Nurses and other healthcare professionals work in a range of places associated with the justice system, including prisons, police custody, secure mental health units and forensic examination settings. I have worked in the field of Justice Nursing for the past 15 years and my current role is as the Nurse Lead for the Sexual Assault Response Coordination Service (SARCS) Network in Scotland. This service was established on the recommendation of a Rape Task Force that the Chief Medical Officer had led for the Scottish Government in 2022-23.
In collaboration with the Right Decision Service in Scotland, which is generating evidence-based tools to support decision-making in health and social care, SARCS has developed A Guidance Document on Disclosure of Rape and Sexual Assault.
This new era of openness is such a welcome change, even if long overdue. I remember as a staff nurse in the 1990s being cautioned that a disclosure of rape or sexual assault could not be entertained, as conveyed in the phrase of the time, ‘you don’t want to open that can of worms’, or by classical references to Pandora. But, like Pandora, that approach is a myth. People have every need, right and expectation that they can disclose to a health care professional that they have been raped or sexually assaulted and that they will receive kindness, support, safety and speedy access to the services that they need.
In SARCS, there is a lived-experience advocate who says that being able to help even one person who has experienced sexual violence, especially when the enormity of the justice system feels overwhelming, can go a very long way. Survivors of rape often need immediate support and protection. A person could be seeking emergency contraception, painkillers or symptomatic relief while in a deeply traumatised and dissociated state. During this period of acute distress, the initial recovery can be catalysed and that is why we must respond with skill and trauma awareness.
The trauma-informed justice programme in Scotland recognises the importance of all staff across all organisations understanding the effect of trauma on witnesses. Those who have experienced complex sexual trauma want to be treated by kind, experienced, compassionate professionals: by people who listen and make them feel safe, but who also can deliver on promises which are made with integrity and skill.
Recognition of the vital part that all health care professionals play in this process lies at the heart of the SARCS Right Decisions guidance. This resource is openly available online – to read or to print out – and every one of us can download the app to our phones. A clear pathway is set out to guide the steps to take, various scenarios are provided to illustrate these steps, and there is a helpful final checklist. By becoming familiar with this guidance, we all can inform ourselves about ‘what would I do if a person disclosed a sexual assault to me?’. We can rehearse our response and, importantly, we each should find out where the nearest SARC centre is located.
For some of us, this might be triggering, raising memories of our own fears and experiences. But altruism, empathy and professionalism can mitigate this. From lived experience, my colleague says: “For survivors taking the first steps to disclosing what has happened to them, the Right Decisions Pathway highlights the ever-important autonomy in decision-making by offering a range of options in a trauma-informed way.”
Our communities are safer every time we empower ourselves to respond to our own powerlessness in the face of the suffering of others. Every innovation, every positive use of technology brings us all into the cohesive, psychologically safe place we can be, even when faced with our own personal or professional vulnerability.
The principle of being ‘disclosure prepared’ is a good one. Overall, preparation ensures that nurses and others can provide compassionate, holistic and effective care, which significantly impacts on the recovery journey. Our ability to respond and be present in this crisis, perhaps at the worst hour of someone’s life, restores faith and balance. Our documentation of what we are told in the process of disclosure can provide evidence that will help to bring justice, and our quick response can provide safety and reassurance to a person who has been subjected to rape or sexual assault.
This is my mission as a nurse who works every day with the justice system, but all of you can also play a part.
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