Handbook on Sexual Violence (32 page)

A recent issue of
Nature
focusing on science in court highlighted how DNA-

profiling laboratory techniques have evolved further, while those used in criminal investigations have not (to the same extent at least) (Gilbert 2010). However, in another article in the same issue the authors, who are co- founders and co-directors of the Innocence Project,
6
acknowledge that compared with other forensic methods currently in use, such as bite-mark

comparisons and fingerprint analysis, DNA profiling has been proved to reliably and accurately demonstrate a connection between evidence and a specific source (Neufeld and Scheck 2010). While there is clearly a need to develop the DNA profiling techniques used in criminal investigations, it remains the most reliable and efficient tool in the rape investigator’s kit.

One consequence of the efficacy of DNA profiling is a shift in the kind of

cases investigating officers need to build. If DNA evidence is available then IOs can be confident that they can prove sex took place. The challenge has now become proving that consent was not given. There is always a need to identify the suspect in a rape investigation and before the advent of DNA evidence, the defence case was often based on challenging the identification of the suspect. This identification or links to the crime would invariably be through visual identification, admissions made by the suspect or some other form of forensic evidence, such as fingerprints or trace evidence. All of this evidence is still available and widely used; however, given the prominence of DNA they may become sidelined. As Rook and Ward (2004) emphasise though, in their widely used book on sexual offences law and procedure, ‘obviously DNA evidence (and the random occurrence ratio) needs to be put in the context of all the other evidence in the case’ (Rook and Ward 2004: 600). The value of fingerprints in interpreting crime scenes and providing

corroborative evidence comes under the remit of a specialist Sexual Offences Development Team
7
(MPS 2010). Fingerprint experts can often provide evidence of suspects’ or victim movements at a crime scene that can prove compelling.

Although DNA evidence is sometimes challenged this is unusual. Strong identification evidence is more likely to lead to challenges focusing on the victim’s account and the issue of consent. This is often a traumatic experience, likened in some research to a ‘second rape’ (Koss 2000; Orth 2002). However, it is also possible that the provision of clear scientific evidence can lead to a plea of guilty being entered, which means the victim is not required to give evidence. No research has been conducted that allows estimations to be given about the frequency of guilty pleas or challenges to the victim’s account but it is worth mentioning here that there are growing concerns about the so-called ‘CSI Effect’, based on the prevalence of popular television shows where forensic evidence is at the heart of every case (see for example Desmarais
et al
. 2008; Houck 2006; Lovgren 2004; Tyler 2006). This has led to the public and juries having a distorted view of the value of scientific evidence with the perception of ‘near-infallibility’ scientific evidence and the availability of instant results (Rincon 2010). In fact in some rape cases the forensic evidence can lead to emphasis being focused back on the behaviour of the victim.

Sexual assault referral centres

A major challenge for investigators of serious sexual offences has always been the lack of suitably qualified female forensic medical examiners (FME). Research into victims’ needs in the aftermath of rape has consistently found that they want to be examined and supported by women practitioners (Schonbucher
et al
. 2009), and perhaps most fundamentally be seen and treated as whole persons (Kelly
et al
. 2005).

In the London area, and across most of the UK, in the 1980s and 1990s, when a victim of serious sexual violence reported to the police there was no guarantee that they would be examined by a female doctor. When female police FMEs were available, victims could be asked to wait for long periods of

time or travel long distances for the examination. The lack of suitably trained female doctors not only frustrated investigations but also adversely affected care of victims. Examinations took place in victim examination suites (VES) that were on police property. The suites were maintained by police staff and replacement clothing was often obtained by well-motivated police officers securing ‘charitable’ donations. If a victim required medical treatment such as medication for potential sexually transmitted infections or other infection, then police officers were required to take the victim to an accident and emergency medicine sites or a genito-urinary medicine (GUM) clinic. Emergency contraception had to be obtained through normal health service channels. The medical and legal responses to rape were lacking and a radical change was needed (Lovett
et al
. 2004).

The solution to the problems outlined in the previous paragraph was the adoption and amalgamation of models used in America, Australia and Canada to provide victim care combining crisis intervention, high quality forensic practice and advocacy (Lovett
et al
. 2004). In the UK these are known as sexual assault referral centres and are usually based in hospitals. SARCs are one-stop shops where victims of recent rape and serious sexual assaults can receive medical care, counselling, and support police investigations by, for example, undergoing a forensic medical examination with the option to formally report or provide anonymous intelligence. What seems to be clear, both anecdotally and from research, is that specialist provision such as that provided by SARCs is key to ensuring victims do not experience ‘secondary victimisation’, diminishes poor practice and increases service use (Brown
et al
. 2010a; Campbell 2008; Sampsel
et al
2009).

The development of SARCs across the United Kingdom has been slow. The first was opened in Manchester in 1986 (St Mary’s) and two further SARCs were established in the 1990s, in Northumbria (Rape Examination Advice, Counselling and Help – REACH) and West Yorkshire (Surviving Trauma After Rape – STAR). In September 2007, there were 18 SARCs operating in England and Wales and a pilot centre in Glasgow (Coy
et al
. 2009). Despite the pledge to establish 40 SARCs in England and Wales by the end of 2008 (made in the Westminster Government’s
Action Plan on Sexual Violence and Abuse
, HM Government 2007), Coy
et al
.’s (2009) analysis of service provision identified only 26.

This
chapter focuses on the evolution of SARCs in London. By 2000 the lack of provision of essential services in London was developing into a critical issue. A commitment was made at a senior level within the MPS and health services to work in a true 50/50 partnership, and develop a service that offered the highest standards of clinical care combined with forensic evidence gathering. The SARCs in London are known as the Havens (www.the havens.co.uk).

In contrast to the pioneering three SARCs opened in the 1980s and 1990s the establishment of the London Havens was the first where the police and the National Health Service shared the cost equally, thus providing a demonstrable commitment to joint partnership working. In 2000 London opened its first Haven at Kings College Hospital, Camberwell, South London. This was followed in 2004 by two further Havens in Paddington and Whitechapel. The doctors in the new SARCs were specially selected from

practitioners with experience mainly in genito-urinary, obstetrics and gynaecological medicine. They were chosen for their people skills and focus on victim care and in addition were provided with forensic training. The doctors work as part of a team and are subject to supervision in the form of peer review and NHS clinical governance. Where police officers would sometimes wait beyond a day to find a female doctor, the Havens aim to offer an appointment within one hour of referral.

There are a number of benefits for investigators when accessing a SARC. All staff are trained and focused on providing the best possible service for victims of serious sexual violence. When a victim arrives at a centre with an STO they are met by a crisis worker. The crisis worker then works with the sexual offences examiner (SOE) to ensure that the victim receives the highest levels of medical treatment and support available. The examinations take place in medical suites that have forensic integrity to ensure that there is no cross contamination of trace evidence. The Havens provide immediate access to emergency contraception and antiretroviral drugs and testing, health advice and counselling for sexually transmitted infections (STIs). In the past this would have entailed untrained police officers visiting emergency pharmacies and then taking victims to emergency medicine units and sexual health clinics. These changes have significantly improved a victim’s experience of reporting rape and in turn have improved police investigations (Against Violence and Abuse 2010). Specifically when the care of the victim is handed over to the healthcare professionals the STO can spend time updating the investigating officer, passing on information that may assist with developing a forensic strategy, and also ensuring that any potential risks to the victim are reduced. Furthermore, within London, the Havens are linked to the internal police computer network.

One unique element of the SARC service is the availability of the ‘non- police referral’ option. This allows victims to report directly to a SARC without first contacting the police. They have the choice of being forensically examined and having swabs taken. They can then choose to have the samples passed to the police anonymously to be analysed and checked against the national DNA database. If analysis results in a match, the SARC client is notified by their crisis worker and they can choose whether to formally report to police. If the client wants to remain anonymous then vital intelligence has still been gathered by the police. Access to this service is quantifiable: in London ‘non- police referral’ cases account for approximately 10 per cent of Haven clients. During targeted awareness campaigns, the number of ‘non-police referrals’ has risen to 20 per cent (Yexley 2009a). The advantage of the SARC service is that these cases would never have been reported to the police in the past and many offenders would still have been at large. A significant proportion of these people subsequently go on to report to the police, but even if they choose not to, their medical and psychosocial needs are still addressed through the provision of the SARC.

Earlier in this
chapter we mentioned the key role played by STOs. In London the Havens offer an ‘STO clinic’, where Haven clients can speak in confidence to an STO about reporting to the police and the criminal justice process. The clinics were set up to allow Haven clients to speak to a police

officer anonymously about what is likely to happen if they were to report a case to the police. Officers can talk through the process of providing a statement, the case being reviewed by a prosecutor and the possibility of applying for special measures.
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Seeing a police officer in a caring and

supporting role can have a very positive impact on a Haven client. There is no obligation to report to the police but the clinic has had significant successes in increasing reporting rates. The manager of the Haven, Whitechapel, commented on the successes of the scheme: ‘We have a weekly STO clinic, when a victim can speak in confidence to a specialist officer about what would happen if they did report . . . Around 60 per cent of people who do that do go on to make a formal allegation. So that is very encouraging that the approach is working’ (Metropolitan Police Service 2009a: 9). The establishment of STO clinics was also identified as good practice in Baroness Stern’s review (2010). SARCs have been identified as good practice in a number of reports because they improve victim care, which in turn can lead to victims continuing to support an investigation, from report to court, and provide a better standard of forensic evidence (HMIC and HMCPSI 2002; HMCPSI 2007). Further, there has been a small number of studies in the UK evaluating SARCs which overwhelmingly find their services to be valued both by victims and the police (Lovett
et al
. 2004; Payne 2009; Regan
et al
., 2008; Robinson 2009; Schonbucher
et al
. 2009). For example, the recent evaluation by Schonbucher
et al
. (2009) used a multimethodology approach, combining quantitative and qualitative data, and this design ensured that baseline and more in-depth data were collected from diverse perspectives, including: service users; service providers; and stakeholders. Service users were found to be highly satisfied with the SARC and commended the care, sensitivity and respect with which they were treated. The evaluation team concluded that the SARC ‘undoubtedly improved immediate response to, and aftercare of, victims of sexual assault and may be making an important contribution to reducing attrition’ (Schonbucher
et al
. 2009: 10). Despite all of these endorsements, more systematic evaluations of SARC services are required and, perhaps more importantly, access to such specialist services is limited by under-resourcing of sexual violence services in

the UK (Coy
et al
. 2009; Women’s Resource Centre and Rape Crisis 2008).

The commitment of the police service to funding healthcare beyond the immediate retrieval of forensic evidence demonstrates the most significant steps forward in a victim-focused approach to crime investigation. This recognises that a positive outcome for a victim of sexual violence does not always rest with a criminal justice outcome, but also with positive physical and mental health outcomes. This in turn places responsibility for victim care within the remit of health services as well as police. The most effective and sustainable way of maintaining and developing SARC services for victims of serious sexual violence is promoted in the Stern Review: