Mandatory Reporting: A Barrier to Accessing Health Care
Medical mandatory reporting laws require that healthcare providers report violent injuries to law enforcement, even if the adult patient does not want a report to be made. Though enacted with good intentions, medical mandatory reporting requirements create barriers for survivors of violence seeking healthcare. Survivors who are not interested in or ready to involve law enforcement may forgo seeking healthcare to avoid mandatory reporting.
Intimate partner and sexual violence have significant health consequences – injuries, brain injury, long-term chronic health conditions, poor pregancy and reproductive health outcomes and more. Because of the serious negative health outcomes associated with experiencing violence, it is crucial that survivors have access to supportive and trauma-informed health care.
Health care providers do have an important role in supporting survivors. They can and should be talking with their patients about domestic/sexual violence, how it impacts health, and facilitating referrals to local advocacy programs when their patients are experiencing violence.
Please see below for evidence and support for eliminating medical mandatory reporting requirements, and resources for how to promote survivor safety and health in medical settings.
Medical Mandatory Reporting Resources
- Health Care Association Statements in opposition of medical mandatory reporting for adults: WHO, AMA, ACEP, AWHONN
- Compendium of State and U.S. Territory Statutes and Policies on Domestic Violence and Health Care (includes medical mandatory reporting laws for each state)
- Modernizing Mandatory Reporting Laws in California Health Settings Policy Brief
- Health Impact of Domestic/Sexual Violence
- Stubbs A, Szoeke C. The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature. Trauma Violence Abuse. 2021 Feb 5:1524838020985541. doi: 10.1177/1524838020985541. Epub ahead of print. PMID: 33541243.
- Coker AL, Smith PH, Bethea L, King MR, McKeown RE. Physical health consequences of physical and psychological intimate partner violence. Arch Fam Med 2000;9:451–457
- Campbell JC. Health consequences of intimate partner violence. Lancet 2002;359:1331–1336
- Research on Mandatory Reporting for Domestic Violence
- Lippy, C., Jumarali, S.N., Nnawulezi, N.A. et al. The Impact of Mandatory Reporting Laws on Survivors of Intimate Partner Violence: Intersectionality, Help-Seeking and the Need for Change. J Fam Viol 35, 255–267 (2020). https://doi.org/10.1007/s10896-019-00103-w
- Sullivan, Cris & Hagen, Leslie. (2005). Survivors’ Opinions About Mandatory Reporting of Domestic Violence and Sexual Assault by Medical Professionals. Affilia-journal of Women and Social Work – AFFILIA J WOMEN SOC WORK. 20. 346-361. 10.1177/0886109905277611.
- Jordan, C. E., & Pritchard, A. J. (2018). Mandatory reporting of domestic violence: What do abuse survivors think and what variables influence those opinions? Journal of Interpersonal Violence. https://doi.org/10.1177/0886260518787206.
- Kimberg L, Vasquez JA, Sun J, et al. Fears of disclosure and misconceptions regarding domestic violence reporting amongst patients in two US emergency departments. PLoS One. 2021;16(12):e0260467. Published 2021 Dec 2. doi:10.1371/journal.pone.0260467
- National Domestic Violence Hotline, Who Will Help Me? Domestic Violence Survivors Speak Out About Law Enforcement Responses. Washington, DC (2015). http://www.thehotline.org/resources/law-enforcement-responses
Evidence for what survivors want from their health providers
- Autonomy: Survivors want to be able to make their own decisions when it comes to health care.This includes choosing their own providers, disclosing in their own time, and having multiple pathways for potential interventions. Additionally, health professionals should always explain procedures thoroughly and allow patients to ask questions or signal discomfort. Intimate partner violence can strip people of control—provider awareness can serve as a powerful tool to combat this.
- Empathy & Compassion: People who have been exposed to intimate partner violence want providers to validate their experiences. Providers should strive to be nonjudgmental and supportive, regardless of how survivors of intimate partner violence respond to interventions. A judgmental, intrusive or controlling provider may recall trauma for survivors.
- Informed Providers: Providers with knowledge about intimate partner violence make a significant difference in the experiences of patients. Survivors cite the value of having health professionals who understand the depth and complexity of IPV. This includes the impact of trauma on health, the long-term nature of this violence, and its intersection with accessing a variety of other needs (employment, childcare, transportation, etc.)
- Reasons for Non-Disclosure: Amongst patients with a history of IPV, reasons for concern about mandated reporting, non-disclosure include fear of judgment, emotional distress, fear of not receiving adequate support from healthcare professionals, religious beliefs, language barriers, and having children in the home.
Please see “Evidence Behind CUES: An Intervention to Address Intimate Partner Violence in Health Settings” for research citations and more info.
Additional Resources to Support Survivors in Health Settings
- IPVHealth.org: online toolkit for building health setting and domestic violence program partnerships
- CUES graphic: evidence-based intervention for addressing intimate partner violence in health settings
- PEARR Tool: Trauma-Informed Approach to Victim Assistance in Health Care Settings
- Center for Partner-Inflicted Brain Injury
- https://myplanapp.org/ (mobile app for safety planning)