Family violence victims need support, not mandatory reporting

At first glance, Victoria Police’s suggestion that health professionals report domestic violence to authorities, as they do for child abuse, sounds like a great idea.

The suggestion was made in its submission to the state’s Royal Commission into Family Violence in 2015. Such a move might connect women with support services quicker. Police could take out intervention orders on women’s behalf, and men who use violence could be prosecuted if an assault occurs.

With mandatory reporting, health professionals may then see domestic violence as a serious health issue in which they play an intrinsically important role, rather than a private social matter on the periphery of their clinical work.

Doctors, in particular, may become increasingly familiar with the existing Royal Australian College of General Practitioners (RACGP) guidelines and World Health Organisation advice on how to identify and respond to domestic and family violence – a potential positive outcome in itself.

But women are not children, and we believe mandatory reporting of family violence on their behalf may threaten dignity and take away their power. Rather, doctors should be trained to provide the kind of support that will empower a woman to take the action she believes is best suited to her situation.

Experiences of mandatory reporting

We know from US experience that some abused women don’t seek medical help because of a doctor’s legal obligation to report injuries, including those from domestic violence, to police. Many women are often the best judge of their own and their children’s safety and prefer that their autonomy and confidentiality are not broken.

In Australia, the Northern Territory is the only place that has specific mandatory reporting laws. These were introduced in response to the high rates of domestic and family violence, particularly towards Aboriginal women.

A 2012 evaluation of the laws showed that, since they became operational in 2009, there has been an increase in reports and intervention orders. As well as a spin-off effect of more specialised services within hospitals and funding for refuges.

The report noted the majority of NT service providers were positive, seeing mandatory reporting as part of a broader strategy to respond to the hidden epidemic.

But the evaluation also showed a lack of training and systems in place in the Territory. Some survivors reported negative experiences of the police response, depending on whether they had consented to the report. Women were often worried about custodial sentences for perpetrators, not wanting children to be removed by child protection and violent retribution for making a report.

Separately from the Northern Territory’s experience, migrant and refugee communities may be particularly susceptible to being pushed beyond the reach of support for fear of mandatory police involvement and potential deportation. Clearly, any intervention in this area requires a high degree of cultural sensitivity.

We also know doctors across Australia currently struggle with mandatory reporting of child abuse; often because of a lack of training and skills, varying state laws, inconsistent responses when they do contact authorities and a lack of accessible advice and support.

Overall, we are unsure if mandatory reporting of domestic violence actually benefits women and their children, with some women feeling it may jeopardise their safety. It’s important to note that the World Health Organisation does not recommend mandatory reporting for health professionals.

More training for doctors in family violence

Rather, all health professionals should be trained in identification and first-line response. This consists of asking women who present with clinical indicators (for instance, depression, trouble sleeping, injuries, chronic pain) whether they feel safe in their intimate relationships.

When women are ready to disclose, health professionals should listen, inquire about their needs, validate their experiences and offer them and their children ongoing support. When women are ready, doctors should assist them through “warm” referrals, by making an introductory phone call to support services that can help them.

Like Victoria Police, we think the solution for health professionals to address the hidden epidemic of domestic violence is mandatory training in family violence.

In the United Kingdom, it’s mandatory for all health professionals to be trained in methods to keep adults and children safe. We know we can train general practitioners to do this work and that this results in more safety discussions and less depressive symptoms for women.

In addition to training for doctors, systems such as protocols, management support and referral services, need to be in place to help doctors assist women and children.

Doctors and other health professionals can play a role in preventing and responding to terrorism within the family. They just need to be trained.

The National Sexual Assault, Family & Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.

Kelsey Hegarty has received funding from Department of Social Services to update Royal Australian College of General Practitioner (RACGP) Abuse and Violence: Working with our patients in general practice Manual (White Book) and online learning module. She is is a member of the Abuse and Violence Network, Royal Australian College of General Practitioner (RACGP) National Faculty of Specific Interests.

Kirsty Forsdike has received funding from Department of Social Services to update Royal Australian College of General Practitioner (RACGP) Abuse and Violence: Working with our patients in general practice Manual (White Book) and online learning module.