Responding to women's experiences of sexual assault in institutional and care settings
- Defining institutional setting
- Populations of institutional settings
- Institutional settings in Australia
- Identifying and responding to sexual assault in institutions
- Responding to sexual assault in institutions: Overcoming barriers, confronting challenges in operational practice
Responding to sexual assault in institutions: Overcoming barriers, confronting challenges in operational practice
Despite research documenting the sexual assault histories of women in institutions, their complex care needs, and the barriers to them disclosing, the extent to which these institutions are equipped to identify and respond appropriately to sexual assault and ongoing vulnerability to abuse appears uncertain. Indeed, in researching this paper the authors encountered difficulty in accessing current institutional policy documents in relation to sexual assault, with many institutions unable or unwilling to provide these documents. A clear understanding of, and access to, relevant legislation and practice protocol provides a starting point for workers’ responses to sexual assault. There remain significant barriers for institutions providing environments that promote safety and reduce further trauma to victim/survivors inside institutions. These barriers operate at historic, structural and cultural levels, including staffing, architectural design, and entrenchment of policies and procedures centred on control and management. Factors such as these all compound the ability to provide space conducive to meeting victim/survivors’ care needs (Pollack & Brezina, 2006). Here we outline some ways to overcome current barriers to responding to sexual assault and sexual assault histories within institutions, including:
- developing sexual assault informed practice and policy;
- creating safe and empowering environments through practice, policy, and physical design; and
- minimising and/or removing re-traumatising or abusive practices from operational procedures.
Sexual assault informed practice
Recognising that sexual assault histories and incidents are relatively common among residents in institutional settings is the first step for addressing this issue. But how are issues around power, credibility and believability to be best addressed within institutions in order to prevent silence around sexual abuse? The British Royal College of Psychiatrists (2007) suggested that best practice in this regard requires institutions to ensure “that systems are in place which enable patients to have a voice, access to advocates and a complaints system which is user-friendly” (p. 28). While this suggestion is made in relation to psychiatric inpatient settings, it is transposable—it is important for women in all institutional settings to have the opportunity to have their voice heard, to be believed, and to speak out without the threat or potential for being reprimanded on the basis of making “false” complaints, or attempting to “cause trouble”. This is the case for disclosures of both recent and historical cases of sexual assault.
Responding to disclosures
Sexual assault counselling and advocacy services may be viewed as a source of expertise in responding to disclosures of sexual assault and, consequently, a model of “good practice”. Indeed women in institutions should be provided with the basic principles as others (such as being believed, respected and supported), provided with practical information, and offered opportunities to make informed choices about responses and support (CASA House, 2010; Brisbane Rape and Incest Survivors Support Centre, n.d.).
Practically, these issues could be addressed through a number of means. Providing information and training to staff about how to respond to sexual assault may assist with disclosures and general support to victim/survivors. Developing clear guidelines for responding based on principles from sexual assault services may promote more consistent helpful responses to disclosures. This could be further enhanced by putting in place clear, accessible operational procedures for staff. Providing all residents with information about sexuality and sexual assault and ensuring they have access to support workers would also go some way to developing sexual assault informed practice (Higgins, 2010). All these aspects emphasise the importance of collaboration and resource sharing between institutions and sexual assault services.
Safe and empowering environments
Sexual assault services generally understand sexual assault through dynamics of gender, power, and control. However, institutions by their very nature function to reduce patient autonomy, control and choice, albeit to varying levels. Theoretically speaking, in a “total institution”,11 patients have all choice and power removed. In practice, people in institutions generally do have some rights afforded to them and protective mechanisms in place to mitigate against this loss of power—although it is unclear how effectively these rights are upheld in practice.12 This suggests that it is the institutional environment, operating practices and culture(s) that need to be addressed in order to reduce sexual violence against women in institutions, to promote and respond to disclosure, and to meet women’s safety and care needs.
There is a range of international conventions, national guidelines and examples of good practice that can be drawn on to establish safer environments and that promote wellbeing. Some of these are included in Box 2. To create environments of respect, support and empowerment requires re-thinking traditional approaches to operating institutions. For example, this might include:
- empowering residents to have control over their movements and decisions that affect them, rather than establishing routines based around control and regulation;
- providing residents with opportunities to contribute positively to the facilities;
- providing greater access to external support services and counsellors;
- enhancing the physical space of facilities to reflect a safe and supportive environment for women, for instance:
- modifications to lighting and colour;
- re-organising accommodation;
- ensuring access to areas for contemplation, prayer and mediation; and/or
- creating attractive outdoors areas;
- providing single-sex access and privacy in bathrooms and sleeping quarters to reduce some risk of being exposed to sexual assault within institutions; and
- monitoring institutions by external agencies, such as Australian Human Rights Commission (AHRC) and Ombudsman Offices, to ensure adherence to safe standards.
The implementation of these (and other) suggestions may assist in both reducing the incidence of sexual assault occurring within institutional settings, as well as reducing the re-traumatising nature of institutional settings for women with sexual assault histories.
Minimising re-traumatising practices in the operating and cultural environment
The day-to-day operational environment of institutions not only serves as a barrier to recognising and responding to specific incidents of sexual assault, it also comprises practices that may be re-traumatising or abusive for women with sexual assault histories. Structural issues that are re-traumatising or prevent disclosure or appropriate responses to disclosure need to be identified and dismantled through institution policy, practice and cultural change. This includes addressing system structures and operations focused on the control, regulation and disempowerment of women. Enabling personal autonomy, choice and decision-making of residents in the everyday operational environment is necessary to address these issues.
To reduce the amount of distress experienced by victim/survivors of sexual assault within institutional settings, there is a need to address operational practices that are understood to contribute to further trauma and disempowerment. A number of practices within institutions have been identified in research literature as distressing, humiliating and/or disempowering to residents, including:
- strip searching (Covington & Bloom, 2006; Dirks, 2004; Easteal, 2001; Kilroy, 2002; Lievore, 2003; Moloney, van den Bergh, & Moller, 2009);
- surveillance by male staff (Easteal, 2001; Jennings, 1994; Lievore, 2003; Pollack & Brezina, 2006);
- forced medication or over-reliance on medication in treatment responses (Graham, 1994; Harris, 1994; Jennings, 1994);
- solitary confinement (Holmes, Kennedy, & Perron, 2004; Jennings, 1994; Johnson, 1998; Martinez, Grimm, & Adamson, 1994; Taxis, 2002); and
- physical restraint, including the use of straitjackets (Dirks, 2004; Jennings, 1994; Johnson, 1998; Taxis, 2002).
These practices have in common that they undermine women’s autonomy, deprive them of control over their bodies, and jeopardise their physical and emotional safety. Indeed, Easteal (2001) argued that practices such as strip searching and the surveillance of women by men can be intrinsically sexually abusive and re-traumatising for victim/survivors of sexual assault (see also Covington & Bloom, 2006; Kilroy, 2002; Jennings, 1994).13 From this position, in order to create an operational environment and culture that is mindful of the sexual abuse histories of women, these practices need to be modified and avoided where possible and appropriate. Given the prevalence of sexual abuse histories within institutions together with barriers to disclosure, it may be argued that changes to practices need to be targeted at a structural level of change rather than applied specifically to identified victim/survivors or to particular individuals or groups identified “vulnerable” to sexual abuse.
Staff training about potentially traumatising practices is also important (Dirks, 2004; Pollack & Brezina, 2006). Staff lacking awareness of the impact of past sexual assault (whether experienced as a child or adult), for example, may misinterpret women’s resistance to practices they find distressing as an attempt to make trouble, and the individual may consequently be reprimanded (Easteal, 2001, p. 106). Providing training for staff around the impact of standard practices and alternative (non-harmful) responses or treatment approaches would be helpful in addressing this concern. Promoting and practicing institutional values of respect, support and equality may enhance relationships between women and staff in ways that are conducive to safety and wellbeing.Again, adherence to safe practices and environments could be monitored by external bodies through regular audits and reviews.
11 The term “total institution” was introduced by Goffman (1961). Some of the key characteristics of a total institution include: “total control over the inmate population … the total structuring of the inmate’s environment and activities; the total isolation and separation of the institution and its inhabitants from the larger society in which the institution resides” (Farrington, 1992, p. 24).
12 Based upon personal communication with a reviewer of this paper, 20 October 2010.
13 Easteal (2001) found that women prisoners found strip searches distressing and many women did not preference women undertaking the procedure over men. As Wybron and Dicker (2009) emphasised, the relationship between the guard and prisoner is a hierarchical one regardless of gender. Of the 41,728 strip searches conducted at the Brisbane Women’s Correctional Centre between 1999–2002, only two searchers uncovered any significant contraband, with similar outcomes in Victorian prisons also documented (Easteal, 2001; Wybron & Dicker, 2009).