Listening to mental health workers' experiences: Factors influencing their work with women who disclose sexual assault

Abstract

Women are overrepresented within mental health service-use statistics, and a disproportionate number of them have experienced sexual assault. While mental health workers are often the first point of contact between these women and the mental health system, within the research to date, women have often reported a negative experience of disclosing sexual assault to these workers. This article presents findings from an exploratory Australian study. The aim of the study was to explore factors that influenced how mental health Crisis Assessment and Treatment Service (CATS) workers respond to women who disclose sexual assault in crisis service settings. Fifteen CATS workers were surveyed and the predominantly qualitative data were then analysed using thematic analysis. This article presents two key findings: (i) the majority of participants had not experienced adequate sexual assault training, and seven of the 15 did not feel well equipped to respond to a disclosure of sexual assault; and (ii) they rarely consulted or referred women to specialist sexual assault services, despite recognizing the significant impact of sexual assault on mental health functioning. Recommendations are made for training and increased communication between mental health and sexual assault service systems to ensure better outcomes for women.

The 5-As Framework for Including Sexual Concerns in Mental Health Nursing Practice

“…Sexual vulnerability and sexual exploitation, especially for female inpatient consumers, is a further concerning occurrence (Brown, Lubman, & Paxton, 2011;Cole, 2003;Judd, Armstrong, & Kulkarni, 2009;McLindon & Harms, 2011), resulting in some mental health units providing additional safety and security measures for women (Price, 2009). The incidence of sexual side effects from psychotropic medications also has significant implications (Balon, 2006;Basson et al, 2010;Schlachetzki & Langosch, 2008;Schweitzer, Maguire, & Ng, 2009;Werneke, Northey, & Bhugra, 2006) for example, non-adherence and subsequent risk of relapse (Basson et al, 2010;Deegan, 2001;Schweitzer et al, 2009).…”

Nurse competencies for health promotion in the mental health context

“…Still regarding to competence in the management of the patient disease/illness status domain, study on how mental health workers respond to women who revealed sexual abuse, in the scenario of crisis service, showed that the participants recognized the impact of sexual abuse in long term manifestation of sexual trauma and psychiatric symptoms, highlighting the different responses in physical, cognitive, emotional and spiritual experienced by individuals. However, half of the sample did not feel confident to respond to a situation of sexual abuse (11) . The results demonstrated appropriate competence when analyzing and interpreting the patient's history and the information to develop appropriate diagnoses, but they showed difficulties in meeting the patient's response to lived experiences (6) .…”

“…The results demonstrated appropriate competence when analyzing and interpreting the patient's history and the information to develop appropriate diagnoses, but they showed difficulties in meeting the patient's response to lived experiences (6) . All participants identified knowledge of the services from Center Against Sexual Abuse, as well as other specialized services for sexual abuse in the community; however, the majority of participants indicated that they rarely or never refer to these services, which denotes failure of the competence as the issue goes beyond the scope of nursing practice (11) . Among the reported barriers to working with the issue of sexual abuse, 12 participants recognized the need for containment of anxiety as a challenge, eight reported their lack of experience and/or training, and two male workers identified sex as a barrier, reflecting the cultural competence when they recognize cultural issues.…”

“…Determining the scope, effectiveness and impact of policies and programs to promote health including the appropriate use of assessment and research methods to support improvement in programs, sustainability and dissemination (15) . Research on the roles of the expanded practice of community mental health nurses indicated that they were less confident about prescribing, even though, more than half (54%) reported that they definitely or Evaluates the coordinated response in development of unplanned care services for mental health (8) Identifies confidence and preparation of community mental health nurses when performing expanded roles (9) Identifies cultural factors that contributed to substance abuse in adolescents (10) Explores how mental health workers and respond to women who reveals sexual abuse in the scenario of crisis service (11) Professionals identify cultural barriers of women in attendance (11) Managing and negotiating health care delivery systems nurse practitioner-patient relationship teaching/coaching Function Analyzes the extent of mental health services provided to families (12) On the significance of the relationship with the patient, highlights the genuine partnership and confidence (13) Unidentified probably felt confident to prescribe medication. More than 90% said they probably or definitely felt confident in making recommendations for involuntary treatment, 84% and 79% showed similar levels of confidence in ordering of diagnostic tests and in referring patients to specialist physicians, respectively (9) .…”

A question of commitment – improving practitioner responses to domestic and sexual violence, problematic substance use and mental ill‐health

“…However, it is only in the last decade that a solid evidence base has emerged which demonstrates that mental ill-health can be a "symptom of [domestic] abuse" (Humphreys & Thiara, 2003), and highlights the extent to which survivors of domestic and sexual violence often use alcohol, illicit drugs and prescribed medication as a means of coping with the physical and emotional pain of abuse (see, for example, Golding, 1999;Howard, Trevillion & Agnew-Davies, 2010a;Howard et al, 2010b;Humphreys & Reagan, 2005;McLindon & Harms, 2011;Rees et al, 2011). The association between substance use and the perpetration of domestic and sexual violence has also been evidenced (Budd, 2003;Galvani, 2004), and research on perpetration and psychiatric illness is currently underway.…”