Sexual violence and mental health services: a call to action

Abstract

People who experience sexual violence are highly likely to experience psychological and/or mental health (MH) problems as a result. People who use MH services often have a history of sexual assault and are also likely to be revictimised as an adult. Yet despite there being a very clear association, MH services are not yet performing routine enquiry, and even if they do, are not confident about how to record and manage disclosures. There is some emerging evidence that people with MH problems are exposed to sexual violence in inpatient MH settings, perpetrated by both other patients or members of staff. In this editorial, we explore the evidence to support a wider focus on sexual violence as a part of routine care, as well as some recommendations about how staff can more effectively discuss sexual issues including that of sexual victimisation.

Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units

“…This narrow focus results in a lack of adequate training on sensitive inquiry and response to disclosure of sexual violence. Thereby perpetuating a cycle of anxiety, avoidance and the use re-traumatising practices such as restrictive interventions, body searches and round the clock observations [21, 22, 37]. This approach is counterproductive for consumers and can result in vicarious trauma for health professionals [38, 39].…”

Sexual violence within mental health units: The forgotten fight?

“…In a 2005 American study, 8% of psychiatric inpatients reported being forced into sexual contact by another patient, and 3% reported sexual coercion by a staff member (Frueh et al, 2005). In the United Kingdom, an analysis of reports of incidents from 54 mental health trusts, published by the Care Quality Commission in 2018, revealed 273 sexual assaults and 29 alleged rapes between April and June 2017 (Hughes et al, 2019). In France, 24 rapes and 143 sexual assaults were reported in mental health units between 2015 and 2018 (Direction Générale de l’Offre de Soins, 2020).…”

“…However, these figures are probably underestimated. A French report published in 2011 (Lalande and Lepine, 2011), and two recent editorials addressing sexual violence in the United Kingdom (Hughes et al, 2019) and the United States (Barnett, 2020), pointed out that sexual incidents were particularly difficult to quantify and may be under-reported by mental health staff. This lack of report was mostly due to (1) victims often abstaining from reporting sexual assault to their caregivers (Hughes et al, 2019; Lalande and Lepine, 2011); (2) caregivers questioning the victim’s statement because of his or her mental condition (Barnett, 2020; Lalande and Lepine, 2011), or because the alleged aggressor was a member of the staff (Barnett, 2020); and (3) the fear of legal action against the unit (Barnett, 2020; Hughes et al, 2019; Lalande and Lepine, 2011).…”

“…A French report published in 2011 (Lalande and Lepine, 2011), and two recent editorials addressing sexual violence in the United Kingdom (Hughes et al, 2019) and the United States (Barnett, 2020), pointed out that sexual incidents were particularly difficult to quantify and may be under-reported by mental health staff. This lack of report was mostly due to (1) victims often abstaining from reporting sexual assault to their caregivers (Hughes et al, 2019; Lalande and Lepine, 2011); (2) caregivers questioning the victim’s statement because of his or her mental condition (Barnett, 2020; Lalande and Lepine, 2011), or because the alleged aggressor was a member of the staff (Barnett, 2020); and (3) the fear of legal action against the unit (Barnett, 2020; Hughes et al, 2019; Lalande and Lepine, 2011). Importantly, in all those countries, there has been concern about the quality of care the victims received: in many cases, the answer to disclosure or discovery of a sexual assault was considered as inappropriate, with heterogeneous medical and psychological care (Barnett, 2020; Lalande and Lepine, 2011), along with delayed or inexistent legal proceedings (Barnett, 2020; Hughes et al, 2019; Lalande and Lepine, 2011).…”

Sexual violence and mental health

“…Drawing mostly on evidence from the UK and Australia, Hughes et al . report that many mental-health professionals do not routinely enquire about sexual violence (Hughes et al ., 2019). Some do not understand the relevance of sexual violence to the development, maintenance and exacerbation of mental-health problems.…”