Document Type

Article

Publication Date

2022

Keywords

domestic abuse, mental illness, ptsd, civil commitment, pre-detention screening, trauma informed care

Abstract

There is significant overlap between the group of people who experience trauma, including domestic or intimate partner violence, and those who are hospitalized for severe mental illness. In recent years there has been a growing awareness in the mental health treatment community of the prevalence of trauma among individuals with behavioral health problems. Despite the strong evidence of elevated rates of exposure to domestic or intimate partner violence among individuals experiencing mental illness (including depression, anxiety, and posttraumatic stress disorder), mental health professionals often do not effectively address this co-occurring factor in assessing and treating their clients or patients. The failure of these clinicians to screen for domestic or intimate partner violence is even more troubling because of the presence of mental health coercion in some abusive relationships. Research suggests that individuals with co-occurring abuse histories and mental illness may be coerced by intimate partners, other family members, or by official agencies, to receive unwanted behavioral health treatment. This coercion may be the product of emergency detention and/or civil commitment procedures initiated by partners and other family members seeking to leverage those legal mechanisms in order to exert unwarranted control.

Paradoxically, an additional group subject to domestic or intimate partner violence experiences coercion that prevents them from accessing behavioral health services. This group includes some individuals who wish to receive mental health treatment (which may or may not relate to abuse) but who are prevented from doing so by their abusers. The group also includes some individuals whose abusers inhibit or discourage medication, treatment, or hospitalization, as well as those whose abusers pressure substance use or interfere in substance abuse treatment.

This article addresses the overlap of trauma and mental disability, the failure of behavioral health services systemically to screen for domestic or intimate partner violence, the risk that abusive partners may manipulate the civil commitment system, and the likelihood that people with mental illness who experience domestic or intimate partner violence fail to receive sufficient trauma-informed treatment for their mental illness or other behavioral health needs. The article calls for more research, screening, and service integration to meet the needs of persons who experience both mental illness or disability and domestic or intimate partner violence, as well as adjustments to the legal rules governing emergency detention and civil commitment. In particular, it explores systematic screening procedures to assess for trauma, abuse, and coercion at the emergency petition and evaluation stages as well as at involuntary commitment hearings, and analyzes the need for greater system integration of mental health treatment with the existing structure of shelters and other supportive services for domestic or intimate partner violence.

Publication Citation

25 Journal of Health Care Law & Policy 225 (2022)

Disciplines

Disability Law | Family Law | Health Law and Policy | Law | Law and Gender | Social Welfare Law

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