From Mandatory Reporting to Mandatory Supporting: Top 3 ways Medical Mandatory Reporting Laws Can Harm Survivors

Did you know that when survivors seek health care for an injury caused by domestic violence in California, health providers are required to make a report to law enforcement – even if it goes against the wishes of the survivor? That’s because California has what is called a medical mandated reporting law for health care providers. Several other states once had similar laws in place, but the overwhelming majority have since repealed or amended their laws to be more survivor-centered and trauma-informed. Domestic violence mandatory reporting laws, while created with good intentions, can have detrimental impacts for survivors: In a survey done by the National Domestic Violence Hotline of survivors who had experienced mandated reporting, 83.3% of survivors stated mandatory reporting made the situation much worse, somewhat worse, or did nothing to improve the DV situation.1

“It’s a life-and-death situation if going to the hospital. If asked how injured, I lied. Because of consequences if you tell the truth.”2

Domestic violence causes long term health consequences,3,4,5 so it’s important that survivors are able to access quality and affordable health care. Fears of mandatory reporting limits trust between patients and providers, leaves underlying causes of health concerns unaddressed, and results in survivors not receiving referrals to supportive services. Mandatory reporting laws have been shown to keep survivors from seeking care6, 7 , and also when survivors do see a health provider, they often don’t feel comfortable bringing up their experiences of violence8,9 . Similarly, health providers may avoid talking with their patients about domestic violence out of fear of having to make a report.

“Things got bad when he found out police were involved”10

Fear of involving law enforcement is a main reason why survivors decide not to tell their health provider about domestic violence, or even seek care in the first place.11 According to a survey by the National Domestic Violence Hotline that documented survivors’ experiences with law enforcement more broadly, even among survivors who chose to involve law enforcement by calling 911, only 20% said they felt safer – 80% said they had no change in safety or felt even less safe12. There are many good reasons why survivors don’t want to involve police: 

• Survivors may not want their abusing partner to be arrested, but just want the violence to stop. 
• If the abusing partner is arrested, that might only result in one day of separation before they are released. The partner may become even more violent, controlling or angry, as a result of being arrested. 
• When law enforcement is involved in DV situations, survivors are more likely to be arrested for defending themselves against the abuse. This is especially true in states like California, where law enforcement are either required/encouraged to make an arrest when responding to a DV call. If an abusive partner seeks medical attention for injuries caused by a survivor defending themselves, this puts survivors even more at risk of criminalization as a direct result of medical mandatory reporting. 
• If a survivor or their family members are undocumented, mandatory reporting to law enforcement could result in deportation if ICE are notified. 

“I was afraid that if I told, my children would be taken away”13

In a lot of jurisdictions in California, a mandatory report to law enforcement for domestic violence exposes survivors and their families to child welfare systems, which can result in over surveillance and children’s removal from the home, even when the children are not directly involved in the abuse. This can have long lasting and traumatic impacts on families’ emotional, economic, and physical safety. And we know that children of color, particularly Black children, are overrepresented in the child welfare system.14 Fear of involvement from child welfare as a result of DV mandatory reporting is common among survivors. It also keeps survivors from being able to access health care not only for themselves, but also for their kids.15

What could California do instead?

Luckily, California has a lot of examples from other states it can look to for modernizing its medical mandatory reporting law to promote survivor health and self-determination. Some of the strategies are:  

• Change mandatory reporting to mandatory supporting! Require health providers  to give survivors information for domestic violence programs instead of making a report to law enforcement. Pennsylvania, Kentucky, North Dakota, Washington, Colorado, Oklahoma, have all included this in their laws. 
• Mandate reports for specific serious injuries, but include exceptions for domestic violence. New Hampshire, Pennsylvania, Tennessee, and Colorado use this approach.
• Require patient consent before making a report to law enforcement, which is required in Oklahoma, Pennsylvania, and Tennessee.
• Collect anonymous data on domestic violence to inform public health programming, which is done in Rhode Island.

Conclusion

Medical mandated reporting laws for domestic violence have a disproportionate impact on the most marginalized survivors. For undocumented survivors, involving law enforcement can result in deportation if ICE is notified. Law enforcement involvement can also lead to involving child welfare systems, which can result in the removal of children from their homes–especially for families of color. California should look to other state models to modernize its law, with the aim to increase survivors’ access to health care and the opportunity to connect them to supportive services, like domestic violence advocacy programs. Health providers have an important role in promoting survivors’ health, safety, and self-determination–they can support survivors in engaging law enforcement if and when survivors want to. And providers can refer survivors to domestic violence advocates, who can work with survivors to ensure that they know their reporting options and have a reporting safety plan in place.

Footnotes:

1 – 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

2 – 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.

3 – 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.
4 – 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
5 – Campbell JC. Health consequences of intimate partner violence. Lancet 2002;359:1331–1336

6 – 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
7 – 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.

8 – 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
9 – 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.

10 – 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

11 – 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

12 – 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

13 – 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.

14 – Dettlaff, Alan J., and Reiko Boyd. “Racial Disproportionality and Disparities in the Child Welfare System: Why Do They Exist, and What Can Be Done to Address Them?” The ANNALS of the American Academy of Political and Social Science, vol. 692, no. 1, 2020, pp. 253–274., https://doi.org/10.1177/0002716220980329.

15 – 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