The management of domestic violence deals with the treatment of victims of domestic violence and preventing repetitions of such violence. The response to domestic violence in Western countries is typically a combined effort between law enforcement, social services, and health care. The role of each has evolved as domestic violence has been brought more into public view.
Historically, domestic violence has been viewed as a private family matter that need not involve the government or criminal justice. Police officers were often reluctant to intervene by making an arrest, and often chose instead to simply counsel the couple and/or ask one of the parties to leave the residence for a period of time. The courts were reluctant to impose any significant sanctions on those convicted of domestic violence, largely because it was viewed as a misdemeanor offense.
The modern view in industrialized countries is that domestic violence should be viewed as a public matter and that all criminal authorities should be involved; once the violence is reported, it should be taken seriously. Further, support needs to be put in place to restore the victim's safety and respect, which often includes the efforts of the person who caused the harm.
Medical response Medical professionals can make a difference in the lives of those who experience abuse. Many cases of spousal abuse are handled solely by physicians and do not involve the police. Sometimes cases of domestic violence are brought into the emergency room, while many other cases are handled by a family physician or other primary care provider. Subspecialist physicians are also increasingly playing an important role. For example, HIV physicians are ideally suited to play an important role in managing abuse given the association between abuse and HIV infection as well as their often lifelong relationships with patients.
Medical professionals are in a position to give advice and refer victims to appropriate services; however, health care professionals have not always met this role, with uneven quality of care and, in some cases, misunderstandings about domestic violence.
Carole Washaw suggests that many doctors prefer not to get involved in people's "private" lives. Jenny Clifton, John Jacobs, Jo Tulloch found that training for general practitioners in the United States about domestic violence was very limited or they had no training. Abbott and Williamson found that knowledge and understanding of domestic violence was very limited among health care professionals in a Midlands, United Kingdom county, and that they do not see themselves as being able to play a major role in helping women in regards to domestic violence. Furthermore, in the biomedical model of health care, injuries are often just treated and diagnosed, without regard for the causes. As well, there is substantial reluctance for victims to come forward and broach the issue with their physicians. On average, women experience 35 incidents of domestic violence before seeking treatment.
In the U.S., the Institute of Medicine recognized the shortcomings of the health care system in its 2002 report entitled Confronting Chronic Neglect and attributed some of the problems cited to a lack of adequate training among health professionals. In the U.S., the Institute of Medicine recognized the shortcomings of the health care system in its 2002 report entitled Confronting Chronic Neglect and attributed some of the problems cited to a lack of adequate training among health professionals.
Health professionals have an ethical responsibility to recognize and address exposure to abuse in their patients, in the health care setting. For example, the American Medical Association's code of medical ethics states that "Due to the prevalence and medical consequences of family violence, physicians should routinely inquire about physical, sexual, and psychological abuse as part of the medical history. Physicians must also consider abuse in the differential diagnosis for a number of medical complaints, particularly when treating women."
Law enforcement
In the 1970s, studies in Europe and North America showed that domestic violence was widespread in many homes, resulting in emotional and physical trauma, and sometimes death. Into the 21st century many countries have taken steps to eradicate domestic violence, such as criminalization of violence against women and other abuses. Organizations have been formed which provide assistance and protection of domestic abuse victims, laws and criminal remedies, and domestic violence courts. In addition, social, legal, psychological, and medical services have been made available for victims of domestic violence.Handbook on effective police responses to violence against women. Criminal Justice Handbook Series. World Health Organization. 2010. p. 12.
Although acts of domestic violence are criminal and a violation of human rights, safety and dignity, as of 2010 the United Nation has found that it is still often considered a private matter. Some countries with laws against domestic violence may not enforce them and there are many countries that do not criminalize domestic violence. The United Nations published Handbook on Effective Responses to Violence against Women for police and other first responders to provide guidelines for police intervention.Handbook on effective police responses to violence against women. Criminal Justice Handbook Series. World Health Organization. 2010. p. 7.
Where there are laws against domestic violence, such abuse is often under-reported. The reasons for not reporting may include that the victim does not want to end the relationship, report the violence or pursue legal remedies include:Handbook on effective police responses to violence against women. Criminal Justice Handbook Series. World Health Organization. 2010. p. 17.
Fear for their safety or their children's safety that they may lose custody of their children inability to support themselves and their children of deportation, if an immigrant External pressure family members or their religious or cultural community due to rationalization of abuse by authorities Loyalty or emotional attachment to the abuser Self-blame or low self-esteem Isolated or without a support system Lack of legal information about victims' rights
Of the cases that are reported, they are often under-prosecuted. Criminologists suggest that abusers who are employed and have ties to the community may initially fear punishment, though many cases do not make it all the way through the criminal justice process. If the victim is uncooperative during investigation, the prosecutor may choose not to pursue the case. If the case is pursued through the criminal justice system, sometimes the resulting sentence is minor. Subsequently, any fear that the abuser has of punishment may have diminished.
According to the United Nations' Handbook on effective police responses to violence against women: "Without clearly targeted efforts to alter institutional culture and practices and to mainstream the issue of gender in legislation and practice, most legal and political reforms have little positive impact." An effective system requires "cooperative, coordinated and effective involvement" of law enforcement, communities, non-governmental organizations (NGOs), courts, and prisons.Handbook on effective police responses to violence against women. Criminal Justice Handbook Series. World Health Organization. 2010. p. 13. Way to manage violence against women is to increase the number of female officers in the police force and to offer training programs for officers.Handbook on effective police responses to violence against women. Criminal Justice Handbook Series. World Health Organization. 2010. p. 19. Other ways to prevent and manage domestic include the development and implementation of the following law enforcement practices:Handbook on effective police responses to violence against women. Criminal Justice Handbook Series. World Health Organization. 2010. pp. 37-86.
Code of Conduct for law enforcement Police agency guiding policies Training programs, including sensitivity training for domestic violence and gender-neutral application of the laws Investigation protocols, including always responding to alleged acts of domestic violence, applying applicable legal remedies, and prosecute criminal acts Threat assessment and risk management Victim services and witness protection Programs to respond to offenders Privacy and confidentiality procedures Police accountability and oversight practices
Community programs include the development of shelters for abuse survivors, programs to create a culture that does not condone domestic violence, creation of prevention and victim services programs, and the development of educational programs for the religious and cultural communities.
Counseling
Counseling for victim Due to the extent and prevalence of violence in relationships, counselors and therapists are encouraged to assess every client for domestic violence (both experienced and perpetrated). If the clinician is seeing a couple for couple's counseling, this assessment should be conducted with each individual privately during the initial interview, in order to increase the victim's sense of safety in disclosing any violence in the relationship. In addition to determining whether violence is present, counselors and therapists should also make the distinction between situations where battering may have been a single, isolated incident or an ongoing pattern of control. The therapist must, however, consider that violence may be present even when there has been only a single physical incident as emotional/verbal, economic, and sexual abuse may be more insidious.
Another important issue in assessing clients for domestic violence lies in differing definitions of abuse – the therapist's definition may differ from that of the client, and paying close attention to the way the client describes their experiences is crucial in developing effective treatment plans. The therapist must determine if it is in the best interest of the client to explain that some behaviors (such as emotional abuse) are considered domestic violence, even if the client did not previously consider them as such.
If it becomes apparent to the therapist that domestic violence is taking place in a client's relationship, there are several statements the clinician can make that have been shown to be effective in rapport-building and immediate crisis intervention with clients. Firstly, it is essential that the therapist believe the victim's story and validate their feelings. It is recommended that the therapist acknowledge them for taking a risk in disclosing this information, and assure them that any ambivalent feelings they may be having are normal. The therapist should emphasize that the abuse they have experienced is not their fault, but should keep their feelings of ambivalence in mind and refrain from blaming their partner or telling them what to do. It is unreasonable for the therapist to expect that a victim will leave their perpetrator solely because they disclosed the abuse, and the therapist should respect the victim's autonomy and allow them to make their own decisions regarding termination of the relationship. Finally, the therapist must explore options with the client (such as emergency housing in shelters, police involvement, etc.) in order to uphold their obligation to protect the welfare of the client.
Lethality assessment