Sexual Assault Services and Sexual Assault Services and the Public Health Model: An the Public Health Model: An Australian ExperienceAustralian Experience

Patricia Leahy, PhDPatricia Leahy, PhD

OutlineOutline

Public Health ApproachPublic Health Approach Sexual Assault Services in AustraliaSexual Assault Services in Australia The Canberra Rape Crisis CentreThe Canberra Rape Crisis Centre Challenges in AustraliaChallenges in Australia Reflective Questions for Best Practice in Reflective Questions for Best Practice in

Hong KongHong Kong

Public HealthPublic Health

Multi-disciplinary, evidence-based, holistic model Sexual violence not just a simplistic two dimensional

model (SW, and legal) but a “whole-of-government” model

– Education

– Health

– Social Welfare

– Public Policy

– Justice

Sexual Violence as a Mainstream Issue

Sexual Assault Sexual Assault Services in Services in Australia Australia (Weeks 2001)(Weeks 2001)

NTNT

5 5 (181,900)(181,900)

QueenslandQueensland

28 (3.3m)28 (3.3m)

NSWNSW

57 (6.2m)57 (6.2m)

SASA

15 (1.4m)15 (1.4m)

VICVIC

15 (4.5m)15 (4.5m)

WAWA

9 (1.7m)9 (1.7m)

Australian Australian Capital Capital TerritoryTerritory

CanberraCanberra

1 (308,000)1 (308,000)

TasTas

3 3 (459,000(459,000))

120 (15m)120 (15m)

National Association of Services National Association of Services Against Sexual Violence (NASASV)Against Sexual Violence (NASASV)

Peak Body (National level lobby group): 1997 (Resourced, on a project basis by the Office of the Status of Women) Assist Governments in policy development (prevention and service

provision) Co-ordinate sharing of information, skills and resources Promote and monitor best practice (1998 national Standards of Practice

Manual) Undertake research Promote equity of access Promote community awareness Promote understanding of sexual violence against women in the

context of gender and power relations

Canberra Rape Crisis Centre (ACT)Canberra Rape Crisis Centre (ACT)

Grew out of the Women’s Movement in the 70’s 1976 opened 1980+ government funded 1989 funding for after-hours service 1994 funding for community education programme 1998 funding to auspice men’s service (SAMSSA) 2001 funding for Aboriginal Support and Education

Programme

Feminist Human Rights ModelFeminist Human Rights Model

Support and Advocacy– Community based counselling, Crisis support and advocacy– Refer and work with medical, legal, and other community resources

Political Role of Social transformation– Promote legislative and criminal justice procedure changes– Community and government education– Promote a feminist analysis of the political nature of sexual violence

Collective governance– power sharing and accountability

Community Based Counselling

Housed in a residential Specific workers for adult women (2), young women (1), and children (1).

Group support Drop in Ongoing group for ritual abuse survivors School based groups for young women

Advocacy Court support, Victim Impact Statements,

referrals/applications for social welfare support

Evidence-based Servicing

Collaborative Research Service effectiveness Identifying needs

– women with disabilities,

– lesbian and bisexual women,

– women from non-English speaking backgrounds

– Indigenous women

Community Education Some examples

Department of Defence Police Dept of Foreign Affairs Dept. of Education Family Services (SWD) Paramedics Hospital staff Paramedics Schools (students and teachers)

Publications

Political and Social CRRC membership:

ACT Sexual Assault Advisory Committee ACT Council of Social Services (VP) NASASV 2 members (Chair)

Examples of CRCC contributions: Legal protection of counsellors’ notes Sexual Assault law reform Criminal Injuries Compensation Scheme Protocols with police, Family services (SWD), Mental

Health Crisis Team, DV services,

Collective Governance Management Collective

Working groups– Child Services– Adult Services– Young Women services– Community Ed.– Access and Equity – Aboriginal Support and Education (Nguru)– Collective processes– Finance and Funding– Employment Working Group

Challenges in AustraliaChallenges in Australia Society attitudes National vs State laws, and policies Resources Political will Lack of co-ordination between service providers Medicalised model (health not public health) Insufficient training of front line health workers Access and equity (90% of victims do not use

crisis, professional, legal or financial services)

Summary

Feminist model as it operates in CRCC mirrors the public health approach: Operates effectively across sectors, Holistic, Evidence based servicing

What PH can possibly provide: Mainstreaming Access to resources

Sexual Violence in a Hong Kong Community Sample Sexual Violence in a Hong Kong Community Sample N = 508 (Leahy, Pang, Tang & Cheung)N = 508 (Leahy, Pang, Tang & Cheung)

0

2

4

6

8

10

12

14

16

18

20

ChildSA AdultSA REVIC

Male

Female

*

*

Sexual Violence in a Hong Kong University Sample Sexual Violence in a Hong Kong University Sample N = 667 (Leahy, Fung, Tang & Cheung)N = 667 (Leahy, Fung, Tang & Cheung)

0

5

10

15

20

25

30

ChildSA AdultSA REVIC

M ale

Female

**

*

Reflective Questioning about Reflective Questioning about Best Practice in Hong KongBest Practice in Hong Kong

If we conceptualise If we conceptualise the pursuit of best the pursuit of best practicepractice as a continuum, then it becomes as a continuum, then it becomes

possible to constantly evaluate and possible to constantly evaluate and review structures and functions without review structures and functions without

the underlying assumption of the underlying assumption of dysfunction or failure.dysfunction or failure.

Criminal Justice SystemCriminal Justice System

How effective is the criminal justice system in communicating to the general public that sexual violence is a serious offence?

Only 4.8% of cases handled by Rain Lilly in 2000 were successfully convicted (SCMP, Nov 2, 2002)

(SCMP, April 27, 2002)(SCMP, April 27, 2002)

Barrister, Finny Chan Fei Nai, “a gentlemanly sort of rape….as soon as one finished he leaves the room and another takes over”

“The victim was slightly more vindictive than hurt”

Judge, Mrs. Justice Verina Bokhary’s response to these remarks….

How effective are the health and social How effective are the health and social welfare systems in servicing victims of welfare systems in servicing victims of sexual violence?sexual violence?

How well-resourced are services providing specialized services to victims of sexual violence?

How well-trained are front line workers in sexual violence issues? (doctors, nurses, social workers, psychologists, ……)

Doctors’ AttitudesDoctors’ Attitudes Wong, Wong, Lau & Lau, (2002)

33% of emergency ward doctors in Hong Kong believe that women are partly to blame for rape (appearance, behaviour etc)

36% believe a woman should be responsible for preventing her own rape

7% believe women secretly desired to be raped 10% believe a woman can successfully resist rape if she

wants to 78% had received no formal training in dealing with

rape victims

Social Workers’ AttitudesSocial Workers’ Attitudes Tang, Pun & Cheung (2002) compared (a) social

workers, nurses etc. with (b) police, laywers etc.

Which group was more likely to have victim-blaming attitudes, (a) or (b)??

How many of us here today have had any formal specialized training (one or more full semester courses) as part of our basic training??

Public Policy?Public Policy?

How effective is public policy in communicating a zero tolerance approach to sexual violence (Mandatory reporting of CSA, mandatory

criminal background checks of all frontline workers with children)

Role for the Women’s Commission?

Education?Education? How effective is the education system in

promoting a zero tolerance approach to sexual violence Gender sensitivity education

– countering myths which silence victims– establishing norms which promote gender and sexual equality– EOC survey of students (2002) found that boys believed that it

is “unacceptable for girls to take the initiative in courtship and dating”

Including sexual violence issues into the sex education curriculum in schools

Finally…..

Best practice in self-care for Best practice in self-care for individual workers in each sector.individual workers in each sector.

McFarlane & van der Kolk, 1996 As long as people deny the impact of their own

personal trauma and pretend that it did not matter, that it was so bad, or that excuses can be made for perpetrators they are likely to identify with the perpetrators and treat others with the same lack of empathy and compassion with which they treat the wounded parts of themselves.