I thank Brooker & Mitchell for their comments on my editorialReference Ingrassia¹ highlighting the potentially neglected, yet complex, interface between mental health services and sexual assault referral centres and the need to articulate formal pathways for adults experiencing trauma following sexual assault. These issues are similarly problematic for adolescents. A recent Lancet study looking at a cohort of young people attending the sexual assault referral centres serving Greater London over 2 years found that 80% of those undertaking a diagnostic assessment had a psychiatric diagnosis.Reference Khadr, Clarke, Wellings, Villalta, Goddard and Welch² The presence of a psychiatric disorder was associated with psychosocial vulnerability including previous contact with children services, with mental health services and a history of sexual abuse, still raising serious concerns about the ability of institutions to protect those young people who are most at risk.

Brooker & Mitchell also raise the need to strengthen policies that support a ‘business as usual’ approach to enquiries about a history of sexual abuse within mental health services, for example through the care programme approach. There are perhaps many reasons why this task remains difficult without ongoing training and support for professionals. Since writing my editorial the Inquiry has published a report of its interim findings,³ one of the emerging themes is the need to focus on the cultural challenge of openly acknowledging, understanding and discussing childhood sexual abuse. This challenge is highlighted by some of the Inquiry's findings, that those charged with protecting them ‘did not see children as victims or felt that it raised issues that were simply too difficult or uncomfortable to confront’.³

I am pleased with Brooker & Mitchell's agreement with my commentary on the responsibility of the individual well-informed clinician as I have previously advocated the importance of taking a reflexive, self-reflective approach to the practice of medicine.Reference Ingrassia⁴

The reports of victims and survivors, heard by the Inquiry, that NHS mental health provisions lack flexibility and are not tailored to their specific needs are disheartening but need to be placed into the challenging context of providing public services within current funding constraints. I am encouraged by the Inquiry's choice to focus, as a matter of urgency, on the financial implications of providing treatment and support to victims and survivors and its recommendation to better understand current levels and effectiveness of public expenditure in this area. It is my hope that this may lead to much needed wider investment and better coordination of mental health services for the benefit of children and adult victims and survivors.