Introduction

Sexual abuse is experienced by 19.1% of women and 2.7% of men over the course of their lives[1]. Sexual abuse is often a feature of domestic or intimate partner abuse and has the same common feature: that of perpetrators achieving power and control over their victims. Most of the time, victims know the person perpetrating the abuse and despite this fact, sexual offences are crimes with low levels of reporting and low levels of conviction through the courts.

Recent research has identified that responding to sexual and physical abuse is a priority across the health service[2].

All ages and both genders are affected, but for the purposes of this Needs Assessment we are looking at male and female adult victims of recent or historical abuse, and teenagers (13 – 18 years) affected by, or at risk from, sexual abuse in intimate relationships. That is to say this needs assessment does not address child sexual abuse by family, carers, or professionals since this is covered elsewhere by the Nottinghamshire Safeguarding Children’s Board

Current trends include:

• a significant rise in reports of historical abuse since 2012, when a number of  high profile historical sexual abuse cases appeared in the media, and
• a growing awareness by parents and educators of the risks to young people from sexual abuse often linked to social media and digital communication

Unmet needs and gaps

Disclosure of sexual abuse is low. Just above 1 in 10 victims report to the Police. Others disclose in confidence to specialist support services long after the event. Many tell no-one about their experiences. Services do exist in Nottinghamshire for both men and women, and for teenagers from the age of 13.  These services support the current demand with managed waiting lists. The potential demand from undisclosed abuse is estimated at more than twice the current level of demand[1]. Since support services are already stretched with the current level of activity, and dependent upon short term funding arrangements to survive, there is no existing capacity to increase services if demand continues to rise.

There is an absence of carefully planned and properly resourced Direct Enquiry programmes in mainstream services. These need to be supported by specific training on sexual abuse to ensure survivors know they are safe to disclose and are supported following disclosure.  

Prevention work with young people is not routinely available in schools or youth projects. Young people at risk are not always identified and supported. (There are links here with the work on sexual exploitation which is led by the Nottinghamshire Safeguarding Children’s Board)

There is a local shortage of male specialist sexual abuse counsellors and the is a lack of specialist therapists in mainstream mental health services.

Recommendations for consideration by commissioners

In the context of limited finance, the emphasis over the next period will be on improving the provision from mainstream health and criminal justice services to encourage earlier disclosure of sexual abuse and implement appropriate support to support victims. Where possible, Nottingham City and Nottinghamshire County Council will work together to avoid duplication and develop services that meet the needs of local residents.

Recommendations are grouped under four headings:

1. Prevention to reduce levels of sexual abuse in the population.

• Promote media campaigns that challenge harmful gender stereotypes and sexualisation of young people. Use the media to encourage greater awareness of risk and publicise the benefits of support services.
• Encourage safeguarding leads in schools to identify young people at risk from sexual exploitation and harmful relationships and signpost them to services that will engage these young people in learning protective behaviour and understanding of risk
• Work with commissioners of children’s services to ensure Healthy Relationships Education is included in the “Mainstream Offer” to all schools.
• Support the research proposal for a longitudinal study of Healthy Relationships Education for young people to test whether knowledge, understanding and attitude change are sustained over several years[1].

1. Improved awareness and identification of sexual abuse by mainstream services

• Ensure criminal justice, mental health, social care and primary care service providers are aware of sexual abuse and how to respond and signpost appropriately.
• Clarify and support the implementation of routine and selective enquiry about sexual abuse in identified mainstream services to increase identification and disclosure. (Recognising that  prior training is essential for successful implementation)
• Analyse existing information from specialist services, Health and Police into a quarterly data report on sexual abuse
• Include sexual abuse as an element in the Human Resource support programmes of partner agencies. Eg The Workplace Health Scheme being developed by Nottinghamshire County Council

1. Support and access to services for survivors of recent or current sexual abuse and for survivors of historical sexual abuse

• Promote the support services in Nottinghamshire through the widespread use of the 24 Hour Freephone Domestic and Sexual Violence Helpline information cards available free to all agencies, and targeting mainstream NHS services that survivors already access.
• Work with mental health commissioners to address waiting times for access to psychological therapies and the availability of specialist counselling services. Developments to include a consistent approach to measuring outcomes for counselling services.
• Work with the Nottinghamshire Police and Crime Commissioner and NHS England to ensure that Nottinghamshire SARC is commissioned successfully with adequate staffing
• Ensure services can safely meet the needs of both male and female survivors of sexual abuse

1. Criminal Justice

• It should be recognised that effective investigation and prosecution of sexual assault and rape are key to building the confidence victims need to disclose sexual abuse.

The criminal justice agencies have a number of plans in place to improve their procedures. These should be linked with the work of other partners using the existing Safer Nottinghamshire Board and Health and Well-Being Board structures