Sexual violence victims

Introduction

Sexual violence is any unwanted behaviour perceived to be of a sexual nature or sexual contact that takes place without consent or mutual understanding.

The World Health Organisation defines sexual violence as:    

“Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including the home” (World Health Organisation Report on Violence and Health, 2002)

There are two sub-categories of sexual offences depending on the seriousness of the crime:

  • Serious sexual crime including rapes, sexual assaults, and sexual activity with children;
  • Other sexual offences (including soliciting, exploitation of prostitution, and other unlawful sexual activity between consenting adults).

The effects of sexual violence on victims can include depression, anxiety, post-traumatic stress disorder, drug and substance misuse, self-harm and suicide. However, when victims receive the support they need when they need it, they are more likely to take positive steps to recovery. It is therefore important that victims of sexual violence have good access to effective services, whether or not they wish to report incidents to the police. 

It is estimated that in England & Wales, up to 9 in 10 cases of rape go unreported and 38 per cent of serious sexual assault victims tell no one about their experience. Each adult rape is estimated to cost over £76,000 in its emotional and physical impact on the victim, lost economic output due to convalescence, early treatment costs to the health service and costs incurred in the criminal justice system. The overall cost to society of sexual offences in 2003-04 was estimated at £8.5 billion.

Addressing the needs of victims of sexual violence through the provision of accessible specialist services can deliver benefits in terms of better health and well-being and quality of life. There are also long-term productivity savings in services and costs to society when the immediate effects of sexual assault are managed effectively.

This topic links with the following JSNA topics:

Sexual health

Sensory disabilities

Physical disabilities

Last updated: 2015-06-03 15:17:45
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1. What are the key issues?

It is generally accepted that there is no entirely accurate way of measuring the true extent of sexual violence. 

There is a national and local increase in the number of sexual violence incidents being reported to the police.  Even after taking this increase into account estimates through the Crime Survey of England and Wales indicate that there are still significant levels of under reporting.  

In 2013/14, the overall increase of sexual offences reported to Cleveland Police was 4.3%, with rape offences increasing by 17.2%.  

There is no shared vision across Teesside, it is unclear who is responsible for commissioning what service and there are risks of duplication and double funding. 

Many clients have to travel to other areas for services that are not available in the area where they live.

There has been a significant annual shortfall in SARC funding that has been met on an ad-hoc basis by the commissioners.  

There has not been a review of SARC funding since the initial financial agreements of partners in 2006.

SARC services are in place, but there is a lack of clarity on who holds responsibility to ensure that appropriate ‘follow-on’ services are in place.  

Due to inconsistencies between the Tees specialist sexual violence services, it is difficult for professionals and members of the public to understand what services are on offer.

Last updated: 03/06/15

2. What commissioning priorities are recommended?

2015/01

All Tees commissioners i.e. NHS England, the office of the Police and Crime Commissioner, the Tees Clinical Commissioning Groups, the Public Health Shared Service, the four Tees Local Authorities and Cleveland Police to consider the potential benefits of a collaborative approach to commissioning sexual violence services in Teesside.          

2015/02

Tees commissioners to consider developing a model evidence-based service specification for the Tees sexual violence services.

2015/03

Tees commissioners to take responsibility for determining what sexual violence services should be available to local residents, how they should be provided, who should contribute funding and how quality and effectiveness can be maintained.  They should carry out this responsibility in partnership with the SARC and specialist sexual violence services to ensure that appropriate pathways and services are in place for stranger cases, acquaintance cases, historical cases and domestic violence and abuse cases.   They should also be clear on how they will address the increasing level of demand.

2015/04

Tees commissioners to establish best practice in respect of the counselling provision that is delivered through the Tees specialist sexual violence and IAPT services.    They should also work with specialist sexual violence service providers to develop a model specification for the provision of counselling for victims of sexual violence.

2015/05

Develop a consistent ISVA service, ensuring that it is available for the SARC to refer into in all parts of Teesside and also ensuring that all victims of sexual violence have the opportunity to access an ISVA to discuss potential progress through the criminal justice system.

2015/06

Commissioners to work in partnership with key stakeholders and specialist sexual violence service providers, in order to clarify and confirm the role of the SARC as ‘a hub’ for sexual violence.   This should cover their requirements of the national SARC Service Specifications as well as the structure of the Teesside sexual violence services.  

2015/07

A “task and finish group” should be formed involving representatives from commissioners, stakeholders and service providers to develop and agree the data to be collated, the frequency of the data being provided and the subsequent monitoring arrangements. 

2015/08

Develop and deliver a communications plan through the TSVSG that raises awareness of sexual violence ensuring that both public and professionals are aware of what exists and where to get help.   The plan should also deliver a preventative approach by raising awareness of risks with particular vulnerable people, encourage action to be taken to reduce risk, addressing issues of consent and reaffirm what is inappropriate and unacceptable behaviour.

Last updated: 03/06/15

3. Who is at risk and why?

Gender

Women and children and young people are most at risk.

About 3.2 million women aged between 16 and 59 in the UK have been sexually assaulted since the age of 16;

Males (0.1%) are much more unlikely than females (0.5%) to report being a victim of the most serious sexual offences.

Single females and those who were separated were more at risk than other females (5.3% and 3.7% respectively).

Research suggests that the additional stigma attached to male rape may account for the higher under-reporting compared to female rape.

Age

Males and females of all ages can be at risk of sexual violence but the most reliable data currently available in the UK (British Crime Survey) focus on those aged 16-59.

Females aged between 16 and 19 were at the highest risk of being a victim of a sexual offence (8.2%) and as age increased the risk of victimisation reduced.

About 1-in-5 rapes recorded by police are committed against children under 16.

Deprivation

Females from households in the lowest income bracket (under £10,000 per year) showed an increased risk of victimisation (3.8%) as did full time students (6.8%), and the unemployed (3.8%).

Poverty is linked to both the perpetration of sexual violence and the risk of being a victim and is therefore more common in deprived areas. More severe forms of childhood sexual abuse are associated with higher levels of deprivation.

Economic circumstances and limited employment opportunities may lead to involvement in sex work. There are a high number of sexual assaults amongst the homeless. In one study 13% of homeless women reported having been raped in the previous 12 months, and 50% of these women were raped twice.

Having previously been sexually assaulted when young

There is some evidence that experiencing sexual abuse in childhood or adolescence is a risk factor for sexual victimisation during adulthood. Women with a childhood history of sexual abuse are 4.7 times more likely to be subsequently raped

Evidence suggests that sexual violence is a learnt behaviour in some men. Studies on boys with a history of child sexual abuse show that 1 in 5 continue in later life to molest children themselves, thus continuing the cycle of abuse.

Violence in the family

One of the most common forms of sexual violence is that perpetrated by an intimate partner. About 50% of women who have experienced domestic violence are raped within their physically abusive relationship.

Alcohol and drug misuse

It is estimated that about 50% of all sexual assaults are committed by men who have been drinking alcohol. Similarly, about 50% of all sexual assault victims report that they were drinking alcohol at the time of the assault.

Mental illness, learning and physical disability

Disabled people and those with learning impairment and mental illness are reported to be four times more likely to experience sexual violence, and yet there is under-reporting of incidents. Victims of sexual violence from these groups may have difficulty verbalising their abuse.

Housing

Factors relating to household location, and housing tenure were also related to risk of victimisation. For example, prevalence rates were higher among females in the ‘City Living’ Output Area Classification category (5.5%), people living in flats or maisonettes (3.9%), those living in an urban area (2.6%) and in rented accommodation (3.4% for social rented accommodation and 4.6% for private rented).

Lifestyle

Sexual victimisation rates were higher for females who reported visiting a pub at least once a week (4.3%) or a night club one to three times a month (5.6%). Those who visited a night club at least four times a month had the highest victimisation rate of any characteristic covered by the CSEW (9.2%).

Last updated: 03/06/15

4. What is the level of need in the population?

Estimated prevalence

Estimated prevalence of sexual violence victimisation in Teesside during 2013/14

The Crime Survey of England and Wales (CSEW) estimates that in Teesside (2013/14), there was around 970 victims of serious sexual assault (rape, attempted rape and sexual assault), with 812  being female victims and 158 male.   Further estimates through the CSEW indicate that there was in the region of 4,700 (4,067 female and 633 male) victims of any sexual assault during the same time period.

When comparing this to the data received from the Police, the SARC and the Teesside Sexual Violence Services, the indication is that there is likely to have been a significant number of people that have been a victim of rape and other serious sexual offences that have not reported the incident to the SARC, the Police or other sexual violence service.   There is some concern that the rise nationally on the reporting of historical incidents may also at some point have an impact on the sexual violence services who may struggle to meet the demand.

Estimated prevalence of sexual violence victimisation in Teesside since the age of 16 years

The Crime Survey of England and Wales (CSEW) estimates that in Teesside it is likely that there are around 9,416 people (16+ years) who have been a victim of one or more serious sexual assaults (rape, attempted rape and sexual assault), with 8,624  being female victims and 792 male.   Further estimates through the CSEW indicate that there is in the region of 36,171 (31,893 female and 4,278 male) people (16+ years) who have been a victim of any sexual assault.

Cleveland Police

The tables below show the numbers of sexual offences were recorded by Cleveland Police during 2013/14 compared to the previous year.  

Office for National Statistics recorded crime statistics

The recorded crime figures for England and Wales showed an increase of 20% in all sexual offences in 2013/14 compared with the previous year. This is the highest level recorded since the introduction of the National Crime Recording Standard in April 2002.

The table below provides a comparison between national trends and the recorded figures for the Teesside.  

Due to levels of previous under reporting and the impact of major investigations in certain parts of the UK it is difficult to interpret anything from the comparison with national and local trends.

Service utilisation data in Teesside

The Sexual Assault Referral Centre (SARC)

Of the above 538 referrals received at the SARC, 447 (83%) were female and 91 (17%) male.  

ARCH North East (Sexual Abuse, Rape, Counselling & Help)

Of the 415 clients referred to ARCH during the reporting period, approximately three-quarters were female, and one-quarter were male.

EVA (Emerging from violence and abuse)

The chart above outlines the number of sexual violence referrals received by EVA during the reporting period, with the main referrer being the SARC.

Harbour

The chart above outlines the number of referrals made to the Harbour Sexual Violence counselling service during the reporting period. Of the 256 people referred, 125 subsequently received a counselling service with 625 counselling sessions being delivered.  

Barnardos

During the reporting period, the SARC made 47 referrals to the Barnardos ISVA Service, all of which received a service. The 47 clients received a total of 749 ISVA sessions.

Last updated: 03/06/15

5. What services are currently provided?

The Sexual Assault Referral Centre (SARC)

SARC is a Tees-wide service that provides crisis intervention, crisis support work, ISVA provision, practical and emotional support, forensic facilities, police interviewing facilities, first line medication, early evidence kits, options for non-police reporting, options for anonymous intelligence sharing, clothing and showering facilities for victims, co-ordination of all non SARC personnel, provides specialist knowledge across Teesside to health, third sector, social services etc. through training and awareness raising sessions, develops and maintains robust pathways to span the whole victim journey and case file tracking.

TASCOR

TASCOR provide the forensic examination and medical services with all adults that attend the SARC.   The service is funded by the PCC as part of the custody contract.   The on-call doctor responsible for calls within the custody environment is also responsible for calls relating to the SARC.

RVI

The RVI see children (under-16 years old) from the North East of England who are suspected of being a victim of sexual abuse. They will see 17 to 18-year-olds if the young person has learning difficulties, if they are particularly vulnerable or if they are in looked after care.  

ARCH North East (Sexual Abuse, Rape, Counselling & Help)

Arch provide the following services to victims of sexual violence and their families:

  • ISVA service – support from report to court for people progressing through the criminal justice system. The team also support those people who may be considering whether or not to make a report to police.
  • Specialist sexual violence counselling service – This is an integrative service from a person centred base and is provided for anyone who has been affected by sexual violence at any time in their lives.  This includes people who have suffered rape or sexual assault (either recent or historic) and those who experienced sexual abuse in their childhood.
  • LESA Service (Life Enhancement Skills Advisor) – Internal service only. Provides practical and emotional support to clients across a range of issues that may be impacting on their ability to recover and move on with their lives.

EVA (Emerging from violence and abuse)

As an organisation EVA Women’s Aid and Rape Crisis provide a wraparound service around domestic violence and also sexual violence.   They provide a range of free, confidential and non-judgemental specialist support for women and children who have been affected by any form of domestic and or sexual abuse at any time in their lives.  

Harbour

Harbour provides a sexual violence counselling service in Stockton-On-Tees and Hartlepool, with female and male clients, generally over 16 year-olds but they have worked with younger people when the needs have required it.   They work with all sexual violence victims and are not restricted to those that occur within a domestic violence setting. 

Foundation

The Foundation ISVA service for females aged over 14 years old that offers regular emotional and practical support to fit in with the client’s needs and help them deal with the impact of rape, sexual assault or childhood sexual abuse.   Foundation provides an assessment of need and risk, individual support and therapeutic intervention.  

Victim Support

Victim Support have specially trained volunteers who provide information to victims, practical help and emotional support.  The service is confidential and is provided regardless of whether it has been reported to the police.  Volunteers visit victims in their own home, a victim support office or somewhere else if the victim prefers.  If the victim would prefer to speak to someone over the phone then equally this can be arranged.  The service is for male and female victims.   When working with young people they tend to work with the family unit rather than just the individual victim.   Practical support includes completion of criminal injuries compensation applications and at times they receive requests from a sexual violence service to help the victim to complete this process. 

Barnardos

Barnardos ISVA team provide a specialist young person sexual violence service.   The ISVAs provide emotional and practical support through intensive face to face outreach sessions, text, letter, and telephone contact.   They act as advisors and provide holistic support for the child and the family. They also provide support related to the following:

  • Child Sexual Exploitation (CSE).
  • Therapeutic services
  • Sexual Exploitation of Children On the Streets  (SECOS)

My Sisters Place

My Sisters Place deal with sexual violence as part of the domestic violence support. 

A Way Out

A Way Out work with women involved in survival sex work (women who exchange sex for money, drugs, accommodation etc.).  The model is very much an on-street operation with a recognised ‘red-light’ area, meaning the women are constantly at very high risk of violence.

Improving Access to Psychological Therapies (IAPT)

IAPT provide a programme that helps people suffering from depression and anxiety disorders to find the best type of therapy for them.  The Local IAPT providers are:

  • Alliance Psychological Services Ltd
  • MIND
  • Starfish Health and Wellbeing
  • Talking Matters Teesside
  • Tees Esk and Wear Valleys NHS Foundation Trust - Tees Time to Talk
Last updated: 03/06/15

6. What is the projected level of need?

There are currently no projected levels of need.

Last updated: 03/06/15

7. What needs might be unmet?

There are gaps and inconsistencies in the sexual violence services across Teesside. There is a need to provide an equal service across Teesside for all, regardless of where the client lives, their sex, age or offending history among others. 

There’s currently no joint commissioning or collaborative commissioning agreement in respect of the Tees sexual violence services. This is particularly in respect of the ISVA Service, counselling, services for men and services for those that have been accused of an offence. 

There is inconsistency in respect of the ISVA and sexual violence counselling services across Teesside.

There are no services for men in Redcar and Cleveland.

A concern has been expressed that the counselling delivered for post-traumatic stress disorder (PTSD) may conflict with the National Institute for Health and Care Excellence (NICE) and World Health Organisation (WHO) Guidelines.   NICE guidance states that patient’s preference should be an important determinant of the choice among effective treatments.   PTSD sufferers should be given sufficient information about the nature of these treatments to make an informed choice.   These concerns could be addressed through consultation with the current specialist sexual violence service counselling providers. 

There may be a need to raise awareness of the Teesside Pre-Trial Therapy Protocol (PTT) with the Improving Access to Psychological Therapy (IAPT) services.  

Some mental health issues cannot be assessed for in the acute stages through the SARC. The specialist mental health assessment should be delivered through the specialist sexual violence services.

There are no service level agreements between the SARC, the Police and the ISVAs.

There are no service agreements between the SARC and the sexual violence counselling and support services.

Promotions and marketing of the sexual violence services to professionals and members of the public could be improved.   This could be co-ordinated through the SARC or delivered individually by each of the services.

Gaps within the individual sexual violence services

SARC

Emotional support where the client is being supported through the SARC ISVA and counselling may not be appropriate, clinical supervision for all staff, continued professional development for the SARC manager and SARC staff.   The SARC has the responsibility to develop robust pathways between the SARC and the sexual violence services but there is a limited resource available to do this. 

Arch

Arch lack the capacity to promote and market the sexual violence services to stakeholders such as GPs, mental health services and members of the public.   This could be improved through collaboration with the SARC.

Eva

There is currently a counselling waiting list.

Harbour

There is currently a lack of funding and commissioning restraints

Victim Support

There is no ISVA. An enhanced service from within victim support, specialist services for BME clients and specialist services for young sexual violence clients would be beneficial.

Barnardos

Addressing peer on peer sexual violence is required.

A Way Out

Specialist ISVA for women involved in sex work is required. More provision for sexual abuse counselling is needed as there is currently a waiting list. An appropriate knowledge concerning women involved in sex work and the abuse they suffer is necessary.

Tees Esk and Wear Valley (TEWV)

There needs to be more knowledge within TEWV of the role and responsibilities of the SARC and the other sexual violence services cross Teesside. There needs to be more information available from TEWV around what is on offer to support families of those that have been involved in a sexual violence incident.

Last updated: 03/06/15

8. What evidence is there for effective intervention?

The following list of standards, guidelines and accreditations are applied across the Teesside sexual violence services to ensure that there is effective intervention through the services:

  • The Teesside Sexual Violence Strategy Group – Core principles and service standards (including children & Young Persons) also Teesside Sexual Assault Referral Centre (Helen Britton House) operating standards
  • National SARC standards.
  • National occupational ISVA standards – These are delivered through Lime, Culture, CAADA, New Pathways and Warwick University.
  • NICE clinical guideline - 26 Post-traumatic stress disorder (PTSD). The management of PTSD in adults and children in primary and secondary care. Issued: March 2005 guidance.nice.org.uk/cg26
  • British Association for Counselling and Psychotherapy.
  • Rape Crisis England and Wales.
  • Lime Culture
  • CAADA

Abbey A, Ross LT, McDuffie D. Alcohol's role in sexual assault. In: Watson RR, editor. Drug and alcohol abuse reviews: Volume 5 addictive behaviours in women. Totowa NJ: Humana Press, 1994.

Acierno R, Resnick H, Kilpatrick DG, Saunders B, Best CL. Risk Factors for Rape, Physical Assault, and Post-traumatic Stress Disorder in Women: examination of Differential Multivariate Relationships. Journal of Anxiety

Disorders 1999;13(6):541–63.

Cunningham S, Drury S. Access All Areas: A Guide for Community Safety

Partnerships on Working More Effectively with Disabled People: Report for

NACRO, 2002.

Department of Health. Home Office, Association of Chief Police Offices. Revised National Service Guide. A Resource for Developing Sexual Assault Referral Centres. In:

http://ww2.reading.gov.uk/documents/community-living/communitysafety/

ResourceforDevelopingSexualAssaultReferralCentres.pdf, editor, October 2009.

Department of Health and Association of Chief Police Officers. Response to sexual violence needs assessments (RSVNA) toolkit: informing the commissioning and development of co-ordinated specialist services for victims of sexual violence (2011).

Farley M, Howard B. Prostitution, violence and post-traumatic stress disorder. Women & Health 1998;27(3):37-49.

Farley M, Kelly V. Prostitution: a critical review of the medical and social sciences literature. Women and Criminal Justice 2000;11(4):29-64.

Her Majesty Government. Cross Government Action Plan on Sexual Violence and Abuse 2007.

Martin SL, Ray N, Sotres-Alvarez D, Krupper LL, Moracco KE, Dickens PA, et al. Physical and Sexual Assault of Women With Disabilities. Violence Against Women 2006;2006(12):823.

Miller, D. (2002) Disabled Children and Abuse. London: NSPCC Information Briefing.

Sin CH, Hedges A, Cook C, Mguni N, Comber N. Disabled people’s experiences of targeted violence and hostility. Manchester: Office for Public Management, Equality and Human Rights Commission, 2009.

Tees Sexual Violence Needs Assessment  2012.

Watkins B, Bentovim A. The sexual abuse of male children and adolescents: a review of current research. Journal of Child Psychology and Psychiatry 1992;33:197-248.

Last updated: 03/06/15

9. What do people say?

The Crime Survey of England and Wales (CSEW)

The CSEW measures the extent of crime in England and Wales by asking people whether they have experienced any crime in the past year.  The survey has measured crime in this way since 1982 and is a valuable source of information for the government about the extent and nature of crime in England and Wales.   It records crimes that may not have been reported to the police, so it is used as an alternative to police records.

In 2013, around 50,000 households across England and Wales were invited to participate in the survey with three-quarters of households invited to take part actually doing so.

As well as the main crime questionnaire, the annual CSEW includes an additional self-completion module that asks males and females, aged 16 to 59, about their experience of sexual offences in the last year.  This estimate of victimisation has the benefit of including offences that do not come to the attention of the police.

The table below provides the CSEW estimation of prevalence of being a victim of a sexual offence for those aged 16-59 years in the 12 months prior to the survey.

England and Wales                                            

% who were victims once or more

 

Males

Females

All

Any sexual offences (including attempts)

0.4

2.5

1.5

Most serious sexual offences (including attempts)

0.1

0.5

0.3

Rape  (including attempts)

0.1

0.4

0.2

Assault by penetration (including attempts)

0.0

0.2

0.1

Most serious sexual offences (excluding attempts)

0.1

0.4

0.2

Rape (excluding attempts)

0.0

0.3

0.2

Assault by penetration (excluding attempts)

0.0

0.1

0.1

Other sexual offences

0.4

2.3

1.3

Compared to the needs assessment prepared in January 2012, there is little change and where there is variation; the changes are no greater than 0.1%.

Last updated: 03/06/15

10. What additional needs assessment is required?

There is a need to develop a much greater understanding of the issues of sexual violence within the BME community

There is a need to develop a greater understanding of the needs of the Lesbian, Gay, Bisexual and Transgender (LGBT) community and assess if people are aware of and have confidence in the current services.

There is a need to develop a greater understanding of the needs of those living with some form of disability and assess if they are aware of and have confidence in the current services.

Further research needs to take place to understand the needs of those that may report incidents of sexual violence that occurred whilst in prison and also have a greater understanding of the needs of victims of historical incidents of sexual violence who are in custody.

Further research could take place in respect of the perpetrators of sexual violence.

Last updated: 03/06/15

Key contact: Graham Strange

Job title: Tees Sexual Violence Strategy Group Coordinator

e-mail: graham.strange@safeinteesvalley.org

Phone number: 07972407297

References

  • National Institute for Health and Care Excellence (NICE) Post-traumatic stress disorder (PTSD) - The management of PTSD in adults and children in primary and secondary care. Issued: March 2005.   NICE clinical guideline 26.
  • NHS England – Securing Excellence in Commissioning sexual assault services for people who experience sexual violence – 13.6.13
  • Public Health functions to be exercised by the NHS Commissioning Board – Service Specification No. 30, Sexual Assault Services – November 2012
  • DAC Beachcroft – NHS England – Health & Justice (Durham, Darlington and Tees) Commissioning Responsibilities in respect of Sexual Assault Referral Centres
  • Teesside Sexual Violence Strategy Group –Core Principles and Service Standards (including children and young people) also Teesside Sexual Assault Referral Centre Operating Standards.
  • Ministry of justice, Home Office and Office for National Statistics - An Overview of Sexual Offending in England and Wales January 2013