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

1. Sexual Assault Services and the Public Health Model: An Australian Experience Patricia Leahy, PhD

2. Outline • Public Health Approach • Sexual Assault Services in Australia • The Canberra Rape Crisis Centre • Challenges in Australia • Reflective Questions for Best Practice in Hong Kong

3. Public 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

4. Sexual Assault Services in Australia (Weeks 2001) NT 5 (181,900) Queensland 28 (3.3m) WA 9 (1.7m) SA 15 (1.4m) NSW 57 (6.2m) VIC 15 (4.5m) Australian Capital Territory Canberra 1 (308,000) 120 (15m) Tas 3 (459,000)

5. National Association of Services 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

6. 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

7. Feminist 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

8. 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

9. Evidence-based Servicing • Collaborative Research • Service effectiveness • Identifying needs • women with disabilities, • lesbian and bisexual women, • women from non-English speaking backgrounds • Indigenous women

10. 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)

11. Publications

12. 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,

13. 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

14. Challenges 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)

15. 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

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

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

18. Reflective Questioning about Best Practice in Hong Kong If we conceptualise the pursuit of best practice as a continuum, then it becomes possible to constantly evaluate and review structures and functions without the underlying assumption of dysfunction or failure.

19. Criminal 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)

20. (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….

21. How effective are the health and social welfare systems in servicing victims of 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, ……)

22. Doctors’ 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

23. Social 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??

24. 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?

25. 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

26. Finally…..

27. Best practice in self-care for 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.