Disclosure of Rape or Sexual Assault – Guidance Document for Health Care Professionals
Responding to the initial disclosure – all scenarios (for children under 16 you must follow Child Protection Protocols)
- Respond to disclosure in a trauma informed, person centred way, as this is a key step for recovery. Reassure the person that telling you is the right thing to do.
- Never "interrogate" the person about the incident. If they seem distressed they may not wish to provide specific detail about the incident and you should not stray into the role of investigator.
- Be alert to the impact on the person of disclosing, perhaps for the first time, whether the events are recent or not. See also Public Health Scotland guidance
- Always consider vulnerability and whether the person is an adult who is unable to safeguard their own wellbeing, property, rights or other interests; is at risk of harm or is more vulnerable to being harmed because they are affected by disability, mental disorder, illness or physical or mental infirmity. If so, follow adult support and protection procedures.
- Discuss safety concerns for the person and any children in the household especially if the perpetrator is known to them. If you know/suspect a child is at risk, follow appropriate child protection procedures.
- Treat any immediate physical or medical conditions requiring attention or make necessary arrangements for this. Do not undertake any clinically unnecessary pelvic examination.
- Forensic samples should only be taken by a trained Sexual Offence Examiner (SOE) at a Sexual Assault Response Coordination Service (SARCS). With consent, the SOE will carry out a Forensic Medical Examination (FME) which may be able to collect evidence (such as bodily fluids or hair) that could help the police to confirm the identity of the person who carried out the assault.
- Explain the options available to the person (police report at any time or self-referral 7 days or less since the assault). Self-referral is available for people aged 16 and over, subject to professional judgement.
- If available, provide the leaflet "Turn to SARCS: Information about the NHS Sexual Assault Response Coordination Service (SARCS)" which will explain the options in more detail, including what a FME involves and how to access other support services. If the leaflet is unavailable, or if the person does not want to take away a physical copy, sign post to Turn to SARCS
- If the assault may have been 'drug assisted' it is important that the FME is arranged as soon as possible, as traces of the drugs can leave the system very quickly, along with other forensic evidence.
- There is a SARCS in every health board area, normally located within or near to a hospital. People would normally attend the SARCS closest to them.
- In all scenarios, patients should be signposted to Rape Crisis Scotland and any locally available support services – see detailed list below.
7 days or less since the assault: Self–referral to a SARCS
Self-referral to a SARCS allows people to access a FME to collect any potential evidence, at a time when they do not feel ready to report to the police or are unsure about doing so.
SARCS staff will address any immediate health care needs including STI and BBV testing and provision of emergency contraception (if appropriate) and will coordinate referrals to onward care and support.
If the person wishes to self-refer, provide the 24/7 telephone number for NHS 24 (0800 148 8888). Encourage the person to look at Turn to SARCS before calling to find out more about the options available to them. If they wish to self-refer, encourage them to call as soon as possible to maximise the preservation of evidence. In exceptional circumstances, it may be more person centred for you to refer them to the SARCS in your health board area directly. You should familiarise yourself with their contact details (noting that staff may only be available to answer calls in hours). Out of hours, the person will need to contact NHS 24 who will liaise with the OoH team to arrange the necessary care. A FME should normally commence within 3 hours of the person making contact with the service to request an examination (National Healthcare Improvement Scotland Quality Indicators).
In the meantime, the person should be advised to try to avoid washing and not to discard any items of clothing worn at the time of the assault. If the assault involved the person's oral cavity, where possible they should try to avoid eating and drinking, smoking, chewing gum, brushing their teeth or taking non-essential medication.
If the person needs to urinate while waiting to be examined, you should advise that they should keep all used toilet tissue/sanitary products in a clean paper or plastic bag.
7 days or less since the assault: Police report
If a person wishes to report the assault to the police, a FME will be arranged through Police Scotland.
If the person wishes to report the assault, they should contact Police Scotland on 101. A Sexual Offences Liaison Officer (SOLO) would normally arrange the appointment at a SARCS to access a FME. SARCS staff will also address any immediate healthcare needs and coordinate referrals to onward care and support.
Provide the same advice regarding retention of potential evidence as you would for self-referral.
7 days or less since the assault: No self-referral to a SARCS or Police report
If the person does not wish to self-refer to a SARCS for a FME or report to the police, you should offer to:
Evaluate the risk of pregnancy either to prescribe emergency contraception or to ensure appropriate management. Assess the wish or need for referral for further assessment and screening, particularly for sexually transmitted infections and blood borne viruses, including consideration of HIV prophylaxis (within 72 hours of assault) and Hep B vaccination.
Refer to other services relevant to the persons needs such as mental health or substance use. If unable to provide immediate healthcare directly, encourage the person to attend their GP or local sexual health clinic as soon as possible.
Let the person know it is still possible to call the NHS 24 self-referral number (0800 148 8888) and arrange to speak to someone in a SARCS if it's within seven days of the assault taking place. Encourage the person to contact the Rape Crisis Scotland advocacy service who can provide advice on what reporting to the police would involve and can support them through the process if they wish to go ahead.
7 days or more since the assault
If an individual discloses the assault more than 7 days after it took place, a FME is not usually required/appropriate.
Assessment for STI, BBV and pregnancy may still be necessary. Provide, or refer to GP or sexual health as appropriate.
Encourage the person to contact the Rape Crisis Scotland advocacy service who can provide advice on what reporting to the police would involve and can support them through the process if they wish to go ahead.
Consider the wish for referral to other services relevant to the person's needs such as mental health or substance use.
Support and information
(If it is unsafe for the person to take information away, advise them to search online for support organisations relevant to their needs when it is safe to do so. The person should also be advised that a copy of the 'Turn to SARCS' leaflet can be accessed at NHS Inform).
Website: NHS inform
Rape Crisis Scotland Helpline
(5pm – midnight, every night)
Call: 08088 010302
Text: 07537 410 027
Website: Rape Crisis Scotland
In an emergency dial 999
Non emergencies dial 101
Website: Police Scotland
Victim Support Scotland
0800 160 1985 (Mon to Fri 8am to 8pm)
Website: Victim Support Scotland
0800 83 85 87 (Mon – Thur 6pm to 2am and Fri 6pm to Mon 6am
Website: Breathing Space
Scotland's Domestic Abuse and Forced Marriage Helpline
0800 027 1234 (24 hours a day, 7 days a week)
Website: Childline (24 hours a day, 7 days a week)
Information about other support services and organisations can be found at NHS inform: turn to SARCS
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