Sally: I'm Sally Jackson. I'm a trustee and one of the volunteers at FiLiA, and I'm delighted today to be joined by two women to discuss a really interesting subject that sadly we're hearing more and more about. First of all, Eddie Byron, who is CEO of the Institute for Addressing Strangulation. She's been working in the violence against women and girls sector for more than 20 years now. I think our paths first crossed back in 2016, when you were at the sexual assault referral centre, St Mary's in Manchester. I'm looking forward to chatting, Bernie, and also to Marianne McGowan, who's the survivor liaison and research worker at the Institute, and likewise has both frontline and academic experience. We're really interested to hear about the Institute and the work you're involved in, some of the things that we're learning about strangulation at the moment. In some ways this is in preparation to a conference that's coming up this year. Perhaps just to start with, so that everyone can get that date in their diary and quickly start looking up how to book if they're interested, tell us a bit about when and where the conference is and how listeners can get involved with that. 

Bernie: The conference is on the 12th of November and it's an in-person conference in Manchester. The idea is to look at how strangulation impacts on all areas of the sector across government or departments and organizations. The title of the conference is Tackling Strangulation, Working Together to Save Lives, because we believe that if we tackle strangulation, we really will save lives. I think it's important for people to attend to understand how often they come across peak lubex fear and strangulation and how they can respond and support people.

Sally: Thank you. It's one of those things that we hear about increasingly now. But actually, what does that mean, what does that look like and what can we do about it, absolutely. But we're still learning. Perhaps starting there, why have this institute for addressing strangulation? Can you tell me a little bit about how that came about? Why did you feel there was a need for a specific institute and what you're trying to do with the institute? 

Bernie: I think, Sally, you mentioned at the beginning that we're seeing more strangulation in general across services and with people that we're supporting. There was a group of people that lobbied for a change in the legislation back in 2021-22 because we were seeing more cases of strangulation, and mainly due to the research that Professor Kath White did at the St. Mary's Centre with people who were coming to a sexual assault referral centre having experienced sexual violence. So, we were asking the question whether they'd also experienced strangulation and I think when we talk about strangulation it's important to think about the language that we use, that people can resonate with the language. Not all people who've experienced strangulation will say that they've been strangled. That work started back in 2016 and a group of us came together to lobby for a change in the legislation. Once the legislation was passed in June 2022 for strangulation and suffocation as standalone offences, it was, well, what do we know about strangulation in the UK? And the answer to that was, very little. We've got lots of American research and other overseas research, including Australia, New Zealand, but actually, nothing relating to the UK. Then a few people put in a home office bid to support the Institute for Addressing Strangulation and we were successful in that. We got a two-and-a-half-year grant to set up the Institute, to look at UK evidence to support best practice, and to raise awareness across the population in general. I think it's important that the general public understand the issues of strangulation as well as for front line professionals. We also had a remit to deliver training so that we upskill people and develop evidence-based resources to support that development and to support that response. 

Marianne: I would just add that the Institute's actually a very small team of people, a small team of four people, and we have a research team. Also, you mentioned my title being the Survivor Liaison and Research Worker. From the outset those who set up the Institute wanted to have someone whose sole focus was on survivor engagement around non-fatal strangulation. We've been constantly bringing in the voices of survivors since the inception of the Institute two years ago. Actually, that's really important for the training and also for the research, that we're constantly hearing from survivors. We haven't had to recruit. People have just seen that we exist and have got in touch with us. They’ve said ‘this happened to me, is there anything I could contribute and share with you that might help?’ They've been very generous with their time and with their experiences. I think that really enhances our small team as well. 

Sally: Absolutely. As you say, it makes all the difference. It's really important to have the evidence, the academic work and the learning, but also the real-life experience which adds so much, and often so much in the nuance of what happens and how it happens when you include women and their lived experience. From what you're saying, is this something that we're seeing within relationships that have been established for some time that are long term relationships or more of something that's part of hookup culture or is it equally across both? 

Bernie: I think across both but originally, because the legislation sits within the Domestic Abuse Act, we're seeing it across domestic abuse relationships and where sexual violence is prevalent as well. But I think Marianne quite rightly will say that the survivors that have been in touch with us are talking about where they're coming across strangulation in these casual hookups and online dating. I think Marianne, you can probably talk a little bit about the blog that we published. 

Marianne: I think we're seeing, or coming to a better understanding of where strangulation exists and that looks like in a domestic abuse context, a sexual violence context. But also, in consensual sex and I think maybe that's where the kind of hookup culture might come in. As you were pointing out, Bernie, about one of the blogs that an individual wrote for us. I say an individual because this woman got in touch with us, not as a survivor but as someone who said ‘this happened to me on two occasions in very close proximity’. She was having consensual sex with someone and they put their hands around her neck and that surprised her that it happened twice within a very short time. She got in touch with us to share that she was concerned about the rise in this activity and how normal it was as she'd had conversations with friends who said it had also happened to them. That's interesting too, that she got in touch with a lived experience but not with an identification as a survivor per se. So definitely there's an element of consensual and non-consensual, but also in long term relationships and casual sex as well. 

Sally: I find it really interesting because, and I remember you said right at the beginning Bernie, about how sometimes women won't use the language of strangulation. But I think most people, if we talk about strangulation, we would see that very clearly as harmful, as something abusive. How did we get to this point where it's actually becoming part of supposedly consensual sex? I suppose there's an argument about whether we are really consenting. Do we understand what we're consenting to? Is it becoming part of the sexual behaviour that young people in particular are now becoming involved with?

Bernie: I think the establishment of the Institute has been really important in this because if we hadn't been started, if we hadn't started to talk about strangulation in general and with the general population, we wouldn't perhaps be aware of the increase in prevalence of strangulation in non-abusive relationships. It's often called sexual choking. It might be called breath play. Some people may choose willingly to participate in that behaviour, understanding the risks, but we feel that the risks are not fully understood. So, coming back to what you were saying, Sally, what are people consenting to? The individual who wrote the blog perhaps hadn't been aware of the risks associated with it, so the more conversations that we have around the risks of strangulation, the more people are saying, oh, I'm not sure that I’d have agreed or not. We have to say that some people do understand the risks and continue. There isn't any blame or shame attached to this; it's just stating the facts. If you look at the increase in porn, particularly around the pandemic and increasingly in pop culture, there is a lot of conversation or lyrics around strangulation. We've seen it on Netflix series such as Lady Chatterley's Lover and The Idol, where it's becoming normalised as part of sexual relationships. That's of concern to us because young people are observing that and thinking that it's okay to participate in strangulation or putting pressure on somebody's neck, either as the person strangling or the person that's being strangled. I think it's important that we nip that in the bud in terms of raising awareness so that people can make an informed choice. Consent is all about making an informed choice, but if people are not aware of the risks and dangers, then that's lacking. Did you want to add anything to that, Marianne?

Marianne: I think you're right to highlight popular culture and the mainstream media. Once we started doing this work, you just see it everywhere on TV. That's the same with when I speak to the survivor group about the things that are important to them or what research we should focus on or things that really need our attention, it's something that comes up. Is this glamourising it or just the presence of it constantly? When you're a survivor or a victim and you're constantly seeing that in a different way and you know what the experience is like, it can be really confronting and they constantly share that as a priority, as something that needs to be changed. Also, things like that lack of awareness then leading to a real minimisation and jokes and things like that being made about people - having your wife in a headlock, or things that are just quite distasteful but that are in people's common language. I guess we have a big mountain to climb, in terms of cultural change, but it's definitely something that I think is growing in momentum in terms of identifying the impact that porn has had and misogyny generally in society.

Sally: I think you're so right, and I want to talk a little bit more about the impact of porn in a minute. But what you've mentioned there about being able to give an informed consent and consequently understand not just the act, but the possible impact of that act. Perhaps it would be really helpful to talk now about the effects of strangulation? Obviously, we know that strangulation can lead to death, but for non-fatal strangulation, does that mean that if you haven't died, it's all okay? 

Marianne: The answer would be, no. The biggest concern, and sometimes misconception, about strangulation would be of an injury to the neck or the top of the spine. But something that is of great concern is actually impeding the blood flow from the heart to the brain. Oxygenated blood getting to the brain is crucial and if that supply has been cut off, we're talking about quite serious implications related to brain injury: the risk of stroke, the risk of cardiac arrest, and you mentioned the risk of death. There was a large-scale systematic review conducted in 2021, I think, by Bangor University in Wales and North Wales Brain Injury Service. They did a large-scale systematic review of existing literature on instances of strangulation across many different mechanisms to include things like hanging and other examples. They found that the long-term physical implications included things like stroke, miscarriages, speech disorders, seizures, and paralysis. Really quite long-term implications that would really inhibit someone's life. Also, there are the psychological long term effects including PTSD, depression, suicidality, which is something that is becoming more and more understood across the sector. I think this year the Vulnerability and Knowledge Practice Programme, VKPP, published data showing that domestic abuse related suicides had exceeded intimate partner homicides. That's horrendous, and I think there's a lot more awareness raising needed around the risk of suicide and domestic abuse generally, but certainly that's a risk with non-fatal strangulation as well as it's such a heinous and serious thing to happen to someone. It can leave them in such a vulnerable and dark place and with very few options, so things like suicidality, insomnia, even dissociation, hypervigilance. There's a lot of shame also attached to being strangled. We know there's a lot of shame attached to sexual violence and domestic abuse generally, but this is something that particularly in speaking to the survivor group, people don't want to talk to you about it. They like to sweep it under the rug and pretend it hasn't happened. Of course that's difficult for people to talk about. You don't like to think that your sister or your best friend has been through something like that. You might not know what to say. You don't want to say the wrong thing. Us pretending that it didn't happen or doesn't happen doesn't really help and it doesn't help people in trying to access support and getting help.

Bernie: I think one of the most telling things that we hear from survivors, and it was in one of the early papers that Kath White co-authored, it's titled: I Thought Was Going to Die. We know that violence against women and girls often has an impact similar to the consequences that Marianne's described, but it seems to be exacerbated with strangulation. What's really important is that we continue our work because we don't know what the effects are of continued strangulation, we don’t know where it might be part of a relationship and people enter into it willingly. We don't know about the impact of regular restriction of oxygen to the brain and whether there is a risk of a long term acquired brain injury, for example, related to strangulation. 

Marianne: You might have heard of Debbie Herbernick in the United States, who's leading on a lot of the research of strangulation during sex, the cohort she’s researched particularly looks at university students. The next line of research with that is about those cognitive deficits that potentially repeated strangulation can have on someone. If your brain is being starved of oxygen, what are the implications on things like your working memory or your problem-solving skills, which are really important if we're thinking about contexts like sexual violence or domestic abuse. If you don't have the problem-solving skills to be able to engage with health or to follow through with a safety plan, then we're leaving people really vulnerable. A lot of that research is in regard to consensual sex and strangulation. Your body doesn't necessarily care or know whether it's consensual and what the context is. Aside from the psychological implications, the context is irrelevant when we think about the implications to someone's body.

Sally: The harm is done however it happened. Going back to pornography, I think is one of the things that comes up time and time again for us, particularly with work that we do with young women - what the impact of pornography on their lives is and how easy it is to access really violent pornography and how that can then inform and, in some ways, become the sex education for young people. I was thinking earlier when you were talking, for a young man who feels this is what he's seen, this is what sex is, how would you possibly know how you could do that to someone you care about. On one level, that must be really scary for them, that's not a nice place to be in if you're with someone you do care about. But also, of course, the risk for the young woman if that's something that he's trying out because he's seen it in porn somehow, with the internet, porn on mobiles, all of that kind of thing. How do we begin to make a difference and counter this porn culture? 

Bernie: I think you've got a really good point, Sally, because the demonstration of strangulation in pop culture and through mainstream media does not show that it's dangerous. There are some websites that talk about ‘how do we do it safely?’ We would say that there is no safe way to strangle or choke or put pressure on somebody's neck. I don't think you can teach how to do it safely because you never know the circumstances. You never know whether somebody's got any underlying problem. Is the first time going to be fatal? Is it not? There are legal consequences for people who do the strangling. It's not to instil fear, but just to give the facts so that people that do want to participate willingly understand the risks, the legal, physical and psychological risks. This is why we've published information for survivors, and we've recently published a fact sheet for those that participate as part of a relationship. We've also developed some guidelines for clinicians so if somebody has experienced strangulation, we would recommend that they seek medical advice and there are clear guidelines for clinicians to follow. We're in the process of developing yet more clinical guidelines, so I think it's important. We're not there yet, which is another reason why we feel that the Institute should continue. 

Sally: Absolutely, it feels to me this is such a current issue in relationships that it’s essential learning. We need to think about both, in how we can prevent it but also in providing support and being able to help survivors who've been subjected to it.

Marianne: I do think you're right as well to bring in that element of young men doing this possibly because of what they've seen and then participating in something that they might not even be enjoying, but they just think that's what you do, and then potentially the other individual just participating because they think that's what you're supposed to do too. It's really important that sex education is having conversations around these things and not shying away from topics that are really current and happening anyway. It's being able to have those conversations and then also think about the resources that we can produce in a way that is digestible to young people and not just us saying, ‘don't do this and don't do that’. We've got some work to do on that as well, I'm thinking TikTok videos and things like that. I think that's key for getting the message to young people about the risks. Bernie mentioned the legal risk as well. It's important for people to understand that you could really harm someone and there would be consequences to that.

Sally: Absolutely. And we want young people to grow up and have safe and healthy and fun sexual experiences with people that they want to have fun, sexual experiences with. That's the best sex that they're going to have, isn't it, when it's like that? One of the things we've talked about, obviously, this is a form of violence and certainly I know the work that we've done with women involved in prostitution, unfortunately they experience particularly high levels of violence within prostitution. Does that mean this is a particular risk for them? I'm thinking of services that are working with women in prostitution. Is this something you were saying about clinicians looking out for signs within exiting services? Is this something we should be really cognizant of? 

Marianne: Definitely. They were one of the groups that from the outset we were quite mindful of. From the start of IFAS we tried to engage with services which work with those in the sex industry and in a supportive capacity. We did some awareness raising sessions with the staff and sharing resources around that. We also had a small-scale survey trying to get experiences of those in the sex industry. It definitely came up through that, choking was something that used to be kind of an add on, something that people would pay extra for. This sort of normalisation means that now it's something that is expected as part of standard sex, if you want to call it that, but certainly, it's something that they are exposed to and that was from feedback as well as from the services that we engaged with. Also, it made us think about the barriers that those women have in accessing help and support because we've talked about accessing medical support or the legislative aspect of this and the criminal justice system. What are the additional barriers that women involved in the sex industry might be experiencing around this if they have been strangled? There's a great deal of help and support that they need to be able to access that, us being in touch with services that provide that frontline support felt like a good way to start that work. But yes, I think they are a group that is at risk. 

Sally: We have a global group of survivors of the sex industry, if ever that's helpful. If you want to be put in touch, do give us a shout. We've talked a lot about non-fatal strangulation but, of course, strangulation is also a huge part of the homicides that we see, and particularly when we're talking about femicide, men killing women. Can you tell us if there is something that we can learn from those homicides that might help us to predict and then ultimately prevent those homicides from occurring in the first place? 

Marianne: I don't mind starting on this one. The Femicide Census, of course, has done such an amazing amount of work over the past nearly 15 years. One of their reports covering a 10-year period found that strangulation was consistently the second most common method of men killing women. So, we know it's prevalent and we know that it's something that has really serious implications. We then, off the back of trying to understand the prevalence, did an analysis of domestic homicide reviews. We looked at over 500 DHRs and found that 14 percent of those were victims of strangulation, the majority of which were women killed by men. We looked into those deaths more thoroughly and will have a report out on DHR analysis of fatal strangulation. Some of the key features showed that the most common age group for victims were those between 25 to 29 years old, but it’s also a really broad range of age: from 16 to 91 years old. I know 25 to 29 is the most common age bracket, but it's happening across all ages. We looked at things like ethnicity and across ethnicities. It’s quite difficult to get some of this data from the DHRs, there was quite a lot of missing data, which means pulling any real findings from the data can be quite difficult. The above are some of the key things in terms of demographics. There is also a really high percentage of intimate partners, either a current or former partner. In our analysis about 85 percent involved a current or former partner. Even more importantly, it was two thirds of those were actually separated at the time. I guess some of our discussions around that and trying to understand it, is that acts like strangulation and deaths by strangulation can be in some ways a perpetrator’s last attempt to regain control over someone. I know in the sector we hate the phrase like loss of control and I agree with that. Not that the perpetrators lose control, but it's when they've lost control of the individual: when they've separated, when this person might be taking steps to independence, when they might have a new home or a new partner or things that make them more independent, and therefore the perpetrator’s sense of losing control of the individual is really quite profound. We're really concerned about those groups where people have separated as well, and in terms of the actual experiences of domestic abuse. We recently did another analysis, which compared 75 cases where the victim had been killed by strangulation with 75 cases where the victim had been killed by stabbing with a sharp instrument. In the strangulation group a higher percentage of victims were experiencing coercive and controlling behaviour, psychological and emotional abuse, and also non-fatal strangulation. So that was more common in the group that were killed by strangulation than in the group that were killed by stabbing with a sharp instrument. So again, we've mentioned this, that increased risk of someone being seriously injured or killed when there's a presence of non-fatal strangulation. The analysis seemed to support that too. Those women who were killed by strangulation had been strangled a greater percentage of times more than in the other group. That kind of reiterates the work that we need to do around identifying non-fatal strangulation as a risk factor for serious injury or a death occurring. Is there anything you want to add, Bernie? 

Bernie: You raise the issue around data, Marianne, and one of the things is that strangulation isn't new. The legislation is relatively new, but the data collection on strangulation across organisations is poor. If we're going to understand the prevalence of strangulation and how it’s associated with higher risks or increasing risk factors, for example are there particular communities that are higher risk, we can't answer that question at the moment because we haven't got the demographic data. That's a plea to all organisations to collect better data on strangulation. The police are getting better, but if strangulation is not the primary offense, then sometimes that data gets lost. Of course, we've got the challenge too, when we're thinking about the cases managing to cross into the criminal justice process. The transfer of cases to CPS and the consistency with which that data is recorded has been problematic in this sector for a number of years, but it's ‘we can't tell you in much detail at the moment, the prevalence of strangulation and the outcomes of strangulation cases within the criminal justice process’, or indeed those cases that present to hospital or GP surgeries. So, we have a plea to those organisations to improve the data on strangulation, and we have got a data collection guide that we share quite widely. But again, this is a longitudinal piece of work that we need to continue to understand better in the UK, the prevalence of non-fatal and fatal strangulation.

Marianne: Just stay out on the aspects of side as well. Another thing that came up in the domestic homicide review analysis that we did was the presence of overkill, these being really violent murders - people being strangled and beaten to death. And the level of violence being really high, the level of dehumanizing as well. There was a case with an individual strangled with a dog lead, for example, so really sinister and also really a personal way to kill someone is how we would see that too. And we say that about non-fatal strangulation too, it's a very intimate form of violence. If you're face on face with that perpetrator, although there are different ways to do it, it could be using both hands, one hand or a headlock or a chokehold using your bicep and your forearm. But they tend to be extremely intimate forms of violence and methods of killing as well. 

Bernie: I think what's important to say in all of that, is making sure that survivors or those that are killed from suicide have a face because I'm conscious that as a small team, Marianne and a colleague have read through lots of domestic homicide reviews. It’s important to remember that a case is a person and has family, relatives, friends, and Collie making sure that we remember that in every single case, but it's important to also look at what's common across all of these domestic homicide reviews.

Marianne: We actually recently ran a project with the Survivor Group at IFAS and we were kind of unpicking and discussing why people were involved. Something that I hadn't expected them to say, and which they did, was being involved for the women who've been killed in this way and doing it so that other people don't die in vain. I thought that was very powerful and I hadn't expected that to be a rationale for wanting to participate in it, but when you're talking about people who've experienced what they perceive to be a near death experience, they thought they were going to be killed by that person, and in some cases believed that's what the person was trying to do to them. That is a real rationale for contributing to this work so that those people haven't died in vain and so that it doesn't continue. 

Bernie: And I think that's why we titled the conference as we did: we're working together to save lives. That's exactly what we want to do.

Sally: Absolutely. And we're always astonished and inspired in so many different areas. Women have gone through something very horrific, traumatic and when they've got to the other side, the number of women that then turn around and think, how could I make this better for someone if it was happening to them? And it's just amazing the strength of women to do that. You know, look back at other sisters and think, what can I do to help you? Even though they've been through the most awful things themselves. 

Bernie: And we shouldn't make that their responsibility. We have a duty, don't we? A duty to make sure that it doesn't happen to other people because we shouldn't leave that burden on survivors themselves. I think that's really important as that's what survivors want. But we have a responsibility to do that. 

Sally: Absolutely, and I'm just thinking of any of our listeners who have been following along here and thinking, actually this is something that's happened to me or my friend, my sister, et cetera has taught me has happened to them. What can they do? What should they be thinking about now, having listened and heard how dangerous it could be and some of the long-term impacts, but perhaps not really thought about that before. 

Marianne: I guess the starting point is kind of reflecting on how this looks in your relationship. Is it something that you are okay with happening? Are we talking about consensual sex? If it is a part of consensual sex, but maybe sometimes it frightens you a bit or sometimes you're scared, then how you might have conversations with someone. Is this happening and your partner really frightens you and you constantly try to manage your behaviour to avoid this from happening, because something that we know about strangulation is that it is one of those forms of abuse that hands over all the control to that individual. If someone has their hands around your neck and you're worried they're going to kill you, you'll probably do anything in your power to not let that happen again. Thus, it’s like managing your behaviour and trying to walk on eggshells. We know that doesn't work with abusers because they'll find something to make issues. It's worth doing a bit of reflection first and then thinking about who you're comfortable speaking to, whether that is a friend or family member, to practice getting it off your chest and saying it out loud for the first time, or calling the helpline, or even seeing your GP. We spoke a bit about this earlier, Bernie. Those domestic abuse services, sexual violence services and primary health care should all sort of inform each other. That's what we hope the kind of response would be at the moment. So, if I was to call a domestic abuse helpline and that they would be able to articulate the risks and suggest that I do see my GP, and equally if I went to my GP, I'd be hoping that they would be asking the appropriate questions around safeguarding and around what referrals to make next in getting that specialist support. I think speak to someone you trust, but the GP and/or a helpline are really great places to start. On helplines you don't always have to say who you are and/or disclose all your personal details. So, it can be a start for saying something out loud that you've maybe never said to anyone else.

Bernie: And I think if you're listening to this and if you've got anybody that is close to you who is practicing strangulation, it is having that conversation, but again, not just focusing on the word strangulation. It's about that pressure to the neck. It's interesting the conversations you have when people ask you where you work, but I've got friends who have had conversations with their young children and they said, ‘Oh yeah, it's really common. We do it all the time.’ My plea back is, please have the conversation so that they're aware of what they're consenting to and the risks associated, and if they choose then to continue, then that is a decision for them. We can't say don't do it, but we would say, please think about the potential risks and dangers and let's not normalise strangulation. 

Marianne: I would also add that if it's happened to you and you have symptoms possibly related to that, often some of the short-term symptoms that people will have might be swelling to your neck or a sore head, or you might have lost consciousness and you might be having difficulty with your memory. If those are things that concern you about your health after it, we would definitely be saying to seek medical attention and it might be just the reassurance that you need to have a conversation with the doctor, but definitely if you're having some symptoms after strangulation, you should be seeking attention.

Bernie: And I guess we'd also say that currently it might be that you go to see a GP or another professional and they haven't heard about the work that we've done. So, visit our website, get information, we'd encourage that. If you're a professional and you're unsure, don't be frightened to ask, the information is there. We are building on it all the time and we're learning something new every day around the issues. It's important that we keep up to date and we keep other professionals up to date. That's where you discover more. 

Marianne: The information that we have for victims on our website, it's in different languages as well. It was developed alongside survivors who were clear that the risks should be included in the information. Initially we worried that we might not want to frighten people. Survivors said those risks really validate the experience I had in how serious and how frightened I was. Those risks match and mirror the experience I had. That's why we've included those in the information leaflet and it is important for people to understand and if these conversations or a leaflet on our website can help someone to say, actually this is quite a serious situation I'm in here and take any step to seek help, whether that's a friend, family member, or a professional that would be a bonus for us, it's one of the aims of our work. 

Bernie: And we've also had conversations around how we get this messaging across without blame or shame. It's really difficult because it is frightening. The consequences of strangulation are frightening, so we can't eliminate all elements of fear. We have to be factual about the consequences of strangulation. And yes, people might be frightened by it, but if you're frightened by it, please seek support and advice. 

Sally: I think that people know the reality of the risk, then others try and be really gentle, lulling them into a really false sense of security, something that could be really dangerous for all of them.

Bernie: Absolutely. 

Sally: Thank you both so much. It's been fascinating to chat with you today. I would say to any professional, if you're not booked onto the conference yet, try and get a place while you can. Thank you both for the work you do. As you say, there's still a lot to learn, but it's going to be a huge benefit to women generally, and to the VAWG, health and legal sectors as well. So really important work and good luck with the conference. I hope it goes really well. 

Bernie: Thanks Sally, and thanks for giving us the opportunity to talk to you about it. It's been great to talk to you, and as you say, the more people that listen and understand the better.