Care for victims of sexual violence : evaluation of setting up sexual assault care centers in Belgium

Abstract

Introduction: Research of 2021 demonstrated that 42% of women and 19% of men already experienced hands-on sexual victimization in Belgium. Only 7% of the victims sought formal help and 4% reported to the police. For decades, victims had to report to the police prior to getting a forensic examination within 72 hours upon their victimization and no guarantee for subsequent care. However since 2017, Belgium has been moving from a perpetrator-focused judicial approach to patient-driven holistic care for victims of sexual violence (SV) with the development, piloting, scientific evaluation and subsequent gradual roll-out of Sexual Assault Care Centres (SACC). Method & sample: During the piloting, between November 2017 and October 2018, 930 victims of recent SV admitted to the 3 SACC. Through registration data we evaluated the violence, the victims, and the care provided, and triangulated this with data from interviews and focus groups on acceptability and outcome with patients, support figures, forensic nurses, doctors, police and justice involved. Subsequently we continued the monitoring and registration of 5 SACCs, resulting in a sample of more than 4750 unique victims of SV that sought care in the Belgian SACC by the end of December 2021. Findings: SACCs provide 24/7 free holistic (=psychosocial, medical and embedded forensic) care to victims of recent SV. Of the victims 69% admits within a week (64% upon rape, 4% upon an attempt of rape and 12% upon physical SV without penetration), enabling full holistic care uptake. The acute care is provided by forensic nurses being supported by specialists. Together with sexual trauma psychologists the nurses foresee in long term follow-up care and case management. Upon their care, and within the SACC, victims can file a complaint to specifically trained vice inspectors or do this later as forensic samples can be stored for 6 months: 66% of the victims eventually do so. Victims and their support figures evaluate the SACC as very supportive, non-judgmental and re-enabling. Police and justice state that the SACC lead to more focused police interviews, more efficient investigations, and a broadened agency. Finally, DNA-labs applaud how the embedded forensic approach leads to focused inquiries on a broader range of traces compared to before. Discussion: Given this positive evaluation, the Belgian governments decided to install a SACC in every Belgian judicial district by 2023. Can patient-centeredness still be improved or will law enforcement eventually prevail over health care and victims needs again?