Alison Scott – Trauma, adapting services to women's needs and thinking outside the box
For our trauma-informed support theme, we interviewed Alison Scott, a consultant gynaecologist who founded the WISHES clinic – a unique woman’s only sexual health service in Edinburgh – and currently heads the student wellbeing service at the University of Edinburgh’s medical school.
Alison shares how she approaches supporting women who sell or exchange sex in a trauma-informed way, including the importance of partnership working, she reflects on why services need to be aware of trauma and discusses making sure that employers look after their support staff.
At the moment you are doing two different but equally important roles. Can you start by telling us about the WISHES clinic and how it came to be?
After training in obstetrics and gynaecology, I started working in a sexual health clinic. Very soon I discovered that the service wasn’t really accessible to people who were most at risk of unintended pregnancy and sexually transmitted infections. The location was difficult to access without a car, it was away from a main road and you had to have an appointment. As a result, the clients we saw were mostly comfortably off women from the centre of Edinburgh. We did have some peripheral clinics in areas of depravation, but they tended to be in the mornings, and again people needed to book an appointment, so overall it wasn’t a particularly accessible system.
Around that time, I met a nurse that worked in a substance misuse service who also offered sexual health sessions. We were chatting and she mentioned working with many women who had very chaotic lives but really wanted to have a baby. Because of their situation, the women’s baby was usually removed, leaving them with a lot of grief. Women in this context want someone to unconditionally love them, so they would try to have another pregnancy and then the same thing would happen – they were stuck in a cycle. Other women would not have a period so whenever they had sex, they thought they couldn't get pregnant. But once they stabilised on a programme and started eating better and taking better care of themselves, then their ovaries would start working again and suddenly they were at risk of pregnancy.
I discussed with the management at my clinic and eventually they allowed me to set up a clinic in the substance misuse hub in the centre of Edinburgh. We had a room adjacent to the waiting area so the women could just drop in after getting their injecting equipment, their methadone or if they were seeing a substance misuse worker.
That was about 15 years ago, and over time we’ve broadened this model because we realised there are other women out there – not just women with substance misuse problems – who could benefit from an accessible service. We also became aware very quickly that almost all women we supported had a history of some trauma. So if we started doing all the really efficient healthcare procedures as soon as the women arrived, like a full sexual health screening, giving them contraception and asking them all these questions, that was too scary and they would just runaway.
From a clinical point of view, these women maybe hadn’t had a smear for a while or were at risk of pregnancy, and that was our health priority; but that was not the women's priority. Their priority was that they were living in a very dangerous situation because they didn’t have a place to sleep. This is when we decided to link in with SACRO’s Another Way project, a service for anyone over the age of 18 at risk of commercial sexual exploitation. They support the person to meet their needs such as benefits, housing and education. Working together we could engage with women who sell or exchange sex and look after their health; but again, it is a very slow process because if you have been a victim of rape or sexual abuse then having an internal examination is really tough and we would never jump straight into that. We do that when the woman's ready for it, not before that.
WISHES started off as a women's clinic and was rebranded a few years ago as the Women's Inclusive Sexual Health Extended Service or WISHES. For us it is about the women’s wishes, their aspirations, and many women do not have that. Here, we allow them the space to talk about where they want to be, what they want, and we follow that.
You are also involved in supporting university students, could say more about that role?
A couple years ago I was invited to get involved in the Women's Health Plan for Scotland, to lead on the sexual health aspect of it. After thinking about it for some time, because I’ve never worked outside of the NHS, I accepted. I worked for the Scottish Government for 18 months during the pandemic and that gave me a little bit of a boost that I could work outside the NHS, that I did have skills that were transferable into different roles. I’d also been a tutor for medical students for quite a number of years doing some pastoral care, so in 2020 I was asked to apply to become Head of Student Wellbeing for the medical school. I got the job, which I really enjoy, and I have to say there's a huge overlap of trauma and mental health problems with the student group.
We are aware that some students are selling sex. When students were working online, Only fans was just too convenient. It was a way of generating income, and with the current economic crisis, I think more and more students will be moving into that. I once met a woman at my clinic who had started a degree and then got into escorting and said she had gone through three months of constant trauma and physical violence. She's now more aware of how to keep herself safe, but she still wants to get out. However, once you're in the ‘sex industry,’ it’s very difficult to leave. Earning enough money to pay bills and finding other employment that gives the same income can be a challenge for women.
At the same time, medical students are probably less likely to disclose that they sell or exchange sex because as doctors we are governed by the General Medical Council, that’s our professional governing body for standards of behaviour and professionalism. The GMC sit on the fence when it comes to commercial sexual interactions. They feel that perhaps it’s not professional, particularly if patients are aware of it, but they don't absolutely say that medical students shouldn't do it. At the wellbeing service, we try to be open about it and about discussing with students how they feel about their sex working.
Women mention that stigma and fear of judgment can really prevent them from disclosing that they sell or exchange sex. How do you create a safe space within your services for women to disclose?
One of the benefits of the WISHES clinic is that it is advertised as a service for women who have experienced gender-based violence or are selling sex. Women don't have to worry about the reaction because they know that the clinic is there for them. If they go to a GP surgery or even a mainstream sexual health clinic and say that they’re selling sex, women may be slightly worried about what the reaction is going to be. Generally it will be a kind and caring reaction of “oh, are you alright?” but that can be interpreted as being judgmental. The benefit of a service which brands itself as being for women involved is that they don't have to worry about those reactions. They can just turn up and whatever they say is not going to generate an adverse response from any of the staff because the service is for them.
For students, we advertise that we are a safe place for them to come and speak to, whether their issue is gender-based violence, commercial sexual exploitation, racial harassment, sexual harassment, homophobia, hate crime, all these kind of things. Our message to students is that we are there for them and we won't judge.
In your experience, how does trauma play out for women who have been involved in the ‘sex industry’?
We have a small number of women who are very open to everyone about what they're doing, but the majority of women keep it secret, often even from their partners – they'll say that they're going out to do a caring role to explain their irregular hours. Their families and partners don't know, so they’re constantly hiding a huge part of their lives. They are worried that they're going to be exposed, that someone is going to say something when they are on a night out with their friends, or that their phone is going to give away their secrets. That's really difficult and stressful, and women become very anxious, constantly worried and unable to relax.
Women have described sort of playing out different roles, feeling as though they have to be someone's partner, someone's girlfriend, someone's mother, and then someone’s sex toy. For each of these roles they are a completely different person, which is why the Inside Outside exhibition resonated so much with me, because women put on a mask, a different face; they put on their makeup and different clothes and become somebody who sells or exchanges sex. Then they go home, change into their pyjamas and they’re someone's partner. And when their partner wants to have sex, the women really don't feel like it because they've spent all day having sex, but they have to put on this act of wanting to do it and they can't explain why they don't want to have sex, which gives women a lot of anxiety, stress and a low mood.
I also cannot think of a single woman involved in selling or exchanging sex who has not been assaulted while being involved. It is seen as “I've got control. I can control what happens and when I have sex,” but the person in the room who has the control is the man because he's paying the money and will demand what he wants. For women, there's that anxiety of never knowing quite how the interaction is going to end. Lots of women have experienced violence and have the PTSD effects of a male violence which is often recurrent.
Trauma can emerge at different stages of a person's life. Have you supported women who after leaving the sex industry start experiencing trauma symptoms related to their involvement?
Yes. Many people, not just those involved in selling or exchanging sex, when they experience something very traumatic, they put it away in a box, put a lid on it, put in the cupboard, shut the door, and then think “OK, I'm over that. It's fine now. I’m healed,” when actually they haven't. At some point there's a trigger, which might be going for a cervical screening, having a baby, a new relationship, anything… and suddenly the lid comes off the box and it all unravels and gets very messy.
One of the issues is that getting trauma counselling is really difficult. Currently in Lothian the only available service is group therapy, and people may not want to sit there and go “I used to sell sex and I got raped six times.” You can't really do that in a group, it is not right for everyone. It is really difficult to heal, really difficult for women to get professional support to help them move forward when they have experienced trauma like that.
Thinking of this reality for women, why do you think workers and support services should have a trauma-informed approach?
I think it is essential. I think workers need to be aware that if someone is kicking off in reception, is really angry and being aggressive, it may well be because they are traumatised and anxious and not because they are really rude and horrible. It’s thinking outside the box, taking them to a quiet space saying “sorry you had this experience, how can we help?” and giving them the space to talk about what they want and need, because otherwise we cannot move forward for them.
Awareness of adverse childhood experiences is also necessary, because so many people have more than one episode of trauma – they've had trauma since childhood with sexual abuse, domestic abuse, poverty and even neglect, which can happen across all demographics. And then they get into poor relationships. This can in turn create a distortion of what love, lust, affection, attention and sex are and what people are looking for. There is also poverty of love. I remember supporting an escort who was earning masses of money. During her upbringing she was always rewarded with material things when she did well, but nobody seemed to spend time with her or show her love, so she had this distortion of what made her valued and it was very material.
I think all support staff need to be trauma aware and trauma-informed, and it's good for yourself as well because then you are more aware of your own traumas and keeping yourself safe, particularly when working with gender-based violence. In primary care and other settings, when people disclose they have been involved in selling or exchanging sex, sometimes staff react in a way which people perceive as being judgmental and is not meant to be. It is meant in a caring way, but we have to be very careful about what we say and how we present our need to care. Because the most important person in the room is the patient and not yourself, so it’s not about doing what you feel comfortable with, it’s about doing what's right for the patient.
In your experience, what does a trauma-informed approach look like?
For me is about being aware that people come from different places, from all sorts of different experiences, and appreciating the fact that coming through the door could be a major thing for them. The last thing we want is to make them feel uncomfortable, so from the very first interaction we need to be aware of what the patients’ needs are and that they may have had really awful experiences in the past.
It is really important that women are given choice to say “no, sorry, I'm really uncomfortable. I'd rather have female staff. I don't want to have a male doctor or midwife if possible.” All these little things that can be a bit of a nuisance for staff really matter to the women, and that's what needs to come first – being aware and giving women some control. For example, intimate examinations are a huge thing in a sexual health clinic. So I've given women speculums to take home with them, to have a look and feel of it, try inserting it themselves. I have patients who insert their own speculum because then they've got control and they know where it feels comfortable and can stop and start. If that is how we can check that they are healthy, then that's fine with me. It's about adapting how you manage a patient to what she needs rather than what is easiest for you. For people who have experienced trauma, it's really important to build trust. If people trust you, then you're more than halfway there, but you've got to think outside the box.
How should workers approach supporting women who are still going through a traumatic experience?
It's about not being judgemental and really listening to what they're saying and what they are not saying while reflecting back the language they're using, even in a way of “can I just check I understand that what you're saying is…” Sometimes when they hear their own words back, they think “actually yeah, I’m really not happy in this situation.”
Also telling people that they are valued and really showing that care. I recently read Edith Eager, a Hungarian Jewish woman who was sent to a concentration camp and after leaving for America, she became a psychotherapist. A lot of her work is about opening your arms and showing care to others, showing them their value. I do that a lot –women will come in with bruises and say they were beaten up but that the man was paying them. My response to that is “people pay me to do my job, but it's no acceptable for me to be beaten up while I'm doing my job. If it was the other way around, you would be saying to me ‘that’s wrong. People shouldn't be beating you up.’”
Bringing that connection of being another woman, big another vulnerable woman – because if my life had turned out differently, we could be in different seats – and saying that it is not acceptable for anybody to be traumatised and abused in that way. Reflecting to them that they are valued and worthy and that they shouldn't be on the receiving end of abuse. I think often women become so overwhelmed and pushed down by the abuse that it becomes the norm for them. Pointing out that this isn't normal and they shouldn't have to be dealing with abuse is crucial.
People are also always worried about saying the wrong thing or making things worse. What I say to my trainees is: “you can't make it worse. Asking a woman if she feels safe at home is fine. You can’t make it worse by saying that, it is already bad enough if she doesn't feel safe. So have the guts to ask questions and use your instinct. If you’re feeling that there's something not quite right in the consultation, just ask a few more gentle questions and see where you go with it.”
Routine enquiry is about asking the right questions, but saying “are you a victim of gender-based violence?” is not the right question. Instead, asking “do you feel safe at home?” can give you information very quickly. Generally people will say “yes, yes, I’m fine,” but even a pause before answering can be an indication that there's something there. Being a little more subtle is a much better way of finding things out than just asking very blunt questions.
We’ve talked about the importance of being trauma aware when working with women who sell or exchange sex, but I wanted to finish by asking what do you think is the impact on support workers and what can organisations do to make sure staff feel supported?
It’s so important to support the people who are giving the support. It's like being on an airplane: you have to put on your own oxygen mask first and then help the others, because without enough oxygen, you can't help. My other analogy is that you would never let your phone run out of battery. You would charge it up regularly. It's the same with yourself –you need to recharge yourself regularly.
Supporting staff means having a safe space to talk about patients or people they’ve worked with who are living with trauma. It’s about getting that out in the open so that they don’t take it home and it doesn't affect their whole life, because it will ultimately affect their health as well, and then people end up taking time off. It's really important to have a good, supportive team and to pick up on when things are getting difficult and when things are traumatic. We can’t always change that, for example now people are barely able to heat their houses and eat, and that's really distressing. At WISHES, we have a psychologist who comes to the clinic to speak to the staff. She doesn't speak to the women, but she speaks to the staff to support them and talk these things through.
I hang on to the fact that we're doing the best we can and we are doing something when other people are not doing anything. That consistency, that always being there, being welcoming, sending out the same message to people is really, really important. Sometimes we don’t appreciate that people don’t have stability, friends and family there for them, so having a place where somebody is looking out for them, who will make them a cup of tea and listen to them can be life-saving.
Alison shares how she approaches supporting women who sell or exchange sex in a trauma-informed way, including the importance of partnership working, she reflects on why services need to be aware of trauma and discusses making sure that employers look after their support staff.
At the moment you are doing two different but equally important roles. Can you start by telling us about the WISHES clinic and how it came to be?
After training in obstetrics and gynaecology, I started working in a sexual health clinic. Very soon I discovered that the service wasn’t really accessible to people who were most at risk of unintended pregnancy and sexually transmitted infections. The location was difficult to access without a car, it was away from a main road and you had to have an appointment. As a result, the clients we saw were mostly comfortably off women from the centre of Edinburgh. We did have some peripheral clinics in areas of depravation, but they tended to be in the mornings, and again people needed to book an appointment, so overall it wasn’t a particularly accessible system.
Around that time, I met a nurse that worked in a substance misuse service who also offered sexual health sessions. We were chatting and she mentioned working with many women who had very chaotic lives but really wanted to have a baby. Because of their situation, the women’s baby was usually removed, leaving them with a lot of grief. Women in this context want someone to unconditionally love them, so they would try to have another pregnancy and then the same thing would happen – they were stuck in a cycle. Other women would not have a period so whenever they had sex, they thought they couldn't get pregnant. But once they stabilised on a programme and started eating better and taking better care of themselves, then their ovaries would start working again and suddenly they were at risk of pregnancy.
I discussed with the management at my clinic and eventually they allowed me to set up a clinic in the substance misuse hub in the centre of Edinburgh. We had a room adjacent to the waiting area so the women could just drop in after getting their injecting equipment, their methadone or if they were seeing a substance misuse worker.
That was about 15 years ago, and over time we’ve broadened this model because we realised there are other women out there – not just women with substance misuse problems – who could benefit from an accessible service. We also became aware very quickly that almost all women we supported had a history of some trauma. So if we started doing all the really efficient healthcare procedures as soon as the women arrived, like a full sexual health screening, giving them contraception and asking them all these questions, that was too scary and they would just runaway.
From a clinical point of view, these women maybe hadn’t had a smear for a while or were at risk of pregnancy, and that was our health priority; but that was not the women's priority. Their priority was that they were living in a very dangerous situation because they didn’t have a place to sleep. This is when we decided to link in with SACRO’s Another Way project, a service for anyone over the age of 18 at risk of commercial sexual exploitation. They support the person to meet their needs such as benefits, housing and education. Working together we could engage with women who sell or exchange sex and look after their health; but again, it is a very slow process because if you have been a victim of rape or sexual abuse then having an internal examination is really tough and we would never jump straight into that. We do that when the woman's ready for it, not before that.
WISHES started off as a women's clinic and was rebranded a few years ago as the Women's Inclusive Sexual Health Extended Service or WISHES. For us it is about the women’s wishes, their aspirations, and many women do not have that. Here, we allow them the space to talk about where they want to be, what they want, and we follow that.
You are also involved in supporting university students, could say more about that role?
A couple years ago I was invited to get involved in the Women's Health Plan for Scotland, to lead on the sexual health aspect of it. After thinking about it for some time, because I’ve never worked outside of the NHS, I accepted. I worked for the Scottish Government for 18 months during the pandemic and that gave me a little bit of a boost that I could work outside the NHS, that I did have skills that were transferable into different roles. I’d also been a tutor for medical students for quite a number of years doing some pastoral care, so in 2020 I was asked to apply to become Head of Student Wellbeing for the medical school. I got the job, which I really enjoy, and I have to say there's a huge overlap of trauma and mental health problems with the student group.
We are aware that some students are selling sex. When students were working online, Only fans was just too convenient. It was a way of generating income, and with the current economic crisis, I think more and more students will be moving into that. I once met a woman at my clinic who had started a degree and then got into escorting and said she had gone through three months of constant trauma and physical violence. She's now more aware of how to keep herself safe, but she still wants to get out. However, once you're in the ‘sex industry,’ it’s very difficult to leave. Earning enough money to pay bills and finding other employment that gives the same income can be a challenge for women.
At the same time, medical students are probably less likely to disclose that they sell or exchange sex because as doctors we are governed by the General Medical Council, that’s our professional governing body for standards of behaviour and professionalism. The GMC sit on the fence when it comes to commercial sexual interactions. They feel that perhaps it’s not professional, particularly if patients are aware of it, but they don't absolutely say that medical students shouldn't do it. At the wellbeing service, we try to be open about it and about discussing with students how they feel about their sex working.
Women mention that stigma and fear of judgment can really prevent them from disclosing that they sell or exchange sex. How do you create a safe space within your services for women to disclose?
One of the benefits of the WISHES clinic is that it is advertised as a service for women who have experienced gender-based violence or are selling sex. Women don't have to worry about the reaction because they know that the clinic is there for them. If they go to a GP surgery or even a mainstream sexual health clinic and say that they’re selling sex, women may be slightly worried about what the reaction is going to be. Generally it will be a kind and caring reaction of “oh, are you alright?” but that can be interpreted as being judgmental. The benefit of a service which brands itself as being for women involved is that they don't have to worry about those reactions. They can just turn up and whatever they say is not going to generate an adverse response from any of the staff because the service is for them.
For students, we advertise that we are a safe place for them to come and speak to, whether their issue is gender-based violence, commercial sexual exploitation, racial harassment, sexual harassment, homophobia, hate crime, all these kind of things. Our message to students is that we are there for them and we won't judge.
In your experience, how does trauma play out for women who have been involved in the ‘sex industry’?
We have a small number of women who are very open to everyone about what they're doing, but the majority of women keep it secret, often even from their partners – they'll say that they're going out to do a caring role to explain their irregular hours. Their families and partners don't know, so they’re constantly hiding a huge part of their lives. They are worried that they're going to be exposed, that someone is going to say something when they are on a night out with their friends, or that their phone is going to give away their secrets. That's really difficult and stressful, and women become very anxious, constantly worried and unable to relax.
Women have described sort of playing out different roles, feeling as though they have to be someone's partner, someone's girlfriend, someone's mother, and then someone’s sex toy. For each of these roles they are a completely different person, which is why the Inside Outside exhibition resonated so much with me, because women put on a mask, a different face; they put on their makeup and different clothes and become somebody who sells or exchanges sex. Then they go home, change into their pyjamas and they’re someone's partner. And when their partner wants to have sex, the women really don't feel like it because they've spent all day having sex, but they have to put on this act of wanting to do it and they can't explain why they don't want to have sex, which gives women a lot of anxiety, stress and a low mood.
I also cannot think of a single woman involved in selling or exchanging sex who has not been assaulted while being involved. It is seen as “I've got control. I can control what happens and when I have sex,” but the person in the room who has the control is the man because he's paying the money and will demand what he wants. For women, there's that anxiety of never knowing quite how the interaction is going to end. Lots of women have experienced violence and have the PTSD effects of a male violence which is often recurrent.
Trauma can emerge at different stages of a person's life. Have you supported women who after leaving the sex industry start experiencing trauma symptoms related to their involvement?
Yes. Many people, not just those involved in selling or exchanging sex, when they experience something very traumatic, they put it away in a box, put a lid on it, put in the cupboard, shut the door, and then think “OK, I'm over that. It's fine now. I’m healed,” when actually they haven't. At some point there's a trigger, which might be going for a cervical screening, having a baby, a new relationship, anything… and suddenly the lid comes off the box and it all unravels and gets very messy.
One of the issues is that getting trauma counselling is really difficult. Currently in Lothian the only available service is group therapy, and people may not want to sit there and go “I used to sell sex and I got raped six times.” You can't really do that in a group, it is not right for everyone. It is really difficult to heal, really difficult for women to get professional support to help them move forward when they have experienced trauma like that.
Thinking of this reality for women, why do you think workers and support services should have a trauma-informed approach?
I think it is essential. I think workers need to be aware that if someone is kicking off in reception, is really angry and being aggressive, it may well be because they are traumatised and anxious and not because they are really rude and horrible. It’s thinking outside the box, taking them to a quiet space saying “sorry you had this experience, how can we help?” and giving them the space to talk about what they want and need, because otherwise we cannot move forward for them.
Awareness of adverse childhood experiences is also necessary, because so many people have more than one episode of trauma – they've had trauma since childhood with sexual abuse, domestic abuse, poverty and even neglect, which can happen across all demographics. And then they get into poor relationships. This can in turn create a distortion of what love, lust, affection, attention and sex are and what people are looking for. There is also poverty of love. I remember supporting an escort who was earning masses of money. During her upbringing she was always rewarded with material things when she did well, but nobody seemed to spend time with her or show her love, so she had this distortion of what made her valued and it was very material.
I think all support staff need to be trauma aware and trauma-informed, and it's good for yourself as well because then you are more aware of your own traumas and keeping yourself safe, particularly when working with gender-based violence. In primary care and other settings, when people disclose they have been involved in selling or exchanging sex, sometimes staff react in a way which people perceive as being judgmental and is not meant to be. It is meant in a caring way, but we have to be very careful about what we say and how we present our need to care. Because the most important person in the room is the patient and not yourself, so it’s not about doing what you feel comfortable with, it’s about doing what's right for the patient.
In your experience, what does a trauma-informed approach look like?
For me is about being aware that people come from different places, from all sorts of different experiences, and appreciating the fact that coming through the door could be a major thing for them. The last thing we want is to make them feel uncomfortable, so from the very first interaction we need to be aware of what the patients’ needs are and that they may have had really awful experiences in the past.
It is really important that women are given choice to say “no, sorry, I'm really uncomfortable. I'd rather have female staff. I don't want to have a male doctor or midwife if possible.” All these little things that can be a bit of a nuisance for staff really matter to the women, and that's what needs to come first – being aware and giving women some control. For example, intimate examinations are a huge thing in a sexual health clinic. So I've given women speculums to take home with them, to have a look and feel of it, try inserting it themselves. I have patients who insert their own speculum because then they've got control and they know where it feels comfortable and can stop and start. If that is how we can check that they are healthy, then that's fine with me. It's about adapting how you manage a patient to what she needs rather than what is easiest for you. For people who have experienced trauma, it's really important to build trust. If people trust you, then you're more than halfway there, but you've got to think outside the box.
How should workers approach supporting women who are still going through a traumatic experience?
It's about not being judgemental and really listening to what they're saying and what they are not saying while reflecting back the language they're using, even in a way of “can I just check I understand that what you're saying is…” Sometimes when they hear their own words back, they think “actually yeah, I’m really not happy in this situation.”
Also telling people that they are valued and really showing that care. I recently read Edith Eager, a Hungarian Jewish woman who was sent to a concentration camp and after leaving for America, she became a psychotherapist. A lot of her work is about opening your arms and showing care to others, showing them their value. I do that a lot –women will come in with bruises and say they were beaten up but that the man was paying them. My response to that is “people pay me to do my job, but it's no acceptable for me to be beaten up while I'm doing my job. If it was the other way around, you would be saying to me ‘that’s wrong. People shouldn't be beating you up.’”
Bringing that connection of being another woman, big another vulnerable woman – because if my life had turned out differently, we could be in different seats – and saying that it is not acceptable for anybody to be traumatised and abused in that way. Reflecting to them that they are valued and worthy and that they shouldn't be on the receiving end of abuse. I think often women become so overwhelmed and pushed down by the abuse that it becomes the norm for them. Pointing out that this isn't normal and they shouldn't have to be dealing with abuse is crucial.
People are also always worried about saying the wrong thing or making things worse. What I say to my trainees is: “you can't make it worse. Asking a woman if she feels safe at home is fine. You can’t make it worse by saying that, it is already bad enough if she doesn't feel safe. So have the guts to ask questions and use your instinct. If you’re feeling that there's something not quite right in the consultation, just ask a few more gentle questions and see where you go with it.”
Routine enquiry is about asking the right questions, but saying “are you a victim of gender-based violence?” is not the right question. Instead, asking “do you feel safe at home?” can give you information very quickly. Generally people will say “yes, yes, I’m fine,” but even a pause before answering can be an indication that there's something there. Being a little more subtle is a much better way of finding things out than just asking very blunt questions.
We’ve talked about the importance of being trauma aware when working with women who sell or exchange sex, but I wanted to finish by asking what do you think is the impact on support workers and what can organisations do to make sure staff feel supported?
It’s so important to support the people who are giving the support. It's like being on an airplane: you have to put on your own oxygen mask first and then help the others, because without enough oxygen, you can't help. My other analogy is that you would never let your phone run out of battery. You would charge it up regularly. It's the same with yourself –you need to recharge yourself regularly.
Supporting staff means having a safe space to talk about patients or people they’ve worked with who are living with trauma. It’s about getting that out in the open so that they don’t take it home and it doesn't affect their whole life, because it will ultimately affect their health as well, and then people end up taking time off. It's really important to have a good, supportive team and to pick up on when things are getting difficult and when things are traumatic. We can’t always change that, for example now people are barely able to heat their houses and eat, and that's really distressing. At WISHES, we have a psychologist who comes to the clinic to speak to the staff. She doesn't speak to the women, but she speaks to the staff to support them and talk these things through.
I hang on to the fact that we're doing the best we can and we are doing something when other people are not doing anything. That consistency, that always being there, being welcoming, sending out the same message to people is really, really important. Sometimes we don’t appreciate that people don’t have stability, friends and family there for them, so having a place where somebody is looking out for them, who will make them a cup of tea and listen to them can be life-saving.
