The National Domestic Violence Hotline states that “An average of 24 people per minute are victims of rape, physical violence or stalking by an intimate partner in the United States — more than 12 million women and men over the course of a single year.”

Given these statistics, a study published in the Journal of Psychiatric and Mental Health Nursing explored the feasibility of email-mediated interaction in survivors of abuse and found that “email interaction is a feasible and acceptable way of providing support and information to survivors of abuse after their Protection from Abuse (PFA).”

For survivors of domestic violence and abuse, asking for help can be difficult, especially when they have to reach out to a healthcare provider or support organization, and their abusive partner is monitoring their communications. Even when a survivor wants support, they may not feel safe making a phone call or discussing their experiences face-to-face.

However, given the ubiquity of healthcare emails, HIPAA compliant emails can give survivors a privately accessible way to communicate with healthcare providers and support services. These emails can help survivors receive information and access resources, giving them support wherever they are.

 

Why email can be useful for survivors of abuse

Some survivors may find it difficult to find a safe space to communicate, especially if their abusive partner monitors their phone calls, reads text messages, controls transportation, or restricts access to healthcare. In these circumstances, email can be a good alternative.

For example, a survivor staying in a domestic violence shelter may not feel comfortable discussing their circumstances over the phone when other people are nearby. They may instead be able to send an email to a counselor explaining what they need and asking what support options are available.

Email also gives survivors time to process which information they are comfortable sharing. It also helps survivors keep an account of everything that happened, where they write it down and identify their immediate needs. They can write down what happened, identify their immediate needs, and decide what information they are comfortable sharing.

The research article stresses that email can provide education, screening information, safety instructions, and follow-up care for survivors of domestic violence. Moreover, its flexibility can help a survivor in an unpredictable or unsafe situation.

 

Equipping survivors with information

The study explains that while emails cannot eradicate the risk of further abuse, it gives survivors the platform to reach out to providers who can “provide immediate and ‘just-in-time’ support, guidance, information, education and referral, too proximate and quick to a calculating assailant.”

Even if a survivor isn’t ready to leave an abusive relationship, HIPAA compliant emails can give them direct access to information on the available resources in their area. So, even if the survivor is financially dependent on their abuser or concerned about their children, their provider could respond with information about safety planning, counseling, legal assistance, shelters, and other available resources. In this case, the HIPAA compliant emails would then give the survivor the information they need to decide what to do next.

 

Providing non-judgmental help

“The nonjudgmental format of email would assist as a device for providing individualized care, education, and information and social support to women and children isolated or in domestic violence shelters,” The Journal of Psychiatric and Mental Health Nursing explains.

As a result, providers should tailor their HIPAA compliant emails in a nonjudgmental way, especially when a survivor blames themselves or feels that they won’t be believed. Some survivors may also struggle to describe traumatic experiences verbally, and email can give them more control over how they communicate.

For example, if a survivor wants to ask a counselor about obtaining a protection order but feels overwhelmed during an in-person appointment, they could email the counselor, asking them about the process. The counselor can then use HIPAA compliant emails to respond with appropriate information and referrals, giving the survivor control of the conversation.

 

How can providers safeguard survivor privacy?

Providers must safeguard survivors’ personally identifiable information (PII) and protected health information (PHI) during electronic communications like email. More specifically, providers must use a HIPAA compliant email solution, like Paubox, which uses advanced encryption methods and two-factor authentication (2FA) to secure survivors’ information during transmission and at rest. Providers should also recognize that the survivor's own device or email account may not be private. For example, an abusive partner might have access to the survivor's phone, computer, email password, or browser history. The study recommends giving survivors instructions about digital safety, including using secure passwords, logging out of shared devices, updating security settings, and being cautious about sharing personal information online.

However, providers should avoid making assumptions about what is safe for each survivor. Digital safety advice should be individualized, as an action that is safe for one survivor could potentially attract attention from an abusive partner in another situation.

 

Giving survivors greater control over communication

Survivors should have control over their own communication wherever possible. So, providers “respect survivors' autonomy by allowing them to control the pace and content of email exchanges.” Additionally, HIPAA compliant emails can give survivors the platform to say when they are ready to communicate and what they are comfortable sharing.

This principle can be applied in practical ways, like when providers avoid sending a survivor a long message demanding detailed information about their circumstances. Providers should also clarify with the survivor what time works best for email exchanges (like when the abuser is at work) or what type of support would be most helpful.

 

Providers should have appropriate boundaries

Email is not an emergency communication system. As such, mental healthcare workers must set clear boundaries and expectations on how email support works. More specifically, patients should know how quickly providers typically respond, whether email is monitored outside business hours, what types of concerns can be handled by email, what to do in an emergency, how to request an appointment, and how to access crisis services.

Ultimately, having clear boundaries prevents a survivor from assuming that an email sent during a crisis will receive an immediate response. Instead, providers should include contact information for emergency organizations like the National Domestic Violence Hotline, which can connect survivors with local direct service providers.

 

Secure email can support ongoing follow-up care

Support should not end after the first interaction. HIPAA compliant emails can help providers maintain communication with a survivor who needs continued counseling, medical care, legal assistance, or referrals to a relevant mental healthcare provider.

For example, a counselor might send a survivor a follow-up message after an appointment saying, “I wanted to check in following our conversation. Here are the resources we discussed. If you would like to schedule another appointment, you can reply to this email.”

Paubox email also automatically encrypts attachments, so providers can attach informational pamphlets on organizations that provide specialized abuse survivor assistance. For example, organizations like RAINN, which offers free downloadable flyers, can attach them to their HIPAA compliant emails.

 

Providing personalized email support

Abuse can come in many forms, and survivors will need specialized support, depending on their situation. For example, A young person experiencing abuse may need different resources from a parent escaping an abusive relationship. On the other hand, someone living in a shelter may have different needs compared to someone who is still living with an abusive partner.

Paubox email allows providers to personalize their communications based on survivor needs. Providers can also use AI to segment these survivor populations and send targeted resources and information to better support them. For example, sending sexual trauma and abuse survivors resources for therapy and support groups, while sending housing resources to those experiencing homelessness due to abuse.

 

What happens if a survivor's email account is compromised?

Healthcare providers should plan for situations in which a survivor's email account has been breached. Since survivors may face heightened safety risks, a compromised account should be addressed as soon as the breach is established. These breaches can occur when an abusive partner gains unauthorized access to the survivor's email account, perhaps through a linked device like an iPad or shared computer.

In these cases, healthcare providers must have protocols in place to quickly secure the account and provide alternative means of communication, so the survivor's safety and privacy are protected.

 

FAQs

What should providers look for in a HIPAA compliant emailing platform?

Therapists must use a HIPAA compliant emailing platform, like Paubox, which offers encryption, access controls, and audit trails to safeguard patients’ health information and mitigate data breaches.

 

How can providers personalize their email support?

Providers can personalize their emails to meet the unique needs of each survivor by offering tailored resources, referrals, and guidance in email interactions. For example, they can send information about legal options, safety planning strategies, and emotional support tailored to the survivor's circumstances.

 

Do HIPAA compliant emails enhance provider relationships?

Yes, HIPAA compliant emails allow providers to directly email their patients with personalized care. Providers can also incorporate AI recommendations for healthcare plans based on specific factors like recipient demographics, leading to more efficient and effective care. Additionally, HIPAA compliant emails can help build trust between providers and patients, further enhancing their relationship.

Read more: Personalized patient education, HIPAA, and AI