Advice on patient disclosure of sexual assault
The Crime survey of England and Wales carried out by the Office for National Statistics estimated that 20% of women and 4% of men have experienced some type of sexual assault since the age of 16. This is equivalent to an estimated 3.4 million female victims and 631,000 male victims. This means it is highly likely that at some point anyone working in the healthcare profession will meet someone who has been sexually assaulted.
It is important that you are able to advise people on their options and what they should do if they make a disclosure to you.
Services offered by a SARC
It will be helpful if you can advise someone making a disclosure of sexual assault about where to go and what they can expect when they get there.
A SARC is a safe and private location that offers medical, practical and emotional support for people that have suffered sexual assault or rape. They are staffed by specially trained NHS doctors, nurses and support workers.
The services offered by a SARC include;
• Immediate medical support
• Injury documentation
• Forensic examination
• Advice regarding STIs and referral for STI testing
• Emergency contraception
• Psychological support
• Practical support and advice about options
• Access to an independent sexual violence advisor (ISVA) to help guide and support them through the process.
Timescales for referral
A SARC is also a purpose built forensic facility that offers forensic examination which could help lead to a prosecution. The opportunity to gather forensic evidence decreases over time so it’s important that the patient is advised of these timeframes, whilst still reinforcing that it is their choice and that there is no pressure on them to undergo an examination.
Acute: 7 days (or less) since assault
Forensic examination is possible. The earlier the referral, the better. You should advise patients not to wash, change clothes, or go to the toilet if possible. Private showers and toiletries are available at the SARC for use following examination.
Historic: more than 7 days after assault (adults 18+ years old)
Forensic medical examination may no longer be possible, although we can still provide advice and support.
More than 7 days after assault (under 18 years old)
A medical examination may still be beneficial even though it may not be possible to collect forensic samples. We would still recommend a referral.
Do they need to report to the police?
In all dealings with victims of sexual assault it is important that they feel in control and that they are free to make their own choices.
The patient has the choice of whether to report to the police or not. If they choose to do so, the police will allocate them a sexual offence liaison officer who will accompany them to their nearest SARC. You can contact the police by calling 101 or 999.
If the patient is unsure or doesn’t want the police involved, they can still access support from the SARC. You should refer them directly by filling in the secure online referral form
or by calling 0300 3034626 if less than 7 days. Patients can choose to undergo a forensic examination or not. They can also choose to have the examination and have forensic samples stored for up to 2 years.
What will happen when they visit a SARC?
On arrival, patients are given the opportunity to speak alone with a crisis worker. When they feel ready, they will meet with the forensic physician or nurse who will tell them exactly what will happen during the examination. Everything will take place at the patient’s pace and they can choose to stop the examination at any point.
The forensic physician or nurse will ask about the patients’ medical history and sexual health. They will also ask some questions about the assault in order to guide the examination and determine which forensic samples are appropriate and what medical care is needed.
As well as documenting any injuries, forensic samples may be obtained during the examination. This is done by using swabs, tiny samples of patients’ hair and sometimes cuttings from their fingernails. Blood and urine samples are also obtained and in some cases, patients’ clothing may be stored for forensic analysis. Which forensic samples are taken will depend on the nature of the assault and the elapsed period of time since.
Risk assessments are undertaken for pregnancy, suicidal ideation, safeguarding issues, HIV, and hepatitis B exposure. This will then inform further care such as emergency contraception, initiation of HIV Post-Exposure Prophylaxis following Sexual Exposure (PEPSE), safeguarding referral, and sexually transmitted infection (STI) screening. PEPSE is medication to reduce the risk of HIV if they have been exposed to the virus.
Forensic medical examinations typically take 3–4 hours. After examination, patients can shower and are offered fresh clothing if required.
More information and advice for medical professionals is available at www.sarchelp.co.uk