour abuse really important corrective rape is occurring still today, and conversion therapy is very common.
You may be aware that conversion therapy has been deemed illegal in many sites now in Australia, which is an improvement, but people often bring these experiences with them.
This is a quotation from document that icon the LGBT Jackie pick in us in new South Wales produced so this was a lesbian she says I’ve been bashed by family member for shaming the family talks at family gatherings that being GLQ is due to corruption of the West, the environment, sheikh, claiming that the death penalty is the punishment is her experience as presumably a Muslim lesbian.
And another context that I think is really important for us to remember is the high rates of suicide and suicidality in our community.
You can see here, this is private lives data again large group who answered the suicidal question.
And we divided into past 12 months experience over ever or prefer not to say so, you can see, compared to population-based data that's around 10 times the number of people who experienced suicidal thinking in the last 12 months or ever this is huge, I mean it's shocking data for us to see this.
And then you can see, if we divide it according to gender it's not equal across genders, so gender people, that is, people who were assigned a gender birth and still identify that gender.
Gender woman, for example, and less likely and trans, non-binary more likely to experienced ever in the past 12 months, so you know that's another contextual thing to keep in mind when you're talking to someone and even to raise that question with them, have you ever felt suicidal in their life, just so that you can understand the context of trauma.
And there are some correlates with suicide, so this was Delaney Skerrett, has been working on suicidal deaths in LGBT community for a few years he's up Griffith Uni in Queensland and so he's analysed death records of suicides and also in this interesting study he interviewed next of kin of LGBTIQA people who had completed suicide.
And he also interviewed next of kin so people who were just like those people in the Community, that they lived in, and so in those interviews he uncovered some correlates with suicide and one of the big correlates was self shame which we talked about before is one of the key points of difference and also lack of acceptance by families of origin.
Abuse from families of origin didn't come up but I mean we could expect that something that this might have underpin some abuse, for some of those people.
And just general physical and sexual abuse was much higher so you can see that there is a interrelationship here.
I wanted to move to barriers to help seeking I’ve already mentioned a few of these around stigma but this is something we're focusing on in the White Book.
And you know it's partly a systemic as in services traditionally have been designed for heterosexual couples, this is family bond services I’m talking about.
They tend to be generally attended by heterosexual couples and data is usually collected around heterosexual couples, so there are a lot of assumptions in the service sector that most people who attend a heterosexual and while that might be the case there's a significant minority who are not in that group.
So this is a lesbian parent in a study I’ve been involved with around family violence prevention for parents in this Community, and she says I guess it's partly systemic the system doesn't accommodate for diversity is also that workers or professionals aren't aware of the different kinds of issues that might arise, you know LGBTQI plus family.
And this is again from the Ambrose report a queer trans woman.
He says, but I think we're I’ve seen or experienced violence in an intimate partner relationship.
Because if your both queer or your both Trans your both trying to survive in a world that wants to kill you basically and by exposing your partner, even if they're being abusive towards you by exposing them to interactions with police or the criminal legal system or prison.
Or, I might add, health, the health system could basically be the death of them and it's far worse than the sort of abuse or violence that has been done within that relationship so she's just highlighting here that this is a enormous barrier to seeking help is the fear that it will actually bring more violence upon the person that I’ve been already experiencing.
In clearly in health system we hopefully not going to perpetrate violence on someone, but even showing some disbelief or showing some ignorance can feel traumatizing.
So what are some tips to identifying people as we've said they're not necessarily going to tell us up front.
So firstly, understanding the full range of families and couples in this population.
So, in terms of family, it might be understanding family of origin first and also families of choice because some people who have been rejected by families of origin actually have gathered around them. Significant families of choice, but also understanding the role of non-biological and on both parents in family it's very important in this Community.
Recognizing specific experiences and triggers and I think an example when you know, some people who are in a same sex relationship, for example the perpetrator may use disclosure or what's the word disclosure that's not a great as of all its technique or as a control picnic so that's quite a different thing you might not experience in a sexual couple.
I would recommend two step approach so basically, the first thing, obviously, is to find out about the person's context their life, who there are in relationships with and how they identify their gender and sexual identity.
So that can be step, one which may happen several consultations before a disclosure file and you know, a person is needing to check in that you're safe that you deal with that information appropriately that you're documenting it in the notes, as they would hope you document and often, I do ask a person if they're happy for me to write these issues in the notes.
And sometimes they say no, and I have to then go okay I’ve got to somehow remember this and then finally second step is direct questioning around abuse and violence, if you are getting some queues in that to that regard. A few slides on responding so having uncovered some violence are the families of origin or intimate partners what should we do about it.
So obviously we also believe this is a systems approach, the whole of general practice the whole clinic needs to be responding appropriately.
Otherwise you're not going to find out what to patent, so you know, we believe it should start in the waiting room at the front door go through the reception be inclusive, in paperwork within the clinical encounter, of course, and then the sensitive and inclusive referrals so waiting room.
I know it's 730 at night and half of you probably hadn't haven't had dinner, so I want you to just think I’m going to stop talking for a moment and just get you to think of your own clinic.
What would an LGBTIQA person think about your clinic in terms of safety.
With they feel safe to tell you that they're in the Community LGBTQA and would they feel safe to tell you about family violence, so what would make them feel safe.
What have you already done in your clinic that would generate this what we would call an inclusive environment so maybe just in the chat or in what's the best place I don't know chat or Q & A I don't know.
Probably the chat because it's easy for me to see if that's right and just write a few words a sentence on what's happening in your clinic or what could happen.
I’m talking about clinic environment I’m not talking about your consulting yet.
LGBTIQA friendly handouts, yes rainbow flag would be met a while the door here.
For the Trans flag, which is the pile of blue and pink one. yep, reception asking as well I’ll come to that sort of pros and cons there.
All right, any other thoughts before I move on.
So yeah there's lots of posters available beyond just having a little rainbow sticker, which is a good start.
But you can get from minus 18 it's a big now becoming national LGBTIQA young people's group they produce, quite a few nice posters, and this is this a Belgian the collective on the right, produced a really nice posted there.
So yeah I mean having some visual imagery is really helpful to start with, because people look out for that.
But it's not enough, this is all going to be a sort of combined effort.
At reception and the first thing I would suggest is that you need to talk to the receptionist about titles, as in calling people, Mr miss Mrs.
Is that really necessary, if they do it.
A lot of particularly trans and gender diverse people just say titles bring them on done like it's completely gendered they're not necessary.
And what we're trying to do in our clinic is just remove titles from everything there's no purpose to them you don't need them in a letter you don't need them at the front desk.
So, and we remove them from our medical records too so that's one thing that's easy.
Having an inclusive intake form I’ll give you a couple of demos, Also, just using the right name it's you know if they've got an a firm name that's different to their Medicare name that needs to be clearly identified in the file for reception to see as well, so they're calling out the right name, for example, with their needing to clarify anything.
Having some really good policies that are up and visible around anti-discrimination and inclusion.
And yeah just do a bit of training occasionally and providing feedback to your staff about how they going with this subgroup.
This is a registration form that is used an icon and the Trans hub in new South Wales.
And you can see the enlarge speed is relevant to what we're talking about so they allow space for preferred name and Medicare listed name may be different.
They also have an open text box around gender if these three categories don't work for people.
And it's a twostep gender question, which is currently that the gold standard, so a trans woman might take female here but she could take the mail here that was listed on this ticket.
So that would give you a clear indication she's trans what pronouns people use and then sexual orientation listed here with the most common variations and I’ve been text box so that's one pretty inclusive form. The one we use in our clinic.
Obviously, is page three they've already been through that Medicare details, etc, so in this space they've got a chance to write their preferred name pronouns and open text for gender and sexual orientation in a relationship area, and then we hand we free text them into the file.
We've had some feedback Lately we shouldn't have preferred here; this is just name and pronouns be better. So, facilitating identification okay they've gone through the clinic they feeling pretty confident and positive because of these various things you've done within the clinic to make them feel included. And then, in the clinic consultation is you've also got some really easy steps you can take using really inclusive language for gender, sexual orientation and six status and giving the person your pronoun at the beginning, no assumptions is an obvious one. Using the patient's own terms for their body parts and identities with their permission.
And also, as I was saying before asking directly about relationships, you know I’ve heard from several friends and colleagues who have sent ex partners, they go into a consultation with their partner and they never asked who the person is what their relationship is and they know that they're being a seem to be just friends. Mind you they could come out and tell Dr as well we help, but you know okay.
So defining behaviours as violence it's a really important one, once you start delving into the violence experience financial abuse is more common in this Community that's a really good one to uncover in discuss.
Enquiring about whether it be LBQTIQA status is being used as it'd be strategy, as I said before, that's sometimes the case often but not always uncovering what the context is around the general experiences of homophobia, etc, just to clarify the you know degree of trauma they've experienced in their life already.
And also understanding this particular person's that connection with Community which between these two they identify most closely with, and some people will say yeah always LGBTIQA community that's really important to me and others will say no, no I’m much more comfortable in the mainstream you know local neighbourhood community for example, that would help you, with your next level of understanding way should be referring a person and asking about what they've already sort in terms of help. Then, finally, the management approach so there's already a great work in family violence sector around using the ecological framework social, ecological framework thinking about the four different levels that a person may be experiencing this So if you start at individual level we've already talked about these issues organizational at the clinic level having the right policy and making it visible If you have any LGBTIQA staff making sure they're supported and feel comfortable in the clinic is really good role modelling.
Engaging in primary prevention, and this is a really unique role, I think we have in general practice we often do see multiple generations in the same family. You know I see what's the parents with trans nonbinary kids.
Often in different consultations so I get a chance to check in with the parents about how they feeling, you know, asking their opinion of the young person's identity and how it's going in the household and encouraging some discussion there around if it's a negative perspective, where does that come from let's do some reality testing here about this is normal range of identities system level.
I think, as doctors, we can be very supportive of the family violence system becoming more inclusive.
You know, giving them some feedback if you've had some negative vibes from a patient, for example, I’ve done that, a few times with local family bought services and they really appreciate it, I think, just may be able to check in with them and explain anonymously what a patient told me.
Having a good understanding of the anti-discrimination legislation in each state.
There is good legislation now in every state and territory, it does protect all LGBTIQA people and understanding that and the way that a person can take a complaint is really helpful.
And then it's sort of level, I mean we can be very strong advocates for inclusive society as leaders in our Community, and we can challenge norms, particularly the gender stereotypes that feed into a lot of family violence experiences.
So referrals I think we've referred to this a little bit there is really important once you've uncovered the issues and try to understand it from the patient's perspective.
If to them, seeing an LGBTIQA specific person or counsellor, for example, is really important than knowing where to find those counsellors is critical, so one port of call is Q life, so this is a nationwide peer led service for support it's often the first port of call for a lot of LGBTIQA people they can read or do web based chat with a peer who can then point them to local services in the area, so that's a really helpful and starting point for a lot of people.
If the person is reluctant to talk to the police which as we've seen is very common, but you feel that police intervention would be important. then you can refer to local or they really LGBTIQA liaison officers now each State has a different program, but I think pretty much most states have a program of LGBTIQA liaison officers within the police, this is a link to the federal police group.
But you know, trying to understand what's out there and be able to refer to those people is really helpful.
The aids Councils now fit into LGBTQIA health services in most states and now Thorne harbour is the old Victorian Aids council, Acon, as I said, is the new South Wales peak. Living positive is WA that's for HIV positive people, of course, so you know they're great to know about and be able to refer to they usually have a range of counsellors. Who are LGBTQIA specific and some of them have medical care services as well.
And some also have some financial and legal advisors that's really helpful place to go and trans hub is a fantastic website, if you haven't seen it have a look it's set up for both client’s, patients who are trans or non-binary but there's also really nice clinician section offers lots and lots of information about gender affirming care, but also about mental health support and a little bit about violence as well.
And then the Intersex human rights Australia is the is the peak consumer body for Intersex.
And that's also got some great resources, so you know there's a fair bit of info out there.
And then, just before we go to questions or point to a few of the other training programs as Marina said, there are lots of training through remember Rainbow Health Australia, Aus path which I’m a member of is fantastic in terms of listing providers who are trans specialist or trans inclusive in each state and territory, so if you've got a trans or non-binary patient who feel needs very specific counselling approach, for example.
You can look up the Aus path list and say there's someone in your local area.
And then LGBTIQ help Australia runs lots of training and MindOut is their mental health specific training that's have a community of practice which is really good.
Alright, so I’ll stop talking there we've got a bit of time for questions so really happy to take questions and Marinas there too, so either of us yeah go for it.
Sue Gedeon
Okay I’ll just read out the questions for you, so we've got three here, so far, so now's the time, please, if you want to pop any questions in the Q &A box.
So I really did touch on this a little bit about stigma so as a lesbian GP I find there is a lot of stigma around women coming out about violence and same sex relationships, because it is viewed less seriously by GPS and police.
Have you found that emotional violence is minimized by mainstream domestic violence services when suffered LGBTQIA people.
Ruth McNair (she/her):
Yeah definitely I’ve had lots of people talk about that with me, I mean once they finally come out, you know just all pause out around.
Their attempts to access support or intervention orders or talk to their parents or you know multiple times, people have told me that they just aren't believed.
And it's not just women actually some gay men in my practice have also experienced that you know that there's this little disbelief around the fact that it's all meant to be a utopia out there and you know it's very disappointing.
I know the police really you might know more about this, but in Victoria, the police of had some specific training around LGBTQ family violence on and off over the years and one of their liaison officers, one of the tasks is to encourage local stations to become better informed.
Marina Carman (she/her) Wurundjeri land:
Yeah I mean there's similar to the myths that exists around you know women can't possibly be violent towards each other there's similar things around men where it's not taken seriously because it's sort of you know this understanding that well, you know, there are equal physical size or power, so it can't be that bad, and I mean, aside from all the stuff that the actual experiences of stigma and discrimination there's also the fear of it up front so, even if they haven't experienced it they might may know other people who have or have heard stories, and so I think that that sort of anticipation of stigma and discrimination is also a really a really significant issue.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Okay, what are common barriers, you have found when it comes to disclosure.
In small close-knit communities, there is a fear of repercussions to disclosure about violence, for example being blackmailed out to homophobic family and being ostracized by family or friends, so they can often be no safe space for victims.
Ruth McNair (she/her):
That's for sure I don't know if any of you watch the l word.
This is relevant you remember Alice had this enormous you know, set of flow charts around the wall of her apartment which connected all the people in her life together, and you know that's sort of sections of the LGBTIQ community, everyone knows each other and they're all interrelated half of them have slept with each other, not quite true, but you know there's a lot of interrelationships.
And as you said was that person who asked the question, said it's a close-knit community so that can be really a barrier to coming out as having a violent relationship other as a perpetrator or as a victim, because it just undermines their whole community engagement.
Marina Carman (she/her) Wurundjeri land:
I it's also a bit of an issue in terms of services to refer people to sometimes people won't want to access LGBTIQ specific services and may actually be more comfortable accessing and mainstream because of that anonymity so, particularly in in really you know high end situations refuge can actually be quite difficult to access and particularly pathways to that through LGBTIQA specific services, people can be quite frightened that that they will be found or You know, even if, even if that confidentiality is absolutely maintained, then I still have that fear that they that they will be found.
Ruth McNair (she/her):
Or there's also appear that the client the sorry the counselling staff or even medical staff part of the Community and their partner, for example, or you know, and especially in regional areas that's a big likelihood.
So that is a huge barrier for some people, which is why I was sort of saying yeah it's important to understand whether they want to go to an LGBTIQA specific service because yeah as Marina said, some of them would actually much prefer mainstream service.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Okay um as a lesbian POC I find it is hard to open up about sexual orientation to someone have similar backgrounds also find that straight members have a similar racial background to me may have limited exposure to LGBT people and may hold stereotypes, they have grown up with it can be hard to know if a GP from a similar background would be an ally or not.
Ruth McNair (she/her):
Yeah, what is it sort of speaks to a similar point around if the closer you are to the Community that you're dealing with the more barriers might arise yeah.
I think yeah that the multicultural issues, and you know for people of colour that is a huge issue in itself that is often much higher rates of them or experiences of discrimination within those communities.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Okay does anyone else have any other questions.
Is there a list of LGBT friendly or trained GPS or medical practices for LGBT patients.
Ruth McNair (she/her):
Now is two lists going now so there's been Doc list which has existed for a few years that's been run by the LSB Medical Association so that's a group of doctors and now psychologists, who have agreed to be on the list and identified by LGBTIQ women as being inclusive, so the recommended Doc list you know saying my doctors grate please put them on the list and then doc list contact the Doctor and their happy to be on the list, and then they go there's a big list so that's quite a useful resource to point people to there are doctors in every state and territory widely every Centre which is listed, but not in every area, but yeah you get a great perspective and more recently there's been a resource for LGBTQ plus people and to me what it's called Marina order it's called Doc something else yeah that the doctor I think Doctors directory.
And that's also developing a list around Australia of LGBTIQ inclusive doctors and other providers.
So these lists are a bit problematic because then it may not be up to date, but I know that Allah one has been maintained pretty carefully so.
Sue Gedeon (She/Her) - on Wurundjeri Country:
Okay, thank you.
To see if anyone else wants to ask a question.
I think that's it tonight.
Okay.
If anyone does have any further questions, please feel free to email me and we can answer them offline.
Thank you to everyone for attending and we hope that you enjoyed the webinar.
Thank you so much to our presenters Ruth and Marina for sharing your knowledge and time this evening.
yeah, like I said, please feel free to get in touch with us, if you have any further questions Thank you and good night.
Ruth McNair (she/her):
Thanks a lot.