Office for the Prevention of Domestic Violence

Mental Health

Screening for Domestic Violence in Mental Health Settings

How to Ask about Domestic Violence Victimization

Screening is a process that may take place over several sessions. It is not enough to just ask, “Are you a victim of domestic violence?” Many victims are afraid to talk about it or don’t define what happens to them as abusive.

Put the question in context: “Many of the people we work with have experienced violence or abuse at the hands of their partner or someone else in their family. We ask everyone about it so that we can try to help. I’m going to ask you some questions about the kinds of things many people who abuse their partners do.”

Ask behavioral questions that reflect a range of controlling behaviors. For instance, does your partner (or any significant person in your life)…

• hit, kick or otherwise hurt you?
• try to run your life, or tell you what you can do or say?
• stalk you, follow you around, or check up on you a lot?
• put you down, call you names, or embarrass you in public?
• make threats (e.g., to kick you out, report you to immigration, or out you) or try to intimidate you?
• demand sexual activity that you don’t want; force you to have sex?
• control all the money in your family?

Use the Power and Control Wheel or the LGBT Power and Control Wheel as a tool for asking about different tactics of abuse, or to prompt yourself to ask alternative behavioral questions.¹

Pay attention to red flags for victimization.  As you talk with the individual, you might see physical injuries that seem non-accidental, repeated, or inconsistent with the reason the individual gives for them.  You might hear about:

• Symptoms of PTSD, depression, anxiety, suicidality, substance abuse or addiction, or traumatic brain injury.
• Confusion, fear and self-blame; shame about being abused.
• Guilt about self-defense; exaggeration of her/his own “abusiveness.”
• The partner’s point of view instead of the client’s own.
• A life that has shrunk over the course of the relationship. The individual has given up activities, jobs, relationships, opinions – and maybe their sense of themselves.
• Multiple attempts to leave, repair the relationship or seek help.
• Rationalizations or minimizations of partner’s abusive behavior; excuses for partner’s behavior; minimization of the client’s own injuries.
• Descriptions of partner as having a bad temper or a drinking problem.
• Involvement in a protracted divorce or custody case.
• Partner’s abuse of children, pets, or other people.

If domestic violence is disclosed, first listen to the person’s story. 

Ask for examples of incidents– the first one, the worst one, and the most recent one. This gives you an overall picture of the client’s experience, and also tells you how bad it has gotten. If the worst incident was also the most recent one, safety must be your first concern.

Asking clients to describe what each partner actually did and said in one or more incidents is particularly important if the person says the abuse was mutual.  It can help you distinguish battering from “just a fight.”

LGBTQ Victims

Remember that domestic violence is not just a heterosexual phenomenon. Lesbian, gay, bisexual, transgender and queer (LGBTQ) clients may also be abused, and will more easily disclose if they perceive you as accepting of their sexual orientation or gender identity. Use inclusive language in your screening. For instance, avoid gender-specific pronouns and say ‘partner’ until you know how the client refers to their partner.

When asking LGBTQ clients about IPV:

• Remember that LGBTQ people may deny being a victim of domestic violence for all the same reasons heterosexuals do.  In addition, they may think domestic violence is a purely heterosexual phenomenon.
• Explore whether the individual’s partner ever disrespects their identity or threatens to out them to their family or employer.
• Ask transgender people whether their partner has ever interfered with their transition (e.g., not allowing them to take hormones, or making them take too many medications).
• Don’t make assumptions based on gender.  Men, including transgender men, can be  victims, and women, including transgender women, can be abusive.  Many different sources of power and entitlement can exist in a given relationship.

Screening tool for LGBT victims can be found at National Center for Victims of Crime

Follow-up

Don’t drop the subject of domestic violence after screening, but follow the client’s lead as far as what kind of help is wanted.  Ask about it again whenever clients:

• Begin or end a relationship.
• Are involved in litigation over child custody and visitation.
• Become pregnant.
• Say that their partner wants to attend their sessions.
• Request couple counseling
• Give any indication that either they or their partner are abusing their children. (Questions about domestic violence should be raised before any decision regarding child abuse reporting is made.)

Helping victims access domestic violence services

Clients who disclose victimization should be offered a referral to local domestic violence services.  They client may or may not take the referral. This is up to them – but you should make sure they have the information to use if they wish. Consult NYSCADV’s county by county list of providers to find the program nearest to your client.

If you’re not sure how well the local domestic violence program is equipped to serve an LGTBQ victim – or a victim who is male or disabled, or belongs to a specific cultural community – contact the program on your client’s behalf.  Ask for copies of their brochures.  Look for whether people like your client are featured in agency materials. Ask whether they have targeted services for that community, and talk with the person responsible for those services.

For LGBTQ clients, for example, you should ask some specific questions and convey the information to the client

• Have staff been trained on LGBTQ issues?
  • Many programs train their staff on lesbian domestic violence.  This does not mean they are ready to serve male or transgender victims.

• What specific services do you have for LGBTQ clients?
  • Do you offer LGBTQ support groups?  Are LGBTQ clients welcome in other support groups?
  • Do you take transgender and male victims into your shelter? 
    • If so, how do you make them feel comfortable (e.g., private bedrooms, restrooms and showers)?
    • How comfortable is your staff with transgender people, especially staff working non-traditional hours – evenings, weekends, etc.?
    • If not, what shelter alternatives do you have in place for them? 
    • If you use safe homes, what sort of neighborhood are they located in?  How safe is the environment – both in general and for LGBTQ people specifically?  What security arrangements are there?
• If an LGBTQ victim is treated poorly by other shelter residents, what are your strategies for dealing with the situation?
• Do you screen for abusiveness, to prevent LGBTQ abusers from gaining admission to shelter?  How?
  • Some lesbian victims seeking shelter have found that the shelter is unavailable to them because their abusive partner is already living there – having  convinced staff that she is a victim.

Next: Asking about Abusiveness

1. The National Center on Domestic and Sexual Violence has many additional power and control wheels for specific populations.