The effectiveness of sexual assault referral centres with regard to mental health and substance use: a national mixed-methods study - the MiMoS Study.

Elizabeth Hughes, Jill Domoney, Nicky Knights, Holly Price, Sibongile Rutsito, Theodora Stefanidou, Rabiya Majeed-Ariss, Alexandra Papamichail, Steven Ariss, Gail Gilchrist, Rachael Hunter, Sarah Kendal, Brynmor Lloyd-Evans, Mike Lucock, Fay Maxted, Rebekah Shallcross, Karen Tocque, Kylee Trevillion
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引用次数: 0

Abstract

Background: Sexual assault referral centres have been established to provide an integrated service that includes forensic examination, health interventions and emotional support. However, it is unclear how the mental health and substance use needs are being addressed.

Aim: To identify what works for whom under what circumstances for people with mental health or substance use issues who attend sexual assault referral centres.

Setting and sample: Staff and adult survivors in English sexual assault referral centres and partner agency staff.

Design: A mixed-method multistage study using realist methodology comprising five work packages. This consisted of a systematic review and realist synthesis (work package 1); a national audit of sexual assault referral centres (work package 2); a cross-sectional prevalence study of mental health and drug and alcohol needs (work package 3); case studies in six sexual assault referral centre settings (work package 4), partner agencies and survivors; and secondary data analysis of outcomes of therapy for sexual assault survivors (work package 5).

Findings: There is a paucity of evidence identified in the review to support specific ways of addressing mental health and substance use. There is limited mental health expertise in sexual assault referral centres and limited use of screening tools based on the audit. In the prevalence study, participants (n = 78) reported high levels of psychological distress one to six weeks after sexual assault referral centre attendance (94% of people had symptoms of post-traumatic stress disorder). From work package 4 qualitative analysis, survivors identified how trauma-informed care potentially reduced risk of re-traumatisation. Sexual assault referral centre staff found having someone with mental health expertise in the team helpful not only in helping plan onward referrals but also in supporting staff. Both sexual assault referral centre staff and survivors highlighted challenges in onward referral, particularly to NHS mental health care, including gaps in provision and long waiting times. Work package 5 analysis demonstrated that people with recorded sexual assault had higher levels of baseline psychological distress and received more therapy but their average change scores at end point were similar to those without sexual trauma.

Limitations: The study was adversely affected by the pandemic. The data were collected during successive lockdowns when services were not operating as usual, as well as the overlay of anxiety and isolation due to the pandemic.

Conclusions: People who attend sexual assault centres have significant mental health and substance use needs. However, sexual assault referral centres vary in how they address these issues. Access to follow-up support from mental health services needs to be improved (especially for those deemed to have 'complex' needs) and there is some indication that co-located psychological therapies provision improves the survivor experience. Routine data analysis demonstrated that those with sexual assault can benefit from therapy but require more intensity than those without sexual assault.

Future work: Further research is needed to evaluate the effectiveness and cost-effectiveness of providing co-located psychological therapy in the sexual assault referral centres, as well as evaluating the long-term needs and outcomes of people who attend these centres.

Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (16/117/03) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 21.

Trial registration: This trial is registered as PROSPERO 2018 CRD42018119706 and ISRCTN 18208347.

性侵犯转诊中心在精神健康和药物使用方面的有效性:一项国家混合方法研究——MiMoS研究。
背景:设立了性侵犯转诊中心,提供综合服务,包括法医检查、健康干预和情感支持。然而,目前尚不清楚心理健康和药物使用需求是如何得到解决的。目的:确定在什么情况下,对到性侵犯转诊中心就诊的有精神健康或物质使用问题的人有效的方法。背景和样本:英国性侵犯转诊中心的工作人员和成年幸存者以及合作机构的工作人员。设计:采用现实主义方法论的混合方法多阶段研究,包括五个工作包。这包括系统审查和现实主义综合(工作包1);对性侵犯转诊中心进行国家审计(工作包2);关于心理健康以及药物和酒精需求的横断面流行情况研究(工作包3);六个性侵犯转介中心(工作包四)、伙伴机构和幸存者的个案研究;以及对性侵犯幸存者治疗结果的二级数据分析(工作包5)。研究发现:在审查中发现的证据不足,无法支持解决精神健康和药物使用问题的具体方法。性侵犯转诊中心的心理健康专业知识有限,基于审计的筛选工具的使用也有限。在流行病学研究中,参与者(n = 78)在性侵犯转诊中心就诊一到六周后报告了高度的心理困扰(94%的人有创伤后应激障碍的症状)。从工作包4的定性分析中,幸存者确定了创伤知情护理如何潜在地降低了再次创伤的风险。性侵犯转介中心的工作人员发现,团队中有心理健康专业知识的人不仅有助于计划后续转介,而且有助于支持工作人员。性侵犯转诊中心的工作人员和幸存者都强调了转诊方面的挑战,特别是转诊到国民保健制度精神保健方面的挑战,包括提供方面的差距和漫长的等待时间。工作包5分析表明,有性侵犯记录的人有更高水平的基线心理困扰,接受了更多的治疗,但他们在终点的平均改变分数与没有性创伤的人相似。局限性:该研究受到大流行的不利影响。这些数据是在连续封锁期间收集的,当时服务不能正常运行,以及由于大流行而导致的焦虑和隔离。结论:参加性侵犯中心的人有明显的心理健康和药物使用需求。然而,性侵犯转诊中心处理这些问题的方式各不相同。需要改善获得精神卫生服务的后续支持的机会(特别是对那些被认为有“复杂”需求的人),并且有一些迹象表明,同时提供心理治疗可以改善幸存者的经历。常规数据分析表明,性侵犯者可以从治疗中受益,但比没有性侵犯的人需要更多的强度。未来的工作:需要进一步的研究来评估在性侵犯转诊中心提供同地心理治疗的有效性和成本效益,以及评估来这些中心的人的长期需求和结果。资助:该项目由国家卫生和保健研究所(NIHR)卫生和社会保健提供研究方案(16/117/03)资助,全文发表在《卫生和社会保健提供研究》上;第11卷,第21号试验注册:该试验注册号为PROSPERO 2018 CRD42018119706和ISRCTN 18208347。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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