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Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse.

ABSTRACT: To experience sexual violence and abuse is to experience silence. This commentary explores some of the ways in which psychiatry reinforces the silencing of sexual violence survivors. We argue that current psychiatric responses to sexual violence typically constitute iatrogenic harm including through: a failure to provide services that meet survivors' needs, a failure to believe or validate disclosures; experiences of medicalisation and diagnoses which can delegitimise people's own knowledge and meaning; 'power over' relational approaches which can prevent compassionate responses and result in staff having to develop their own coping strategies; and poorly addressed and reported experiences of sexual violence within psychiatric settings. We argue that these multiple forms of silencing have arisen in part because of biomedical dominance, a lack of support and training in sexual violence for staff, inconsistent access to structured, reflective supervision, and the difficulties of facing the horror of sexual violence and abuse. We then describe community-based and grassroots responses, and consider the potential of trauma-informed approaches. Whilst this paper has a UK focus, some aspects will resonate globally, particularly given that Western psychiatry is increasingly being exported around the globe.

SUBMITTER: Sweeney A

PROVIDER: S-EPMC6998991 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse.

Sweeney A A Perôt C C Callard F F Adenden V V Mantovani N N Goldsmith L L

Epidemiology and psychiatric sciences 20190412 6

To experience sexual violence and abuse is to experience silence. This commentary explores some of the ways in which psychiatry reinforces the silencing of sexual violence survivors. We argue that current psychiatric responses to sexual violence typically constitute iatrogenic harm including through: a failure to provide services that meet survivors' needs, a failure to believe or validate disclosures; experiences of medicalisation and diagnoses which can delegitimise people's own knowledge and ...[more]

PMID: 30977461

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Project description:Background: There is a dearth of research which explores sexual abuse from perspectives of Caribbean women, despite its high prevalence in the region. While sexual violence is universal, tackling it requires a deep understanding of the contextual specificities in which it arises and of the intersections of gender with other sources of oppression and marginalisation. It also calls for the recognition that intimate partner violence against women is not separate from, but linked to violence against girls, not only because both are forms of gender-based violence but because together they speak to its historical, persistent and accumulative effects. Methods: In-depth intensive interviews were carried out with 35 women from Barbados and Grenada, aged 18-60 years who had experienced intimate partner violence under one of the following circumstances: during pregnancy (n = 15), as a woman a with disability (n = 8), as a woman living with HIV (n = 12). Interviews were digitally recorded, transcribed and thematically analyzed. Results: The participants experienced multiple forms of violence within their relationships, often concurrently. Twenty-one of the women had been subject to sexual violence and of these, 19 had experienced sexual abuse as children; these experiences were viewed as interconnected and bolstered by the high level of violence-acceptance reported within communities. Women were subject to different forms of control by their partners depending upon prevailing discourses related to their circumstances (as pregnant, disabled, or HIV positive); being 'vulnerable' was synonymous with having one's agency as an independent, autonomous person constrained and little external help was available. Conclusion: The study identified a clear chain of sexual behaviors, each of which fuel different layers of the problem: the prevalence of early sexualization of children is associated with the prevalence of child sexual abuse; child sexual abuse is pervasive in large part, because of the normalisation and social acceptance of violence against women and girls; "cultural" normalcy, in turn, fuels attitudes which contribute to sexual violence against women and women in especially vulnerable circumstances face additional risks. Integrated policy, which tackles these as interconnected issues is called for.

Project description:ObjectivesTo establish a James Lind Alliance (JLA) Priority Setting Partnership (PSP) to identify research priorities relevant to the health and social care needs of adults with lived experience of recent and/or historical sexual violence/abuse.ParticipantsAdults (aged 18+ years) with lived experience of sexual violence/abuse (ie, 'survivors') were consulted for this PSP, alongside healthcare and social care professionals who support survivors across the public, voluntary, community, independent practice and social enterprise sectors.MethodsIn line with standard JLA PSP methodology, participants completed an initial online survey to propose research questions relevant to the health and social care needs of survivors. Research questions unanswered by current evidence were identified, and a second online survey was deployed to identify respondents' priorities from this list. Questions prioritised through the second survey were presented at a consensus meeting with key stakeholders to agree the top 10 research priorities using a modified nominal group technique approach.Results223 participants (54% survivors) provided 484 suggested questions. Seventy-five unique questions unanswered by research were identified and subsequently ranked by 343 participants (60% survivors). A consensus meeting with 31 stakeholders (42% survivors) examined the top-ranking priorities from the second survey and agreed the top 10 research priorities. These included research into forms of support and recovery outcomes valued by survivors, how to best support people of colour/black, Asian and minority ethnic and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) survivors, improving access to high-quality psychological therapies, reducing public misconceptions/stigma, the impact of involvement in the criminal justice system on well-being, and how physical and mental health services can become more 'trauma informed'.ConclusionsThese research priorities identify crucial gaps in the existing evidence to better support adult survivors of sexual violence and abuse. Researchers and funders should prioritise further work in these priority areas identified by survivors and the professionals who support them.

Project description:IntroductionKey measures in preventing spread of the virus that causes coronavirus disease 2019 (COVID-19) are social distancing and stay-at-home mandates. These measures along with other stressors have the potential to increase incidences of intimate partner violence (IPV), sexual assault, and child maltreatment.MethodsWe performed a retrospective review of county police dispatches, emergency department (ED) visits, Sexual Assault Nurse Examiner (SANE) consults, Domestic Violence Healthcare Project (DVHP) team consults, and Child Protection Team consults at a large, tertiary, Level I trauma center. We queried International Classification of Diseases Revision 10 codes most specific to IPV, sexual assault, and child maltreatment from March-October 2020 compared to 2019. Similarly, the number of consults performed by SANE, DVHP, and our Child Protection Team were collected. We compared all ED visits and consultations to total ED visits for the reviewed time period. Finally, the total number of calls and referrals to a child advocacy center and resource call line for victims were recorded during this timeframe.ResultsPolice dispatches for IPV-related assaults increased by 266 reports from 2019 to 2020 (P = 0.015). Emergency department visits related to IPV increased from 0.11% of visits in 2019 to 0.15% in 2020 (P = 0.032), and DVHP consults increased from 0.31% in 2019 to 0.48% in 2020 of ED visits in the first three months (P < 0.001). Child maltreatment visits increased from 0.47% of visits in 2019 to 0.81% of visits in 2020 (P = 0.028), and a higher percentage of patients required Child Protection team consults from 1% in 2019 to 1.6% in 2020 (P = 0.004). Sexual assault-related visits and SANE consults both showed a small increase that was not statistically significant. Fewer calls and referrals were made to our child advocacy center and resource call line, decreasing by 99 referrals and 252 calls, respectively.ConclusionDespite decreased ED volumes throughout the pandemic, we observed an increase in police dispatches, ED visits, and utilization of hospital consult services related to IPV and child maltreatment following the initiation of stay-at-home orders. However, use of community resources, such as the local child advocacy center, declined.

Project description:BackgroundResearch indicates that sexual violence affects about 30% of women in the general population and between two to three times as much for autistic women.Materials and methodsWe investigated prevalence of sexual abuse, autistic traits and a range of symptoms, using an online survey addressed to the women of the French autistic community (n = 225). We assessed victimization through an open question and through a specific questionnaire, derived from the Sexual Experiences Survey-Short Form Victimization.ResultsBoth case identification methods yielded high figures: 68.9% victimization (open question) compared to 88.4% (standardized questionnaire). Two thirds of the victims were very young when they were first assaulted: among 199 victims, 135 were aged 18 or below and 112 participants were aged 15 or below. 75% of participants included in our study reported several aggressions. Analyses indicate that primo-victimization was highly correlated to revictimization and that being young increased that risk. Young victims were also at higher risk of developing post-traumatic stress disorder. A third of the victims reported the assault. 25% of those were able to file a complaint (n = 12) and/or receive care (n = 13). For the remainder 75%, reporting did not lead to action.DiscussionThose findings indicate a very large proportion of victims of sexual assault among autistic women, consistently with previous research. The World Health Organization states unambiguously that sexual violence is systemic and that vulnerable individuals are preferably targeted by offenders. We therefore postulate that it would be erroneous to consider that victimization of autistic women is mainly due to autism. On the contrary, autism seems to be just a vulnerability factor. Some authors propose that educating potential victims to better protect themselves would help preventing abuse. We reviewed this proposition in the light of our results and found it to be impossible to apply since more than half of the victims were below or at the age of consent. Literature about sexual violence is discussed. Large-scale prevention programs proposed by World Health Organization and the Center for Disease Control aim at cultural changes in order to diminish gender inequality, that they identify as the very root of sexual violence.

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Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse.

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Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse.

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