"We need to learn directly from survivors": Dr Ruth Reed on sexual harm and mental health

This interview contains topics of abuse and sexual harm. 

Dr Ruth, what attracted you to specialising in women's mental health?

I co-chair the Women’s Mental Health Special Interest Group with my colleague, Beena Rajkumar. We both have a strong interest in complex trauma, gender-based violence and its social and health impact. The patients I work with who have experienced sexual harm are mostly but far from exclusively female. It is important to keep in mind the additional barriers that male and gender-diverse survivors commonly face in disclosing abuse and accessing support. There are so many barriers already. We need to ensure equally good services are available to everyone and that training recognises the diversity of survivors. 

What do you feel is the most common misconception surrounding sexual abuse and sexual violence?

People make assumptions about how events affect someone based on their own view of the apparent severity of the event. The sense of ongoing threat that comes with misuse of power in harassment or repeated abuse situations greatly amplifies the impact of any single incident. It is easy for people to underestimate how apparently ‘minor’ sexual harm affects someone in a context where they fear repetition or other consequences of the misuse of power.

Can you describe the impact of sexual abuse and sexual violence on a person’s mental health?

The impact of any event depends on so many factors from before, during and after the incident itself. Like many traumatic events, sexual harm often occurs after a series of other adversities, and commonly sets of a chain of further distressing events such as medical examinations and court proceedings. Many people need to change school or lose their jobs, lose the support of friends or contact with part of their family in the wake of sexual harm. So it is rare for sexual harm to be an isolated experience without other harms coming before or after it.

How can front-line staff be trained in sexual abuse and sexual violence?

There are different aspects of learning that are all necessary. Trusts generally deliver safeguarding and protocol-based training, but this is not sufficient. Staff need to have visualised for themselves how they would respond to a disclosure at a human level in the moment, in different scenarios. Much of the time survivors disclosing have a very negative experience because although staff are fairly good at following protocol, under stress people tend to focus on getting the process aspects right, and forget connection and continuity of care. Also, classroom-based learning only goes so far; we all need to learn directly from survivors as to what is and is not helpful for them, and meaningfully involving survivors in shaping services and delivering training is key. Reading about lived experience in literature and long-read media articles is important to go beyond what can be provided through formal learning. 

How can schools educate their students on sexual abuse and sexual violence? How can they empower their students to discuss these difficult topics?

Schools are starting earlier, at ages which can feel uncomfortable for us as adults, but previously education about sexting a couple of years into secondary was missing the boat. We’d all like to think our children don’t need to know these things, but they do, and they need to know before they are exposed to it. Education about healthy relationships and relationship abuse also needs to start far sooner than we would think. Relationship abuse is a very common precursor to sexual harm in adolescents. Schools can only do so much; one of the most important aspects which many schools do is to provide workshops for parents on internet safety, relationship abuse and sexual harm. It’s very hard for parents to keep up with the ever-changing risks that come with technology but not knowing about this leaves gaps in safety for young people, and providing this in an accessible form for parents is something schools are increasingly successfully doing. 

How can we offer support to a friend or family member who is a survivor of sexual abuse and or sexual violence?

Following their lead as to what is and isn’t helpful to them, which might be very different at different stages of their experience. Also, by not giving up on them if they are not wanting to go out or to chat, or aren’t responding reliably to messages. It is comforting to know someone is keeping you in mind and values you, even if you cannot face talking to them at that time.