Where you reasonably believe a patient is in imminent threat of danger, you should seek their consent to report the matter to the police. If the patient is not capable of giving the consent for any reason, which may include intimidation, the GP is relieved of any obligation to adhere to privacy principles to the extent that disclosure is necessary to safeguard the patient’s immediate wellbeing. You may want to seek legal advice if you are in doubt, but common sense should be applied if the patient is manifestly in danger or threat of physical harm, and the police contacted.
Privacy and imminent threat
Sometimes the patient does not fall under mandatory reporting laws and does not want to go to the police, but you may perceive an imminent threat. This might be a situation such as a patient who is cognitively impaired, or where there has been a life-threatening risk, such as when a gun or knife is involved. The NSW Department of Health recommends in its Domestic Violence Policy discussion paper that health workers notify the police where the victim has serious injuries such as broken bones, stab wounds, lacerations or gunshot wounds (refer to Chapter 13 ). It is wise to get advice from appropriate authorities in these instances, including your medical defence organisation.
Safety of children and mandatory reporting
Children are particularly vulnerable to the impact of intimate partner abuse (refer to Chapter 6 ). In the context of intimate partner abuse, where the child or young person does not appear to have directly experienced any violence, you may consider a referral to a vulnerable children’s organisation (refer to Resources) or a report to Child Protection. The overlap with child abuse and intimate partner abuse is strong.60 Interventions that assist children to realise that their parent’s violence is not their fault and to safety plan for the next episode of violence, are key features of a response for safety.61,62
Referring children to vulnerable children’s or family services may be appropriate where there is a low-to-moderate impact on the child and their immediate safety is not compromised. As an example, the Department of Human Services in Victoria provides useful information for professionals working with vulnerable children, suggesting factors that may trigger a referral to a vulnerable children’s service. This service, upon assessment, may then make a report to Child Protection.
The Victorian Department of Human Services also summarises the circumstances in which a report to Child Protection should be made, together with factors to consider when deciding whether to make such a report.
The Victorian Government has also developed a comprehensive framework for family violence risk assessment.
These principles and guidelines apply to any vulnerable families across Australia and local resources can be found in each state and territory (refer to Tool 7 ).