Title: The Effectiveness of Sexual Assault Referral Centres with regard to Mental Health and Substance Use: A National Mixed Method Study
Funder: Department of Health and Social Care

Abstract: BACKGROUND: Sexual Assault is a common but often under-reported crime. The consequences of sexual assault are significant and include the risk of developing long term psychological problems including substance use disorders and post-traumatic stress disorders. Sexual Assault Referral Centres (SARCs) have been establised across the country to provide a "one stop shop" for people who have experienced assault (either recent or non-recent). Recent research has highlighted that 40% of people who attend SARCs because of an assault are also known to mental health services or have mental health problems. In addition, rates of substance use problems are also common. SARC guidance indicates that mental health problems should be identified and people referred to appropriate care. However, it is not clear how this is being actioned, and whether these needs are being met. AIM: To generate and test a programme theory which will seek to identify the context and mechanisms involved in the identification of mental health and substance use in SARCs and the pathways to care following that contact to ensure that people get the right care at the right time (outcome) Setting: SARCs in England. Participants: adults who attend SARCs who have experienced sexual assault (recent and non-recent); people who work in the SARCs; people who work in partner agencies (such as local substance use, mental health services, domestic abuse, and voluntary sector rape counselling services etc). Design: The design is a mixed method multi-stage study using realist evaluation. It will comprise of 6 work packages (WP) which will produce outputs in their own right as well as inform the next. 1. Review of literature pertaining to SARCs and how to effectively address mental health issues (and similar models in other countries)(WP1) 2. National survey of managers within all 47 SARC services in England (WP2) 3. A prevalence study for n=360 people who attend SARCs to identify types and level of mental health and substance use problems with follow-up on mental health, substance use and third sector service use (WP3) 4. Case studies in 6 SARC settings using realist evaluation methodology (WP4) entailing focus groups with stakeholders representing the workforce within the SARC and partner agencies to understand how they work with a range of mental health issues from offering emotional support, identifying those with high risk of mental health problems, how to ensure people can access appropriate ongoing care, workforce training and skills needs in regard to mental health and trauma. In addition we will undertake individual interviews with service users and significant others. This will also include documentary analysis. 5. A comparison of CORE outcome data between people presenting at a SARC (which has an in-house psychological therapies service) and a mainstream mental health service using analysis of anonymised datasets. (WP5). The findings of the study will generate a programme theory about how mental health and substance use are identified and managed, and make recommendations about improving SARC mental health pathway through improved local commissioning, multi-agency working arrangements, and examples of good practice as well as areas where there are blocks or barriers. We will co-produce a set of actionable tools to enable findings to be translated into practice (WP6).

Lay abstract: Sexual assault (an sexual act committed by force on another person against their will) is very common in UK but often people who have experienced this don't ask for help. The consequences of sexual assault are often serious and long lasting, affecting not only their physical health but also their mental health. Sexual assault is also common in people who use mental health and substance use services. Sexual Abuse Referral Centres have been set up all over the UK to help people who have experienced sexual assault. They can offer health tests and screening as well as supporting people emotionally. They work with other services as well including charities who offer counselling services for people who have experienced sexual assault. When we talked to people with lived experience of sexual assault they told us that they thought SARCs were an excellent model but that it was unclear how they work with mental health issues to ensure longer term help was provided. One of the applicants for this proposal has already undertaken work to examine how SARCs identify and work with mental health and recommend that more attention needs to be paid to mental health in the SARC services, noting that in many SARCs the staff are not mental health experts. The HS&DR programme that funds research related to health services and delivery have specifically put out a call for groups of researchers to submit proposals to address several key areas for SARCs in order to see how well they are working and how things could be improved to make sure that people who attend get their needs met. We are a group of researchers, practitioners and people with lived experience who have an interest in this topic and experience of similar research. We will first do a review of all the currently available published work on SARCs and on mental health issues. We will produce a report that brings all the findings together. This review will help us in the next stage which will be a national survey. We will create a survey asking questions about mental health assessment, support, and working with other agencies. This will be distributed to all 47 SARCs and completed by the manager. The findings will help us to group SARCs according to their ways of working. Using these groupings we will then invite SARCs that fall into each group to take part in the third study. In this "case study" we will gather richer data from staff and people who use the services about how they work with mental health, working with others, gaps and blocks in getting needs met and get examples of good practice. Within this we will also invite people who attend SARCs to take part in a "prevalence" study where we will use brief screening questionnaires to identify the types of mental health and substance use problems that they have. We will follow up people to see what happens to them over that time, whether they get the care they need at the right time, how satisfied they feel about their treatment, and how much of services they use. The final aspect of the study will be to use anonymised data from SARC service (which has its own psychological therapy service) and compare with data from a mental health trust to see whether there is differences in outcomes. We will work in partnership with people with lived experience to develop reports designed for users, carers and staff who work in relevant services so that services can be improved or adapted depending on what we find.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH