Mental Health System Setting Barriers

• Poor or Inadequate Security Can Present Barriers to Disclosure
  It is important that mental health care settings (inpatient, outpatient, private offices) employ appropriate security to protect clients experiencing domestic violence. Such measures include:
      • Use of employee photo identification cards
      • Silent alarms
      • Well trained security guards who have instruction in domestic violence
      • In cases of homicide attempts, registration of client / victim as “Jane Doe”
      • Verification of caller before staff releases information
      • Note orders for protection (injunctions) in client’s file, inform security, etc.
      • Utilize debriefing protocols after any security related incident
   
• Confidentiality Lapses Can Both Impede Disclosure and Increase Risks to Clients
  Batterers can be extremely manipulative in their attempts to gain access to their victims through mental health care providers. Make sure that staff do not disseminate information about the victim inappropriately; verify callers before giving out information.
   
• Minimal or No Routine Use of Domestic Violence Protocols Can Prevent Identification and Assessment
  The AMA, since 1992, has instructed physicians to ask female patients, as part of taking their medical history, if they have experienced abuse. Also in 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) required all accredited hospitals to develop and utilize domestic violence protocols. In 1995, the American College of Emergency Physicians stated that domestic violence identification and assessment are critical components of emergency room patient evaluation. Despite these efforts, research indicates that these protocols are not always followed. A 1996 study of Florida hospitals showed that 34% of surveyed hospitals did not employ such a protocol, further, that 88.6% of emergency rooms were not utilizing domestic violence intake or assessment forms (Maxwell, 1996). A recent JAMA article (Rodriguez, M.A., et al, 1999) looked at 900 California physicians and found that while a majority were screening for domestic violence, less than 15% were doing so during new patient visits or during prenatal visits. The same findings may also be true of mental health professional working in community mental health centers.
   
  
• Lack of Familiarity with Community Resources
  Not being familiar with the availability of community resources for victims and not understanding the role and limits of these resources can also impede successful intervention. Staff from mental health care settings should actively participate in domestic violence councils, shelters, and/or domestic violence mortality review teams.
   
• Failure to Utilize a Multidisciplinary Approach
  Domestic violence requires a multidisciplinary approach involving physicians, nurses, and social workers as well as law enforcement officers, prosecutors, religious leaders, and others who act together to create a coordinated community response.