The identification and treatment of mental health and substance misuse problems in sexual assault services: a systematic review

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Stefanidou, T, Hughes, E, Kester, K, Edmondson, A ORCID: https://orcid.org/0000-0002-0224-1997, Majeed-Ariss, R, Smith, C, Ariss, S, Brooker, C, Gilchrist, G, Kendal, S, Lucock, M, Maxted, F, Perot, C, Shallcross, R, Trevillion, K and Lloyd-Evans, B, 2020. The identification and treatment of mental health and substance misuse problems in sexual assault services: a systematic review. PLoS ONE, 15 (4): e0231260. ISSN 1932-6203

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Official URL: https://doi.org/10.1371/journal.pone.0231260

Abstract

Background: Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders’ views and policy recommendations about optimal SARC practice.

Methods: A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted.

Results: We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services.

Conclusions: This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required.

Item Type:	Journal article
Publication Title:	PLoS ONE
Creators:	Stefanidou, T., Hughes, E., Kester, K., Edmondson, A., Majeed-Ariss, R., Smith, C., Ariss, S., Brooker, C., Gilchrist, G., Kendal, S., Lucock, M., Maxted, F., Perot, C., Shallcross, R., Trevillion, K. and Lloyd-Evans, B.
Publisher:	Public Library of Science
Date:	10 April 2020
Volume:	15
Number:	4
ISSN:	1932-6203
Identifiers:	Number Type 10.1371/journal.pone.0231260 DOI 1322219 Other
Rights:	© 2020 Stefanidou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Divisions:	Schools > School of Social Sciences
Record created by:	Linda Sullivan
Date Added:	09 Jun 2020 14:39
Last Modified:	22 Jun 2020 13:01
URI:	https://irep.ntu.ac.uk/id/eprint/39949