A rapid appraisal of the status of mental health support in post-rape care services in the Western Cape

Abstract

Background: Despite the well-known impact of rape on mental health and the widespread problem of rape in South Africa, mental health services for rape victims are scant and not a priority for acute-phase services. Survivors encounter multiple mental health struggles in this period including adherence to the post-exposure prophylaxis drugs to prevent HIV and finding support from important others. We have little information on what mental health is provided, by whom and how it is integrated into the post-rape package of care.Aim: The aim of the study was to do a rapid appraisal of mental health services for rape survivors to gain a better understanding of the current acute and long-term (secondary) mental health services. Method: We conducted a qualitative study using a rapid assessment with a purposive sample of 14 rape survivors and 43 service providers recruited from post-rape sexual assault services in urban and rural Western Cape Province. Data were collected using semi-structured in-depth interviews and observations of survivor sessions with counsellors, nurses and doctors. The data were coded thematically for analysis.Results: Survivors of rape experienced a range of emotional difficulties and presented varying levels of distress and various levels of coping. Receiving support and care from others assisted them, but the poor integration of mental health within post-rape services meant few received formal mental health support or effective referrals. Multiple factors contributed to the poor integration: mental health was not given the same level of priority as other rape services (i.e. clinical care, including forensic management), the inadequate capacity of service providers to provide mental healthcare, including mental health illiteracy, the lack of continuity of care, the poor linkages to ongoing mental healthcare, and the mental health challenges caused by vicarious trauma and compassion fatigue.Conclusion: Providing effective, compassionate mental health services should be seen as essential components of post-rape care. The strengthening of support for providers and linkages to ongoing mental healthcare are essential to improve mental health services within acute post-rape services.

Towards the development of a forensic psychology training curriculum in South Africa

“…For too long, forensic mental health has concerned itself largely with accused persons, to the relative neglect of complainants and survivors of crime, especially those who have been subjected to sexual violence. Many of these survivors have mental health issues, either pre-existing or consequent to the assaults, which are often left formally unaddressed (Abrahams & Gevers, 2017). This can impact their participation in court proceedings, of which courts need to be made aware.…”

Depression and post-traumatic stress symptoms two years post-rape and the role of early counselling: Rape Impact Cohort Evaluation (RICE) study

“…Effective and accessible mental health care post-rape has been identified as a critical gap in point-of-care services for rape survivors in LMIC (Abrahams & Gevers, 2017 ; Keynejad et al, 2020 ). In South Africa, immediate crisis counselling is offered to rape survivors who attend post-rape services i.e.…”

“…Thuthuzela Care Centres (TCCs) who in partnership with non-government organisations (NGOs) provide crisis counselling. The same NGO also offer rape survivors long-term supportive counselling (Abrahams & Gevers, 2017 ). A concerted effort to provide holistic care to rape survivors has been made in the last decade through Thuthuzela Care Centres (TCCs) which are one-stop service centres that provide comprehensive services to victims of gender-based violence (GBV), including rape.…”

“The Ugliness of It Seeps into Me”: Experiences of Vicarious Trauma among Female Psychologists Treating Survivors of Sexual Assault

“…Nearly one-third of participants stated that they had not disclosed their sexual assault because they were financially dependent on the perpetrator. The prevalence of sexual assault can also be deduced from male perpetrator prevalence studies, which indicate that 28–35% of men report having committed a sexual assault [ 7 ].…”

“…Studies conducted in South Africa have confirmed that sexual victimization is strongly associated with PTSD, depression, and suicidal behavior [ 7 , 8 , 9 ]. Many victims seek formal mental health care to address the emotional distress of sexual assault and its adverse impact on relationships and academic and occupational functioning [ 1 ].…”