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The Independent Inquiry into Child Sexual Abuse in the UK: reflecting on the mental health needs of victims and survivors

  • Antonina Ingrassia (a1)
Summary

The nature and extent of the sexual abuse of children and young people and the pervasiveness of inappropriate institutional responses to its occurrence continues to raise serious concerns. The work of the Inquiry is a powerful reminder of the role of mental health services in addressing the needs of victims and survivors.

Declaration of interest

None.

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References
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2Jay, A. Independent Inquiry into Child Sexual Exploitation in Rotherham 1997–2013. Rotherham Metropolitan Borough Council, 2014 (https://www.rotherham.gov.uk/downloads/file/1407/independent_inquiry_cse_in_rotherham).
3Her Majesty's Inspector of Constabulary. In Harm's Way: The Role of Police in Keeping Children Safe. HMIC, 2015 (https://www.justiceinspectorates.gov.uk/hmicfrs/wp-content/uploads/in-harms-way.pdf).
4Care Quality Commission. Not Seen, not Heard – A Review of the Arrangements for Child Safeguarding and Health Care for Looked After Children in England. CQC, 2016.
5Independent Inquiry into Child Sexual Abuse. Victim and Survivor Voices from The Truth Project. IICSA, 2017 (https://www.iicsa.org.uk/document/victim-and-survivor-voices-truth-project).
6Royal Commission into Institutional Responses to Child Sexual Abuse. Royal Commission into Institutional Responses to Child Sexual Abuse. Interim report Volume 2. Commonwealth of Australia, 2014 (https://www.childabuseroyalcommission.gov.au/sites/default/files/file-list/final_report_-_interim_report_volume_2.pdf).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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The Independent Inquiry into Child Sexual Abuse in the UK: reflecting on the mental health needs of victims and survivors

  • Antonina Ingrassia (a1)
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eLetters

Professor

Charlie Brooker, Honorary Professor, Royal Holloway, University of London
Damian Mitchell, Independent Healthcare Consultant
10 October 2018

Thanks to Dr Ingrassia for her recent editorial on the Independent Inquiry into Child Sexual Abuse in the UK, particular her focus on the role of mental health services. She cites the Mental Health Trust's collaboration project commenced in 2006 but omitted to mention that since 2008 it has been a policy requirement that all those on the Care Programme Approach (CPA) are routinely assessed about their possible history of sexual abuse or sexual violence - so-called 'routine enquiry' (RE). However, training figures for RE obtained from NHS Mental Health Trusts indicate in 2015 (and again in 2017) that RE is becoming less likely in clinical practice and we argued that the policy needed re-invigoration (Brooker et al, 2016).

Sexual Assault Referral Centres (SARCs) provide a one-stop health shop for those that report a sexual assault. The NHS England Specification for the SARC service (Public health England/NHS England 2018) implies that a thorough mental health assessment should take place in a SARC not least because decisions should be made about the best mental health service to access if required: if risk is a concern the crisis team; if the client is known to mental health services maybe the CMHT or CAMHS service; possibly an IAPT service if trauma is not complex. In our experience such pathways are seldom formally negotiated, in the main, Mental Health Services rebuff many SARC referrals. This often leaves specialist voluntary sector counselling services overwhelmed as they take on not just 'acute' cases (those recently sexually assaulted) but cases of historic abuse too. The new national strategy for sexual abuse and assault services (NHS England, 2018) proposes that integrated commissioning is required involving NHS England, CCGs, Police and Crime Commissioners, Local Authorities, the Ministry of Justice and the Home office with the creation locally of a new Sexual Assault and Abuse Services (SAAS) Partnership Board.

The articulation of formal pathways for those experiencing trauma following a sexual assault is clearly an important task for these new commissioning boards. In a recent audit of a SARC service (Brooker et al, 2018) we found the following. In a sample of 105 people who consented to undertake a full assessment: 76% of the sample had seen a health professional for their mental health in the preceding 12 months with half being treated by their GP but an important sub-group of people (31%) were being seen by a mental health professional most often a psychiatrist; Nearly one-fifth of the sample(19%,n=21)had been previously admitted to a psychiatric unit where, on average ,they had been admitted three times in total. The remainder of the sample without no previous history of mental health treatment were now, following the sexual assault, at risk of developing a mental health problem.

To conclude, as Dr Ingrassia stated, 'the responsibility rests with the sensitive and well-informed clinician's ability to see past the presenting problem' maybe a willingness to assess in this manner is a pre-requisite to better pathways between SARCs and Mental Health Services in the future.

References

Brooker,C., Tocque,K., Brown,M and Kennedy,A (2016) Sexual violence and abuse and the care programme approach The British Journal of Psychiatry, 209, 359–360. doi: 0.1192/ bjp.bp.116.18612

NHS England (2018) Public health functions to be exercised by NHS England – Service Specification: Sexual Assault Referral Centres https://www.england.nhs.uk/publication/public-health-functions-to-be-exercised-by-nhs-england-service-specification-sexual-assault-referral-centres/ (accessed October 2nd 2018)

NHS England (2018) A strategic direction for sexual abuse and assault services: Lifelong care for victims and survivors https://www.england.nhs.uk/wp-content/uploads/2018/04/strategic-direction-sexual-assault-and-abuse-services.pdf (accessed October 2nd 2018)

Brooker,C., Tocque,K and Paul,S (2018) Assessment of the mental health status of a one year cohort attending a two Sexual Assault Referral Centres in England Journal of Forensic and Legal Medicine 54 (2018) 44–49

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Conflict of interest: None declared

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