Then an officer came in to say that they were trying to find a woman doctor to examine me. He had assumed that I would prefer a woman. I didn’t tell him that I really didn’t care; I thought his sensitivity was too nice to throw away. And when I finally had the medical examination later that day, I was pleased I hadn’t said anything. The examination was far more extensive than I would ever have imagined; I could not have coped if the doctor had been male. (Leefman, 2005, p. 31).
I was beginning to understand that this thing – rape – was far more taxing, far more demanding, than I had ever imagined. I thought I was strong enough to overcome its effects. I thought I could keep living the way I’d always lived…… At first I had refused to allow the attack to change my life, but now I realised that it was a greater force than I’d reckoned with. (Leefman, 2005, p.53)
Ideally need two staff to work with family:
Immediately she was in tears. I put my arms around her to comfort her, knowing that I didn’t have the strength for this. Fortunately she had a good neighbour who came in to take care of her. My trauma was different from hers, and each of us needed support. (Leefman, 2005, p. 49).
NZ – Jordan (1998) – Identified four themes of what women need to be satisfied with police performance in their experiences in reporting process:
- To be believed
- To be treated with respect and understanding
- To be allowed to retain some degree of control over proceedings; and
- To be provided with adequate information. (p.70)
These themes form the basis of much of the advocacy work crisis support workers do in police and medical processes.
USA – Campbell (1998) – Contact with medical and legal systems can lead to higher levels of post-traumatic stress following rape. This effect can be ameliorated with mental health support.
USA – Campbell (2006). Rape advocates assist victims/survivors to get a better deal in medical and legal systems and to feel less distressed by them.
USA- Wasco et al (2004) State wide evaluation of Illinois sexual assault advocacy services (what we would consider call-outs to police interviews, medical exams and court support). Of those who participated in the evaluation, 87.2 % reported that they got somewhat or a lot more information, 96.5% some or a lot of support, and 84.7% reported somewhat or a lot of help in making decisions.
UK- Lovett, Regan & Kelly (2004) – 93% of survivor/respondents were satisfied with crisis worker role at medical examinations. This was the highest score for any of the services provided by the Sexual Assault Referral Centre. Both survivors and police supported the role of the support worker at the police interview. Survivors said that she helped them to feel safe and relaxed, and police commented that it assisted the survivor to stay the distance through a difficult process, and it allowed them to concentrate on their own role. Statistics also showed a relationship between the crisis support worker being involved and survivors withdrawing from the legal process – of those who did not have a crisis support worker, 53% withdrew, of those who did, only 20% withdrew.
Petrak (2002) identifies a number of factors indicating need for assessment in the acute post-rape period:
- a history of suicidal behaviour is associated with the presence of suicidal ideation post-rape. (Petrak & Campbell, 1999, cited in Petrak).
- a prior history of sexual assault leads to more severe signs of traumatisation post-rape (Ruch, Amedeo, Leon, & Gartrell, 1991, cited in Petrak).
- Alcohol and drug abuse relates to increased PTSD symptomatology (Ruch & Leon, 1983, cited in Petrak).
- Stressful life events in previous 12 months may increase post-rape symptomology, though this hasn’t been confirmed by all studies – (Ruch & Leon, cited in Petrak).
Zoellner, Foa, & Brigidi (1999, cited in Petrak) Found that positive social support might offset the development of PTSD following rape.