Award-winning project turns lived experience into change

A question about a service gap for survivors of strangulation and suffocation has led to a multi-agency collaboration in Whanganui.

Social workers Debz Tongotea (Ngāti Maniapoto, Ngā Puhi) and Hayley Herkes (Ngai Tahu, Tuahuriri) were awarded the Interprofessional Practice Award at the Health New Zealand | Te Whatu Ora Allied Health Awards for their work with Project NFSS (Non-Fatal Strangulation/Suffocation).

This initiative exemplifies the spirit of kotahitanga by addressing a significant service gap through integrated partnerships across hospital services, police, community agencies, and national providers. 

The duo work within the family harm space with Debz at Whanganui Police Family Harm (known as FLOW) and Hayley in the hospital as Violence Intervention Programme co-ordinator.

Debz identified a critical gap in the care pathway for individuals who had experienced non-fatal strangulation or suffocation.

The current model requires police-only referrals to a clinic based in Palmerston North - over an hour’s drive from Whanganui - creating significant barriers for survivors, including transport, childcare, and other complexities, all in the wake of a traumatic experience. 

In response, Debz and Hayley initiated a deeply collaborative and systemic approach to develop a local solution.

They are working with a range of colleagues within Health NZ as well as Medical Sexual Assault Clinicians Aotearoa (Medsac), family violence service provider SHINE and to ensure that survivors can access this assessment with ease.

This year the national SHINE educator visited the Whanganui campus to deliver further education around the subject to hospital staff and community. 

As a result a local NGO has offered a space that could potentially be used to host a local NFSS Outreach Clinic.

Patients who disclose to the Emergency Department that they’ve been strangled or suffocated have an initial assessment, which assesses and treats any acute medical needs. This includes learning more about the mechanism of strangulation.

“That starts to give us the bigger picture of how close to death a person was,” Hayley says.

“We’re trying to share with our doctors that this isn’t just another form to fill out, they’re very important questions to ask when it comes to evidence.

“Loss of consciousness can happen at as little as 6-8 seconds, bladder control can happen at around 15 seconds and, soiling can happen at around 30 seconds.

“The level of information supplied can also be the difference between an ACC claim being accepted or declined. We are educating on the difference between a mechanism of injury and the injury/symptom itself.”

The NFSS assessment typically happens around 10 days after an episode and examines longer term impacts and consequences as a result of a strangulation or suffocation event.

Hayley said survivors of strangulation and suffocation present similarly to patients with a traumatic brain injury.

Symptoms such as memory loss, headaches, difficulty sleeping, discomfort around the neck, are all common.

“The NFSS assessment lets them know this is all related to what they’ve been through, Debz says.

“They get an understanding of what might be happening to them and then can access support they be able to access from an ED visit. This includes ACC, as well as concussion clinics and other services who can help them.”

In the year to October 20, there had been 186 family harm alerts in Whanganui and 67 of these had disclosed NFSS.

Debz and Hayley both have a personal reason for bringing this service closer to home as they’ve both experienced non-fatal strangulation/suffocation.

“When I think about what wasn’t offered to me I want to make sure the world we are in now is better than 17 years ago,” Hayley says.

“I’ve taken my life experience and transferred it to something powerful, I can sit beside people and say I get it.”

Facts

Non-fatal strangulation is a common and dangerous form of intimate partner violence and is a criminal offence in New Zealand, carrying a maximum sentence of seven year’s imprisonment.

Your risk of being killed may increase by up to seven times if you’ve been strangled by a controlling partner.

Strangulation (often confused with "choking") is when pressure is applied on or around the neck with enough force to reduce or stop breathing, or change the blood supply to and/or from the brain.

Suffocation is when breathing is reduced or stopped either by an obstruction over the nose and mouth or compression on the chest or abdomen so that the lungs cannot expand and take in air.

Most people get better after a strangulation/suffocation injury, however sometimes longer term problems or injuries may result. It is important that you seek medical advice from a medical practitioner as soon as possible, and let them know you have been strangled/suffocated.