Examining the prevalence of sexual safety incidents and effectiveness of sexual safety prevention and management strategies in mental health, disability and older adult settings
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Date
2023-12-01
Authors
Mahony, James O
Dalton O' Connor, Caroline
Biskupovic Goulding, Ryan
Naughton, Corina
Hegarty, Josephine
Burton, Aileen
Hartigan, Irene
O'Malley, Maria
Wills, Teresa
Martin, Anne-Marie
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Sexual safety in health and social care involves protecting vulnerable populations in various care environments from a wide range of inappropriate and harmful sexual behaviours, including non-consensual acts, harassment, and exploitation. Despite the lack of national standards in Ireland, there is a growing recognition of the need for comprehensive policies and frameworks to prevent, report, and manage these incidents, as evidenced by international efforts and forthcoming initiatives by the HSE. This study aims to estimate the prevalence of sexual safety incidents in HSE managed centres in Ireland for older persons, adults with disabilities, and inpatient mental health units, and evaluate the effectiveness of prevention and management strategies. Using data from HIQA NF06 reports and the National Incident Management System, together with capacity data, prevalence was estimated per 1000 beds. A scoping study of empirical peer reviewed and grey literature provides a detailed understanding of definitions, prevalence, prevention strategies, reporting mechanisms, and management of sexual safety incidents in health services similar to Ireland. The scoping review highlights the variability and lack of consensus in defining 'sexual safety' and 'sexual safety incidents' in empirical literature, noting that while empirical definitions emphasise subjective experiences and individual perceptions, the grey literature, especially from the UK and Australia, offers more explicit, practice-oriented definitions. This analysis, which includes complex terms like 'sexualised behaviour', 'sexual harassment', and 'sexual assault', highlights the need for clear, inclusive, and context-sensitive definitions to inform the development of a comprehensive sexual safety framework in healthcare settings in Ireland. The existing international evidence on the prevalence of sexual safety incidents is limited and lacks generalisability, with varying rates and types of abuse reported. Studies highlight the need for standardised definitions and measurement methods yet provide no specific recommendations to enhance the accuracy of prevalence measurement in the future. A review of the studies relevant to prevention highlight the importance of staff training, management models, and various prevention strategies and while some training interventions show promise in increasing staff knowledge and incident reporting, the overall evidence for effective prevention methods is limited, with a need for more comprehensive research and standardised approaches. The evidence highlights the complexity of postincident risk reduction and the need for comprehensive strategies to ensure the safety and dignity of individuals in older persons, disability, and mental health care settings. The importance of effective reporting, response, and prevention measures for sexual safety incidents is emphasised in the literature. Despite the mandatory reporting of such incidents in many jurisdictions, existing literature highlights challenges in reporting mechanisms and investigative outcomes. Concerns about compliance with compulsory reporting have led to calls for standardisation and improvement in reporting practices. Challenges such as the absence of consistent data on the nature and severity of abuse, the harm inflicted on victims, and other variables significantly impact the course of investigations and subsequent outcomes. This not only affects the impact on alleged perpetrators and victims but also hinders the ability to learn from incidents. Various sources stress the need for enhanced reporting standards to better address the complexities of sexual safety incidents. The grey literature reveals an emphasis on safeguarding policies, data analysis, and reporting strategies for sexual safety incidents, advocating for zero tolerance of abuse and a traumainformed approach, particularly in mental health services in Australia and the UK. It highlights the importance of implementing training, leadership support, and regular risk assessments, although the evidence supporting these practices is not fully established. The analysis of sexual safety incident prevalence in Irish HSE designated centres for older persons, adults with disabilities, and inpatient mental health units, based on data from the past five years, reveals fluctuating reporting rates across care settings, including significant increases in some years possibly due to historical case reporting. This variation in incident reporting, alongside the ambiguity in interpreting higher or lower rates as either actual changes in incidents or differences in reporting practices, highlights the need for more effective reporting mechanisms and careful data interpretation. Comparisons with international data show mixed prevalence rates, highlighting the need to contextualise Irish data globally, while identified data collection limitations suggest a need for more nuanced metrics in understanding these trends. To move toward meeting the identified challenges in sexual safety within Irish healthcare settings, this study presents recommendations focused on enhancing data collection prevention, reporting, and management of sexual safety incidents. Drawing from limited international best practices, these recommendations emphasise the need for standardised definitions, improved data methodologies, trauma-informed approaches, and comprehensive staff training to support a consistent, effective, and respectful approach to sexual safety across various healthcare environments. Several recommendations are being proposed as a direct result of the findings which are synopsised here and described in more detail in Chapter 8
Description
Keywords
SDG 16 - Peace, Justice and Strong Institutions , Sexual safety , Sexual safeguarding , Prevention , Older adults , Intellectual disability , Mental health , Health and social care settings , Scoping review , [NursingMidwifery] , [SocialStudies]
Citation
O’Mahony, J., O’Malley, M., Biskupovic-Goulding, R., Naughton, C, M., Hegarty, J., Burton, A., Hartigan, I., Dalton O Connor, C., Wills, T., Martin, A.M., Caples, M., Egan, C., Leane, M., Ó'Súilleabháin, F., Drakos, K., O’Donovan, A., Hughes, L. & McLoughlin, K. (2023). Examining the Prevalence of Sexual Safety Incidents and Effectiveness of Sexual Safety Prevention and Management Strategies in Mental Health, Disability and Older Adult Settings. Cork: University College Cork.
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Copyright
© 2023, the Authors.