These fears are well-founded, Warshaw noted. Psychiatrists must be cognizant of these barriers and skillful in eliciting information. For example, in a psychiatric crisis, it is typical to use a family member to provide collateral information. “First ascertain whether the informant is an abusive partner,” she advised. Obtaining information from abusers can be “dangerous.”
Psychiatrists must also be aware that abusers often “deliberately undermine their partner’s sanity.” Abusers may try to control their partner’s access to treatment, or use the fact that she is receiving mental health or substance abuse services to sabotage her efforts to obtain custody or protective orders.
If Your Patient Confirms Being Abused
There are critical steps to take once your patient has confirmed that some type of abuse is taking place.
Assess the level of imminent danger, which could include homicidal or suicidal threats from the partner, the presence of weapons in the home, excessive substance use, escalating verbal abuse or threats, physical or verbal abuse of children, and harm to pets.3
Provide information about local community resources. These include domestic violence prevention programs, hotlines, mental health centers, specialized therapists, and women’s shelters. It may be too dangerous for the abused person to take a pamphlet home because it can increase the danger if the perpetrator finds it. There are creative ways to provide this information — for example, a tiny piece of paper with a hotline number can be slipped into a lipstick container, pillbox, or tampon container.5
If the danger is imminent, have the patient call a shelter or social services while he/she is in your office.5