Multi-disciplinary Evaluation of Sexual Assault Referral Centres for better Health (MESARCH)

Sexual violence refers to any sexual act, attempt to obtain a sexual act, or other act directed at a person’s sexuality using coercion. One in 5 women and 1 in 25 men have experienced sexual assault since the age of 16 (CSEW, 2017). In 2014/15, there were 88,106 police-recorded sexual offences in England and Wales (including 29,234 rapes) reflecting a 37% increase on the previous year (Office for National Statistics, 2016). In the same period, there were 47,008 sexual offences against children (Bentley and colleagues, 2016). Sexual violence exposure is associated with adverse short and long-term physical and mental health consequences, in female and male, adult and child survivors. The negative effects of sexual violence ripple across generations, affecting individuals’ capacities to work, and participate in family and community life. Sexual violence is very costly in terms of lost productivity, police and criminal justice costs, and health burden. Estimates suggest that child sexual abuse alone costs £182m in health spending annually (Saied-Tessier, 2014). The World Health Organization (2013) called for dedicated longitudinal research to better understand the health effects of sexual violence over the long-term, as most evidence comes from observational and clinical research, and small samples. Providing an accessible, evidence-based, best practice response to all victims and survivors of sexual assault and abuse is not only a moral imperative, it is essential to limit its devastating consequences across the lifespan and disrupt costly pathways to poor health. Investment in sexual assault referral centres (SARCs) has grown considerably in the last 20 years and NHS England (2018) recently set out core priorities for service providers and commissioners in its 'Strategic direction for sexual assault and abuse services'. Given these developments, the variation in models, and recent innovations for children’s provision, this is a key point in time to evaluate SARCs to determine benefits (and harm) in the long-term. Furthermore, as most victims do not connect with SARCs when seeking help, health inequalities in access (and outcome) need to be addressed. The collaboration is led by researchers at the Centre for Advances in Behavioural Science at Coventry University, working the Universities of Bristol and Birmingham, University Hospitals Birmingham NHS Foundation Trust, Coventry Rape and Sexual Abuse Centre, and Juniper Lodge Sexual Assault Referral Centre. Across 4 work packages our team will: (i) synthesise current global evidence on impacts and experiences of psychosocial interventions for sexual violence; (ii) add to understanding on the content and mechanisms of SARCs, through mapping models and referral pathways, and in-depth case studies; (iii) undertake a 2-year cohort study to compare experiences, outcomes (including PTSD, depression, sexual health, substance use, health service use and violence) and costs of attending SARCs across multiple sub-groups including men, children, members of the LGBT and BME communities; (iv) draw all the evidence together to co-produce good practice guidance for SARCs including recommendations for addressing inequalities of access and outcomes. Outputs will include: (i) evidence summary of the synthesis of the literature; (ii) infographic on SARC key facts and figures and feedback to SARCs; (iii) evidence briefings on survivors' journeys – mental and sexual health, life quality, health costs; (iv) resources for survivors, families and the public; (v) best practice guidance to inform SARC service provision. Knowledge-sharing will use multiple strategies to reach patients and public, third sector, NHS, health and crime commissioning groups and academia.