Nurses can help prisoners open up about sexual assaults
Sexual assaults in prison are hidden and underreported, as the Howard League for Penal Reform pointed out in a 2014 report on coercive sex in prison.
Many prisoners who have been victims of sexual assault experience similar feelings to those who have experienced sexual abuse outside the prison setting. The feelings of shame, self loathing, worthlessness and loss of control are magnified and intensified in a custodial setting, with many people seeing no means of escaping their abusers and their situation. They are often terrified of reporting the abuse and assault for fear of reprisals from their attacker and, in the experience of a recent young man I have been working with, fearful for reprisals against family members if he ‘grassed up’ his abuser.
It is difficult to imagine the stress and pressure that these often vulnerable people are under in these situations and this often can manifest itself in a deterioration in both mental and physical health.
Gay and trans prisoners have been identified at being of high risk of sexual assault and coerced sex, and nurses need to be aware of this when conducting their reception interviews when people come into the prison setting. The vast majority of sexual assaults are perpetrated on men. Of the 169 sexual assaults reported in 2013, only four were reported by women prisoners. Prisoners with learning difficulties and those with mental health problems have been identified as being vulnerable to sexual assault.
We need to be aware that men find it very difficult to talk about what has happened to them due to the common myth around male sexual assaults, in that ‘real men should be able to defend themselves’ and the difficulty men have in identifying themselves as victims. Nurses are often seen as helpful and approachable by prisoners in comparison to discipline staff and are in a key position to spot signs of both mental and physical ill health and offer support.
Taking these ideas and feelings into account, it is little wonder that victims of sexual assault are reluctant to talk about it and disclose anything during their time in custody. They may display their distress in other ways such as agitation, self harm, changes in their usual behaviour and in extreme cases tipping into a psychotic state because they just cannot bear the extreme stress of their situation.
Mental health nurses need to be mindful that when someone is referred to them displaying symptoms of stress, depression or self harm and suicidal thoughts, they consider the possibility of sexual assault as part of their assessment. It is not always comfortable to ask a prisoner or patient if they have been sexually assaulted directly, but by giving them time and space to discuss their feelings, you may be able to build up enough trust for this to happen.
A great worry for people who have been sexually abused is contracting HIV and other sexually transmitted diseases. Prisoners may present to prison healthcare teams asking for testing, often in an indirect way thorough concerns about sharing needles. Again, nurses need to consider sexual abuse in this situation.
Often it is following release from prison that people will make disclosure to nurses and health staff that they have been abused in prison. I am working with one young man in the community who has been through this experience and he still cannot bring himself to name his abuser for fear of reprisals. He is suffering from post traumatic stress disorder, depression and is reliant on substances to manage his feelings. We cannot underestimate the impact the experience that sexual abuse in these custodial settings have on a person’s life and need to be vigilant to support and protect those in our care.
As nurses we need to keep the question ‘has this person been the victim of sexual abuse?’ at the forefront of our minds when conducting our assessments and giving treatment to some of the most vulnerable people in society and, when they feel the time is right, be able to ask our patients that most difficult of questions.
About the author
Mark Warren is a member of the RCN forum on nursing in criminal justice settings