Threats to core domestic violence services
Some time ago I was driven in a small car through inner-city Sydney by Karen Willis, who was then head of the New South Wales Rape Crisis Centre. We had been at an all-day meeting of the national committee to prevent violence against women and their children. I can’t remember where Willis was taking me afterwards, just that she was doing me a favour. Willis exuded bonhomie that evening. She swung her little blue car around the narrow streets of Paddington, nudging the edges of the endless roundabouts, talking the whole time. Eventually I became sure we were lost, but Karen kept driving and turning, up and down the inclines, until I realised we weren’t lost, or at least she wasn’t. I remember feeling lucky to be speaking with her – this activist, this legend – so much so that I started to laugh. It was that kind of time in the women’s movement. The new Labor government had not yet started to eat its young, and the national committee was in the process of creating the first National Plan to Reduce Violence Against Women and their Children. It was 2008. People such as Willis had been working decades for this.
On Tuesday I spoke to a very different sounding Willis. As executive officer of Rape and Domestic Violence Services Australia (RDVSA), a non-government organisation, she was in Canberra meeting with politicians to try to secure redundancy payments for the 70 workers she anticipates having to lay off by October 28. The organisation has not renewed its contract. It has “ethical concerns” with the quality and confidentiality of the service it was being asked to provide as part of 1800RESPECT, the national domestic violence and sexual assault hotline. The layoffs would include specialist trauma counsellors, their expert supervisors, technical support and administrative staff. The workforce would be reduced to about 18 full-time positions. The redundancy payments would total about $1 million, which the service does not have in reserve. Willis sounded gutted. Flanked by Natalie Lang, branch secretary of the Australian Services Union (ASU), she sometimes passed the phone to Lang to take over the conversation.
This story goes back to 2010, when Rape and Domestic Violence Services Australia were subcontracted by the private provider Medibank Health Solutions to wholly provide the 1800RESPECT hotline, funded by the Australian government. Established under the national plan, the hotline is cited at the bottom of media reports about domestic violence and sexual assault and emblazoned on billboards. During this period there was a significant and unprecedented improvement in community awareness about violence against women, particularly domestic violence, and promotion of the hotline. From 2010 until 2016 there was a 234 per cent increase in use of the service, but only a 158 per cent increase in funding. “From day one,” Willis says, “demand was above funding capacity to supply.”
Figures on just how many calls were abandoned and how long callers had to wait vary between parties. Willis says the worst percentage of unanswered calls was above 30 per cent; the government says that between 2015-16 more than two-thirds of calls to the hotline were abandoned. Either way, following complaints made by the sector, and repeated calls for more funding, the federal government injected an additional $4 million into the service, but the difference this made to service delivery was not seen soon enough.
The government commissioned accountancy and consultancy firm KPMG to review the service, with a focus on how to decrease call wait times and abandonment rates. Also at this time, Medibank Health Solutions paid Women With Disabilities Australia to research experiences of the services by women with disability who had experienced violence, and this detailed numerous concerns.
KPMG recommended three options: increase funding for the existing operating model; create a trauma-specialist triage function; or create a social worker/first responder triage function. The last option was the only one KPMG said held a risk for callers requiring trauma-specialist services, because “they would have to navigate an additional layer of service”. This is the option the government chose.
The new triage model was introduced last year. Instead of calls being answered by a trauma specialist counsellor from Rape and Domestic Violence Services Australia they were now answered by a generalist counsellor employed by Medibank Health Solutions. These workers are qualified and experienced counsellors and psychologists, but they are not required to have as much training as an RDVSA worker, including specialist trauma expertise. They work in their own homes and also answer calls from other telephone lines such as beyondblue and Nurse on Call. They do not receive the supervision, support and professional development provided to RDVSA workers. What they do when they pick up the phone comes from a generalist “health” or clinical perspective, rather than one informed by the latest trauma research and a gendered understanding of violence against women.
When the generalist triage counsellor answers, they can refer a caller to a local service, emergency service or an online resource such as a fact sheet. They can also make a referral to a specialist trauma counsellor – some in the sector now advise callers to specifically ask for the trauma specialist if that’s required. Rape and Domestic Violence Services Australia were contracted to provide the specialist trauma referral arm, but when their contract came up for renewal this year, they were told after initial negotiations that three other services would also be offered contracts and their share of the service would be reduced to 25 per cent. “We were being sidelined,” Willis says.
What constitutes a specialist trauma service – and who provides it – has become hotly contested in this field. One sector leader said that “pitting women’s services against each other” was a side effect of the tendering process. Willis argues that the expertise of these other services lies more in, for example, assisting women to find safe accommodation options and creating a safety plan, but this is disputed. Willis states that RDVSA’s trauma counselling model is best practice and explains that it was developed in 2004 after two years of research into what constituted best practice in this field, and 40 years’ background experience. Also, that it has been renewed and updated twice, and is studied internationally by Churchill Fellows. Natalie Lang points out that it has received a letter of support from the International Network to End Violence Against Women and Girls.
Expertise is not the only issue raised by splitting the trauma counselling arm of the hotline between several services. It also creates difficulties for continuity of care. One of the functions of 1800RESPECT has been the provision of ongoing support for victims and survivors while they are on a waiting list for a local face-to-face counselling appointment. Continuity of care is unlikely if the specialist service they are referred to varies each time they call.
But none of this is what caused RDVSA’s refusal to sign the contract, a decision agreed on by both the board and workers, including those who are likely to lose their jobs. The deal-breaker was when Medibank Health Solutions asked the service to hand over all client file notes from the past six years.
“This is mostly women who’ve contacted us, told us their stories, trusted us, and we were just expected to dishonour that,” Willis says.
Added to this, Medibank Health Solutions have a regrettable record on confidential personal records. In 2015 a company subcontracted by MHS for the federal government, Luxottica Retail, suffered a significant data security breach when it sent eye test records and the personal contact details of hundreds of military personnel, including soldiers posted overseas, to a processing facility in Guangdong province, China.
Medibank Health Solutions also required RDVSA to record all calls. RDVSA are concerned these recordings could be subpoenaed by defence lawyers and used against women, and some recommend callers now specifically request their call is not recorded. And MHS stipulated they would determine workers’ rosters on a three-monthly basis, making it difficult for RDVSA to fulfil existing industrial obligations and guarantee jobs. Workers would also not receive the supervision considered important for workers in the trauma field to ensure ongoing quality of service and prevent vicarious traumatisation.
Finally, the services were asked to adhere to the counselling model proposed by MHS, which had not yet been disclosed. Willis thinks this is because it had not yet been developed, but that it would likely follow a generalist counselling model rather than a trauma specialist model.
No one disputes the new triage model has led to an improvement in call wait times. The government reports this has been “reduced to 45 seconds with 80 per cent of calls answered in 20 seconds and 92 per cent of calls being answered”. But calls are also shorter, with time now a major consideration. Many point out that time should not be the most important factor when responding to a victim or survivor of violence. They require a high-quality, caring, trauma-informed response. Research shows that the quality of the first response to a call – a call that might be years in the build-up – is crucial.
“When we got that national plan in 2009 and then the service and the commitment to provide a nationally consistent trauma service … after so many years of the women’s movements, we were actually getting somewhere,” Willis says. “And now this. Over the last couple of years, under the conservative government, they have handed it over to the private sector and wound back, wound back, wound back. Now quality equals the number of calls answered.
Social Services Minister Christian Porter says it is offensive to suggest MHS are making a profit based on calls taken. But earlier this year, Medibank group executive Andrew Wilson was reported in The Australian as saying that hotlines including 1800RESPECT are all an active part of their business: “We have put a stake in the ground and said we’d like to double the operating profit of this part of the business in the next three years.”
This speaks to the heart of the problem. Willis says that in meetings MHS talk a lot about “the client” and “keeping the client happy”. In this case, the client is not the person on the phone; it is the Australian government. In organisations such as RDVSA, representing the voices of people who have experienced violence and advocating their interests is considered a core responsibility. By reducing their funding, this representation and advocacy – which was central to the creation of core services such as 1800RESPECT – is also threatened.
On Wednesday, Karen is sounding better. She says there is support brewing for a senate inquiry into the MHS contract. She and the ASU hope this will result in her service receiving $1 million in funding for redundancy payments. They also hope for funding of $8 million for the RDVSA to provide the trauma specialist counselling. If that happens they are asking that the three other services keep the $2 million they would have each received for additional service provision.
But the key issues remain: there is too much violence and not enough money for an effective and appropriate response, and the government’s solution is to privatise care.
Sexual Assault and Domestic Violence National Help Line 1800 737 732. (Callers may ask to be put through to a specialist telephone counsellor. They may ask that their call is not recorded.)
This article was first published in the print edition of The Saturday Paper on Sep 9, 2017 as "Where’s the respect?". Subscribe here.