A compassionate and attentive listener: People exposed to violence and their encounter with the public assistance services and the police.

Grøvdal, Y., Saur, R., & Skaalerud, A. R. (2014). En velvillig og oppmerksom tilhører: Mennesker som har vært utsatt for vold og deres møte med hjelpeapparatet og politiet [A compassionate and attentive listener: People exposed to violence and their encounter with the public assistance services and the police.] Norwegian only. Oslo: Nasjonalt kunnskapssenter om vold og traumatisk stress. (Rapport 2/2014).

This report addresses both domestic and non-domestic violence (violence in public places) for both men and women. The purpose of the project was to study the provision of help and support to victims of violence from various angles.

Background
Studies show that a significant number of people in Norway experience various forms of violence in their lifetime. According the Living Survey conducted by Statistics Norway, men are more likely to experience violence from strangers or casual acquaintances, while women tend to suffer violence from people they know well, such as husbands and boyfriends. However, women are also subject to violence from clients or patients at their places of work. This report addresses both domestic and non-domestic violence (violence in public places). Offences range from physical violence such as punches and kicks, to belittling or controlling behaviour and harassment, also referred to as mental or psychological abuse. Sexual abuse is one aspect of this wider picture. 

Aim
The purpose of this project was to study the provision of help and support to victims of violence from various angles. Our report is divided into three main sections. The first section looks at provisions for helping victims of violence in some Norwegian municipalities. In part two, we explore these provisions from the viewpoint of employees in various care services and of victims themselves. The third section reports from a small study of the Swedish Crime Victim Compensation and Support Authority (Brottsoffermyndigheten or BrOM for short). BrOM, an agency within the Swedish legal system, has been described by some in Norway as a form of «national victim care», and held up as an example worth following for Norwegian authorities in the way it organizes assistance to victims of violence. 

Method
Since our starting point was «deficiencies in the system», we looked mainly at the opinions of the study’s respondents about what they felt should be better or different. The method we used to obtain answers can be described as qualitative; it comprises telephone interviews with members of staff and managers in some Norwegian municipalities; two focus groups of people with experience of various types of violence; and two focus groups of staff employed in different care services which people can access without the need of a medical referral (i.e. primary healthcare or frontline services). The section dealing with BrOM also includes document studies and telephone interviews with relevant stakeholders in Sweden who deal with violence-related issues in their work. All participants in the study were adults over 18, and we have primarily studied the situation of adult victims of violence. Nevertheless, we do address certain issues relating to children in the report.

Results
The challenges described in this report relate essentially to issues such as cooperation, participation/involvement/consultation, time /capacity, accessible help and skills/expertise in the care services. Information and awareness of care options were other topics of key importance. Virtually all these matters were brought up by members of staff and participants with experience of abuse alike. What also came to light in interviews with employees in some of the municipalities and in the focus groups, was that some victims of violence apparently find it harder to obtain help than others.

When we discuss in more detail the various topics, it will be easier to see the connections between them. For example, working together can take time, but can also save time; on the other hand, without knowledge about each other, a system of collaboration may never materialize. In that sense, some of our categories and divisions might seem somewhat «contrived». All the same, as far as possible we do address each issue separately in this summary.

Collaboration
The importance of inter-service and inter-agency cooperation has been an issue for decades, especially since the 1970s when what was called the abuse of women found a place on the political agenda. Cooperation has, however, proved elusive in practice. Some of the obstacles include hectic workdays, professional jealousies, a desire to preserve one’s «monopoly of knowledge», and general unfamiliarity with the working methods and thinking of other professions and sectors. Participants in our project who worked in various parts of the health and care services cited lack of time and knowledge in particular as barriers to collaboration. Both in the focus groups and in the interviews with municipal employees the monopolising of knowledge (see over) was mentioned. Some care services were described as acting like they own the field instead of wanting to share their competence. Cooperation can also be seen as a perishable commodity. Creating a climate favourable to cooperation requires a sustained, conscious effort partly because organizations change and staff leave for various reasons. It is also important that collaboration is anchored in the leadership of the different organizations, agencies etc.

At the same time, collaboration is frequently described as the key to providing care successfully, also in our study. The more complicated and challenging the circumstances of victims of violence, the more important it can be to pull together. According to participants in our study who had been victims of abuse, collaboration can save time and effort, provide confidence and security, and deflect frustration. Many had experienced that their attempts to obtain help had stranded, and some were exhausted at the mere thought of all the things they had to get sorted out. It takes only a little discouragement, we were told, for people to give up looking for help, and building up the necessary courage and strength to start over again could take a lot of time. Staff and managers in small and large municipalities alike stressed the importance of working closely together, both within municipalities and across municipal boundaries. The latter was in some cases regarded as a virtual necessity, not least because the provision of care, particularly in small and medium-sized municipalities, is likely to be limited. Participants in this study shared a desire to see better coordination in the delivery of care by the various agencies and services to victims of abuse. But as discussions in the focus groups revealed, there is still some way to go before their wishes and ideals become reality.

It seems that for cooperation to succeed, people need to know each other. Successful cooperation will often depend on familiarity with each other’s field of knowledge, area of work and working methods. With this information, the individual care worker will also be better equipped to act as a source of knowledge and information on the care services. Knowledge and access to reliable information were what many participants in the study, especially victims of violence, wanted. Although a great deal of information is available online, and some have contacts or acquaintances to go to for advice, many wanted what we describe as a «spider in the web», in other words a professional who knows what the care services can offer. We also found in particular that men seeking help want to learn as much as possible about the various options before they get in touch. Many of the victims of violence saw hotlines as the ideal service: They are staffed by people you can talk to and ask advice of, and they are available around the clock. This seems particularly important given that many people, especially victims of domestic violence, do not really feel that contacting the police – who after all are also on duty around the clock – is an option.

Qualifications
Better qualifications/skills have been something of a mantra in the public discourse in recent years. It is often claimed that workers in the various services need specialized knowledge of the different aspects of violence and what it means to be a victim of abuse. They need to know about the various «groups» and «cultures» where violence occurs. That said, there is reason to question the strong focus on skills, especially the effect that focus can have on the individual whose job it is to provide the assistance. To simplify, and speaking broadly, today’s focus on skills can have two different outcomes: Having acquired the skills, the worker feels confident and capable and does a far better job than if he or she did not have them. Or alternatively the person becomes like Socrates, never sure of anything. Because it is impossible «to know everything», the care worker can become prey to an unremitting sense of uncertainty. Also, to put it bluntly, the first outcome can undermine the person’s capacity to reflect over and take the victim’s point of view, and more prone to «fail to see» the individual in need. The uncertain person can end up thinking too much and feeling too afraid to do anything at all, because it could be wrong.

The strong focus on skills was a central aspect of this study as well. Expertise, or rather lack of expertise, was a recurring subject in our interviews with municipal employees. There were calls for specialization in certain areas, above all when it comes to dealing with traumas and traumatized individuals, for example in the field of child protection. The participants of the focus groups discussed the issue of qualifications and expertise. What surprised us, however, was how the participants spoke of skills and expertise. Rather than emphasizing the need to ensure further training in trauma, violence and related subjects, they conceived of expertise as a broad or blanket category, without necessarily implying specialist qualifications in the treatment of victims of violence. The groups emphasized rather helpers having the courage to talk about violence and ability to establish a sense of trust and confidence conducive to good, open conversations. Empathy and strength to listen to disturbing stories were highlighted as important qualities of a skilled helper.

The good helper
Several participants in the project, including victims of violence and staff members, insisted moreover that the good helper should be willing and able to take the perspective of the victim into account and ask their opinion. Among those who had been subjected to violence, some felt that care staff and police officers had ignored or played down their personal accounts. Some had been treated in ways they felt were demeaning and insulting. Competent helpers need to let patients and clients take an active part, among other things by letting the victim’s situational understanding inform their response, rather than insisting on their own opinions and perspectives. On the other hand, a good helper also needs to take control when required, but know when to let go and help the individuals use their potential to help themselves. Many stressed the importance of engaging family members and friends. Much good, it was maintained, can be done without formal training.

For some, expertise implied an awareness and a readiness to make the most of possibilities inherent in collaborating and interacting with others. Knowing how to build relations both with people in need of help and with members of other professions therefore, seem as important as a thorough knowledge of violence. 

According to many members of staff, skills and knowledge in the care services are often not exploited effectively enough. 

Time and capacity
Time, or capacity, was described as an essential ingredient of good care, we were told by staff members and victims of violence in the different focus groups. For many employees, however, time is perceived as a scarce resource. Pressure to increase «throughput» made it difficult, some had experienced, to comply consistently with their own professional standards in their work. It was also suggested that more resources in the frontline could have alleviated some of the pressures on the often overstretched specialist services. Some participants in the staff focus groups said that victims of violence sometimes failed to make use of available specialists, or lost a place in a therapeutic programme because of failing to follow through. The tougher a person’s experiences, the longer it can take to return to a tolerably good life. Some may never manage to extricate themselves from the difficult situation, but this doesn’t diminish their need for reliable support structures in everyday life.

Individuals who find it challenging accessing help
As we mentioned above, participants in this study, especially people interviewed in the municipalities, referred to «groups» of people who find it particularly challenging to access help. In other words, care would appear to be far less accessible to some people than to others. It is not just a case of limited availability at certain times of the day or night, which some of the victims of violence mentioned. Women with substance abuse problems are often in an extremely difficult position. Many initiatives for victims of violence, including emergency shelters, have no procedures in place for these individuals. Mention was also made of older people and ethnic minorities, particularly refugees and asylum seekers, who could also find it difficult to obtain necessary support and assistance.

It was also maintained in the study, that male victims of violence frequently confront obstacles in their attempts to get help. Indeed, in connection with what we call the municipal part of the study, it was said that men’s problems with violence are not taken as seriously as women’s. Part of the reason is possibly the strong focus on domestic violence/violence in close relations, where women are more likely to suffer serious abuse. Some of the participants in the present study wanted to see bespoke procedures or measures put in place for male victims of violence both in the domestic sphere and, not least, outside the home. Shelters have recently started to admit men, which is a step in the right direction, but many men are unlikely to see an emergency shelter as a relevant option. As we mentioned above, it seems that many male victims in need of help want first to decide what is «right» for them, and try to learn as much as possible about the various care options before making contact.

On the other hand, some participants in our study maintained that male victims of violence were less inclined to seek help anyway. This contention is supported by the limited research that has been done on this subject. Also in the experience of some of the participants in the project, many men react to unpleasant incidents, including violent incidents, with aggression and acting out, both of which are likely to discourage classification as victims. 

Assistance services
Several of the agencies represented in the study were criticized for poor performance, not least by victims of violence. However, opinions were divided – some were quite satisfied with the very same agencies, or at least with some of the care workers they had been in contact with. Two agencies came under particular attack, however. They were the social service wing of the Norwegian Labour and Welfare Organization (NAV), and the police.

Criticism of NAV’s social services was especially acute in one of the staff focus groups. Several members of this group knew of victims who were simply unable to face the idea of visiting NAV alone because of how they had been treated on previous occasions. For example, clients were obliged to recount difficult stories in a waiting room full of strangers. Many wanted NAV to collaborate more with other agencies and services. Municipal employees in telephone interviews critisised the slow processing of applications for financial assistance from female victims of violence, and some NAV- offices were also accused of knowing little about other care options. It was also said that help from NAV in many cases was too person-dependent.

In the second focus group, however, we gained a little insight into the situation from the viewpoint of a NAV employee. For her part, it was not the shortage of expertise but demands of efficiency and throughput in the NAV system, that were the biggest problems at her place of work. An article in Dagbladet, to which we refer in the report, confirms her views in many respects.

In light of what we now know about the relationship between economic hardship and violence, it could be useful to involve NAV in the development of response procedures for people exposed to violence.

The police
Regarding the police, they were criticized for inadequate information, poor investigative performance, for failing to support people in distress, and for not making space for the victim’s viewpoint. Two male victims in the focus groups experienced that for the police all needs were subordinate to the question of whether or not the men wanted to support criminal proceedings. Several members of the focus groups of victims of violence wanted better procedures and greater understanding among police officers of what violent abuse actually entails, including when the victim is male.

Only one of six female victims of domestic violence had taken part in a criminal trial. The others were largely negative to the idea, either because they couldn’t bear having to go through the process, or because they were wary of the consequences, especially if children were involved.

A national victim care?
The question of what has been called a «national victim care», as it has been taken up by politicians and other stakeholders in recent years, affects all of the participants in our study in some way. It is implicit in the concept that it is about help that should be available to anyone subjected to (in our case) violence, irrespective of where they happen to live in Norway. Some of the advocates of a national system of victim care have cited the Norwegian community re-integration guarantee for prisoners on release from prison as an argument in favour of a national commitment to victims of crime. It is not hard to understand the point that victims of violence and other offences should enjoy the same rights as prisoners, but the re-integration guarantee is not a guarantee in the legal sense. It is a policy target, with the aim of providing whatever assistance is necessary to offenders on release, to reduce the risk of recidivism. The assistance in question can be anything from help with finding accommodation and work, to claiming social benefits and health care. The philosophy behind the guarantee is also far more inclusive than the scope of the Swedish Criminal Victim Compensation and Support Authority, which some hold up as a model for a national victim care system in Norway. BrOM is a legal entity; it focuses mainly on issues relating to the legal system.

The Swedish Criminal Victim Compensation and Support Authority – BrOM
According to BrOM, its mission is to promote the rights, needs and interests of victims of crime. The Authority has three main tasks, the biggest of which, in economic terms, is to deal with applications for what we in Norway call criminal injuries compensation, and to pay out awarded sums. As in Norway, the Swedish state advances money on behalf of people who have been sentenced to pay compensation in criminal cases, from whom they seek reimbursement after they have served their (prison) sentence. BrOM is also designed as a centre of knowledge on matters relating to victims of crime, including what it means to be a victim of a criminal act. The Authority is tasked with engaging with the outside world in its activities, giving lectures and arranging seminars for different stakeholders, not least in the legal community, which constitutes an important target group. BrOM emphasizes in particular the training of employees in the criminal prosecution service on what to be aware of in meetings with victims of crime. BrOM’s third task is to manage the Swedish Fund for Victims of Crime, created in 1994. All persons convicted of, or fined for, an offence punishable by imprisonment under the Swedish Penal Code (equivalent of the Norwegian Penal Code in addition to certain provisions in the Norwegian Road Traffic Act), are obliged to donate to the fund. The same applies to individuals whose sentence involves wearing a security tag. The Fund also receives gifts. The Fund’s resources go mainly to research and non-profit organizations involved in helping victims of crime.

Our review of its work gives us reason to maintain that BrOM is a highly relevant body in its field in Sweden. However, there is also reason to say that the Authority is important primarily to people who want an offence brought to trial, and to people seeking damages. In light of the scientific evidence that only a relatively small percentage of victims of violence report the incident to the police, BrOM can hardly be called a national victim care organization, understood as a body catering to every need of the victim of crime. Against that background, it would not make sense for Norway to set up a body such as BrOM. This does not mean that work on legal matters stemming from being a victim of violence cannot be organized differently in Norway than they are today. An integrated approach to, and efficient cooperation on, matters pertaining to victims of violence – something many of our interviewees in Sweden advocated – implies, however, a national system of victim care with a much broader range and powers than we see in the case of BrOM.

Conclusion
As mentioned before, our study shows the importance of accentuating inter-authority or inter-agency collaboration and the involvement of the individual in her or his own case if we are to talk about a satisfactory response in cases of violence and abuse. However, we have had no ambition to tell the authorities how this response should be organized. What we have done is to outline three different ways of thinking about how the response could be organized. The first is what can be called a special care response, in other words, a body, or organization, which deals with all relevant issues. We can also envision a rights model, where assistance is provided by the regular care services, but where victims of violence are specifically entitled to assistance. Rights, however, are of little worth if the agency involved lacks the capacity or necessary staff. This is one of the problems one sees in Sweden, where, according to the law, women and children who are victims of violence must receive assistance. The last way of thinking involves giving special responsibilities to all agencies that come in contact with victims of violence. Combined with specific rights, this organizational approach could pursue a stricter policy that ensures that rights are realised in practice. Whatever solution is chosen towards a better care for victims of crime (violence) we recommend that the government investigate the various options thoroughly before deciding how the response system should be organized, among other things by consulting with bodies and individuals who in different ways will be affected by the choice of organizational approach.

The Researchers