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CLINICAL REVIEW: Jan Welch and Fiona Mason Rape and sexual assault BMJ 2007; 334: 1154-1158 [Full text]

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“RAPE”- Is it only a physical trauma?

Vibha Pandey   (6 June 2007)

Strategise to prevent sexual assault

Saddichha Sahoo   (6 June 2007)

Archway, Glasgow - A first for Scotland

AMBREEN BUTT, Deborah Wardle   (28 June 2007)

“RAPE”- Is it only a physical trauma? 6 June 2007
Vibha Pandey, Psychiatric Social Worker Central Institute Of Psychiatry Send response to journal: Re: “RAPE”- Is it only a physical trauma?	The present article is definitely an eye opener to all Health and Mental Health Professionals. The information regarding different domains of the problem like “who is sexually assaulted”, how can services be assessed”, what is the initial management, etc, are some of the essential information which a mental health professionals must be aware of in order to help the victim medically as well as psychologically. Current article is pointing towards the prevention of unwanted pregnancies, sexually transmitted disease if action is taken on time which is very important part of knowledge in the area especially among the health and mental health professionals. In addition to the awareness among the professionals, it also becomes pertinent for general public to know what are the services available and how they can get assess to it, most importantly why the physical examination after the incidence is important. Here the role of the government in formulating policies regarding the issue, and creating awareness becomes very important. In the present article focused has been given to physical rape in which Rape is defined as the non-consensual penetration of the vagina, mouth, or anus, by a penis; both sexes can be raped. Assault by penetration is the non-consensual, intentional insertion of an object other than the penis, into the vagina or anus (1). But there can be various other mode of raping any one. One of the most common mean is “eve teasing”, or psychological rape where the victim is psychologically raped by the perpretrator. It might not lead to any physical injuries but it might have long term psychological consequences. There are number of people who silently tolerate the exploitation or in psychiatric term they can fall in the catagory of “learned helplessness”. Attention should also be focus in this area. REERENCES 1. Jan Welch and Fiona Mason 2007, Rape and sexual assault. British Medical Journal 334; 1154-1158. Competing interests: None declared
Strategise to prevent sexual assault 6 June 2007
Saddichha Sahoo, Resident in Psychiatry Central Institute of Psychiatry, Ranchi, India-834006 Send response to journal: Re: Strategise to prevent sexual assault	Rape is one of the most reprehensible crimes committed against women today [1]. Although the medical and psychiatric sequelae have been outlined [1], suicidal attempts and loss of self –esteem, not linked to depression, are also commonly seen. This is more often seen among women in the subcontinent who are often blamed for “provoking” the rape. The consumption of alcohol renders the person vulnerable to sexual assault [2] and also fosters the belief that the woman is “easily available”, hence making rape a distinct possibility. Keeping this is mind, most women do not drink, but are often forced to, by their friends and peers who then indulge in date-rape [3]. The first and foremost task after an assault has taken place is to comfort the victim. Most often, the victims are too traumatized to remember that “evidence dissipates rapidly” and would therefore delay reporting the rape. That should, in no way, reduce the value of the victim’s complaint and prompt action should be the underlying strategy. A “Special Victims Unit” should be in place in all cities and towns linked to a national helpline that can respond when the need arises. Social workers should be the first point of contact who can effectively comfort and counsel the victim. If the individual so desires, all legal and medical help should be provided. Rather than the gender of the doctor, it is the sensitivity of the examination that matters. Evidence should be meticulously collected and documented. Arrangements should then be made for protection against both unwanted pregnancies and sexually transmitted diseases, especially HIV, which could potentially disable the victim further. Lastly, education is the need of the hour, which should extend to all fields including the police and the judiciary, who either do not pursue or acquit on frivolous grounds. Also, when one is strategizing services against sexual assault, one should not forget that men are sometimes also victims and not just assailants [4], which this article has completely ignored. 1.Welch J, Mason F. Rape and sexual assault. BMJ 2007; 334: 1154-8. doi: 10.1136/bmj.39211.403970.BE. 2.Horvath MA, Brown J. The role of drugs and alcohol in rape. Med Sci Law 2006;46:219-28. 3.Hurley M, Parker H, Wells DL. The epidemiology of drug facilitated sexual assault. J Clin Forensic Med 2006; 13:107-11. 4.Jewkes R, Garcia-Moren C, Sen P.Sexual violence. In: World report on violence and health. Geneva: World Health Organization, 2002:149-81. Competing interests: None declared
Archway, Glasgow - A first for Scotland 28 June 2007
AMBREEN BUTT, Consultant Sandyford Initiative, 2-6 Sandyford Place, Glasgow G3 &NB, Deborah Wardle Send response to journal: Re: Archway, Glasgow - A first for Scotland	We read with great interest the article regarding rape and sexual assault by Jan Welch and Fiona Mason.1 The article outlined the extent of sexual assault and the importance of provision of accessible medical and psychological support services in a safe environment in addition to forensic facilities. In 2006 the Scottish Executive approved and released funding for a three year pilot project to provide sexual assault services in collaboration with NHS, police and local authority for the geographical area of NHS Greater Glasgow. A stakeholder steering group was established that approved and oversaw the establishment of a working model of a sexual assault referral centre known as Archway. Archway provides forensic services to complainer are who self present or present via the police or other agencies within seven days of an incident. There is the option of storage of forensic samples at Archway for those initially uncertain regarding police engagement. In addition to forensic services, immediate medical care for minor injuries, emergency contraception and STI prophylaxis are available. Support services, follow up STI screening and counseling are also available through the service. Archway became operational on 16th April 2007. To date there have been 23 cases, the majority (87%) female in the age range 20 – 36 years. In contrast to many studies the majority of services users alleged assault by strangers (80%)2, this may reflect the majority of referrals having been police referrals (85%). Of the 3 cases not initially engaging with police only one has subsequently engaged. There have been no STIs diagnosed to date3. Support worker allocation is offered to all attendees to provide advocacy, support and advice during the initial twelve weeks following an assault. There has been uptake of support by six individuals. Even at such an early stage there are investigative results with four charges being made and nine enquiries continuing. A formal evaluation is being funded by the Scottish Executive allowing monitoring of service provision. An important element of this evaluation process is user involvement. Accessible data is proving to be a great motivator in feeding back to staff the early outcomes of their work. Ultimately, it is envisaged that the increasing use of supportive services like Archway, will enhance disclosure rates and minimize the long term sequelae associated with sexual violence4,5. Deborah Wardle, Ambreen Butt Lead Consultants Archway References 1. Welch J , Mason F., BMJ 2007;334;1154-1158 2. Walby S, Allen J. Domestic violence, sexual assault and stalking: findings from the British Crime Survey. London: Home Office research, Development and Statistics Directorate, 2004. 3. Gibb AM, McManus T, Forster GE. Should we offer antibiotic prophylaxis post sexual assault? Int J STD AIDS 2003;14:99-102. 4. Kilpatrick DG, Saunders BE, Amick-McMullen A, Best CL, Veronen LJ, Resnick HS. Victim and the crime factors associated with the development of crime-related post traumatic stress disorder. Behav Ther 1989;20:199- 214. 5. Resick PA, Calhoun, KS, Atkeson BH, Ellis EM. Social adjustment in sexual assault victims. J Consult Clin Psychol 1981;49:705-12. Competing interests: None declared