Journal of Forensic and Legal Medicine (original) (raw)
Related papers
Sexual violence and mental health services: a call to action
Epidemiology and Psychiatric Sciences, 2019
People who experience sexual violence are highly likely to experience psychological and/or mental health (MH) problems as a result. People who use MH services often have a history of sexual assault and are also likely to be revictimised as an adult. Yet despite there being a very clear association, MH services are not yet performing routine enquiry, and even if they do, are not confident about how to record and manage disclosures. There is some emerging evidence that people with MH problems are exposed to sexual violence in inpatient MH settings, perpetrated by both other patients or members of staff. In this editorial, we explore the evidence to support a wider focus on sexual violence as a part of routine care, as well as some recommendations about how staff can more effectively discuss sexual issues including that of sexual victimisation.
The Role of Psychiatry in the Management of Sexual Assault: A Case Series
Cureus, 2021
Victims of childhood sexual abuse are at an increased risk for a multitude of mental health conditions. While many children exhibit concerning behavioral changes following abuse, there is often a delay in identification and implementation of psychiatric services, resulting in worsening mental and physical health outcomes for victims. This case series aims to demonstrate the importance of multidisciplinary victim-centered and trauma-focused treatment including proactive psychiatric care. The review presents three cases of child victims of sexual abuse who received psychiatric care after their initial presentation to the Puerto Rico Health Justice Center (PRHJC). As evidenced by the following cases and extant literature, child victims of sexual abuse have an increased risk of severe mental health disorders. This indicates the importance of recognizing and understanding behavioral warning signs of childhood sexual abuse and the importance of psychiatric care as early as possible following disclosure. Categories: Psychiatry Keywords: child sexual abuse, multidisciplinary decision-making, mental health services, child abuse and neglect, access to healthcare, • access to healthcare and health outcomes of vulnerable populations, child and adolescent psychiatry, clinical forensic medicine, psychiatry and mental health
Forensic psychiatric evaluation of sexual crime cases
Medical Science and Discovery , 2015
Objective: Sexual crimes are one of the most offensive crimes committed against individuals. Given that individuals from every age and both genders are affected from this action. In the USA, 20% of women and 5-10% of men exposes to sexual violence. It appears as a serious problem that threatens society and preventive measures have to be taken against it. It is an undeniable fact that; mental health seriously affected by sexual assaulted or abuse. In this study, we aimed to evaluate forensic psychiatric examination reports of the cases that are sending to examine whether or not any permanent psychiatric impairment after sexual assault or abuse. Methods: Findings from examination of cases which are sent to Department of Forensic Medicine, Medical Faculty of Celal Bayar University between October 2012 and February 2014 for determining permanent psychiatric impairment were evaluated. Results: Number of examined cases was 55 and number of diagnosed cases was 33. The age range of cases were from 7 to 77 years (SD=20.39±13.17). Of the cases; 57.6% (n=19) were younger than 18, 87.9% (n=29) were women, 63.7% (n=21) were simple sexual assaulted or abused, in the 72.8% offender was known by cases, in the 30.3% (n=10) crime happened at the home of offender or case. As a result of forensic psychiatric evaluation, in the %30.3 of cases (n=10) were detected permanent psychiatric impairment. Conclusion: Examination of cases has to be performed scrupulously because, permanent psychiatric impairment by sexual crimes, not only negatively affect case his/her social environment but also it is a country's laws punishment-enhancing factor.
Sexual Abuse – Current Medico-legal, Forensic and Psychiatric Aspects
Legal and Forensic Medicine, 2013
Violence against women and minors is a worldwide problem that has not yet been sufficiently acknowledged. There are many obstacles especially when sexual abuses have to be evaluated. These problems are present both when victims of sexual abuse are evaluated and when sex offenders are dealt with, especially when the offenders are juvenile sex offenders (JSO). These issues give cause for great concern about prognosis, and the resulting psychosocial implications, and call for a special effort from the scientific community in identifying appropriate prevention and treatment methods. This chapter is divided into two parts. The first part deals with the forensic and psychiatric features, such as diagnostic and therapeutic/rehabilitative strategies for JSO, while the second part analyzes the legal-medicine aspects related to rape/sexual assault in a European context.
Prevalence of mental health problems and deliberate self-harm in complainants of sexual violence
Journal of Forensic and Legal Medicine, 2007
The Haven Whitechapel, a sexual assault referral centre, provides a forensic service and after care to victims of serious sexual violence across North East London. Survivors of sexual assault display psychological sequelae including elevated rates of suicide ideation/attempts. Prevalence of mental health problems of 121 forensic cases seen between June and August 2004 was established. Of female clients aged over 13 years 8% had learning difficulties, 21% gave a past history of deliberate self-harm (DSH) and 20% psychiatric history. We formally assessed levels of safety and vulnerability prior to clients leaving the Haven. When mental health problems were identified additional screening questions were asked, followed by a flow chart outlining appropriate care pathways. Such practice was carried out over 6 months (September 2004 to February 2005). Of the 240 clients, 8% reported learning difficulties, 26% DSH and 21% psychiatric history. 4% of clients required urgent follow-up and 3% immediate referral to a psychiatric liaison team. There is a high background prevalence of mental health problems and DSH in our study population. Vulnerable people are at increased risk following sexual violence. Risk needs to be recognised and addressed. These findings have implications for the expansion of the SARC network.
BMC Public Health, 2018
Background: Research supports the association between adult sexual violence (SV) and poor mental health. However, most studies focus on rape and physical sexual assault. Little is known about how more subtle forms of SV affect women's well-being. Furthermore, evidence for the impact of the perpetrator's identity is mixed. There is also little data from clinical populations to help health practitioners identify SV. This paper addresses these gaps by exploring the associations between different types of adult SV, perpetrator identity, and women's mental health in the Australian primary care setting. Methods: We conducted a descriptive, cross-sectional study in general practice clinics. Adult women completed an anonymous survey while waiting for the doctor. Measures included PHQ-9 (depression), GAD-7 (anxiety) and PCL-C (post-traumatic stress disorder). SV was measured using items from the National Intimate Partner and Sexual Violence Survey and categorised into three groups (rape/sexual assault; coercive behaviours and/or reproductive control; and unwanted sexual contact). Results: We found significant associations between rape/sexual assault and poor mental health, and between coercion and/or reproductive control and higher PTSD and anxiety scores, compared to women with no SV experiences. SV perpetrated by an intimate partner was associated with significantly higher mean PTSD scores than SV perpetrated by a stranger, and significantly higher depression scores than SV perpetrated by another known person. Conclusion: Findings suggest that associations between SV and mental health are mediated by type of SV and perpetrator identity. Health practitioners should enquire about different types of SV beyond stranger rape as a cause of poor mental health, and about perpetrator identity to inform them about the likelihood of ongoing symptoms.
Sexual assaults in therapeutic relationships: prevalence, risk factors and consequences
ABSTRACT A law has been passed in Germany (paragraph 174c StGB), which prohibits therapists from having sexual contact with their patients. This provides the background for a follow-up survey to the previous study completed by Becker- Fischer and Fischer in 1995. The results of this survey are discussed here on the basis of the current status of research concerning preva- lence and risk factors of sexual assaults in therapeutic relationships. The focus of the re- search lies in determining the specific condi- tions of sexual assaults in psychotherapy and psychiatry, risk variables of the therapists and patients, the effects it has on the patients as well as the legal consequences it results in. To en- sure the comparability of the data, an online version of the Questionnaire about Sexual Con- tacts in Psychotherapy and Psychiatry (SKPP; Becker-Fischer, Fischer & Jerouschek) was cre- ated and a survey of N = 77 affected patients was conducted. The majority of the participants in the study reported a serious decline in their overall well being following the incident. How- ever only very few undertook legal steps - only in three cases did it come to a legal procedure. The assumption that sexual contacts in psy- chotherapy result in extremely damaging con- sequences to patients, was affirmed. Despite the changed legal situation, therapists in Ger- many are still not held legally responsible more often than they were 10 years ago. Based on these results a more intensive education of the patients concerning their legal rights is recom- mended.
Caring for victims of sexual abuse
International Journal of Gynecology & Obstetrics, 2005
Recognizing sexual abuse to be universal, in stable as well as disordered societies and directed predominantly but not only against younger women, this article first considers legal definitions of sexual abuse and the forensic evidence health care providers may be expected to gather. It explores the impact on victims of historic definitions of rape, and legal reforms to dispense with proof of sexual penetration. The WHO 2003 guidelines for medico-legal care for victims of sexual violence are noted, which emphasize the need for physical and psychological care of victims. The guidelines show that goals of treating victims and retaining forensic evidence can create a clinical dilemma. Ethical issues concern management of this dilemma, probing whether patients' psychological disturbance may have roots in past sexual abuse, and the conduct of appropriate research. It concludes that much sexual abuse is symptomatic of women's sexual subordination and disregard of their human rights.