Health

A years-long battle to have the psychological trauma caused by domestic violence correctly diagnosed and treated has finally resulted in Australia’s first specialised women-only mental health facility. By Jane Caro.

The woman who would not give up

Psychiatrist Karen Williams, founder of Doctors Against Violence Towards Women.
Psychiatrist Karen Williams, founder of Doctors Against Violence Towards Women.
Credit: Bobby Kidd

A few kilometres north of Wollongong, on the fringes of the Dharawal National Park, a sanctuary is taking shape. It is the first hospital of its kind, dedicated to the treatment of complex post-traumatic stress disorder (cPTSD) among women who have suffered domestic violence.

This shouldn’t sound revolutionary, but it is. Even recognition of the condition has been a hard-won battle for psychiatrist Dr Karen Williams, and she doesn’t pull any punches.

When I first met her at a domestic violence services fundraiser about five years ago, Williams was on a one-woman crusade to rethink the way we treat trauma in female victims of domestic abuse compared with the first responders – mostly male – who suffer trauma as a result of their job. She particularly wanted to change the diagnosis women survivors are often saddled with – borderline personality disorder (BPD) – to complex post-traumatic stress disorder. The difference is between saying “there is something wrong with you” and “something bad happened to you”.

At that time, Williams told me a terrifying story about a woman who was murdered by her partner with an axe in front of her child. The police officer who was first to the scene was understandably traumatised by what he saw and became a government-funded patient of Williams’. What upset her was the knowledge that the child who had witnessed the murder and the woman’s sister, who was now the child’s guardian, received no such help.

Williams’ passion and persuasiveness led to an article in these pages in October 2019, and Williams says her argument about the catch-22 with which women struggle in abusive situations has since garnered serious attention. First she received an invitation to speak at a conference at Sydney’s Prince of Wales Hospital dealing with the treatment of complex trauma. This speech led to more such invitations.

Dr Angelo Virgona, chair of the New South Wales branch of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), became an important and powerful ally. After an awkward initial meeting, he rang Williams to apologise. Never one to let an opportunity go by to advocate for the women she treats, Williams describes how she was “in his ear” for the next two years. Eventually she converted him.

“It doesn’t matter if BPD exists or not, we should replace it with complex PTSD as a diagnosis. We can’t rehabilitate it. BPD has become stigmatising,” Virgona tells me over the phone. “Many staff have become negative in their attitude to BPD sufferers, and this is terrible for people who present in distress.”

Bianca, a patient of Williams, who has struggled with the BPD label for 10 years, agrees. After being raped multiple times, Bianca felt that the medical system had let her down. “I coped with my trauma in the wrong way for years, cutting, burning, dancing with death with overdoses.” When one counsellor asked her if she “had a reason for those scars on your arm”, Bianca felt dismissed and not believed. When she talked to another a few years later about what she had lost at the hands of the man who had repeatedly raped her, this trained professional suggested she “think about what he had lost when he went to jail”.

Williams explains the trap of a BPD diagnosis succinctly. “The women are traumatised and ashamed of the abuse, so they don’t ask why no one is paying attention,” she says. “They internalise the oppression and have lost their voice. But it’s more than that. They know speaking out could lead to them being labelled mentally ill, and that could mean they lose custody of their children.

“These women are trapped between a legal system that wants them to take their abusive husband back and family services who will take their children away if they do. We’ve made the outside world more dangerous for women than the man who is trying to kill them.”

Psychologist Merrylord Harb, who works with Williams, is in no doubt about the needs of women suffering complex PTSD. “These are very vulnerable people daring to open up and trust, so that has to be very carefully and expertly managed, otherwise they clam up forever. A safe and secure space is vital before any healing can take place.”

No wonder, along with consigning BPD to the psychiatric history books, Williams was determined to get a specialist ward, staffed by trauma-trained professionals, to help her patients. For a long time she got nowhere. The best she was offered was the opportunity for her female patients to join PTSD groups that were largely for men. This does not work, Williams told me, because women who have been damaged by men tend to be triggered by men and go quiet in mixed groups.

“They think: these men have been to war, their trauma is worse than mine,” she says, sighing with exasperation.

Desperate, she decided to pitch to Anne Mortimer at Ramsay Health Care. “I ranted at her for 45 minutes, not letting her get a word in edgeways. When eventually I paused for breath, wondering if she thought I was crazy for talking so much, she asked me what I wanted. ‘I want a ward,’ I said. ‘What if I give you a hospital?’ she replied. I burst into tears.”

Far from being deterred by the unorthodox pitch, Mortimer, who is the director of Ramsay Mental Health Australia, was inspired. Williams’ timing was perfect. “Being a woman in a senior position, I feel very privileged I was able to make this happen, and super quickly,” Mortimer says.

The hospital – Ramsay Clinic Thirroul – will open on August 1. It will be the first women-only mental health facility dedicated to the psychological and psychiatric consequences of trauma in Australia. Unlike the domestic violence trauma recovery centre announced in the recent federal budget – another much-needed initiative – the Ramsay clinic will be a 43-bed unit offering both inpatient and outpatient services.

Mortimer expects that, depending on the clinical assessment, women may stay for as long as two to three weeks and then be offered extensive aftercare. Mortimer emphasises the importance of follow-up treatment. Aware that the hospital will treat patients from far and wide, the clinic will offer day-patient care for those who live nearby, one-on-one consultations with a psychiatrist and telehealth services for those who live further away.

The hospital will also be a hub for other female-centred mental health services, including outpatient treatment for eating disorders and substance abuse, and will include a 10-room consulting suite. After all, as Mortimer, an ex-mental health clinician herself, points out, “often these issues also lead back to trauma in the woman’s past”.

The hospital is under renovation and all signs of its previous life as a rehabilitation facility are being erased. Mortimer says it will be a beautiful light-filled space creating a calm and nurturing environment. Each inpatient will have a single room with an en suite: “I want it to be a sanctuary.”

Williams will be its medical superintendent and both she, Merrylord Harb and Anne Mortimer are of the same mind. All three are looking to develop a treatment model that can be rolled out. “Scalability is very much in my thinking,” says Mortimer.

Williams’ patient, Bianca, is unequivocal about the need for such a facility. She was diagnosed with BPD within 10 minutes by a psychologist who had no knowledge of her trauma. “It’s so important to have the trauma centre and hospital for women,” she says.  “I spent years feeling ashamed that there was something wrong with me, until finally someone said, ‘No, it’s complex PTSD.’ ” 

National Sexual Assault, Domestic and Family Violence Counselling Service 1800 737 732

This article was first published in the print edition of The Saturday Paper on May 7, 2022 as "The woman who would not give up".

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Jane Caro is a Sydney-based novelist, writer and documentary maker.

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