Title: Multi-disciplinary Evaluation of Sexual Assault Referral Centres for better Health (MESARCH)
Funder: Department of Health and Social Care

Abstract: 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.

Lay abstract: Society has a duty to safeguard its citizens, and promote people’s rights to live free of violence. Sexual violence refers to any unwanted sexual act or activity. There are many different kinds of sexual violence, including but not restricted to: rape, sexual assault, child sexual abuse, sexual harassment, rape within marriage or relationships, forced marriage, so-called ‘honour’-based violence, female genital mutilation, trafficking, sexual exploitation, and ritual abuse. Each year there are 473,000 adult sexual offences in the UK, including 58,000 cases of rape. In 2014/15, there were 47,008 sexual offences against children. Sexual violence has devastating short- and long-term consequences for the wellbeing of victims and survivors. These include physical problems like sexually transmitted infections, injuries, and pain, and mental health issues like post-traumatic stress, anxiety and depression. The negative effects can be seen across families and communities, affecting people’s abilities to work and participate in family and social life. Estimates suggest that child sexual abuse alone costs £182m in health spending annually. Hence, sexual violence is very costly to society, both in terms of the suffering and emotional pain it causes but also in terms of lost work, and health, policing and legal costs. A victim of a sexual crime can find help from a Sexual Assault Referral Centre (SARC), either by making contact themselves or being offered a referral by another person or organisation like a doctor, nurse, school or member of the police. A SARC is intended as a one-stop location where individuals can receive medical care including a forensic medical examination if they consent to this, advice, counselling and support. There are over 40 SARCs across England, Wales and Scotland. SARCs are thought to provide the best response when a person discloses sexual assault or rape whether this occurred recently or in the past, and can prevent or reduce some of the serious consequences in victims’ lives. However, the true impact of SARCs on users is largely unknown. The way things are done can vary from one centre to another, and it is not known what works best for different groups of people like men, members of the LGBT community, and people with particular vulnerabilities (e.g. those with disability, minority ethnicity, and children). Our project will take an in-depth look at the work of SARCs and how they impact people’s recovery journeys. An experienced research team from 3 UK universities will work over 4 years with survivors, patients and members of the public, charities, SARCs and NHS services and those who make decisions about services in different areas. 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. We will: (i) look at the research already done to see what it says about supporting survivors; (ii) gain insights into how SARCs care for service users including how they work with charities that specialise in supporting survivors and NHS services, by interviewing staff and service users; (iii) with permission, follow a large group of adults and children who attend SARCs, collecting information over 2 years to understand the impact of different treatments on mental and sexual health, life quality and costs; (iv) examine the benefits (and possible harms) for different user groups who access SARCs and put forward recommendations. Our approach was co-created with survivors of violence and charities that support them to ensure our project will be conducted respectfully and ethically and will lead to relevant changes in practice and policy. The findings will be shared online (through our website), as part of a host of events for a range of people, in academic journals and at conferences.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INJURIES AND ACCIDENTS