d.When domestic violence is identified, mental health providers should collaborate with the victim in evaluating the impact of any recommended treatment strategies on her safety, develop mental health treatment plans that give priority to safety-related needs, and pro-actively assist victims in developing short and long-term safety plans.
The ability of victims to follow through on mental health treatment plans can be compromised by the actions of their abusive partners. Victims should not be expected to comply with mental health treatment plans that require them to do things that directly or indirectly endanger them. For example, a goal for a client in mental health treatment might be to increase their independence through becoming more assertive, setting clear limits and personal boundaries, and/or expanding their social networks. For victims, these behaviors may, in fact, precipitate increased violence from their abusive partners. Abusers are often resistant to their partners' attempts to seek help of any kind and may increase their use of violence and threats in order to reestablish control. The consequences of treatment plans should be evaluated with regard to immediate and long-term safety.
Victims with histories of psychiatric illness might have even greater difficulty in getting safe or planning to leave their violent partners. A victim might rightfully fear the abuser's threats of institutionalizing her and of losing custody of her children. She might not have outside support from family, friends, and other resources. Safety-planning and an expansive identification of options is critical. (See Guiding Principles, 1.d.)
In some cases, medication may be indicated and might support a woman's attempts to become safe. Some medications, such as psychotropic drugs, however, also have the potential to impair a woman's ability to assess risk and respond accordingly. Medications should be prescribed only after careful assessment by the professional of both a victim's medical needs and safety-related needs, and should be re-evaluated on a regular basis. Frequently, once a victim is safe, presenting symptoms dissipate without medication.
e.Mental health treatment providers should recognize that, at times, the legitimate survival and safety strategies employed by victims (such as resistance, non-compliance, and dishonesty) may conflict with mental health treatment strategies. Treatment strategies and activities should be continually reviewed and modified, as necessary, to reflect a victim's ongoing safety-related needs.
The safety-related concerns of victims do not necessarily remain constant. As a result, victims may attempt to protect