Inside a Sexual Assault Referral Centre
by Amelia Gentleman
The Guardian
25 November 2010
At 11am a young woman wearing pink striped pyjamas is led into a discreet side entrance of St Mary's hospital, Manchester, by a huge, bearded police officer, keys jangling from the breast pocket of his black nylon stab vest, vast brown paper evidence bags tucked beneath his arm.
She says that in the early hours of that morning she was raped by an acquaintance, a man she had spent the evening chatting to in a pub. The police have brought her here to the Sexual Assault Referral Centre (Sarc) to undergo a forensic examination, receive counselling and be advised on and supported in the process of pressing charges.
Everything about the unit has been designed to avoid further humiliation for the victim. The side door is deliberately unmarked, allowing women who have recently been assaulted to avoid the embarrassment of being paraded through the hospital alongside police. The woman is led to a door marked Initial Room, a forensically safe, sterile space with wipe-clean plastic surfaces so that there is no possible contamination of evidence before she is examined. Pictures of orchids and sacks of brightly coloured oriental spices have been hung in a not wholly successful attempt to dilute the clinical atmosphere. A crisis worker sits with her, explaining what is about to happen, while the officer slips across the corridor to brief the doctor.
He runs through his logbook notes of her account, in curtly formal police officialese. "She visited a public house. She met up with a male," he reads. "The offence happened round about two this morning." He explains that she and a girlfriend had met up with a man she vaguely knew, and later the three of them went back to a house; after some time, he said he wanted to have a word with her in private and when she followed him, he raped her. She was shouting a lot, telling him to get off and to stop, and her friend heard and said she would call the police. "At which point he stopped and left the address," the policeman finishes. Beneath the formality he is gently solicitous for the girl's wellbeing and explains that she is exhausted and has had no sleep.
Manchester's police service has a good reputation for its handling of sexual assaults, and this officer has been given extensive training in how to interview women who have been raped. While he can ask her any of the "when", "where", "what" and "how" questions, he knows he is not to ask "why". A line of questioning that looks at her own decisions, questions her choice to go home with someone, to be alone with them, suggests that she should blame herself for the assault and must be avoided.
The woman walked home by herself and the police arrived at her house in the early hours of the morning to take a statement and collect her jeans and underwear for DNA testing, before bringing her here for a full examination. The doctor, a specialist in handling rape cases, makes her own notes, before going to meet the victim to start a physical examination that will take more than two hours. Someone has stuck a public information poster on the wall above her computer that declares: "Rape – short word, long sentence." But the trouble is that rape, short word or not, usually doesn't result in a long sentence, which is why this unit has been set up.
Campaigners tell us that only 6% of reported rapes in this country end up with the rapist convicted, one of the lowest rates in Europe. The figure is controversial, dismissed by some as unhelpfully discouraging, making victims feel so cynical about the process that they do not bother to press charges. The police point out that the rate of conviction for those who are actually charged with rape is a more encouraging 58%, but there remain a large number of reported rapes where charges are never pressed. Years of hostile treatment in the courts, at police stations, at the hands of juries, has left a lingering sense that rape victims are not believed, and many prefer not to submit to unwelcome scrutiny. The 29 Sarcs in England and Wales are described officially as victim-centred medical units, one-stop shops designed to improve the immediate care provided to rape victims, primarily to help them recover better from the attack, and as a side-effect, to boost the conviction rate by supporting women through the prosecution process.
Sarc is staffed 24-7, with doctors constantly on call, so that victims can be seen quickly whenever they are attacked – usually in the middle of the night (with spikes in numbers around Christmas party time, freshers' week, the hot weeks of summer and any time when people are drinking more than usual).
The unit is equipped to gather the most comprehensive forensic evidence, offer advice on sexually transmitted diseases and pregnancy, and provide counselling and assistance throughout a legal process. For those women who decide not to press charges, the support is still on offer. Clothes are stored, and forensic evidence kept in a freezer for seven years in case they change their mind and want to take legal action later.
Vera Baird, Labour's former solicitor general and a champion of the new system, remembers how badly women were treated as recently as a decade ago. "It's very different from going to a police station and knocking on the glass window, probably in a crowded, noisy waiting room, blood on the floor, to tell someone you'd been raped. You would have had to sit there and wait until they found a police medical officer, who'd perhaps come straight from certifying someone dead in the road, or assessing a heroin addict's ability to give evidence, and who wouldn't be a specialist in this area of forensics," she says. "Sarcs treat you like a patient, someone to whom this has happened, with none of the scepticism of a police officer. This gives people the fortitude to go ahead and report the attack."
Upstairs at the morning meeting there are eight women – doctors, counsellors, independent sexual violence advisers (who help victims navigate the legal process) – discussing the cases that have come through over the weekend. First there is the mother of a three-year-old girl, who suspects that the estranged father may have abused her daughter because she has been complaining of a pain and has started crying when she sees him. The girl is booked to come in for an examination later in the morning.
Then there is a student who had a lot to drink and woke up on the floor of the student accommodation, not knowing what had happened for several hours. She is worried she may have been raped.
Next a 17-year-old woman who had been out drinking with her friends. She met up with three lads, whom she recognised, and ended up in a hotel room; she suspects that her drink was spiked and remembers very little of what happened, just the sensation of her face being pushed on to the bed and her arm being bitten.
Last is a Bulgarian woman, in her 20s, whose story had to be untangled through an interpreter. It seems she has been trafficked, brought over here by a Bulgarian man, with the suggestion that she would be employed to look after his children, and perhaps have an opportunity to marry him at some point in the future. She has been examined and counselled but is unwilling to press charges
"She was looking for a better life, but was treated really badly. She was raped on the first day and only managed to escape after two weeks," a counsellor says. "She's asked the police not to take action because she is frightened about reprisals, because the man knows where she lives in Bulgaria."
Staff run through the cases expressing little emotion, skimming through notes biro'd on to pink paper, elbows on the table. Only occasionally do they wince at an unexpected detail.
Michelle Carol, one of the forensic physicians who perform detailed examinations on victims, says women are not put under any pressure to report the case to the police if they don't want to, but staff will try to help them see that they will be believed. "Sometimes they are nervous about how they will be received by the police. They think they will be blamed. A lot of the time they are blaming themselves anyway – if only I hadn't got drunk, if only I hadn't got in that taxi by myself – so they wonder why anyone else would come to another conclusion. We have to explain that this is not about their behaviour, it is about someone else's," she says.
"The police have historically a bad reputation in this area and it's not something that they have shaken off. The view was that many allegations were false, and that they had to weed them out. Often the public are the same. Sometimes we will get a client who thinks that she hasn't really been raped because it doesn't fit into the stereotype of someone being dragged off the streets and beaten, abused and then violently raped. But the bottom line is if you haven't given consent, it's rape, and that's it."
She says most people have ill-informed preconceptions about how a rape victim will behave. "People think they would shout and fight, but they don't. Often they freeze, do nothing. They think they are going to die and think only about self-preservation. They tell themselves: 'Do what he says and then it will be over, and maybe I will survive.' They don't always want to report the attack straight away. They want to crawl into a corner and forget it," she says.
"We don't want to give the impression that we are judging anyone or blaming them, but alcohol is very often a feature because that is when people are often vulnerable. The majority of rapists are acquaintances or well known to them or someone they have spent an evening chatting to, rather than a total stranger."
Each examination can last up to three or four hours, taken at the individual's pace, and is painstakingly methodical and precise to ensure that nothing is missed and that all the evidence found is carefully measured and noted, so it will stand up to scrutiny in court. The work is inevitably gruelling, and being alone with the victim and one crisis worker for long stretches can be quite isolating. Even after several years with the unit, Carol is still occasionally shocked by "the callousness of human nature", constantly "being exposed to the horror of what humans can do".
"If you were emotionally moved by every case, you would be no help to anyone, so you develop coping mechanisms but it's not always possible," she says. "Gang rape is particularly hard. You can understand that there are individuals who are just nasty pieces of work or who have their own mental health problems, but when you have a group of people, you wonder why none of them stood back and said: 'This is wrong.' We see that on a regular basis."
Staff here have a good sense of why rape cases still do not result in as many successful prosecutions as they should. When cases rest on consent, pitting one person's words against another, with no witness to support either side, then even the most expertly gathered forensic evidence may not secure a conviction.
Sharon Scotson, a DCI with Greater Manchester police, who works with Sarc to try to increase the prosecution rate, says victims need to be handled sensitively right from the start. "If you don't get it right in the first instance – if you don't secure evidence, get witnesses, gather CCTV, if the victim is not dealt with properly the first time – then you could lose an investigation," she says. "If the police officer says, 'Well, why did you do that?' then the victim will be lost straight away."
Part of the problem, she concedes, is that successful campaigns have helped police officers shed preconceptions about rape and sensitised NHS staff in handling these cases, but the general public – from which juries are drawn – remain ill-informed, and so cases will be lost.
"It's down to 12 members of a jury, who will have their own preconceived notions," she says. "We have to rely on our victims being able to vocalise, to be able to justify themselves: 'Why didn't you scream, why didn't you run away, why didn't you defend yourself?'
"The victim has to prove that something has happened to them. If you have had a burglary, you don't have to prove that you have been burgled. People tend to believe you."
Alison Barber, a detective sergeant who heads a rape investigation unit in Manchester, adds: "That's why it's so important to have specially trained police working with Sarcs. The victims who come to speak to us are believed, 100%, and it's our responsibility to gather the evidence and put their case before the courts."
A lot of cases are dropped by the Crown Prosecution Service before they get to court because it judges that there is not a "reasonable chance of conviction". If the victim is classified as "vulnerable" in some way, Home Office research suggests that the chances of conviction drop further. The Manchester Sarc's own analysis shows that the majority of the 1,000 or so women, men and children who visit the unit every year have some kind of vulnerability.
"I've seen everyone, from a prominent member of a political party down to an alcohol- and drug-addicted sex worker, but certain groups are over-represented," the unit's clinical director Dr Catherine White says. "People with mental health problems, alcohol problems, learning difficulties, children in care. That's obvious: predators are going to target the vulnerable. It is like a lion with a herd of gazelles . . . they are going to pick off the weakest. When we did an audit, 55% [of the people seen by the unit] were classified as vulnerable in some way."
She agrees that the women who come in are often inclined in the first instance to blame themselves, and are surprised at the way they've handled the situation. "We explain that just because you flirt with somebody, that doesn't mean you want anal sex in the public toilets down the road 10 minutes later," she says. "Also, people in stressful situations don't always manage to do what they'd like to do. Even if it's just an argument with your boss, you never think of the killer putdown line until later on. You always think, I should have said this or done that. You don't think of it until later."
Bernie Ryan, the centre's manager, would like to see more prosecutions, but she concedes that it's not always the best thing for the woman. "We always have to ask ourselves: 'If it happened to me, who would I want to tell?' If the perpetrator was my best friend's husband I might decide to tell nobody," she says. Still, she believes there is evidence to suggest that more cases are going to court than ever before across Manchester, estimating that the conviction rate there is around 68%, slightly higher than the national average.
The last government was committed to increasing the number of Sarcs across the country, in line with recommendations set out by Baroness Vivien Stern, who published an independent review into how rape complaints are handled just before the election. Campaigners have been alarmed by signals from the new government, with its early announcement of anonymity for rape defendants (only reversed earlier this month, after widespread fury), and there was further dismay at a decision by home secretary Theresa May to cancel an inquiry into what lessons could be learned from flawed police handling of the John Worboys and Kirk Reid rape cases (a London taxi driver and a chef and children's football coach who were both, separately, allowed to rape and sexually assault multiple victims before being caught).
A Home Office spokesman would only comment: "The government remains committed to ensuring every victim has access to the dedicated medical and support services they need to help them through their ordeal."
But Stern recently voiced concern that her recommendations would be ignored in the rush to find services that could easily be cut. "It would be very, very sad if we went back to the bad old days where rape victims were dealt with by untrained police and when they need a forensic examination they wait for hours in the custody suite for a police surgeon. We don't want to go back to those days," she said in a BBC interview. "Rape victims must not be forgotten."
Ryan says she would be "foolish not to be concerned" about future funding, but for the moment she is optimistic that their work is too valued to be lost.
In the children's room, where an effort has been made to cheer the atmosphere up with framed photographs of jelly babies and pink-iced cupcakes, Joanne Muccio, a child advocate, has been preparing a 13-year-old for a doctor's meeting and counselling. The girl was raped about two months ago by a family friend. She reported it a few weeks later and a test showed that she had been infected with chlamydia. It's too long ago for any forensic evidence to remain (a week is the outside limit), but the meeting will focus on offering support to the mother, who is very distressed, counselling the girl and discussing the legal process.
"If it's a child, I always ask them first: Do you have a loud voice? Do you know how to shout? You just shout, 'I don't want to do that, Joanne!' if you don't want to do anything," she says, anxious to ensure that a physical examination never echoes the original assault.
Downstairs in the examination suite, the doctor has finished collecting evidence from the 18-year-old who was raped in the night, and she has fallen asleep on a sofa in the room next door, waiting for the policeman to finish sealing up the evidence bags and drive her home. The doctor has found a scratch on the inside leg. "That doesn't show that it was forced, but there is more likely to be an injury if it is; the evidence would suggest that if you have an injury it is more likely to have been non-consensual. Still, most of the people we see don't have any injuries. Even if you have never had sex before it's quite likely there won't be any injuries. People don't realise that," she says.
The patient was not overtly distraught, the doctor says. "She was pretty exhausted. She said, 'I feel dirty,' which is what many say. Very few are overtly distressed by the time they get here. Very few are desperately, desperately upset. They feel they just have to keep on going. We do laugh and joke. The crisis worker will be there, on the side of the bed, holding her hand."
She thinks the case will hinge, as many cases do, on consent: "I just gather the evidence. I can't judge because I don't know the full story." The girl plans to press charges, but a formal police video interview will not be done until the following day, to allow her to get some sleep. The police officer hopes her resolve will not waver.
"Rape is one of the hardest offences to prove. That's the problem. A lot depends on how the victim comes across in interviews, how they come across on the stand, as to how the jury takes it," the officer says.
"You sometimes wish they would report, but knowing what happens when they go through the justice system you can understand why so many don't," the doctor says.
Even those who do not go on to report a rape will receive support from the staff for several weeks if they want it. White says the impact of their work is often visible in the demeanour of the woman as she leaves the unit. "The person who walks out two or three hours later is hugely different to the one who walked in. They might well be smiling. You treat them like human beings. It is part of the healing process," she says.
http://www.guardian.co.uk/society/2010/nov/25/rape-sexual-assault-referral-centre
