One Stop Crisis Centre: Dilaasa’s Model for Domestic Violence Survivors in Mumbai

When a woman suffering from domestic violence walks into a hospital emergency room, she typically receives treatment for her injuries and is sent home. The violence itself often goes unrecorded, and the cycle continues. Dilaasa, which means reassurance in Hindi, was created to break this pattern by recognizing that healthcare facilities can serve as critical intervention points for survivors of domestic violence.

India’s first hospital-based crisis centre 🔗

Established in 2000 at Mumbai’s K.B. Bhabha Hospital, Dilaasa emerged as a joint initiative between the Centre for Enquiry into Health and Allied Themes (CEHAT) and the Municipal Corporation of Greater Mumbai. The centre’s creation stemmed from a troubling realization: countless women experiencing domestic violence were reaching hospitals but receiving care only for their physical injuries, while the underlying violence went unaddressed and undocumented.

The Municipal Corporation of Greater Mumbai was among the first organizations in India to formally acknowledge violence against women as a health issue requiring systematic medical sector response. This groundbreaking recognition led to the development of a model that would transform how hospitals engage with survivors of domestic violence.

Institutionalizing care within the health system 🔗

Dilaasa’s primary goal extends beyond helping individual women. The centre seeks to institutionalize domestic violence as a critical public health concern within Mumbai’s hospital system. This means embedding awareness, protocols, and support mechanisms into the everyday functioning of healthcare facilities.

Building capacity among hospital staff forms the cornerstone of this approach. Doctors, nurses, and paramedical personnel receive training to identify signs of domestic violence and respond with sensitivity to survivors’ complex health and psychosocial needs. The training covers not just physical indicators but also covert signs like chronic sleep problems, anxiety, repeated health complaints, and unwanted pregnancies.

Screening and early identification 🔗

A core function of the Dilaasa model involves systematic screening for domestic violence in hospital casualty departments and outpatient clinics. Healthcare providers learn to ask appropriate questions during consultations, creating opportunities for women to disclose abuse in a safe environment.

The emphasis lies on documentation and referral. Every identified case of domestic violence gets recorded in hospital records, ensuring the violence becomes visible in official statistics. Survivors receive information about Dilaasa’s services and, when ready, are referred to the crisis centre for comprehensive support-even if they’re not immediately prepared to pursue legal action.

Comprehensive support services 🔗

Dilaasa provides multi-layered assistance addressing the varied needs of domestic violence survivors. The centre operates as a distinct department within hospitals, typically located near the emergency department or outpatient clinic for easy accessibility and maximum visibility.

Psychosocial counselling 🔗

The model employs feminist counselling principles, understanding domestic violence as rooted in patriarchal structures rather than individual failings. Counsellors work to help women recognize they bear no responsibility for the violence inflicted upon them. Sessions focus on addressing fears and anxieties, validating experiences, and supporting women to regain control over their lives.

The counselling team follows the LIVES framework, which includes listening with empathy, inquiring about needs and concerns, validating experiences and feelings, enhancing safety through personalized planning, and supporting connection to resources. This structured yet flexible approach ensures survivors receive care tailored to their specific circumstances.

Legal assistance and shelter 🔗

Recognizing that many survivors need legal support to break free from abusive situations, Dilaasa collaborates with legal organizations. The centre works with groups like Majlis and Lawyers Collective to provide legal aid, helping women understand their rights under laws including the Protection of Women from Domestic Violence Act, 2005.

For women in immediate danger with nowhere safe to go, hospitals offer emergency shelter for up to three days. This temporary accommodation provides crucial breathing space for survivors to recover strength and work with counsellors to determine next steps without pressure or fear.

Impact and recognition 🔗

Dilaasa’s success has been substantial and well-documented. The centre has supported thousands of domestic violence survivors, with recent data showing the 11 Dilaasa centres operating in Mumbai responded to over 6,200 survivors in 2022 alone, averaging more than 17 cases daily across the network.

In 2003, the United Nations Development Program recognized Dilaasa as one of the best practices in gender mainstreaming, bringing international attention to this innovative model. The World Health Organization similarly acknowledged it in 2009 as an exemplary health systems response to violence against women in low and middle-income countries.

Replication across India 🔗

The model’s proven effectiveness has sparked replication efforts. CEHAT has facilitated the establishment of Dilaasa-based crisis centres in multiple states including Haryana, Kerala, Karnataka, Maharashtra, Meghalaya, and Goa. Each adaptation maintains core principles while adjusting to local contexts and resources.

By 2015, under the National Urban Health Mission, 11 public hospitals across Mumbai had integrated Dilaasa centres, collectively serving populations covering approximately 75% of the city. This expansion demonstrates the model’s scalability within existing health infrastructure.

Contributing to legal reform 🔗

Dilaasa’s experiences working directly with domestic violence survivors provided valuable ground-level insights during the drafting of national legislation. The centre’s documented cases, intervention strategies, and understanding of survivors’ needs contributed to the development and enactment of the Protection of Women from Domestic Violence Act, 2005.

This landmark legislation, which came into force in 2006, offers civil remedies for domestic violence survivors and defines domestic violence broadly to include physical, emotional, sexual, verbal, and economic abuse. The Act established protection officers and service providers, roles that Dilaasa’s model had already demonstrated were essential for effective support.

The cost-effectiveness of care 🔗

One significant aspect of the Dilaasa model is its affordability. Estimates from 2012 showed the annual cost of establishing and running the Bhabha Hospital centre was approximately 30 lakh rupees, translating to just 19 rupees per woman in the catchment population. The additional cost to hospitals averages around 9 rupees per woman, making comprehensive violence response remarkably cost-effective.

This economic viability strengthens the case for widespread adoption, demonstrating that resource constraints need not prevent hospitals from addressing domestic violence systematically.

Challenges and ongoing work 🔗

Despite its success, scaling crisis centres nationwide faces obstacles. Funding remains inconsistent across states, with some providing no dedicated allocation for such programs. Even where centers exist, requested budgets often receive only partial funding, limiting service capacity.

Additionally, shifting healthcare system attitudes requires sustained effort. Many health officials continue viewing domestic violence primarily as a social welfare or criminal justice issue rather than recognizing it as fundamentally a health concern requiring medical sector engagement.

What do you think? Could integrating domestic violence screening and support into routine healthcare delivery help break cycles of abuse that often remain hidden for years? How might healthcare providers in your community better identify and assist those experiencing violence at home?

References

1. https://www.svri.org/scaling-up-dilaasa-how-health-care-systems-are-helping-women-facing-violence-in-india/
2. https://www.cehat.org/project-details/57
3. https://en.wikipedia.org/wiki/Protection_of_Women_from_Domestic_Violence_Act,_2005
4. https://scroll.in/article/1053624/how-hospitals-are-helping-combat-violence-against-women
5. https://www.indiaspend.com/health/karnatakas-muktha-centres-show-how-govt-hospitals-can-support-domestic-violence-survivors-859444
6. https://www.indiacode.nic.in/handle/123456789/2021