Free to leave? Domestic abuse & health care

 

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Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.

How are the working class and poor especially vulnerable to domestic abuse and sexual violence? How would Medicare for All help address this vulnerability? We spoke to Michele Hamilton, a counselor and advocate for survivors of domestic abuse and sexual violence since 2004. Michele’s also a board member of Health Care 4 All-PA. The views expressed are her own and do not represent her employer.

Welcome to Code WACK!, Michele!

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Q: Is there a connection between economic insecurity, such as food and housing insecurity, race and the experience of physical or sexual abuse, and if so, what is that connection?

Hamilton: I’m always careful in answering that question because I want to start off by saying that there’s domestic violence happening, in sadly,  all economic households and all race households and everything in between. The difference and I think there is a writer named Lundy Bancroft who actually works with perpetrators and his work is very good. He says it better so I’m just going to paraphrase him. When the survivor is poor, the poverty traps them. And when the survivor has more money, which is usually connected to the perpetrator or abuser, then the abuser’s money traps them.

But what the difference is and the biggest difference is that survivors who have less income are more dependent on public services, which is why, for lower income survivors, we need Health Care for All even more because they are more dependent on public services. So if you don’t have family and friends who own a house where you can just go and stay in their house for as long as you need to stay in their house, then if you have friends and family who are in apartments and you can only be at their apartment for two weeks because that’s what’s on the lease, then you are going to be more likely to have to use a shelter. And so we know more about working-class and poor survivors of abuse because they have to use the public services that we have. But I don’t want to give the impression that in and of itself being poor makes you more likely to…It makes you more vulnerable and abusers look for vulnerability. 

Sadly, I spoke to a sexual assault survivor where they needed a place to stay because they were homeless and this person allowed them to stay in their apartment but then demanded sexual favors. So I would say that people who are working class and poor have more economic vulnerability and predators look for vulnerability. But I don’t want to give the impression that poor people are more likely to be abusive because that is a stereotype that has been used against working-class people and particularly people of color who are working class. Similarly, because there’s a huge economic divide between people of color sometimes and white people, we (people of color) are more likely, like I said to have to use things. We are also sadly over-policed, which means we are more likely to have law enforcement involvement whether we want it or not. So I think that those are reasons for some of the numbers and stuff.

So I would never say…The numbers are definitely what they are but I would always say that you would want to look at the various reasons why they are and I would always emphasize the vulnerability of survivors and how perpetrators look for vulnerability and the fact that there’s less privacy for lower income people in terms of needing to use public services. And that’s why I feel we need a better safety net overall and definitely Health Care for All so that there isn’t that much vulnerability and need for health care help with, um,  like a spouse, a partner, a relative, someone who might come off as someone who is going to support you but really not. You know what I’m saying?

 

Q: Right, right. Michele, you mentioned a couple interesting stories. Is there a story that really touches you, that has impacted you, of a woman that you can share with us that kind of illustrates some of these very significant challenges that they face when it comes to health care and accessing health care? 

Hamilton: Okay. Without giving too much away and I do want to say, we work with survivors of all genders. So there have been times where someone has been a survivor of sexual assault, and in Pennsylvania, we have something called a SART process or a SANE process where you go to the hospital and can get tested but that doesn’t mean that all the follow-up is free if certain medications are needed, so that is sometimes a huge barrier for people. 

I remember once working with someone who was formerly incarcerated and they said that because of a fine that they didn’t pay, they didn’t have access to health care. And at first I thought what? But when you look it up, you can be sanctioned for several things. And in multiple states, one of the things you can be sanctioned for is not paying fines and stuff. So I feel like I want to bring that up because I feel like it’s an issue that does affect survivors. Like I said before, we do have survivors who are also formerly incarcerated and incarcerated right now, and you know it is something I didn’t even really think about. I just thought everybody who income-wise could get assistance would just naturally get assistance. 

And then if you have certain illnesses, for example, if you’re HIV-positive, if you have certain mental health disorders that need more care and specialized medicines,  then not having access to health care or to the full range of health care options is sort of, is even more dangerous, and that can affect some of the decisions that you make with your relationship and stuff. I know some people ask why certain survivors go back or why they get involved in certain relationships. It’s not that people want to be in controlling or abusive relationships but sometimes you also don’t want to be homeless and you also don’t want to be without health care and sometimes there are abusers who are caregivers and stuff and so it can be both and so that’s a particular situation that can be very complicated.

One of the things I sometimes talk to survivors about who are married is who is your, basically your Medical Advance Directive person because the basic assumption is that usually it’s your spouse. And if you are leaving the relationship, part of a safety plan is who has access and who could speak for you medically if something happens to you.

 

Q: Right. And so how would a Medicare for All system impact this dynamic do you think?

Hamilton: I think the philosophical part of it is that Health Care for All really brings in this concept that everyone deserves care and it gives everyone — or the possibility of everyone — of having access. And I think psychologically, in terms of how we are thinking as a country, that’s very important because right now health care is seen as a commodity that you get if you can afford it or if your job can afford it. And we have people, for example, who are doing gig work and that includes survivors as well. Maybe they are on somebody else’s health insurance. Maybe they have Medicaid but maybe they have nothing. You know? If you’re doing Uber and also doing Instacart and also doing Grubhub, none of those places provide any health care. And many of our survivors are doing those types of jobs and many people in this country are doing those types of jobs.

It’s not something you get based on financially what you can afford that everybody deserves it. And I just think that change in thinking, while it wouldn’t directly affect domestic violence victims, would affect the way we look at people overall and not putting people into silos. But tactically in terms of policy,  I think it would give us as service providers more options so that we can be helping people, where health care is the goal from the beginning. Shorter waits to see mental health, shorter waits to see health care people overall, less dependence on the abusers money if they need to and more independence in their choices. 

Thank you Michele.

 

Find more Code WACK! episodes on ProgressiveVoices.com and on the PV App. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for health care reform around the country. I’m Brenda Gazzar.

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