Healthcare professionals - supporting adults who present having experienced rape or sexual assault: clinical pathway

6. Responding to Initial Disclosure

Key points

• Responding appropriately to disclosure is a key step for recovery
• Early and appropriate multi-agency information sharing with the person’s involvement, and preferably with their consent, should be considered in every case

Where appropriate, child and/or adult support and protection referrals should be made following local procedures in response to disclosures

As noted in section 1.4 this guidance has been designed to cover adults aged 16 and above who disclose a rape or sexual assault.

The points below should always be considered when responding to initial disclosure of rape or sexual assault whether it is historical or recent:

• Direct the person to locally available support services and provide clear and accessible information on these services as per the adult sexual assault - 7 day window considerations: guidance document^[42]
• Reassure the person that telling you is the right thing to do
• Document details of the consultation as soon as possible
• Use the person’s own words as far as possible. Date and sign the documentation including details of anyone else present
• Discuss the options available for clinical care and forensic examination
• Discuss wider support, advocacy and follow up services (within the local context)
• Be alert to the impact on the person of disclosing, perhaps for the first time, whether the events are recent or not
• Make sure you know and follow your organisation’s child and adult protection procedures for the involvement of police and social work services
• Provide information in a clear way which ensures the person has a full understanding
• Let the person know what you are documenting and why
• Where the initial disclosure takes place more than 7 days after the rape or sexual assault, local decision-making pathways should be followed
• Where an individual has made an appointment for a consultation and subsequently does not attend, the requirement to follow up on non-attendance is subject to professional judgement.

6.1 Adult Support and Protection

Under the Adult Support and Protection (Scotland) Act 2007^[43] (“the 2007 Act”), an ‘adult at risk’ is someone aged 16 or over who is unable to safeguard their own wellbeing, property, rights or other interests, is at risk of harm and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.

The 2007 Act provides for adults who are at risk of harm if another person’s conduct is causing (or is likely to cause) that adult harm or the adult is engaging (or is likely to engage in) conduct which causes self-harm. The provisions of the 2007 Act are in place to support and protect any adults who are at risk of harm.

Where an employee of a Health Board knows or believes that an adult is at risk of harm, they are under a statutory duty to refer their person to and respond to information requests from the council or delegated agency. Please note that these duties are in addition to others you may have in terms of reporting a potential crime.

Harm is defined in the 2007 Act as all harmful conduct and in particular includes conduct (or unlawful conduct) which causes physical, psychological, financial and self-harm.

Where you believe a person lacks capacity regarding a specific task or issue refer to your local protocols regarding the Adults with Incapacity (Scotland) Act 2000 especially with regard to assessing mental capacity. Similarly, if you have concerns regarding the person’s mental health refer to your local protocols regarding the Mental Health (Care and Treatment) (Scotland) Act 2003^[44].

Any conduct which constitutes rape or sexual assault is highly likely to come into the category of ‘behaviours that constitute harm’ and should be reported under local adult support and protection procedures as per the statutory duties outlined above. On such occasions the person who lacks capacity, and their Guardian, proxy or representative should be made aware a report will be made. There may be occasions where the healthcare provider is of the professional opinion that the information in relation to rape or sexual assault should be reported in the wider public interest without the need to obtain consent of the person, for example where a child or a vulnerable adult, other than the person themselves, is at risk. Disclosures without consent should be discussed with a senior clinician, Caldicott Guardian, or Data Protection Officer, and the decision to share and the justification clearly documented. The medical record should include the steps taken to seek the person’s consent for information sharing with relevant agencies, the information to be shared and the services involved or record the reasons for not informing the person of the decision to share information without their consent.

More information, including guidance on specific steps and processes on this area, can be found in The Code of Practice for the Adult Support and Protection (Scotland) Act 2007^[45].

Useful Resources

A survivors guide to the criminal justice system (Rape Crisis Scotland) ^[46]

Little Green Book (Edinburgh woman’s rape or sexual assault centre, 2016)^[47]

Unlocking sexual abuse and learning difficulties(Enable 2009)^[48]