Ep 110 – Sexual violence (part 2)

Disclosing sexual violence is a difficult and emotional prospect for a patient and the way a GP responds can set the course of that person’s journey. It is important we get it right, but it is a complex topic. In this second part of our series on sexual violence, Dr James Waldron is joined again by Hayley Wilson (Consent and Sexual Violence Development Officer at Nottingham Trent University) to explore the consultation in detail. This episode discusses how to respond to a disclosure and the importance of “listen, believe, validate” when supporting a patient. They outline the concept (and myth) of the “perfect victim”, the importance of the language we use and how to help guide someone who has made a disclosure.

Key take-home points

• When dealing with patient disclosures of sexual violence, remember three key steps: listen, believe and validate.
• There is no “perfect victim”: they may not look like people you might expect to have been abused. People who do not fit the expected narrative may not receive appropriate support from their GP or healthcare professional.
• Challenge your preconceived ideas of who a sexual violence victim/survivor might be: it could be anyone.
• People giving a disclosure may have gone through a lot before they make a disclosure.
• Always keep in mind the “impact” on the person. That is what you are there to consider.
• Survivors may not be aware they are subjected to sexual violence – you may need to pick up on clues or hints and support people through it.
• Give people space to “open up” and talk about it.
• Listening is key: practice it and learn how to do it better.
• The language used, particularly at first disclosure, is important.
• Avoid the word “why”. You are not there to be the judge or prosecute a crime; you are there to listen and believe.
• Avoid the “righting” mechanism; sometimes people simply want to be heard.
• Avoid focusing on only mental health; support for those affected by sexual violence is more specific and may be better referred to a sexual violence support service.
• As healthcare professionals, we can refer patients to specialised services that aim to support victims/survivors emotionally and practically, and if requested by the individual, these services can also assist in the criminal justice process. These services employ Independent Sexual Violence Advocates (ISVAs), who complete a national qualification as part of their training.
• An additional service we can refer patients to is the Sexual Assault Referral Clinic (SARC). This excels at providing advice to victims/survivors and forensic medical examinations within a 7-day period. It is advised that patients seek their services sooner rather than later.
• Both ISVA and SARC services can be utilised as good sources of advice for GPs and healthcare professionals.
• When responding to a disclosure make sure you listen and outline what options may be available to the person. They may just want to be heard and not take it any further.
• We can help by giving some autonomy and power back to the person.
• The key to “healing” is different for each person: some will not want to talk about it ever again, and others might want personal or group therapy.
• Take away call to action:
  • Practice not trying to solve problems and instead listen and validate.
  • Research which services are available in your local area.

Useful links

1. Rape Crisis England & Wales. https://rapecrisis.org.uk/.
2. Rape Crisis England & Wales. ISVAs and advocates. https://rapecrisis.org.uk/get-help/support-and-services/advocacy-isvas.
3. The Topaz Centre. https://www.topazcentre.org.
4. The Survivors Trust. Sexual Assault Referral Centres (SARC). https://thesurvivorstrust.org/sarc.
5. Survivors UK. https://www.survivorsuk.org.
6. Galop. https://galop.org.uk.