Management of people who have been raped
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7387.458 (Published 01 March 2003) Cite this as: BMJ 2003;326:458All rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests