Challenges in sustaining a hospital based crisis centre: Learnings of the first hospital based crisis centre in India Sangeeta Rege CEHAT

Overview Dilaasa: the first hospital based crisis centre in India Dilaasa: the first hospital based crisis centre in India Rationale Rationale Salient features Salient features Major achievements Major achievements Challenges Challenges Creating a sustainable model Creating a sustainable model Journey ahead Journey ahead

Contribution of the Womens Movement Highlighting the issue of violence against women in 1980s by bringing the custodial rape in the public domain. Providing a gendered lens for questioning the entire spectrum of oppression. It is rooted in caste, class, religion and gender. Initiating and establishing different spaces for women in the form of informal shelters, counselling services etc.

Rationale for setting up a crisis centre Health care providers ( HCP)may be the first contact for a woman facing GBV. Health care providers ( HCP)may be the first contact for a woman facing GBV. Doctors are in a unique position to probe for any history of violence. Doctors are in a unique position to probe for any history of violence. They are trained to identify the cause of injury, burns and differentiate between injuries caused by fall or assault. They are trained to identify the cause of injury, burns and differentiate between injuries caused by fall or assault. Public health system is the only place to provide important medico legal evidence. Public health system is the only place to provide important medico legal evidence.

Objectives of the state/NGO partnership Dilaasa is a joint initiative of the public health department of Mumbai and CEHAT, a research organization working on health issues of marginalized people. Objectives: Training the hospital staff Training the hospital staff Equipping the department with feminist perspective on counselling. Equipping the department with feminist perspective on counselling. Gradual withdrawal and retaining monitoring activity Gradual withdrawal and retaining monitoring activity

Salient features of Dilaasa Dialogue, cooperation, democratic decision making, joint ownership and women centered approach. Dialogue, cooperation, democratic decision making, joint ownership and women centered approach. Crisis intervention services linked to shelters, legal aid agency and other womens organizations. Crisis intervention services linked to shelters, legal aid agency and other womens organizations. Use of research tools through all stages. Use of research tools through all stages.

Salient features of Dilaasa Change in the information system. Change in the information system. Awareness programs in out patient departments Awareness programs in out patient departments System of ongoing training System of ongoing training

Achievements Establishment of a nonjudgmental, compassionate, safe, confidential space for women. Establishment of a nonjudgmental, compassionate, safe, confidential space for women. Bringing the feminist perspective to a mainstream public health system. Bringing the feminist perspective to a mainstream public health system. Increase in referrals over the past 3 years. Increase in referrals over the past 3 years.

No. of women referred to Dilaasa DepartmentYear 2003 Year 2002 Year 2001 Casualty50 20 Out Patient Department In patient department Hospital staff Other organisations2248 Self referral71257 Community16244 No information 023 Postures/Pamphlet20 -- Total

Achievements Twelve staff emerged as trainers and trained 833 HCPs on domestic violence over two years. Twelve staff emerged as trainers and trained 833 HCPs on domestic violence over two years. Program is being replicated in 4 other hospitals Program is being replicated in 4 other hospitals

Challenges in sustaining such a model Integrating the understanding about violence into practice is difficult. Integrating the understanding about violence into practice is difficult. No routine screening No routine screening Weak medico legal documentation Weak medico legal documentation Counselling not valued as a health care need Counselling not valued as a health care need

Challenges in sustaining such a model One time training is not enough One time training is not enough No budget for ongoing training within public health department No budget for ongoing training within public health department Over-enthused staff get into arbitration with the abuser, overriding the autonomy and breaching her confidentiality. Over-enthused staff get into arbitration with the abuser, overriding the autonomy and breaching her confidentiality.

Challenges in sustaining such a model Fear of dilution of the feminist perspective after CEHAT withdrawal Fear of dilution of the feminist perspective after CEHAT withdrawal Professionals not interested in training on DV Professionals not interested in training on DV Violence perpetrated by the health system in terms of hierarchy,as well as domestic violence faced by the staff is something that needs to be addressed. Violence perpetrated by the health system in terms of hierarchy,as well as domestic violence faced by the staff is something that needs to be addressed.

How to create a sustainable model A hospital based crisis centre can run with high level of commitment from collaborating partner. A hospital based crisis centre can run with high level of commitment from collaborating partner. A separate room and hospital staff assigned to such work brings a sense of ownership to sustaining the department. A separate room and hospital staff assigned to such work brings a sense of ownership to sustaining the department. The nursing staff play the role of carers and spend long period with the patients: can be trained as Para counselors. The nursing staff play the role of carers and spend long period with the patients: can be trained as Para counselors.

How to create a sustainable model Need to collaborate with staff of peripheral hospitals such as the Primary Healthcare Centers (PHC). This will help in early identification of abuse and timely referrals. Need to collaborate with staff of peripheral hospitals such as the Primary Healthcare Centers (PHC). This will help in early identification of abuse and timely referrals. The partnering external organization needs to provide technical expertise in training, monitoring and evaluation. The partnering external organization needs to provide technical expertise in training, monitoring and evaluation.

The Journey Ahead Initiating the issue of GBV within the medical curriculum Initiating the issue of GBV within the medical curriculum Violence faced by providers needs to be addressed. Violence faced by providers needs to be addressed. Expand DV work at all levels of the public health system Expand DV work at all levels of the public health system Community health workers(CHW) are an important link between the community and health system. Community health workers(CHW) are an important link between the community and health system.

Training sessions conducted by the core team of the hospital

Thank you