Brain Sciences


New study highlights support gaps in sexual assault services

26 May 2020

People who experienced sexual assault might not be receiving the care and support they need to deal with subsequent mental health problems and substance misuse, finds a new study led by UCL’s Division of Psychiatry.


The systematic review published in PLOS ONE reviewed the international academic literature to see how sexual assault services respond to the mental health and substance misuse needs of their clients.

Specialist sexual assault services exist internationally and have been designed to provide holistic support that meets people’s forensic, physical and mental health needs following sexual assault. In England, these services are called sexual assault referral centres (SARCs).

The study found variation in provision of mental health care in sexual assault services with some services providing in-house support and others signposting to other services. When services reported in-house support that was often in the form of supportive counselling rather than structured psychological interventions. Likewise, the identification of mental health needs was based more often on clinical judgement rather than the use of standardised tools. The review team found no robust evidence about how best the services can identify and meet the mental health and substance misuse needs of their clients.

The study’s first author Theodora Stefanidou said: “Our study found that there is indeed great variability in mental health and substance misuse provision. For example, in England some SARCs provide in-house emotional support whereas other SARCs don’t and only signpost or refer people to relevant mental health services.”

“This variation in provision creates an element of “post-code lottery” when it comes to mental health and substance misuse support.” she said.

She explained that people who seek the support of SARCs are particularly vulnerable to mental health problems and substance misuse.

“Sexual violence has a long-term impact on people’s mental health, including increased risk of suicide, development of post-traumatic stress disorder (PTSD), hazardous drug and alcohol use and other long-term mental health problems.”

The study ultimately emphasises the lack of clear pathways from SARCs into mental health care and substance misuse services. It highlights an urgent need for clearer guidance from policy makers about how SARCs should identify and meet clients’ mental health needs.

MiMOS Study UCL Lead, Dr Bryn Lloyd-Evans, said: People who have experienced sexual assault and go to a SARC deserve the best possible response to their mental health and substance misuse needs. But current evidence cannot tell us what that should look like. The variation in practice and the lack of clarity in policy guidance for SARCs which our review found reflect this uncertainty.

We need more research. First, we need to ask people who have used SARCs about their priorities and preferences for care. Second, we need to define and evaluate different models of addressing mental health and substance misuse needs in SARCs. The MiMoS study, which our review was the first stage of, will be a great step forward with this.”

The systematic review was conducted as part of the MiMoS Study - an NIHR funded study investigating the effectiveness of SARCs with regard to mental health and substance misuse, led by Professor Liz Hughes from University of Leeds. The systematic review was led by researchers in the UCL Division of Psychiatry and in collaboration with University of Leeds, King’s College London, University of Sheffield and University of Huddersfield.