Around 1 in 5 women will experience sexual assault at some point in their life. The results can be devastating for victims and survivors. They not only have to deal with the psychological trauma of the assault, but often suffer physical harm and social consequences, including financial ones, as a result. The impact of these results can be felt long after the original assault. Injury, unwanted pregnancy, sexually transmitted infections, and the breakdown of relationships are just some of the long term impacts of sexual violence that persist well beyond the immediate aftermath of sexual assaults. In this blog Laura Watt, David Gadd, Maria Pampaka, Filippo Varese and Rabiya Majeed-Ariss explain their findings from a research project that investigated the long term needs of sexual assault survivors and make recommendations for policy makers.

• The needs of sexual assault survivors are varied and complex. Local Authorities must invest in coordinating the efforts of the various actors involved in meeting those needs. These include health and social care services, the criminal justice system and the Voluntary, Community and Social Enterprise (VCSE) sector. We are delighted to see such an approach adopted in the Greater Manchester Gender Based Violence Strategy.
• Psychological and social support must be provided for survivors before, during, and after the court process, meaning this support could extend for several years.
• Services offering support to survivors must anticipate the ongoing threat of further victimisation client groups face and have strategies in place to maintain contact with those at risk.
• Further research into the long term impact of sexual abuse on victims’ health, wellbeing, and everyday lives must be funded. As our study has shown, conducting research in a sensitive, confidential manner that, respects and protects participants, can only be achieved through sustained collaborations between researchers and those providing frontline services for survivors.

In the UK around 50 Sexual Assault Referral Centres (SARCs) provide support for survivors of sexual violence. Largely operated by the NHS, they offer medical, psychological and legal assistance for victims. While centres like these can be excellent at meeting the immediate needs of assault victims, how well equipped they are to deal with the long-term needs of survivors is less known, and are not well recognised in government policy or well documented in recent research.

Between 2019 and 2022, with funding from the Violence and Mental Health Network, we created and piloted a questionnaire designed to learn more about what sexual assault survivors need in the longer-term so that services can be better equipped to deal with them. The self-report questionnaire is accessed online and is designed to be completed at multiple time points – three, six and twelve month intervals following an assault – so that changing needs can be tracked. It asks respondents about the affects they suffer from the assault, what types of support would be helpful to them. It also measures their mental health using widely accepted measures of anxiety, depression and Post Traumatic Stress Disorder (PTSD).

Despite a small sample of 18 respondents, constrained to some degree by the impact of the pandemic, initial results confirm the need for further research and interventions that address sexual assault survivors’ longer term needs. Three months after the assault:

• 13 of the 18 respondents suffered from moderate or severe anxiety, 7 of which suffered from severe anxiety
• 15 suffered from moderate or severe depression
• 7 had both severe anxiety and depression
• 12 had Complex Post Traumatic Stress Disorder (CPTSD), all of whom also had both moderate or severe anxiety and depression

Based on these results, it is unsurprising that, when survivors were asked what support would be ‘essential’ to them, they rated ‘emotional and psychological support’ the highest. Over two thirds said psychological support through counselling was essential and wanted emotional support specifically during the court process. Support in the legal process features routinely in the long-term needs of sexual abuse survivors because court hearings typically take several years.

Another key long-term need is support in stopping further abuse. Half of the sample had been sexually assaulted more than once, and just over a fifth had suffered attacks at least ten times. It is no surprise then that, when asked about the specific effects of the assault, 78 per cent cited frequent fear of being assaulted again. Other commonly cited consequences were ‘anger’ (67 per cent), ‘difficulties with sexual intimacy’ (56 per cent), ‘avoiding travelling alone’ (50 per cent), ‘problems with physical health’ (44 per cent) and ‘avoiding family and friends’ (44 per cent).

The vast majority – 85 percent of the sample – who had accessed support from the Sexual Assault Referral Centre said they were ‘very satisfied’ with the service they received. Assessments of other sources of organisational support were more mixed. Nevertheless, the question remains whether SARCs are well equipped to deal with the ongoing issues that survivors of sexual assault have to contend with, in particular complex psychological ones. There can be no quick fix for victims of sexual abuse who need ongoing support to redress emotional needs that are amplified both by legal processes that rarely secure convictions and by the ongoing threat of repeat victimisation.

While our study gives some insight into the type of long-term support sexual abuse victims need, it also shows just how difficult it is to gather survey data about these needs. The questionnaire we designed is a powerful tool that service providers are welcome to use to assess whether the needs of those they serve are being met. However, recruiting representative samples of sexual assault survivors – a population which is both vulnerable and largely hidden – is incredibly difficult. Considerable care needs to be taken to maximise inclusivity among prospective participants who are often unable to decide whether to engage with research in the aftermath of trauma. Service providers and researchers must work together to overcome these difficulties so that long-term needs can be tracked, and the appropriate support given to those who need it.

We make the following policy recommendations:

• The needs of sexual assault survivors are varied and complex. Local Authorities must invest in coordinating the efforts of the various actors involved in meeting those needs. These include health and social care services, the criminal justice system and the Voluntary, Community and Social Enterprise (VCSE) sector. We are delighted to see such an approach adopted in the Greater Manchester Gender Based Violence Strategy.
• Psychological and social support must be provided for survivors before, during, and after the court process, meaning this support could extend for several years.
• Services offering support to survivors must anticipate the ongoing threat of further victimisation client groups face and have strategies in place to maintain contact with those at risk.
• Further research into the long term impact of sexual abuse on victims’ health, wellbeing, and everyday lives must be funded. As our study has shown, conducting research in a sensitive, confidential manner that, respects and protects participants, can only be achieved through sustained collaborations between researchers and those providing frontline services for survivors.

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