COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

Draft Sexual Violence Strategy

Thursday 28 June 2007

Members present for all or part of the proceedings:

Mrs Iris Robinson (Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Tommy Gallagher
Mrs Carmel Hanna
Mr John McCallister

Witnesses:

Mr Leslie Frew }
Mrs Marian McIlhone }Department of Health, Social Services and Public safety
Mr Colin McMaster }

The Chairperson (Mrs I Robinson):

I welcome our witnesses from the Department of Health, Social Services and Public Safety (DHSSPS): Mr Leslie Frew, the Department’s director of mental health; and Mrs Marian McIlhone and Mr Colin McMaster from its sexual violence unit. As with today’s previous two evidence sessions, the witnesses will give an initial 10-minute presentation.

Witnesses, you are very welcome. The Committee looks forward to hearing your presentation, which is on a fairly emotive issue, and one that is, unfortunately, making headlines too regularly.

Mr Frew, you have 10 minutes to make your presentation — either by yourself or in tandem with your colleagues. After that, we will have approximately 40 minutes for questions.

Mr Leslie Frew (Department of Health, Social Services and Public Safety):

Thank you very much. You may not be able to hear me, as the acoustic is not very good.

The Chairperson:

It is not the best.

Mr Frew:

If you cannot hear me, let me know, and I will shout as loudly as possible. The Minister of Health, Social Services and Public Safety, Mr McGimpsey, has sent the Committee a copy of the consultation paper, ‘Hidden Crimes, Secret Pain’ so this is an opportunity for the Committee to add its comments to that document.

The proposed strategy had its beginnings a couple of years ago. It was clear at an early stage that, although there are many Departments, agencies and service providers whose work impacts directly or indirectly on victims and survivors of sexual violence, there was no comprehensive framework through which that work was planned or supported. Nor, indeed, was there any regional context in which to establish whether the range of services that the statutory and voluntary sectors provided were delivering the intended outcome of meeting the needs of victims.

It was agreed that the way ahead lay in a collaborative approach with those Departments responsible not only for healthcare but for the legislative framework, the investigative and criminal-justice mechanisms, community safety, education, gender equality, benefits, and other support systems. It was also agreed that the strategy should address the needs of people who had suffered either historical or recent sexual victimisation and should include the needs of children.

An interdepartmental steering group on sexual violence was established in February 2005 to develop the strategy. The steering group was chaired jointly by the DHSSPS and the NIO — I was one of the group’s joint chairpersons along with Adrian Arbuthnot of the NIO. As well as the various Departments, the group’s membership comprised several representatives from the health and social services boards, the Police Service of Northern Ireland (PSNI), the Public Prosecution Service (PPS), the Court Service, the Prison Service, the Probation Board, the Youth Justice Agency and the Office of Law Reform — all the players with an interest in the matter.

The steering group’s terms of reference are explained in the document that we have provided for members of the Committee. They are:

“To oversee the development of a comprehensive regional framework for addressing sexual violence which will guide policy and service responses from our healthcare, education, criminal justice and support systems to ensure that they: meet the needs of victims/survivors; encourage the reporting of offences; focus strongly on prevention; tackle issues affecting the successful prosecution of cases; maximise the accountability of perpetrators; promote awareness; and challenge social attitudes.”

As members can see, the strategy is designed to develop around three key themes: prevention; protection and justice; and support. In developing the strategy, the steering group established a number of general principles that we wanted to see applied. We adopted an approach that made it possible to regard sexual violence as preventable, and something that we could do something about.

The group wanted to develop ways in which to assess the needs of victims and survivors, and to take those needs into account with the implementation of policy and practice. That seemed like a common-sense approach. We wanted to put arrangements in place that would ensure that the statutory and voluntary sectors worked together to best effect — the collaborative approach to which I referred earlier.

The steering group held several pre-consultation workshops involving health and personal social services (HPSS) groups, voluntary organisations that work in the area of sexual violence, and survivors of sexual violence, their families and friends, and other interested parties. The workshops gave us a good base from which to develop the consultation document. All that culminated in the document containing the strategy for addressing sexual violence, ‘Hidden Crimes, Secret Pain’. It was issued for public consultation at the end of January 2007, and it makes 12 key proposals, which include: the production of a directory of current services for Northern Ireland; a multi-agency training plan; and a comprehensive study to help understand the extent and nature of the problem of sexual violence. The consultation paper also confirms that a sexual-assault referral centre (SARC) will be set up in Northern Ireland.

The consultation period ran from the end of January until the end of April. The Department wanted to be proactive so, during that period, it held several events throughout the Province to provide opportunities for the public to respond. Voluntary and community organisations also ran some events and responded on behalf of their clients. The Department has received 49 responses to date, and the Committee has received copies of those.

The next step is for the Department to publish a summary of the responses to the consultation — of which the Committee has a draft — and it hopes to do so by the end of July. That summary will include all the responses and will be published on the Internet. The Department will draw together a final document, taking account of all the responses, and will devise an action plan in conjunction with the voluntary and community sectors. We intend to publish that around November 2007. We expect the associated action plan to run for about 18 months from the end of this year until the middle of 2009. That plan will detail short-, medium- and long-term actions that the Department believes should be taken.

The Department is already acting on some proposals. For example, it is trying to make progress on key proposal 1, which deals with research into the prevalence of sexual violence. It is also commissioning a review of counselling services for victims.

I will say a few words on the statistics, because the Committee may wish to return to that matter. I wish to emphasise that, at present, there is no robust way in which to estimate the real scale of sexual victimisation in Northern Ireland. Without a baseline from which to work, it is difficult to plan medium- to long-term measures that are geared towards prevention and protection and the development of good support services.

Those cases of sexual violence that are reported to the police may represent only the tip of the iceberg. The Department estimates that between only 5% and 25% of incidents are reported.

The Department has established a project team to examine the setting-up of a SARC. It is envisaged that that will be a new regional facility, which will be part of the new health and social care authority, if that authority is established. Dr Olive Buckley, who is a GP from Carrickfergus, chairs the project team, which includes representatives from the police and health estates, together with healthcare professionals and members of the voluntary sector who are involved in providing services.

That is the end of my summary, Madam Chairperson, and I am happy to answer questions or further clarify points.

The Chairperson:

From a personal point of view, and from having listened to ‘The Stephen Nolan Show’ and ‘Talkback’ on the radio, I believe that the most frequent accusations about sexual attacks on children in Northern Ireland, which we are warned occur mostly in families, is that not enough is done for the victim and that the sentencing does not fit the crime. Perhaps Mr Frew can give the Committee his views on that. The overarching view seems to be that the public have lost hope in expecting the judiciary and police to tackle the issue of sexual attacks on children. The police do their best to catch the culprits, but it seems that the system fails the victims when they go to court.

Certainly, the people with whom I deal in my advice centre have voiced their disgust at the inappropriateness of the length of time that perpetrators serve. The period that they have been held on remand is taken off sentences, and then there is 50% remission. Sentences are a joke, and people do not have any faith in how culprits are handled. Perhaps, you could tease out that issue.

Mr Frew:

No NIO officials are present, and we would not feel competent to speak on issues such as sentencing, except in general terms. We are happy to take any questions to the NIO, and its officials would be happy to provide any data that the Committee would find beneficial.

From a health point of view, the Department wants to ensure that the strategy identifies victims’ needs. The consultation is taking place so that victims can tell the Department exactly what their needs are, in order that those needs can be taken into account and services can be co-ordinated accordingly. At present, as the Committee will appreciate, many health services are available, such as counselling and accident-and-emergency units, to deal with cases. Forensics are also involved. Therefore services are available, but they must be better co-ordinated.

Awareness must be increased so that professionals working in particular areas, such as health, voluntary services, and protection and justice, can be well attuned to cases’ sensitivities, be supportive and have a clear view of the services that are available. Many of them probably do not have clear service literacy. That will be the benefit. I have emphasised words such as “collaborative”, as well as the need to take preventative measures. More of that kind of action must be taken.

Of course, the big challenge is societal — to get communities not to take it as read that some inappropriate sexual behaviour is OK. That attitude must be changed. Through the domestic violence strategy, action has been taken to raise awareness among the judiciary of sentencing and of how to handle victims in court in order to increase sensitivity. Many of those lessons can be applied to sexual violence cases. The Chairperson is quite right: it is disappointing that, even when cases go to court, perpetrators are not adequately dealt with. The Department hopes to introduce positive strategies to deal with perpetrators. Marian may be able to add to what I have said.

Mrs Marian McIlhone (Department of Health, Social Services and Public Safety):

The Chairperson’s point is one of many that were raised during the formulation of the strategy. Many of the issues pertain to the criminal-justice system as it affects victims and their families. With the proviso that I am not an expert on the criminal-justice system, a key proposal is that a full, end-to-end examination of the process will be carried out by Kit Chivers, the chief inspector of criminal justice for Northern Ireland, to consider the multitude of issues that occur, including sentencing, which is only one end of the process. However, before that stage is reached, a raft of issues must be dealt with in order to improve outcomes for victims and their families.

The Chairperson:

Victims must endure so much during a trial, such as having to give evidence. They are then faced with a double whammy when they see the perpetrators walking the streets a short time later. The question of remission must be examined. It could be removed completely in order to act as a deterrent, so that when someone serves time, they serve the full time. That would give victims some comfort. That is my view, and one that, I believe, many people would hold were a poll taken in the public domain.

Dr Deeny:

Thank you, Madam Chairperson, and thank you, Marian, Leslie and Colin. The problem of sexual abuse is awful and it seems to be getting worse in developed countries. I concur with the Chairperson that there must be a deterrent, although that is probably not in the remit of medical people.

As a society — although the problem is not just confined to Northern Ireland — we are medicalising too many issues. In America, there is a new condition named intermittent explosive disorder (IED): if people beat up their wife or husband often enough, they fulfil the criteria to be diagnosed with the condition. Unacceptable and illegal behaviour is being medicalised, which concerns me, as a doctor.

Last week, I mentioned that, across the water, there were recommendations that some paedophiles should be given medication. That leads to a public perception that such conditions can be medically treated. There is a danger in medicalising abhorrent behaviour that should be punished. It concerns me, as a doctor, that everyone seems to think that the medical profession can deal with such matters. Medical professionals cannot be expected to sort out all society’s problems.

Counselling is extremely important for victims. The Committee will help in any way that it can to ensure that counselling is in place for those who have been harmed and victimised as a result of sexual abuse.

What do the witnesses think about the role of the media? The media are sensationalist and hype matters. Why not use the media in a constructive way so that we can tackle and try to prevent sexual abuse?

Collaboration with the education sector, through schools, is important. As the Chairperson said, sexual abuse leads to awful situations and destroys families, and all family doctors have seen the consequences of that. If children have access to information in schools and are made more aware of the issue, victims of sexual abuse may be able to broach the subject earlier, rather than let a situation get worse over years.

Do you believe that we are in danger of medicalising such abhorrent and illegal behaviour? Is that the direction in which society is going? Do you agree that schools and the media can play a constructive role in preventing this awful problem?

Mr Frew:

Those are points that I echo. We want to ensure that the behaviour behind sexual abuse does not become a health issue. In many aspects of life, including mental health, there is a tendency to think that such issues are for the Department of Health, Social Services and Public Safety to deal with. That is why I said that the Department wants a collaborative approach. The key to prevention lies in education.

I agree with Dr Deeny about the media; proper media campaigns have been shown to change societal attitudes; trying to ensure that the press handles stories of sexual abuse in a more positive and less sensational way is also important. Progress has been made, for example, in the coverage of suicides. Therefore there are lessons that we can learn.

The Department must keep working on a collaborative approach. Education is vital in deeming what is and is not acceptable behaviour. The Department acknowledges all the points that have been raised and wants to address them, although that will not be easy and will take time. We must make sure that we do not medicalise unacceptable behaviour.

Mrs Hanna:

I agree with my colleagues about deterrence and that the criminal justice system does not deal with the problem of sexual violence adequately. Those are big, challenging societal issues. It is difficult to understand the relationship between victims and perpetrators.

Has sexual violence on TV and video been deemed to have an effect? Has the revised curriculum addressed those concerns?

Mrs McIlhone:

Not specifically, but as Dr Deeny said, education is a medium for increasing awareness, particularly among young people and students of all ages. Education will be a big factor when considering proposals for the draft strategy. It has not yet been decided whether such awareness education will be delivered by teachers or by others who already carry out awareness education in schools.

Mrs Hanna:

If the proposed strategy is to mean anything and is to affect outcomes, awareness education must be part and parcel of it and run alongside other measures. What specific proposals to address those issues could be included in the revised curriculum?

Mr Frew:

I take those points on board. From the outset of our work, it has struck us how complex this area is, and Dr Deeny’s comments highlighted that. Even the individual components are not simple; they are all desperately complex, and we do not pretend to have the answers. However, we want to produce short-, medium- and long-term action plans that will grow and change, and we want to use them to challenge the Government and other providers to address some of the issues in a way that will produce meaningful outcomes. I hope that our research will answer your questions and show us which buttons to press, so to speak.

Mr Gallagher:

I note that about half the victims of sexual assault in Northern Ireland are children. Given that those who are in contact with children outside the home are largely the responsibility of the Department of Education, how does the Health Department plan to work out a strategy to deal with that problem?

It will take time and resources to train teachers to be sufficiently competent to deal with suspicions that a child is being sexually abused. When developing such strategies, it concerns me that, sometimes, Departments hand over problems on the assumption that they are the responsibility of another Department. To be effective, Departments must go further. What are your thoughts on the matter?

Mr Frew:

The interdepartmental group includes everyone who holds relevant responsibility. We want to continue with that work, and that will be a key element in developing a strategy. A ministerial group may also be established, which would bring together all the Departments to play their appropriate roles.

Mrs McIlhone:

I will outline how we plan to take forward the proposals in each component part of the strategy, many of which overlap.

Specific working groups have been set up, with people from the education sector as the primary players. Voluntary and statutory sector agencies that work with children, such as the National Society for the Prevention of Cruelty to Children (NSPCC) and Barnardo’s, are also represented so that, collectively, a pool of knowledge can advise on how best to address issues. The work is done collaboratively.

Mr Buchanan:

The main proposal in the strategy was to establish a sexual assault referral centre (SARC). What stage is that development at, how is it organised and does it provide adequate geographical cover? Does sexual violence contribute to the high suicide rates in the Province and, in particular, among abused young people who have never acknowledged that abuse or talked about it to anyone?

Mr Frew:

I will deal first with your final question and then talk about the SARC.

When I became director of mental health, I was staggered to discover that nearly 50% of women who are in psychiatric hospitals say that they have had a history of sexual abuse. Although suicide is a complex issue and there is no one-size-fits-all solution to how people get to where they are, it is certain that sexual violence has a major detrimental effect on the mental health of victims. The cost to society, not only at the time of the abuse but throughout a victim’s life, can only be speculated on, but it is huge. Statistics suggest that the impact of a rape, for example, costs society £76,000. Although that is a speculative figure, I have no doubt that sexual violence has a major detrimental effect on mental health and contributes to many of the problems that people encounter in later life.

A team has been established, which is led by a GP, to consider the sexual assault referral centre. Although we want it to have a geographical spread, it should be thought of as a service rather than simply a place. A location has not yet been determined, but it must be accessible. However, it will have to outreach and collaborate with other services across the Province. It will be a region-wide service with accessible outreach.

The Chairperson:

Given that it is widely accepted that violence on television, videos and DVDs plays its part, are you in contact with people such as the director general of the BBC and his counterpart at Ulster Television and with those who manufacture and market videos and DVDs? Are such people involved in the consultation? The media have a responsibility to curtail the material that feeds minds that may commit sexual or copycat crimes. The history of the kids who shoot their peers at American universities can be traced to violent videos that they had watched.

Have there been contacts in the wider sense with people from the media, because they all have a responsibility?

Mr Frew:

That is something that we want to do; the media context is important. I mentioned, but probably did not go on to talk about, suicide, and the media are being more responsible now in how they portray that. There is a copycat element, and studies in Sweden and elsewhere have shown that if a television programme shows someone committing suicide, there will be many copycat suicides, so the media are being responsible about the matter.

We must develop codes of practice with the media, and that is probably a difficult area, given freedom of information and so forth. However, it is important to tackle the issues that you raised, and everyone has signed up to that.

The Chairperson:

There is a contradiction between political correctness on the one hand and the most violent filth that you could ever wish to see on television before the watershed on the other. With the greatest respect to anybody who is a fan, programmes such as ‘Emmerdale, ‘ Coronation Street’, and ‘EastEnders’ try to outdo one another in graphic storylines. They portray bed-hopping and sexual promiscuity to which children are exposed because they are broadcast before the watershed. Such programmes are good at highlighting certain themes and illnesses such as AIDS, but they do not deal with the main issue; they are saying, “Such behaviour is normal”. We do not hear about prevention or about having a lifelong love partner. We are getting away from moral issues and allowing — and accepting — all the less desirable activity, shall we say.

I am old enough to remember when expletives were not allowed on television. Now there is a chef — I will not name him — whose every other word is the F word. It is disgraceful that that is broadcast on television, as it encourages our children to imitate that type of language. I do not care if I am called a “Mary Whitehouse”; indeed, I wish there were more such people, and it is sad that she passed away.

So many elements feed the mentality of those who abuse a child, a woman or a man. It is fed and indoctrinated by the sort of stuff that we, as ratepayers, taxpayers and licence-fee payers, accept. There has to come a time when we say that enough is enough. We no longer know where to draw the line on moral issues — and now we are paying the price.

Mr Frew:

Those are important points about how society is becoming desensitised. I recently read an article about a campaign on road safety. Essentially, it said that people are not all that shocked by advertisements that show people suffering horrendous injuries because they regularly see similar scenes in films and videos.

The Chairperson:

That is scary.

Mr Frew:

A different approach has been developed in Australia. It is difficult for any campaign to find what is acceptable; that is what we want to change here: to find out what is acceptable behaviour.

The Chairperson:

I know that it will not happen overnight, but at least we are considering and addressing the issue and including the people who broadcast such programmes and who should bear some of the responsibility. With that moral hat on, I thank Leslie, Colin and Marian for their presentation. Thank you very much.