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EDITORIALS: Jantje Wilken and Jan Welch Management of people who have been raped BMJ 2003; 326: 458-459 [Full text]

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Your definition of "rape" is inadequate!

Judith Ronat   (28 February 2003)

Provision of Services to rape and sexual assault victims

Raine Roberts, Dr. Cath White.(in coming Clinical Director) Bernie Ryan Centre Manager.   (13 March 2003)

Walk in Centres: often 1st line contact for rape victims

Maria J. Gough, 1a Wych Elm, Harlow, CM20 1QO   (31 March 2003)

Your definition of "rape" is inadequate! 28 February 2003
Judith Ronat, Medical director Rishon L'Zion Community MHC IL-75522 Send response to journal: Re: Your definition of "rape" is inadequate!	Both the definition "nonconsensual penetration... of a woman or man" and the entire tenor of the editorial are inadequate! You ignore the serious problem of rape of young children. Competing interests:   None declared
Provision of Services to rape and sexual assault victims 13 March 2003
Raine Roberts, Clinical Director St. Mary's Sexual Assault Referral Centre M13 0JH, Dr. Cath White.(in coming Clinical Director) Bernie Ryan Centre Manager. Send response to journal: Re: Provision of Services to rape and sexual assault victims	We welcome the BMJ's initiative in publishing a leading article on the need for special expertise in the management of people who have been raped. The need for sexual assault referral in the UK was raised in your columns by Duddle in 1985 (BMJ 290:771-3) and the first sexual assault referral centre in the UK was set up at St. Mary's Hospital in Manchester in 1986. Progress in setting up other Centres has been slow with various interested groups being unconvinced of the need for such centres and the likely benefits. There is now, following the HMICPSI - A Report on the Koint Inspection into the Investigation and Prosecution of cases involving Allegations of Rape (April 2002), a working group set up by the Association of Chief Police Officers (ACPO) to promote models such as St. Mary's and the Haven in London, nationally. The police service is now wholeheartedly committed to this, but the Health and Social Services appear to be less ready to further these ends. St. Mary's could not have been set up without energetic support and funding from the hospital authorities. Initially the costs of self referral cases and the funding of a dedicated sexual health clinic were provided by the hospital, but without any formal written agreement for this funding to continue. It is now the responsibility of the police to pay for certain aspects of the service, which are arguably almost wholly medical and therapeutic rather than forensic. It can be argued strongly that immediate care tailored to the complainant's needs. whether the case goes to court or not, is likely to be cost effective and help to reduce the trauma suffered thereby perhaps avoiding long term medical, gynaecological and psychological problems with the considerable costs to the NHS and public services in general. There needs to be an understanding on the part of hospital managers that this is a matter, which requires a posistive approach from them and a willingness to facilitate and fund this essential development of services. This is not a peripheral or unimportant matter and the time is now right for these services to be organised and funded properly. Competing interests:   None declared
Walk in Centres: often 1st line contact for rape victims 31 March 2003
Maria J. Gough, Walk in Centre Nurse Practitioner Harlow NHS Walk in Centre, 1a Wych Elm, Harlow, CM20 1QO Send response to journal: Re: Walk in Centres: often 1st line contact for rape victims	Walk in Centres provide Emergency Hormonal Contraception: we see women presenting for EHC because they have been raped. Victims include 'date rapes' or victims of domestic violence - not everyone feels able to divulge the circumstances of their experience. Amazingly, some do not even realise that they have been 'raped'. Few want police involvement. WICs could, in the future, take samples for blood and urine 0-72 hours post rape (for drugs) which is also the timeframe for post trauma reactions and administration of Levenelle-2. WIC's offer long opening hours; minor injury treatments, medication under Primary Group Directions on site. Staff also have access to other relevant areas via liaison links and referral pathways. WIC nurses could even be trained in forensic & sexual health examination: indeed, there is currently a Nurse Forensic Examiner Pilot scheme (Sister Millie Doregos, St. Mary's Centre) in Manchester. The recent changes to the Rape laws to encourage reporting of this crime is likely to affect the NHS - the 42 WICs country wide could help improve the quality of care currently offered to this client group. Competing interests:   None declared