شیوع مشکلات روانی و عمدی خود آسیبی در شاکیان خشونت های جنسی

The Haven Whitechapel, a sexual assault referral centre, provides a forensic service and after care to victims of serious sexual violence across North East London. Survivors of sexual assault display psychological sequelae including elevated rates of suicide ideation/attempts. Prevalence of mental health problems of 121 forensic cases seen between June and August 2004 was established. Of female clients aged over 13 years 8% had learning difficulties, 21% gave a past history of deliberate self-harm (DSH) and 20% psychiatric history. We formally assessed levels of safety and vulnerability prior to clients leaving the Haven. When mental health problems were identified additional screening questions were asked, followed by a flow chart outlining appropriate care pathways. Such practice was carried out over 6 months (September 2004 to February 2005). Of the 240 clients, 8% reported learning difficulties, 26% DSH and 21% psychiatric history. 4% of clients required urgent follow-up and 3% immediate referral to a psychiatric liaison team. There is a high background prevalence of mental health problems and DSH in our study population. Vulnerable people are at increased risk following sexual violence. Risk needs to be recognised and addressed. These findings have implications for the expansion of the SARC network.

The Haven aims to provide an efficient and sensitive service to all victims of acute rape and serious sexual assault across London in partnership with police and health. Clients are provided with informed choices about reporting to police/other agencies and their ongoing health care/support needs. The Haven Whitechapel offers forensic examination, emergency contraception and prophylaxis, management of sexually transmitted infection’s, psychological care and specialist follow up clinics to the 10 boroughs of North East London. During the forensic medical examination clients are routinely questioned about learning disabilities, deliberate self-harm (DSH) and psychiatric history. The Sexual Offences Examiner uses their professional judgement to assess whether the complainant is safe to leave the Haven. There is no standardised, accepted guidance for assessing risk management options, used at a local or national level. Professional bodies have addressed the issues of identifying risk following DSH and managing DSH.[1], [2], [3] and [4] Particular emphasis has been placed on identifying factors associated with suicidal behaviour, determining motivation for the act, identifying potentially treatable mental disorders, assessing continuing risk of suicidal behaviour and developing an appropriate aftercare strategy. No reference has been made in any of the above to sexual assault. A link between traumatic experience and psychological distress has been well documented. Kilpatrick (1985) reported elevated rates of suicide ideation (44%)/attempts (19%) among survivors of sexual assault.5 The author noted that a third of females reporting rape develop long-term psychological and social problems.6