Download Sexual assault services – an overview

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Women’s Health
Sexual assault
services – an
overview
Early referral to a sexual assault treatment
unit is vital for victims of sexual violence, write
Aideen Walsh, Anne McHugh and Maeve Eogan
Since the landmark National review of sexual assault
services in Ireland in 2005,1 there are now six specialist
units strategically placed nationally to provide a unified
continuum of care, on one site, including treatment and
forensic clinical examination for patients giving a history
of recent rape/sexual assault.2,3 These sexual assault treatment units (SATUs) ensure that standardised responsive
care is available for men and women over the age of 14
years, within three hours drive from any location in Ireland.
There are units in Dublin, Mullingar, Galway, Waterford,
Cork and Donegal; and also at the Mid-Western Regional
Hospital, Limerick on an out-of-hours basis. Accessibility to
appropriate care needs to be timely and easily accessed to
respond and encourage reporting of the crime to the Gardaí,
healthcare professionals, Rape Crisis Centres, or a combination of these agencies.
Incidence and impact of sexual crime
Internationally, the incidence of sexual crime remains
largely under-reported. Nationally, the Rape Crisis Network
Ireland statistics4 reflect this trend, with only one in three
survivors ever reporting the incident to a formal authority.
The consequences for the survivor of not reporting this
crime can vary from person to person and may include both
physical and psychosocial difficulties. Long-term sequelae
(for example, post-traumatic stress disorder) can impact on
the individual’s day-to-day life and that of their families.
There is also the wider impact on society; if the perpetrator is not held to account for their crime, they may
reoffend repeatedly.5 If survivors do not access support
services, information about the violence is not available
and the impact of the violence on individuals and society
cannot be effectively highlighted.6 Responsive care following sexual violence can reduce future consequences
for the person and the response received after the assault
may critically frame the person’s recovery.7 Care provided
in SATUs is based on an interdisciplinary team response. A
patient-focused approach is taken to meet the individual’s
medical, psychological and forensic needs. The interdisciplinary team comprises forensic clinical examiners (nurses,
midwives or doctors), support nurses, psychological support
workers from Rape Crisis Centres and the Gardaí, depending on whether the person chooses to report the incident.
Contact with the SATU
Victims of sexual crime currently have two options when
seeking assistance following an assault: either to report
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to the Gardaí or not to report and receive a health check.
Reporting sexual crime is always preferable and early
involvement with the Gardaí can enhance the opportunity
for collection of time-sensitive forensic evidence, where a
24-hour-a-day service is available.
The majority of people who access SATUs report the incident; over 80% were accompanied to an SATU by a member
of the Gardaí in 2011.8 Initial contact with the SATU is
generally made by the Gardaí on the person’s behalf, but
access can also be initiated by the victim, family or friends,
GPs, Rape Crisis Centres, emergency departments, youth
support services and other agencies. If the person contacts
one of these agencies and has not already reported the
assault to the Gardaí, their options are discussed, depending on the timeframe since the incident.
Forensic clinical examinations are carried out up to seven
days post-assault.9 After this time, the person may still be
examined to document injuries, identify healthcare needs
and facilitate liaison with follow-up care and other support
services; however, forensic evidence will not be collected.
Those who opt not to report the crime to the Gardaí are
offered the same full range of services as those who are
reporting the crime, with the exception of the collection of
forensic evidence. An appropriate appointment for SATU
services is arranged on a case-by-case basis.
When a person makes an allegation of rape or sexual
assault to the Gardaí, the on-call SATU team is contacted
and an appointment is made for the person to attend an
SATU within three hours. Acute medical needs, eg. head
injury, take priority over forensic needs and this is discussed
with the caller. Key elements in that telephone conversation
include the duration since the assault, the person’s age
(parental/guardian consent may be required), their capacity
to consent and if the person is medically stable.
Treatment at a SATU
On arrival at the SATU, the patient is met by the support nurse/midwife and the process of the examination is
explained. The forensic kit is prepared with the attending
member of the Gardaí and the forensic clinical examiner,
while the patient talks with the psychological support
worker from the Rape Crisis Centre.
Once the patient’s demographic details are documented,
the forensic clinical examiner obtains written consent for
the examination. A detailed clinical history is taken and
vital signs are recorded. Following this, the person is
asked to give details of the incident, including the time
and location where the incident took place, details of the
assailant(s) and the nature of the assault.
The main purpose of taking this detailed account is to
guide the forensic clinical examination and collection of
forensic evidence. Top-to-toe examination follows, which
includes documentation of injuries (if present) and forensic
sample-taking. The forensic samples are packaged in the
presence of the Gardaí to ensure continuity of evidence for
the criminal justice system. The person can take a shower
following the examination.
Appropriate medications are administered to the patient,
which are determined by the timeframe from assault to
examination, history of events, clinical history and patient
consent. These medications may include emergency contraception, sexually transmitted infection prophylaxis,
hepatitis B vaccination and HIV prophylaxis.
Holistic review is arranged in one month with a follow-up
appointment for sexual health screening, administration of
a second dose of hepatitis B vaccine where appropriate,
and use of psychological support services.
A referral to the HSE social work services is made for
all persons who are under 18 years as per Children First
guidance.10 Further follow-up appointments are also carried
out at six months (for administration of third hepatitis B
vaccine and repeat HIV test) and eight months (hepatitis B
titre levels) following the initial SATU attendance.
The forensic clinical examiner prepares a medico-legal
report for the Gardaí, which forms part of the book of evidence that may be forwarded by the Gardaí to the Office of
the Director of Public Prosecutions. The forensic clinical
examiner may be summoned to court to present professional evidence of fact as to what was found during the
forensic clinical examination and to give an opinion regarding these findings. Training in courtroom appearance and
giving evidence is thus part of postgraduate training for
forensic clinical examiners in the RCSI for nurses and midwives and in UCD for medical doctors.
Prompt access is vital
Prompt access to specialist services for victims of sexual
violence is vital for appropriate care and improved outcomes. A prompt response is also vital if a forensic clinical
examination is to be carried out to collect time-sensitive
forensic evidence. Initial contact can be made by victims
themselves, the Gardaí, GPs, Rape Crisis Centres or any
other agencies, by telephoning a SATU on a 24-hour basis
(www.hse.ie/satu). A caring non-judgemental sensitive
approach delivered by competent, skilled and appropriatelytrained professionals is vital when responding to someone
who gives a history of recent rape or sexual assault.
Early referral from primary care services of the medically
stable patient to a SATU or Garda station is crucial and a
prompt SATU inter-agency team response is vital to ensure
that the medical, psychological and forensic needs of the
person following recent rape or sexual assault are met.
Aideen Walsh is a clinical nurse specialist (sexual assault
forensic examination), Anne McHugh is project manager and
Maeve Eogan is a consultant in obstetrics and gynaecology at
the Sexual Assault Treatment Unit, Rotunda Hospital, Dublin
References on request
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