Literature Review – Part 2

Commissioned by The Ministry of Women’s Affairs

Authors: Elaine Mossman, Jan Jordan, Lesley MacGibbon,Venezia Kingi, and Liz Moore

For a PDF [2.4 MB], click HERE

 

Return to Responding to sexual violence research reports

   

Contents

List of Tables
List of Boxes
Acknowledgements
Executive Summary

PART ONE: Overview of adult sexual violence and good practice
1    Introduction
2    Overview of sexual violence
3    Overview and critique of good practice

PART TWO: Summary of the literature
4    Medical system
4.1    Introduction
4.2    Sources of medical care
4.3    Forensic medical examination
4.4    Follow-up medical care
4.5    Responding to the needs of diverse groups – medical system

5    Mental health system
5.1    Introduction
5.2    Crisis intervention
5.3    Post-crisis mental health care
5.4    Responding to the needs of diverse groups – mental health

6    Criminal justice system
6.1    Introduction
6.2    Police practices and initiatives
6.3    Prosecutors and the prosecution service
6.4    Specialist courts
6.5    Criminal justice system victim advocates
6.6    Statutory reform
6.7    Restorative justice debate
6.8    Responding to the needs of diverse groups – criminal justice system

7    Support services
7.1    Introduction
7.2    Specialist sexual violence services
7.3    Non-specialist sexual violence victim support systems
7.4    Community collaboration
7.5    Responding to the needs of diverse groups – support services

PART THREE: Summary
8    Good practice services for adult survivors of sexual violence

Appendix: Methodology – search criteria and sources of references
References

 

Part two: Summary of the literature

The second part of this report reviews available literature on what is considered good practice across the four main service systems, with which victim/survivors are likely to come in contact. The systems are the:

• medical system (assessment and treatment of injuries and collection of forensic evidence) (chapter 4).
• mental health system (crisis and longer term interventions) (chapter 5).
• criminal justice system (police, lawyers, judges, the court system) (chapter 6)
• community support system (specialist sexual violence support agencies and other more generic victim support services) (chapter 7).

 

Victim/survivor experiences of these systems can range from supportive, highly validating and therapeutic through to inflicting secondary victimisation. Understanding good practice within and across these systems is essential to minimising harm and maximising potential benefits for victim/survivors.

 

4    Medical system

 

4.1    Introduction

Immediately following rape there can be two differing sets of needs for a victim/survivor. They need to have any medical needs met, but also, for those who wish to bring the offender to account, there is a need for forensic evidence to be collected. The co-occurrence of these needs results in the convergence of two different systems.

• Medical system – assessing and treating health concerns.
• Criminal justice system – collecting forensic evidence.

 

These two systems both involve medical intervention and are typically addressed together in what is referred to as the ‘forensic medical examination’. There is useful coverage in the sexual violence literature on what is considered good practice in conducting a forensic medical examination. This has included who should conduct it, where it should be conducted and the conditions under which it should be conducted. A key and influential piece of work on this is the review by Kelly and Regan (2003) Good Practice in Medical Responses to Recently Reported Rape, Especially Forensic Examinations.

These immediate responses post-rape are often referred to as ‘acute post-rape care’. Responses following this can be divided into addressing short-term and longer-term needs. However, very little research was found on what was considered good practices following acute post-care, hence, for the purposes of this review the two stages have been combined into ‘follow-up care’.

The World Health Organization guidelines for the medico-legal care for victim/survivors of sexual violence identified principles that should be considered as indicators of good practice in the provision of medical services to victim/survivors of sexual violence (WHO, 2003) (see Box 4). These principles apply to all modes of delivery, and appear to be applicable to acute and follow-up care.

Box 4: Good practice principles in the provision of medical services

This section of the literature review covers:

• sources of medical care, i.e. hospital emergency rooms; primary health care
• forensic medical examination and acute post-rape care, i.e. Doctors for Sexual Abuse Care (DSAC), forensic nursing, forensic rape kits
• follow-up medical care.

 

This section does not cover the delivery of mental health needs, which is dealt with under the mental health system (chapter 5).

 

4.2    Sources of medical care

The health consequences of sexual violence are numerous and varied, and include physical and psychological effects, both short and long term. This is demonstrated in Box 5, which summarises the health outcomes of violence against women, including health outcomes of sexual violence.

Box 5: Health outcomes of violence against women

Gender-based victimisation Sexual assault Child sexual abuse Physical abuse
Non-fatal outcomes		Fatal outcomes (direct and indirect)
Physical health	Mental health
Injury Functional impairment Physical Poor subjective health Permanent disability Injurious health behaviours Smoking Alcohol and drug use Sexual risk-taking Physical inactivity Overeating Functional disorders Chronic pain syndromes Irritable bowel syndrome Gastro-intestinal disorders Somatic complaints Fibromyalgia Reproductive health Unwanted pregnancy Sexually transmitted infections (including HIV) Gynaecological disorders Unsafe abortion Pregnancy complications Miscarriage/low birth weight Pelvic inflammatory disease	Post-traumatic stress Depression Anxiety Phobias/panic disorders Eating disorders Sexual dysfunction Low self-esteem Mental distress Substance abuse disorders	Femicide Suicide Maternal mortality AIDS-related

Source: Adapted from M. C. Ellsberg and L. Heise (2005) Researching Violence against Women: a practical guide for researchers and activists. Washington DC, United States: World Health Organization, p. 23.

 

In the United States, a third of female (32 percent) and 16 percent of male victim/survivors of rape were physically injured; of those women who were injured just over a third (36 percent) said they had received medical treatment (Gonzales, Schofield and Schmitt, 2006).

In New Zealand, those victim/survivors who access medical care will do this through either a hospital emergency department or a primary health care service.

4.2.1    Hospital emergency rooms
There are no statistics available on what proportion of victim/survivors are treated in hospital emergency rooms in New Zealand, but at least some are referred there for forensic medical examinations or because of emergency acute post-rape medical needs.
International literature on sexual violence identifies that there are specific problems with this context that limit the victim/survivors having their needs met (Kelly and Regan, 2003; Logan, Cole and Capillo, 2007). Irrespective of whether the attending physicians have been trained or are experienced in treating victim/survivors of sexual violence, emergency rooms present difficulties, including:

• delays as patients with physical injuries are prioritised; studies indicate around 70 percent of sexual violence victim/survivors show no obvious serious physical injury (Cantu, Coppola and Lindner, 2003, Deming, Mittleman and Wetli, 1983, Marchbanks, Lui and Mercy, 1990)
• lack of privacy
• lack of facilities for changing, showering and making phone calls
• lack of counselling and support services
• a reluctance of attending doctors to be involved in the court process following their examination of the victim/survivor (Logan, Cole and Capillo, 2007).

 

Box 6 lists the recommendations for good practice for victim/survivors of sexual assault following a study of hospital emergency rooms in New York (Fry, 2007). These recommendations were based on comments provided by victim/survivors.

Box 6: Good practice recommendations for hospital emergency rooms

Note: There is debate as to whether tests for sexually transmitted infections should happen at the initial examination or be delayed until a follow-up consultation with appropriate counselling (Ackerman et al., 2006).

 

4.2.2    Primary health care
Primary health care is typically delivered through community-based medical centres by a local general practitioner, Family Planning or Sexual Health Clinics. These medical centres can provide acute post-rape care, and longer-term and/or follow-up care. These groups provide health care to the majority of victim/survivors who require medical care but do not wish to report their sexual assault to the police. They can also be the venue for forensic medical examinations for those victim/survivors who do report to the police (Beckett, 2007). Forensic medical examinations are covered in section 4.3.

Very limited literature was located about primary health care service providers working with victim/survivors of sexual violence. The Family Violence Intervention Guidelines: child and partner abuse (Ministry of Health, 2002), whilst not specific to victim/survivors of sexual violence, are relevant due to the overlap between rape and domestic violence. They were developed as a practical tool to assist health providers to work safely and effectively with victims of violence and abuse. The guidelines recognise the valuable role health care providers can play in the early intervention and prevention of family violence, as victims of abuse seek health care more often than individuals who have not experienced abuse. They cover the appropriate conditions for conducting an interview (e.g. for partner abuse – questioning about violence should be conducted in private) and outline a range of good practice guidelines for health care consultations.

Astbury (2006), based on experiences in Australia, reviewed appropriate treatment for victim/survivors of sexual violence in the primary care setting. Considering that the majority of victim/survivors who seek help access primary health care services rather than specialist sexual assault services, Astbury suggested the lack of research in this area was a concern.

In her review, Astbury does not distinguish between acute post-rape care and follow-up care. She points out that, as primary health care providers have been trained to develop expertise in the diagnosis and treatment of ill health, when they provide treatment plans and give advice, they expect clients to adhere to those plans and advice, with patient compliance being a primary goal. Astbury raises concerns that this approach could be counterproductive with victim/survivors as it mimics the controlling behaviour of the perpetrator. She also asserts that the range of physical examinations that general practitioners routinely engage in (particularly gynaecological examinations) have the potential to cause secondary victimisation (Astbury, 2006).

Box 7 lists some of Astbury’s (2006) recommendations for generalist primary health care providers who are working with victim/survivors of sexual violence or sexual assault. Her recommendations are based on the limited research that was available.

Box 7: Good practice recommendations for primary health care providers

4.3    Forensic medical examination

In New Zealand it is estimated that one in ten victim/survivors of sexual violence report to the police (Mayhew and Reilly, 2007), and many of those who do are likely to require a forensic medical examination. As noted above, these victim/survivors can be referred to either a hospital or a primary health care facility, as per regional police protocols (Beckett, 2007). At either location, the forensic medical examinations will be performed by a specialist sexual assault doctor (most often a Doctors for Sexual Abuse Care–trained doctor).

4.3.1    Doctors for Sexual Abuse Care
Until the late 1980s, in New Zealand it was usual for forensic and medical examinations of sexual violence victim/survivors to be undertaken by a police surgeon, sometimes in a police cell (Jordan, 2001). Concerned doctors formed a professional organisation, Doctors for Sexual Abuse Care (DSAC), with the specific aim of ensuring the maintenance of internationally recognised standards of best practice in the medical and forensic management of sexual assault (DSAC, 2006). These doctors provide medical care for child and adult victim/survivors of sexual assault in New Zealand.

DSAC provides a range of victim/survivor services, including the provision of education and training programmes; liaison with allied organisations, such as the police and Crown prosecutors; accreditation (in conjunction with the police) for doctors trained in forensic examinations; as well as publishing and regularly updating a comprehensive medical manual, The Medical Management of Sexual Assault, which is in its sixth edition (DSAC, 2006).

In addition to performing forensic medical examinations, DSAC-affiliated or -trained doctors also provide specialist sexual abuse medical care for child and adult victim/survivors as required (regardless of whether the sexual violence has been reported to the police).

DSAC-trained doctors are on call-out throughout most of the country to perform forensic medical examinations. The preferred practice is for a victim/survivor to be referred to a support agency by the police and for a medical examination to be undertaken at a clinic by a female DSAC-trained doctor (Jordan, 2001).
In New Zealand there is some confusion over the role of DSAC-trained doctors. DSAC has identified four functions of a forensic practitioner (doctor or nurse) with regard to adult sexual assault patients. The functions are to:

• perform an examination and recording findings
• interpret findings, including being an ‘expert witness’ in court, explaining what the findings were and how they might be interpreted
• provide a therapeutic function, including treating injuries, deciding on need for inpatient treatment, prescribing emergency contraception and sexually transmitted infection prophylaxis, Accident Compensation Corporation (ACC) paperwork for cover of treatment, assessment of safety and mental state
• follow up on factors affecting safety, physical symptoms and mental state to monitor outcome and promote recovery.

 

No evaluations of DSAC or its training procedures have been carried out, and no literature was found on similar schemes overseas. However, it is clear that the use of specialist, trained sexual assault medical examiners is considered good practice by researchers in New Zealand and elsewhere (Beckett, 2007; Jordan, 1998; Kelly and Regan, 2003; Ledray, 2001; Plichta, Clements and Houseman, 2007).

4.3.2    Good practice guidelines for performing a forensic medical examination
In the United Kingdom, early medical responses were predominantly forensic (Blair, 1985), meaning rapid processing of victim/survivors without consideration for their psychological health (Campbell and Raja, 1999). This is in contrast to more recent understanding that if the forensic examination is combined with sensitive medical care, this will provide an opportunity to begin the victim/survivor’s recovery (Beckett, 2007).

In New Zealand, the DSAC manual includes detailed guidelines for conducting a forensic medical examination. This includes appropriate medical procedures but also how to provide effective support (DSAC, 2006). These guidelines are based on research and informed by professional clinical opinion. Jan Jordan has also published recommendations based on her interviews with victim/survivors (Jordan, 1998, 2004, 2008). In the United Kingdom, Kelly and Regan (2003) have published comprehensive guidelines based on an international review of literature. Common points from all these sources are summarised in Box 8.

Recognition of the physical and psychosocial consequences of sexual violence has been followed by a growing realisation that the levels of support required during this examination period could not be delivered by legal and medical systems alone (Astbury, 2006; Campbell and Raja, 1999; Campbell and Ahrens, 1998; Ledray, 2001; O’Shea, 2006). Strong arguments have accordingly been made not only for specialist responses but for these to be delivered in collaborative systems that incorporate high levels of psychosocial support (Beckett, 2007).

 

Box 8: Good practice principles for performing a forensic medical examination

Kelly (2005) identifies forensic nursing as a promising practice, although she cautions for the need for forensic nurses to receive sufficient court training. This reflects the considerable literature on the operation of forensic nursing schemes in the United States, which conclude that the Sexual Abuse Nurse Examiners projects are beneficial (for example, Ahrens et al., 2000; Campbell and Diegael, 2004; Crandall and Helitzer 2003; Kelly, 2005; Lang and Brockway, 2001; Littel, 2001; Regan, Lovett and Kelly, 2004). Benefits of forensic nursing cited by these authors include:

• increased availability (particularly during the daytime)
• less expense
• prompt and compassionate care to victims
• less psychological trauma and secondary victimisation avoided
• enhanced collection of evidence.

 

The best known model of forensic nursing is the Sexual Abuse Nurse Examiners programme in the United States (Beckett, 2007; Patterson, Campbell and Townsend, 2006). The goals of the Sexual Abuse Nurse Examiners forensic nursing programme are to:

• provide prompt and compassionate care that addresses victim/survivors’ emotional and medical needs
• improve the quality of forensic evidence collection (Patterson, Campbell and Townsend, 2006).

 

Crandall and Helitzer’s (2003) study in which comparative data from pre– and
post–Sexual Abuse Nurse Examiners cases were used found that victim/survivors who had been examined by qualified Sexual Abuse Nurse Examiners nurses received:

• more medical services for sexual assault, including sexually transmitted infection treatment, pregnancy testing and treatment
• a greater number and more-comprehensive type of referrals to victim services.

 

They also found that more victim/survivors:

• reported to the police (72 percent compared with 60 percent)
• had sexual assault victim/survivors’ kits collected (88 percent compared with 30 percent).

 

However, Patterson, Campbell and Townsend (2006) warn that not all Sexual Abuse Nurse Examiners programmes have the same emphasis and those that prioritised the collection of forensic evidence and prosecution of cases provided fewer services to victim/survivors.

In New Zealand there are no forensic nursing programmes enabling nurses to conduct forensic medical examinations. However, DSAC supports the concept of specialist nurses providing assessments for sexual assault or abuse, provided that they are appropriately trained and supported in a multidisciplinary fashion (i.e. a minimum training requirement of nurse practitioner and previous wide clinical experience in an appropriate area). They also point out that any forensic medical practitioner, including forensic nurses, should:

• have a wide experience of relevant normal ano-genital examinations (e.g. working in a sexual health or family planning clinic, or general practice doing examinations and seeing normal genitalia). This experience assists in the identification of abnormal circumstances and increases credibility at court.
• not work in isolation and should participate in peer review.

 

While their therapeutic benefits are apparent, it is important to note, from a criminal justice perspective, that the scope of any forensic nursing programme in New Zealand will be limited by whether or not courts accept such nurses as ‘ordinary’ witnesses (testifying on their personal opinion), as opposed to doctors who are accepted as ‘expert’ witnesses. For their full benefit to be realised legal provisions would be needed that allowed them to be accepted as ‘expert witnesses’.
In the United States, forensic nurses conduct the majority of forensic medical examinations and provide services to the police and participate in the court proceedings; whereas, in the United Kingdom, the forensic nurse’s practice is limited because they are accepted by the courts as an ordinary witness only (O’Shea, 2006).

4.3.4    Forensic rape kits
Rape kits were developed to standardise the collection and recording of relevant physical forensic evidence for use in a criminal investigation (DSAC, 2006; Du Mont, Parnis and Mason, 2004; Parnis and Du Mont, 2003). Rape kits are known by a variety of different names including the forensic medical examination kit (DSAC, 2006) and sexual assault evidence kit (Parnis and Du Mont, 2003).

The kits are designed to collect the required evidence to help establish proof of:

• offender identity
• time-frame of the offence
• evidence or otherwise of the use of force
• corroboration of the victim/survivor’s account (Kelly and Regan, 2003; Du Mont, Parnis and Mason, 2004).

 

Studies that have looked at the impact on victim/survivors reported that the vast majority of victim/survivors found the use of the rape kit somewhat or very intrusive and distressing, although these negative impacts can be ameliorated when there is a good relationship between health professional and victim/survivor, with each step carefully explained (Jordan, 2008).

Although their primary purpose is to collect evidence, interestingly, such processes may also have a therapeutic role. Undergoing a forensic examination has been found to corroborate women’s narratives of being sexually victimised, and to have a positive effect on emotional and psychological well-being (Du Mont, Parnis and Mason, 2004; Parnis and Du Mont, 2003).

Issues of good practice relate mainly to procedures for using a rape kit and in what circumstances they should or should not be used. Good procedural practices around using a rape kit for a forensic medical examination have been presented in section 4.3.2. Guidelines on when they should be used are based around their potential evidential value in any particular case. Kelly and Regan (2003) strongly recommend that their use must be adapted to the facts of the case. For example, unless the victim/survivor is a child under the age of 16, proving sexual connection took place and in some circumstances, the identification of the accused, is not in and of itself proof that the crime has been committed (Kelly and Regan, 2003). However, it may not always be possible to predict at this point what the likely defence will be.

Parnis and Du Mont (2003) highlight that some medical evidence gathered through the rape kit may have little effect on legal outcomes, and sometimes can work against the woman who has been sexually assaulted (e.g. back door evidence at trial, where evidence of an unrelated sexually transmitted infection may be used as evidence of the victim/survivor’s sexual promiscuity). Experienced forensic examiners will recognise situations when it is not necessary to ask a victim/survivor to undergo such an intrusive procedure, especially where the victim/survivor is highly distressed to begin with.
If a victim/survivor does not report the assault to the police, a decision must still be made whether to offer to collect evidence and to store the information in case the victim/survivor changes their mind in the future. This should be an informed choice made by the victim/survivor. However, it is likely other factors will also have an impact, such as the cost of the rape kits and the time it takes to conduct the examination (DSAC, 2006).

4.4    Follow-up medical care

The importance of follow-up medical care for victim/survivors of sexual violence is widely recognised (Cantu, Coppola and Lindher, 2003; DSAC, 2006; Ferguson, 2006; Olle, 2005). After the acute post-rape care, there may be a range of
short-term and longer-term medical needs of victim/survivors, including ongoing assessment and treatment for sexual and reproductive health problems, pain syndromes, eating disorders, gastro-intestinal problems, and assessment and treatment of mental health needs (Astbury, 2006; Krakow et al., 2002; Leserman et al., 1998). However, there appears to be little research on good practice principles in relation to these; what research there is tends to be related to follow-up mental health care, which is dealt with in chapter 5.

In New Zealand, the DSAC manual recommends that following a forensic medical examination, doctors should make a phone call or visit at one week, and follow-up visits at three weeks and three months post-assault.

One issue is how to increase the likelihood of victim/survivors seeking follow-up medical care. A study in the United States found only 22 percent of sexual assault victim/survivors who had seen a forensic nurse sought follow-up medical care. These authors identified several characteristics of victim/survivors that predicted follow-up care (e.g. age, nature of injuries, prescription of medication, nature of the assault, relationship with offender), but could not identify any such evidence in relation to procedural factors (Ackerman et al., 2006).

In New Zealand, women who were asked to report to sexual health clinics for follow-up tests found this practice difficult to manage because of their public nature and the social stigma attached to ‘VD’ (venereal disease) clinics (Jordan, 2008).

4.5    Responding to the needs of diverse groups – medical system

The health care system that operates in New Zealand predominantly reflects a westernised approach to health. Commentators have questioned the ability of this system to meet the needs of all sectors of society. It has been argued that the New Zealand health care system, based on European/westernised culture, values individualism and self-advocacy. As such it provides care in a manner that advantages certain groups, including higher socio-economic groups, non-Māori, non-Pacific people, and people without disabilities (Jensen and Smith, 2006).

Whilst acknowledging the diverse realities within any group (Durie, 1995), some of the key differences in the needs of particular groups and their implications for good practice for these groups are reviewed below.

4.5.1    Māori victim/survivors
Traditional Māori approaches to health and well-being are more holistic than Western approaches (Durie, 2001, 2006; Ministry of Health, 2002). But all are underpinned by the desire to improve Māori health outcomes through the promotion of whānau ora – moving towards strengthening Māori whānau (i.e. a collective approach). Several Māori models and frameworks illustrate Māori holistic approaches to health and well-being, but perhaps the most well-known is Te Whare Tapa Whā (Durie, 2001), which has subsequently become embedded in Māori health policy (Pitama et. al., 2007). In contrast to Western approaches to health, which tend to focus on physical aspects of being unwell, Te Whare Tapa Whā consists of four dimensions of health and well-being:

• te taha hinengaro (psychological or mental health)
• te taha wairua (spiritual health)
• te taha tinana (physical health)
• te taha whānau (health of the extended family).

 

It is generally agreed that for services to be effective for Māori (including those who are victim/survivors of sexual violence), they should respect and address, in an integrated manner, all of these four dimensions (Durie, 2001). For a fuller understanding of Māori understanding and approaches to health, see Mauri Ora: the dynamics of Māori health (Durie, 2001).

Three guidelines were located that provide guidance on the appropriate way to meet the needs of Māori victim/survivors of sexual violence. One was the Medical Management of Sexual Assault manual, which included some general guidance on providing medical care to Māori victim/survivors (DSAC, 2006), and the other two were guidelines for working with Māori victims of family violence:

• Family Violence Intervention Guidelines: child and partner abuse (Ministry of Health, 2002)
• Screening, Risk Assessment and Intervention for Family Violence Including Child Abuse and Neglect (Standards New Zealand, 2006).

 

The Standards New Zealand guidelines are based largely on the Ministry of Health guidelines. Neither is specific to victim/survivors of sexual violence. However, they are relevant as a significant proportion of women who have been abused by their partner will have experienced sexual violence (Fanslow and Robinson, 2004).

Guidance on the delivery of culturally safe and competent interventions that respond to Māori victims of family violence was the same for both sets of guidelines, and included:

• victim safety and protection must be paramount
• the provision of a Māori-friendly environment – for example, Māori images in environment, Māori staff, staff conveying a genuine attitude that is gentle, welcoming, caring, non-judgmental and respectful – first contact is vital
• culturally safe and competent interactions – for example, familiarisation with Māori models of health, engagement with local hapū and kaumātua to provide cultural guidance
• a collaborative community approach to family violence – for example, development of knowledge of referral agencies appropriate for Māori (Ministry of Health, 2002: 13–17).

 

The Ministry of Health guidelines also stress the importance of the first point of contact with Māori women, which can influence their level of trust in the health care provider. Culturally safe and competent interactions are seen as essential and some suggestions are outlined.

Medical Management of Sexual Assault (DSAC, 2006) provides guidelines for doctors working with victim/survivors of sexual violence. The importance of cultural competence, including working appropriately with Māori, is outlined in section A2 of the manual, Principles of effective support. The manual states that Māori are at greater risk of heightened trauma from the Pākehā (European) medical, police and criminal justice processes. In response, the manual recommends ‘a commitment of health professionals to the principles of Te Tiriti o Waitangi and biculturalism and to work towards better meeting the unique needs of Māori’ (p. 5, section A2).

The manual notes the importance of recognising that Māori health models include a more holistic world view than European health models, and provides specific guidance in relation to providing crisis medical care to Māori victim/survivors. This includes:

• understanding the special significance of parts of the body to Māori (e.g. wharetangata (uterus) is the birthplace of whakapapa; the head is extremely tapu (sacred), so taking head hairs can have extra significance;
• the body itself is tapu (sacred) and food is noa (neutral), so making sure food is away from examination couches and bottoms are away from food places such as tables)
• being aware that body language and ways of expressing oneself can be different (e.g. the appropriateness of eye contact, expressing hostility);
• anticipating that family (whānau) involvement might be the norm and meeting with whānau before any examination; and the individual or whānau may wish to have an opportunity for karakia (incantation/prayer) and/or mihi (greeting speech)
• providing a culturally appropriate person or people to support the patient and doctor during medical examination and to support whānau during and after medical examination; ensuring that the support person is consulted and involved with the process from the beginning or at the time of referral; and that it is welcoming and appropriate to be able to offer kai and inu (food and drink) (DSAC, 2006: 6, section A2).

4.5.2    Pacific victim/survivors
Traditional Pacific approaches to health and well-being are, as with those of Māori, more holistic than Western approaches. As with Māori, the perspective is collective and family based. Effective services thus need to take account of Pacific family and community structures, values, beliefs and practices specifically in relation to health and ill health (Tiatia, 2008). In meeting the health needs of Pacific clients it is also important to acknowledge the importance of Christianity, spirituality and the pivotal role of the church in Pacific families and communities (ACC, 2006).

Two publications were located that provided limited guidance on the appropriate way to meet the needs of Pacific victim/survivors of sexual violence. These are the same as those cited above for Māori.

Guidance on the delivery of culturally safe and competent interventions that respond to Pacific victims of family violence for the most part replicate those for Māori as described above. Additional points included awareness of the effects of migration on Pacific peoples; and recognising that, for solutions to be meaningful to Pacific peoples, other sectors might need to be involved (Ministry of Health, 2002: 13–17).

It is acknowledged that services provided by Pacific people for Pacific people cannot meet the needs of the entire community (Tiatia, 2008). Therefore, it is important that mainstream and other (e.g. Māori) providers are supported and encouraged to offer their services in a manner acceptable to and appropriate for Pacific people (Tukuitonga, 1999, cited in Tiatia, 2008).

4.5.3    Young adult victim/survivors
Research indicated that one of the main reasons that young adults and adolescents seek help less often from service providers is because they fear being blamed and are concerned that information will not be held in confidence (Black et al., 2008; Jackson, Cram and Seymour, 2000). Hence, it is clear that, in relation to these groups of service users, it is essential that privacy and confidentiality are integrated into any medical, counselling or legal service provision. In New Zealand this issue has been recognised, and youth (12–18 years) are entitled to health care without the consent of their parents (Ministry of Health, 1998).

4.5.4    Male victim/survivors
Medical Management of Sexual Assault (DSAC, 2006) gives principles of effective support for male victim/survivors of sexual violence. These include:

• helping male victim/survivors to understand that male sexual assault is not uncommon and that the assault was not their fault
• emphasising confidentiality, because some male victim/survivors may fear public disclosure of the assault and the stigma associated with male sexual victimisation
• respecting and honouring requests for an advocate of a particular gender
• encouraging advocacy programmes and mental health services to build their capacity to serve male sexual assault victim/survivors and to increase their accessibility to this population (ACC, 2008: 10).

Kelly (2002) also suggests that it might be more appropriate that examinations are carried out by women.

4.5.5    Victim/survivors with disabilities
The medical practitioner treating an adult with a disability who has been sexually assaulted has the same responsibility as with other victim/survivors to provide crisis care, follow-up care, and forensic medical examinations if required (Blyth, 2002).

Medical Management of Sexual Assault (DSAC, 2006) provides some guidelines for doctors working with people with disabilities. These include understanding the nature of sexual violence for this group (e.g. caretakers, family members or friends may be responsible for the sexual assault); that communication can be difficult but must be done in a clear and respectful manner, and that information may need to be sourced from others; and that the ability to consent to an examination may be compromised.

Blyth (2002) outlines the processes for establishing informed consent for individuals with intellectual disabilities in Australia. In New Zealand, The Code of Health and Disability Services Consumers’ Rights details steps for medical practitioners to take if they judge that the victim/survivor is not competent to made an informed choice (DSAC, 2006).

4.5.6    Sex-worker victim/survivors
New Zealand research with sex-workers documented the distrust sex-workers had in health care workers (Abel, Fitzgerald and Brunton, 2008). Much of this distrust arose from sex-workers’ fears of the judgemental and discriminatory attitudes of health care professionals, and that health care providers would be not accepting of their profession. Social workers were particularly distrusted, but there was also a perceived threat posed by visiting doctors, psychologists and other health professionals. It was argued that the most effective way to provide health care services that are acceptable to sex-workers is to involve them in the design and running of those services. Outreach services are also important and are provided through the New Zealand Prostitutes Collective, either in its offices or through outreach work on the streets.

Since the Prostitution Reform Act 2003, guidelines for informing best practice in relation to occupational health and safety have been adopted in New Zealand. This includes guidelines on how to reduce the risk of violence and sets out brothel managers’ responsibilities in relation to managing hazards in the workplace, including violence (Department of Labour, 2004).

4.5.7    Ethnic, migrant and refugee victim/survivors
For non–English-speaking individuals, communication issues can make informed consent and collection of evidential information difficult. The name of the interpreter and the language used is a requirement of the Consent to Medical Examination Form, listed in the Medical Management of Sexual Assault (DSAC, 2006).

The Ministry of Health has produced a handbook on refugee health care, providing guidelines for health professionals who care for refugee people, including how to conduct culturally sensitive consultations and the effective use of interpreters (Ministry of Health, 2001).

5    Mental health system

 

5.1    Introduction

Rape is considered to be one of the most severe types of trauma (Breslau et al., 1991 cited in Koss et al., 2003), and its psychological impact has been extensively researched (e.g. Foa and Rothbaum, 1998; Koss et al., 1994, Crowell and Burgess, 1996, and Golding 1999, all three cited in Koss et al., 2003).

Research indicates that, in the aftermath of sexual assault, some women may experience relatively short-term impacts on their mental health, while others will have chronic, long-lasting symptoms (Ahrens and Campbell, 2000; Goodman, Koss and Russo, 1993; Olle, 2005). Factors that seem influential include victim/survivors having already experienced forms of sexual or violent victimisation, their state of mind at the time of the attack, their relationship with the offender, and the extent to which they subsequently receive support and positive intervention. The most frequently experienced effects include fear, anxiety, depression, and loss of trust and self-esteem (Ahrens, 2006; Astbury, 2006; Howard et al., 2003; Petrak, 2002; Wasco, 2003). Post-traumatic stress disorder (PTSD) is also recognised as a common psychological response, with 90 percent of victim/survivors found to meet the criteria for PTSD within two weeks of a sexual assault (Rothbaum et al., 1992, cited in Koss et al., 2003).

Despite this, the literature identifies that not all victim/survivors seek mental health treatment following sexual assault. Campbell (2001) reported that rates of mental health services utilisation vary across studies, but it appeared 25–40 percent of victim/survivors seek treatment.

The delivery of mental health interventions is typically divided into three stages.

• Crisis intervention – this occurs immediately or soon after the sexual assault.
• Short-term – post-crisis responses addressing short-term needs.
• Long term intervention – in the months and/or years after the sexual assault.

 

In New Zealand, crisis intervention by health professionals may be delivered by
 ‘on-call’ specialist sexual violence service crisis workers and counsellors and/or specialist sexual abuse doctors at the time of the forensic medical examination. These professionals may also deliver follow-up short-term interventions or may refer the victim/survivor to another specialist counsellor.

Longer-term interventions are delivered by counsellors or psychologists who are either affiliated with specialist sexual violence services or working independently in the community. Many of these counsellors will be Accident Compensation Corporation (ACC) registered counsellors who can provide government-funded counselling to victims of sexual abuse, including sexual violation.

Eligibility for government-subsidised treatment through ACC-registered counsellors is determined by acceptance of a claim by the ACC Sensitive Claims Unit of mental injury resulting from sexual abuse/violence. The Sensitive Claims Unit operates under a third-party funding system, where independent practitioners are funded on a per-client basis to provide counselling services to sexual abuse victim/survivors. In order to be a service provider of sexual abuse counselling, practitioners must be specifically accredited by ACC. Accreditation requires practitioners to be registered (if appropriate to their discipline) as current members of a relevant professional body, for example, the New Zealand Association of Counsellors or New Zealand Psychology Society), to have received training specifically related to sexual abuse treatment, and to receive regular supervision (Jenner, Woolley and Mortimer, 2006).

Victim/survivors also receive treatment through non-specialist, mainstream mental health services. It could be that victim/survivors who had pre-existing mental health problems, preferred non-specialist services, or sought help with problematic mental health concerns that had not initially have been identified as being the result of sexual violence (e.g. depression, suicidality, substance abuse, anxiety).

This section presents available literature on good practice for mental health crisis intervention and post-crisis intervention. However, before this there is a brief discussion on the appropriateness of psychiatric diagnosis and the welfare of those delivering mental health. New Zealand good practice guidelines are also identified.

5.1.1    Labelling debate
A formal diagnosis such as of PTSD can be useful in scientifically documenting the impacts of the trauma of rape, and as way for a person to qualify for funding criteria for treatment (Koss et al., 2003). However, feminist researchers and counsellors have criticised the use of the psychiatric diagnosis such as PTSD as the main way of understanding and responding to the psychological distress of victim/survivors of sexual violence. This is because, like all psychiatric diagnoses, PTSD individualises and pathologises a victim/survivor of sexual violence as a person with a psychiatric disorder. They argue that by focusing on the victim/survivor as a person with a mental illness needing treatment, attention is deflected from the social causation of rape, and onto a de-contextualised and medicalised set of symptoms rather than the overall health and well-being of the victim/survivors (Astbury, 2006; Koss et al., 2003).

In the New Zealand context, the recently published Sexual Abuse and Mental Injury: practice guidelines for Aotearoa New Zealand (ACC, 2008), argues that sexual abuse is a complex life experience, not a diagnosis or disorder, and although there is a higher rate of PTSD after sexual assault than for any other type of trauma,
a diagnosis of PTSD is not inevitable for all victim/survivors.

5.1.2    Welfare of mental health providers
Several studies have documented that mental health providers working with sexual violence victim/survivors may experience secondary traumatic stress symptoms that mirror those of their clients (Astin, 1997; Brady et al., 1999; Ebeth, 1989; Hartman, 1996; Monroe et al., 1995; Pickett et al., 1994; Schauben and Frazier, 1995; Wasco 1999, all cited in Campbell, 2001). Self-awareness and self-care strategies are particularly important for therapists engaged in this kind of work.

5.1.3    New Zealand good practice guidelines
Sexual Abuse and Mental Injury: practice guidelines for Aotearoa New Zealand (ACC, 2008) describes good practice guidelines for professionals from all disciplines providing therapeutic services to people who have experienced sexual abuse, which includes sexual violation. The guidelines have been created from principles developed by the Canadian Task Force on Empirically Supported Treatments, together with evidence from a series of research studies undertaken in New Zealand that are directly relevant to professional practice in New Zealand. The guidelines were designed to be ‘appropriate to the unique needs of males as well as females, while also taking into account cultural considerations of various ethnic groups’ (ACC, 2008: 8).

The guidelines were specifically designed for therapists, counsellors and practitioners providing therapy, counselling and treatment (referred to collectively as ‘therapists’ in the document). However, given the dearth of New Zealand good practice guidelines for working with victim/survivors of sexual violence, it is likely that they will be used in wider contexts. The guidelines acknowledge this by suggesting that they are aimed at ‘any mode of professional involvement in which the focus is on improved mental health and the enhancement of personal, social, and emotional life’ (ACC, 2008: 49).

The practice guidelines are organised into two parts: Part one comprises the principles and recommendations designed for work with sexual violence victim/survivors within bicultural New Zealand. The recommendations are based on the good practice identified by the research (see Box 9). Part two is the practice guide, which elaborates on research findings and provides greater detail to support the principles and recommendations.

Box 9: Summary of Accident Compensation Corporation principles of good practice

Principle 1: Safety – The safety of the client and relevant others is paramount throughout the therapy process. Aspects of safety include risk to self, risk from others, and risk to others (including abuse or neglect of children). Cultural safety is also important, including ethnicity, religion, gender, age, sexual orientation, gender identity, and (dis)ability (p. 21). Principle 2: Client focus – A client focus emphasises the importance of tailoring therapy to the client on the basis of a detailed assessment. The most appropriate therapy depends on several factors, including the victim/survivor’s age, culture, type of sexual violence, and the frequency and severity of the abuse. Complex need can be identified early in the process through assessment so that the relevant services are accessed for the client (p. 23). Principle 3: Therapeutic relationship – The guidelines state that the therapeutic relationship is one of the foundations on which successful therapy rests, and the quality of the therapeutic environment will influence the outcome of therapy. The therapeutic relationship should be evaluated in a cultural context as cultural preferences may be pivotal in developing a positive therapeutic relationship (p. 25). Principle 4: Culture, identity and diversity – Considerations of culture, identity and diversity emerge as a strong principle for inclusion in the guidelines as culture impacts on therapy. A lack of knowledge and respect for differing cultural word views, systems of belief, social customs and ways of being can undermine the therapeutic relationship. The guidelines state that where possible and favoured by the victim/survivor, a therapist and client match is preferable whether this is ethnic, religious, gender or otherwise. Practitioners also need to have a good understanding of the impact of their own culture as well as that of the victim/survivor (p. 27). Principle 5: Effects – Sexual violence always affects the victim/survivors in some way, and there is a vast array of emotional, behavioural, social, cognitive, physical, and environmental effects of sexual violence, which differ with each individual. There is a close interplay between coping strategies and effect. Effects may be expressed in a cultural context and may refer to tapu, tikanga, whakapapa, and identity issues. Sexual abuse is a complex life experience, not a diagnosis or disorder, and those who have experienced sexual violence can display a variety of effects at any point in time (p. 31). Principle 6: Assessment – Assessment is an essential process for understanding the victim/survivor and formulation of a therapy approach. Assessment should use a variety of approaches and sources and is an ongoing process. Important areas to assess include safety, risk, and physical and mental health, as well as relationships, family/whānau, identity and self-esteem (p. 33). Principle 7: Goals – Collaborative goal-setting is an essential component of effective therapy, as client-focussed approaches are important for good outcomes. It is important to emphasise realistic goals that can be attained (p. 37) Principle 8: Rationale and process – Explaining the process and rationale of therapy to the victim/survivors is essential, including preparing them for therapy and providing information about what to expect, reflecting the principle of informed consent. The pacing and timing of therapy should meet the needs of the victim/survivors and are particularly important aspects for Māori and Pacific peoples (p. 39). Principle 9: Monitor and feedback – Monitoring is undertaken collaboratively with the victim/survivors and needs to be regular so that it can guide the direction of the therapy. Therapy must always be judged in terms of the extent to which it is benefiting the victim/survivors, and the extent to which goals have been achieved. Feedback to victim/survivors is useful because it enables them to evaluate progress (p. 41). Principle 10: Opportunities and challenges – Therapists who work with people who are victim/survivors of sexual violence have the responsibility to provide the most effective professional service possible, as well as ensuring that the victim/survivors are protected from further harm. Therapy with victim/survivors who have been sexually abused requires specialised training and supervised experience. Practitioners must have processes in place to deal with practitioner stress, fatigue and burnout (p. 43). Principle 11: Context – Understanding the social, familial and physical environments of each victim/survivor is pivotal in ensuring effective therapy. Effects can be triggered or can re-emerge with a changed environment. This may include living situations, social or intimate relationships, or a subsequent triggering event (p. 46). Principle 12: Therapy completion – Ending therapy requires collaboration between the therapist and victim/survivor and can be planned for early in therapy. Finishing therapy is not the end of the victim/survivor’s journey, and also involves helping clients to anticipate and plan for setbacks in their progress. The therapeutic relationship can have emotional significance, and there needs to be open discussion and collaboration with the victim/survivor (p. 47). (ACC, 2008)

 

5.2    Crisis intervention

Counselling is beneficial through all stages of recovery, but crisis intervention during the initial stages immediately after rape is crucial to health and well-being of victim/survivors (Daane, 2006). Hence, it is important that assessment and intervention in relation to a rape victim/survivor’s psychological state happens as early as possible. For a rape victim/survivor who undergoes a forensic medical examination and assessment, there is an opportunity to also assess his or her psychological status. The victim/survivor can then be referred on for appropriate services.

The immediate crisis reactions to sexual violation are shock, fear and feelings of hopelessness, resulting in high levels of acute distress (Astbury, 2006; DSAC, 2006). This distress is described as corresponding to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) Acute Stress Disorder (DSAC, 2006). It is suggested that these levels of distress are high in the first week, tend to peak at three weeks and stay for the next month. The manual goes on to say that in the first month, 90 percent of people who have been sexually assaulted show symptoms of PTSD, although this cannot be diagnosed until symptoms have persisted for more than a month (DSAC, 2006).

The goal of crisis intervention is to assist in returning the victim/survivor to pre-crisis (pre-rape) levels of functioning (Daane, 2006; DSAC, 2006). Limited literature was located on good practice guidelines for crisis mental health interventions. A World Health Organization review on health responses to rape victim/survivors concluded that research evidence on the appropriateness of interventions to reduce early distress and prevent later psychopathology was inconsistent (Wang and Rowley, 2007).

Some authors have offered recommendations that appear to be based on a combination of clinical judgement and review of very limited literature (Daane, 2006; DSAC, 2006; Osterman, Bariaz and Johnson, 2001). These recommendations appear in Box 10.

Box 10: Good practice recommendations for mental health crisis intervention

5.3    Post-crisis mental health care

The majority of trauma victim/survivors recover spontaneously. However,
25–30 percent of women who have been raped continue to experience negative effects for several years, including major depression, generalised anxiety, panic attacks, phobias and suicidal ideation (Astbury, 2006). Development of persistent PTSD is common (DSAC, 2006; Koss et al., 2003; Wang and Rowley, 2007). In a review of the research conducted on PTSD, Foa and Rothbaum (1998) noted that while not all trauma sufferers will necessarily experience PTSD, victim/survivors of sexual assault tend to have longer-lasting reactions than victims of non-sexual assaults, and also that those who initially experience more severe symptoms are also more likely to have persistent symptoms.

Problems such as depression and anxiety are often co-morbid with PTSD. While some problems might improve with the treatment of PTSD this does not always happen. The co-morbid disorder may even impede effective treatment of the PTSD and may require specific treatment (National Collaborating Centre for Mental Health, 2005).

A systematic review of empirical evidence for the treatment of PTSD as a result of different traumatic events commissioned by the National Institute of Clinical Excellence (National Collaborating Centre for Mental Health, 2005). The findings of the review are generic to the treatment of PTSD regardless of the particular trauma that caused the symptoms, and so findings are applicable to those suffering from PTSD as a result of sexual violence. The reviewers noted that PTSD suffers may be first accessed through primary health care (e.g. a general practitioner) or secondary health care such as hospital emergency departments, and presented the following recommendations.

• When PTSD sufferers present to primary care, general practitioners should take responsibility for the initial assessment and co-ordination of care.
• Assessment should be done by competent people and be comprehensive, including, physical, psychological and social needs and a risk assessment.
• When patient care is split between primary and secondary health professionals, there should be clear agreement about responsibility for monitoring patients.
• Families and carers have a key role in supporting sufferers, but may also need support themselves. Healthcare professionals should be aware of the impact of PTSD on the whole family.
• Where the healthcare professionals and the PTSD sufferer are from different ethnic or cultural backgrounds, the professionals should familiarise themselves with the sufferer’s cultural background.
• Language and cultural differences should not be a barrier to the provision of effective trauma-focused interventions. This could be achieved through the use of interpreters and bicultural therapists.

 

Once mental health needs have been identified longer-term treatment will be referred to mental health providers. As noted earlier in New Zealand these providers can be generic mental health providers or those specialising in the treatment of sexual violence (e.g. ACC-registered counsellors).

5.3.1    Effectiveness of different types of mental health interventions
This review revealed a gap in knowledge about what types of counselling therapies or modalities are used in New Zealand and by whom; and it was beyond the scope of the review to consider clinicians’ or counsellors’ views on what types of therapy might work and how or why they work.

A review of overseas literature also located very few articles that commented on the effectiveness of different types of mental health interventions (Astbury, 2006; Campbell, 2001; Wang and Rowley, 2007). Evidence on what is effective was limited and incomplete (Astbury, 2006; Campbell, 2001). This lack of research means that interventions available may or may not be the most appropriate ones to respond to a victim/survivor’s needs (Astbury, 2006).

The most comprehensive information located was from a recent World Health Organization review on therapeutic approaches to victim/survivors’ mental health needs (Wang and Rowley, 2007). In reviewing evidence on the major therapeutic approaches used to treat survivors of sexual violence findings on the comparative superiority of approaches were also inconsistent. A summary of findings from the Wang and Rowley (2007) review appears below.

• Different types of cognitive behavioural therapies aimed at managing the memory of the trauma were found to reduce sequelae such as anxiety, depression and PTSD, at different post-rape stages. These included prolonged exposure treatment and stress inoculation training. Cognitive processing therapy has also been found to be effective in treating PTSD. There is evidence that brief interventions improve functioning and decrease the severity of
• re-experiencing and arousal symptoms associated with PTSD.
• Relational therapy, which integrates a victim/survivor’s immediate social network into the treatment, has also been found to decrease symptoms of depression compared with those undergoing individual treatment, although decreases in PTSD symptoms were similar and there were no significant differences in family functioning between the two groups.
• Not all forms of therapy have been evaluated. For example, feminist approaches often integrate elements of cognitive behavioural therapy with group therapy to reduce short-term fear and anxiety as well as longer-term issues of self-blame, shame and guilt. Feminist therapies seek to help the survivor to see a victim/survivor’s experience as part of a larger social problem and thus to reframe the causes of the sexual violence and reduce long-term feelings of personal guilt, shame and self-blame. There are some indications that feminist therapeutic approaches are effective, but there does not seem to have been any research documenting integrated therapies.

 

The latter point highlights one of the inherent limitations of literature reviews and what can and cannot be inferred.

Box 11 presents the key findings on which Astbury (2006), Campbell (2001) and Wang and Rowley (2007) concurred.

Box 11: Effective long term mental health interventions

Following in-depth interviews with 48 sexual violence victim/survivors, Jordan (1998) made the following recommendations for New Zealand support agencies and counsellors providing both crisis and long-term support mental health care and support (see Box 12).

 

Box 12: Consumers’ perspective’s on good practice for mental health services

5.4    Responding to the needs of diverse groups – mental health

Responding to the specific needs of special population groups, including Māori and Pacific peoples, Asian peoples and other ethnic communities, refugee and migrant communities, and people with disabilities, was one of ten leading challenges to improving the quality of New Zealand mental health and addiction services (Minister of Health, 2005). Hence, one of the strengths of Sexual Abuse and Mental Injury: practice guidelines for Aotearoa New Zealand (ACC, 2008) is that it addresses cultural diversity and issues of cultural safety specific to the New Zealand context.

When working with victim/survivors from another culture, the ACC guidelines suggest that a therapist should consider whether they are the most appropriate person to work with this client. Because of the shortage of counsellors and therapists from all ethnic groups in New Zealand, it is likely that a client may be from another culture to the Pākehā therapist. When this happens, the therapist should not make assumptions about what is best for the victim/survivors, and may need to obtain their consent to consult with others about cultural issues, and to receive cultural supervision (ACC, 2008).

5.4.1    Māori victim/survivors
Achieving improvement in Māori mental health outcomes was singled out as a specific challenge for New Zealand (Minister of Health, 2005). Key to this is understanding the approaches to mental health services that are effective for Māori. These same approaches are likely to underpin good practice in providing counselling to Māori victim/survivors of sexual violence. Pitama and her colleagues (2007) note that within psychological practice Te Whare Tapa Whā forms the foundation of a number of practice frameworks. One of these is the Meihana Model, a clinical assessment framework that encompasses the four original dimensions (see chapter 4) and adds two additional elements – taiao (the physical environment) and iwi katoa (societal impact on the client/whānau).

Durie (2003) has written that conventional Western approaches to counselling do not always meet the needs of Māori. Māori understandings of well-being and mental health are underpinned by a relational perspective, which emphasises the wider set of relationships between the individual and the environment that affect mental health. This is at odds with the more tightly focused orientation of many Western psychological interventions, which tend to centre on acquiring particular skills or overcoming emotional or behavioural problems. They may exclude consideration of the wider environment, and may not adequately recognise culture as a means of change. Māori approaches seek balance across the spiritual, mental, physical and social domains.

The primary aims [of Māori-centred methods] are to develop a secure cultural identity, establish balanced relationships with whānau and society, and achieve a sense of reciprocity with the wider social and physical environments. (Durie, 2003: 50).

Many of the above points are included in the ACC practitioner guidelines in the section on cultural awareness when working with Māori clients. Within a holistic framework, using a Māori approach that acknowledges the wairua (spiritual aspect) is considered paramount in the healing process for Māori victim/survivors of sexual violence (ACC, 2008). Other points highlighted included that cultural issues such as tribal preferences and styles need to be considered because shared understandings and beliefs are important. The process of whanaungatanga (making family and ancestral connections) and references to shared experiences are seen as important elements in establishing a therapeutic relationship as well as reinforcing the focus on whānau (ACC, 2008: 88–89). Whilst acknowledging a traditional way of working with Māori, the section also notes that it is important to consider each client as unique and to not assume that Māori models of therapy are appropriate or desirable for all Māori (ACC, 2008: 88)

In considering the type of approaches available to Māori, Durie (2003) has identified three approaches to incorporating Māori cultural beliefs and values into counselling and healing (see Table 5). They centre on the use of traditional healing services, creating bicultural models by adding Māori values and practices to mainstream treatment programmes, and developing Māori-centred techniques.

Table 5: Māori and counselling

	Broad approaches
	Traditional healing	Bicultural models of treatment	Māori-centred approaches
Approach	Customary practices	Modification of conventional Western methods, partnership	Māori concepts and values form basis for interventions
Examples	Rongoa, mirimiri, karakia	Bicultural therapy	Mauri therapy, Paiheretia
Type of therapist	Tohunga	Psychologists, Māori community experts	Mauri therapists, relational therapists

Source: M. Durie (2003) Ngā Kāhui Pou Launching Māori Futures. Wellington: Huia Publishers, p. 47.

Durie (2003) notes that different forms of therapy need not be in conflict and that a single approach is unlikely to meet multiple and complex needs. Ideally, Māori who live in two worlds (i.e. both Māori and Pākehā) would have access to the benefits of both.

5.4.2    Pacific victim/survivors
As mentioned in chapter 2, Pacific people in New Zealand come from a number of diverse cultural backgrounds, with differing systems of social organisation and perspectives on mental health. There is also a growing number of
New Zealand¬ born Pacific people, whose views of traditional cultural values are influenced by contemporary ideas.

The New Zealand ACC guidelines address appropriate ways of working with Pacific people, but note that there is no ‘one size fits all’ and there are differences between what is appropriate for the different Pacific communities. However, whilst acknowledging the cultural and intergenerational diversity, there is sufficient common ground to enable identification of a Pacific world view on mental health, which is applicable also to mental health service provision for Pacific victim/survivors of sexual violence. The Northern Regional Pacific Mental Health and Addictions Plan 2003/05 is useful in understanding this world view (Counties Manukau District Health Board, 2003).

Pacific models of mental health are underpinned by a holistic view of health.
For Pacific people, recovery is achieved through harmony between the physical, spiritual, emotional and family domains (see chapter 4). The centrality of the extended family in Pacific cultures means that families are critical to recovery. Educating non-English-speaking Pacific families about mental health, and assisting them by providing information in their own language, could therefore be seen as a key role of effective service provision (Counties Manukau District Health Board, 2003).

There is some overlap, at a conceptual level at least, in good practice principles for mental health services for Pacific people and Māori. As for Māori, conventional approaches tend to be neither appropriate nor effective for Pacific people; Pacific mental health staff need to be clinically and culturally competent; and the mainstream workforce needs to be more responsive to the needs of Pacific people and to understand the cultural values that influence their mental health (Counties Manukau District Health Board, 2003).

Recovery is also assisted through partnerships between mental health service providers, clients and a wider network, ranging from employers and landlords to social and government agencies (ACC, 2008; Counties Manukau District Health Board, 2003). This entails recognising consumers’ strengths and ability to resolve their own problems, engaging communities and developing community resources, and working with other health and social services in an integrated, multidisciplinary system of care (Counties Manukau District Health Board, 2003).

The Mental Health Commission (2001, cited in Tiatia, 2008) noted that some Pacific people choose to access traditional healers for their mental health needs, and anecdotal evidence indicates that the percentage is large. The implication of the use of traditional healers and how this fits with mainstream mental health services has not been explored, but there are examples of where partnerships between Pacific mental health services and Pacific traditional healers work well (e.g. Faleola Services (Counties Manukau District Health Board) and Isalei Pacific Mental Health service (Waitemata District Health Board) support and monitor Pacific service users who wish to access traditional healers) (Ministry of Health, 2008: 18).

In relation to the specific counselling needs for Pacific sexual violence victim/survivors, the New Zealand ACC guidelines suggest that mental health practitioners be aware that this group of clients may find it very difficult to talk about sexual matters. It is also noted that, for this group, important goals for healing may include forgiveness (of the perpetrator), strengthening cultural identity, and strengthening family connections (ACC, 2008: 89–125).

5.4.3    Victim/survivors with disabilities
People with disabilities are at higher risk of all types of abuse, and it is important that the therapist understands the implications of the disability. People with intellectual difficulties are at high risk of being sexually abused on an ongoing basis, and their mental health problems often go undiagnosed. In addition, victim/survivors with intellectual difficulties are less likely to be believed when reporting sexual abuse. The New Zealand guidelines (ACC, 2008) provide checklists for therapists to consider when working with clients with intellectual difficulties.

In Myalla: responding to people with intellectual disabilities who have been sexually assaulted, Julie Blyth (2002) has produced a practical resource, based on current research, aimed at improving the quality of services to victim/survivors with intellectual disabilities.

5.4.4    Male victim/survivors
The New Zealand guidelines (ACC, 2008) recognise that men are less likely to disclose sexual abuse, less likely to seek assistance, and more likely to feel confused about their sexual orientation, and experience increased sense of shame about being abused, than women victim/survivors.

Issues for counsellors to be aware of include:

• male victim/survivors need reassurance about issues concerning their sexuality in a way that female victim/survivors may not necessarily need (Crome, 2006)
• given the length of time for many men between the rape and the reporting, it is highly likely that this group of victim/survivors will be experiencing chronic mental health issues (Crome, 2006).

5.4.5    Ethnic, migrant and refugee victim/survivors
Studies from various parts of the world have found proportionately higher rates of psychiatric hospitalisation among recent migrants, but it is not possible to determine the prevalence of mental illness in immigrant groups in New Zealand from official mental health data (Abbott, 1997).

In her paper Sailing in a new direction: multicultural mental health in New Zealand (2007), DeSousa found that although new migrants and refugees make up an increasingly significant section of the population (one in five New Zealanders were not born in New Zealand), they underutilise mental health services. She recommends workforce development is needed to reduce prejudice and discrimination and make the services more culturally acceptable.

More specifically related to sexual violence, Savage (2003) noted that the disgrace and shame associated with rape, particularly in more traditional cultures, results in low levels of disclosure and the silencing of the voices of the abused. She points out that in some communities there is no alternative language for the symptomology and concept of PTSD than they are ‘mad’ (Savage, 2003: 3). Specialist counsellors working with refugee women have found that establishing a therapeutic relationship of trust can aid disclosure in the long term (Savage, 2003).

5.4.6    Sex-worker victim/survivors
A recent review and consultation process in Australia noted that sexual assault counselling services are not equipped to deal with sex-workers as victim/survivors because of the multiple difficulties sex-workers face (Quadara, 2008). These included:

• stigma and prejudice within counselling services
• sex-workers having to ‘re-educate’ counsellors before they could begin working on the impacts of sexual assault (Quadara, 2008).

 

Some sexual assault services have addressed issues of barriers to accessing services, by providing an information sheet explicitly for sex-workers, or outreach counselling for street-based sex-workers. It has been suggested that counselling services may benefit from attending training by sex-work organisations and obtaining sex-workers’ advice to inform service provision and crisis care (Quadara, 2008).

 

6    Criminal justice system

6.1    Introduction

If a victim/survivor reports the offence, they enter a criminal justice system that can be experienced in diverse ways, ranging from highly validating and supportive to inflicting secondary victimisation (Herman, 2005; Jordan, 2004). Key needs for victim/survivors who enter this system are to be believed, have sufficient support and be provided with good ongoing information (Jordan, 2008; Lievore, 2005).

The criminal justice system is the network of courts and legal processes that deals with the enforcement of criminal laws, including the laws that prohibit sexual violation. Key components and players are the complainant (the victim/survivor of the sexual violence), the accused (the alleged perpetrator), the police, lawyers, judges and the court system itself. The collection of forensic evidence is also part of this system but has been addressed in chapter 4.

There are two key issues with the criminal justice system in relation to sexual violence.

• The low rates of reporting, prosecution and conviction of sexual violence offences. In New Zealand and globally these rates are lower than for other crimes (Amnesty International Australia, 2008; Ministry of Justice, 2008).
• The impact of criminal justice system processes on those victim/survivors who engage in this system. The literature has consistently identified this area as being one of potential secondary victimisation, where victim/survivors are at risk of experiencing ‘a second rape’ (Koss, 2000; Lees, 1996; Lievore, 2005; Moult, 2000; Scutt, 1998; Thomas, 1994). Despite significant legislative and procedural changes around the world, concern has been increasingly expressed that rape victim/survivors’ experiences of the criminal justice system have not substantively improved (Gregory and Lees 1999; Jordan, 2001, 2004; Kelly, Lovett and Regan, 2005; Lea, Lanvers and Shaw, 2003; Temkin, 1997; Temkin and Krahé, 2008).

 

These two issues are obviously interrelated. The New Zealand Law Commission was recently reported as saying that evidence from focus groups showed that one reason why many women did not lay complaints was because the ordeal of a sexual offence trial was regarded as so unpleasant that they did not want to go through it (Watkins, 2008).

A number of initiatives have been undertaken to address these two issues.
The remainder of this section will examine the literature in relation to:

• police practices and initiatives
• specialist prosecutors
• specialist courts
• victim advisors
• statutory reform
• restorative justice.

 

6.2    Police practices and initiatives

Police occupy a pivotal role in the criminal justice system as the first agency that the reporting victim/survivor encounters. The quality of that contact with the police officer often determines the future of the prosecution process (Campbell and Raja, 1999; Epstein and Langenbahn, 1994; Felson and Pare, 2005; Goodstein and Lutze, 1992; Gilmore and Pittman, 1993; Jordan, 1998, 2004; Lord and Rassel, 2000). On this basis alone, it is clearly in the overall interests of law enforcement for the police to act in ways that are consistent with promoting the victim/survivor’s emotional well-being (Burgess, 1999). Historically, however, police departments internationally have been criticised for often displaying myth-informed, judgemental and disbelieving attitudes that resulted in rape complainants feeling interrogated (Chambers and Millar, 1983; Gregory and Lees, 1999; Jordan, 2004). Increasing acknowledgement has been given to the ways in which the trauma suffered by a rape victim/survivor can be compounded by involvement with police officers and procedures. The police response to rape victim/survivors has been the subject of considerable pressure to improve police performance overall (Brown and Heidensohn, 2000; Epstein and Langenbahn, 1994; Gregory and Lees, 1999; Temkin, 1997).

In relation to their role as law enforcers, police, when an alleged sexual assault/rape is reported, have to:

• ensure the safety of the victim/survivor
• investigate whether a sexual offence has been committed
• identify those responsible for the offending
• decide whether there is sufficient evidence to make an arrest
• decide on the type, severity and number of the charges to be laid.

6.2.1    Good practice principles
Amnesty International Australia (2008) identified six police practices that support women through reporting and investigation procedures and protect them from further victimisation. These are applicable to all forms of violence against women, including sexual violence, and appear in Box 13.

We use these Amnesty International Australia (2008) good practices as a framework for exploring literature on good police practices and, where relevant, comment on how these relate to New Zealand police guidelines. There is also a brief section on the use of female police officers, which has also been discussed as good practice in some literature.

Box 13: Good practice principles for police

6.2.2    New Zealand Police good practice guidelines.
Police policy and principles for the investigation of adult sexual assault (including rape) are primarily outlined in the Adult Sexual Assault Investigation (ASAI) Policy published by the New Zealand Police in 1998. This policy was developed with assistance from medical practitioner groups, counselling agencies, and community groups. Twelve aspects of an investigation are covered, including roles and responsibilities of various parties, specific staffing and training requirements, and investigation procedures. Overarching principles are also outlined. The principles and practices set out in this policy were aimed at ensuring the effective prosecution of sexual assault offences, but they also clearly identified a role for police in ensuring victim/survivor safety and well-being. For example, under section 1 ‘Policy principles’, the first point states (New Zealand Police, 1998: 11):

1.1     The police acknowledge the destructive consequences of adult sexual assault, and that the safety of the victim is paramount.

Later, section 1.11 states (New Zealand Police, 1998: 11–12):

1.11    The police response to the needs of the victim is aimed at:

i.     ensuring early intervention and maximum protection;

ii.     aiding the victim’s long term recovery from the trauma; and

iii.     ensuring the victim’s co-operation with the investigation through to completion.

The ASAI Policy is specific to the investigation of adult sexual assault offences. However, some police practices are common to other types of offending and are also covered in more general guidelines. For this reason, the policy was designed to be used in conjunction with these other more generic guidelines that govern police practice. At the time of publication the additional guidelines cited included the Manual of Best Practice, Victims of Crime Policy, Family Violence Policy, and, in the case of an intellectually disabled victim/survivor, the Policy and Guidelines for the Investigation of Child Sexual Abuse and Serious Physical Abuse (New Zealand Police, 1998).

The ASAI Policy and relevant sections of the Manual of Best Practice were reviewed by Dame Margaret Bazley in 2007 as part of the Commission of Inquiry into Police Conduct (Bazley, 2007). Bazley commented that in general she was impressed with the policies and the apparent shift towards practices that recognise the impact of recent trauma, encourage a good working relationship with professional support agencies, and restore to the victim/survivors a sense of empowerment. However, there were areas that raised some concerns. These concerns resulted in two recommendations:

• a review of the ASAI Policy to ensure that the training and resources necessary for its effective implementation are available
• the incorporation of the ASAI Policy within the ‘sexual offences’ section of the Manual of Best Practice to reduce inconsistencies between the two (Bazley, 2007: 91–92).

 

It is important to note that reviews of policy are different to evaluations of how well a policy has been implemented. In her report, Bazley (2007) cited some concerns in this regard with reports of some experienced detectives being unaware of the existence of the ASAI Policy as recently as March 2005.

We found one other piece of research on pre-trial sexual violence interventions that included an assessment of issues around the implementation of the ASAI Policy. This was a doctoral research study carried out by Linda Beckett that included visits to all 12 police districts to interview relevant police, medical and agency personnel (Beckett, 2007). A total of 113 interviews (44 of which were with police personnel with relevant expertise in relation to sexual assault investigation) were carried out. The qualitative interview data were analysed and triangulated using additional interviews, source documents, site visits and participant observation. Beckett’s research identified some difficulties with the implementation of the policy; significant among these has been the time-lapse in establishing the positions and procedures to ensure the policy moves from paper status to practical reality. These findings are discussed in more detail below.

6.2.3    Dual focus on support and conviction
A primary role for police is the investigation and conviction of offending and/or offenders. However, it is widely recognised that co-ordinating the provision of support for victim/survivors is also good practice for police (Amnesty International Australia, 2008; Beckett, 2007; Epstein and Langenbahn, 1994, Metropolitan Police Service, 2005). In the United States, the provision of ‘in-house victim/witness advocates’ has been a strategy recommended as good practice (Epstein and Langenbahn, 1994). In other countries, including New Zealand, the police have formal relationships with external specialist support agencies such as Rape Crisis groups and Victim Support (Beckett, 2007).

This dual focus on support and conviction, however, can be challenging for police. Historically, a gulf has existed between the needs of rape victim/survivors and the responsibilities of the police. This arises in part from the police being focused on outcome, which for them ideally means offender identification, prosecution and conviction, while the paramount needs of victim/survivors may revolve more around process, particularly in the initial stages but also throughout their engagement with the criminal justice system. A traumatised person often needs support and belief at the same time that the police are required to be obtaining evidence and conducting interviews (Jordan, 2001). They may adopt an interrogative style that can be experienced as hostile and disbelieving by victim/survivors, and may even result in some genuine complainants deciding to withdraw the allegation (Jordan, 2001, 2004). Addressing these competing needs has been recognised as a potential source of tension for police:

A common source of concern is the perceived failure of the police to strike a consistent and compassionate balance between the victim/survivors’ needs and the demands of investigative and administrative priorities. (Law Reform Commission of Victoria, 1991, cited in Gilmore and Pittman, 1993: 12)

In New Zealand, recognition of the importance of the dual focus on both conviction and support for victim/survivors is evident in the ASAI Policy. As illustrated in section 2 ‘The police commitment’, the main functions of police in a sexual assault are listed as (New Zealand Police, 1998: 12):

2.1.1    to ensure the safety of the victim;

2.1.2    to investigate and, when evidence is available, consider the prosecution;

2.1.3    to coordinate the support for the victim, and keep the victim informed of the progress of the investigation as far as possible; and

2.1.4    to identify those responsible for offending and ensure they are held accountable.

While police are responsible for co-ordinating the provision of the support, the policy suggests that it is the support person (e.g. specialist sexual violence support worker) who is responsible for ensuring the victim/survivor receives crisis support, counselling and the initiation of therapy (section 2.5.2).

Support for the victim/survivor was recognised as important in the New Zealand Commission of Inquiry into Police Conduct. Bazley (2007) recommended that sexual violence complainants and their support people should be provided with ongoing information regarding case progress and delays and given assistance to understand the reasons for any decision not to prosecute.

Based on research with victim/survivors, Jordan (2004) was of the view that supporting a complainant’s well-being is important even in cases that the police suspect, or even know, to be a false allegation, since at least some of the latter may mask underlying issues requiring referral for counselling or other appropriate intervention.

6.2.4    Specialist units
Specialised sex crime units are also recognised as good practice (Amnesty International Australia, 2008; Brown and Heidensohn, 2000; Epstein and Langenbahn, 1994; Lord and Rassel, 2000; Metropolitan Police Service, 2005). They are seen as a way to develop and focus expertise, as well as a way to send a message to the community that sexual offending is being taken seriously.

Specialisation was supported in the New Zealand ASAI policy, including the setting up of specialised Adult Sexual Assault Teams and the development of specialist co ordinator positions at the district level. There have been some concerns raised over the delays in implementing this part of the policy (Bazley, 2007; Beckett, 2007). However, in 2006 Auckland police formed a specialised Adult Sexual Assault Team (New Zealand Police, 2006). Initially, the team included a detective sergeant, four Criminal Investigation Branch (CIB) staff, and one General Duties Branch attachment. Two of the staff were women. The team comes under the Auckland CIB General Squad where the Child Abuse Team is also aligned, and operates along similar lines to Child Abuse Team. The Adult Sexual Assault Team is expected to enhance relationships with agencies such as Auckland Sexual Abuse HELP and Doctors for Sexual Abuse Care (New Zealand Police, 2006).

Specialised units have been introduced within the United Kingdom context. In London, under Project Sapphire, dedicated Sexual Offences Investigation Teams were established by the Metropolitan Police. These teams included specialist officers and a dedicated detective inspector who was only responsible for investigating rape and other serious sexual offences. The Sexual Offences Investigation Teams were well resourced, with experienced staff, especially at the supervisory level. They also had senior team management to ensure compliance with standards for rape investigations. In a qualitative review of police practice in London, Sexual Offences Investigation Teams and dedicated investigators were two of a range of factors that were found to impact positively on both the proportion of crimes solved and the level of care afforded to victims (Metropolitan Police Service, 2005).

In the United States, Epstein and Langenbahn (1994) emphasised that recruitment to specialised sex offence units should involve employing staff who not only have the necessary technical skills with respect to investigation and interviewing but who also have the necessary personal skills for dealing empathically with victim/survivors and who are positively motivated to work specifically in a sex crimes unit.

6.2.5    Safe, confidential and respectful environments
Adherence to professional policy and procedural guidelines is important, but rape victim/survivors are also sensitive to the attitudes conveyed, whether verbal or non-verbal (Temkin and Krahé, 2008). The loss of safety and control experienced creates a need for reassurance and validation. This is enhanced by the fact that many of those victimised have internalised societal rape myths that blame women in particular for ‘getting themselves raped’. Key themes emerging from Jordan’s interview studies with rape complainants include:

• the need to be believed by the police
• to be treated with respect
• to be able to exercise some choice or control over processes and personnel
• to be provided with ongoing information and support (Jordan, 1998, 2001, 2004, 2008).

 

The need for an appropriate environment is recognised in the New Zealand ASAI Policy, which states that interviews with victims must be conducted in an area that is appropriate, comfortable, secure, private and safe and should not be a suspect interview room (section 5.3.3.). It is not clear whether all police stations in New Zealand are equally able to comply with this part of the policy. Bazley (2007) noted that dedicated facilities especially designed for the interviewing and examination of the victims of sexual assault tended to be limited to larger police stations.

Studies of victim/survivors in New Zealand have revealed cases where safe, confidential and private interviewing environments have not always been provided. Examples of failure to provide such an environment included multiple interruptions when a statement was being taken, statements being taken in the same rooms used for interviewing offenders, and women reporting feeling on show as the ‘latest victim’ when having to walk repeatedly through the station (Jordan, 2004, 2008).

Epstein and Langenbahn (1994) suggest two procedures, based on recommendations for United States law enforcement that can assist with victim/survivors’ need for privacy and confidentiality.

• Reporting: offering different options for reporting, including third-party reporting by rape crisis centres without identifying the victim, and information-only reports without prosecution (blind reporting).
• Ensuring privacy: victim/survivors have the right to confidentiality; police can conceal the information from the public and the media, and by doing so can alleviate victim/survivors’ fears in this respect.

 

These two procedures have subsequently been supported as good practice in a review of sexual assault investigation practices in police and sheriff departments in nine United States counties (Lord and Rassel, 2000).

Police attitude towards victim/survivors
A profound scepticism towards women rape complainants has been evident in criminal justice systems internationally. Concern has been expressed regarding the high proportions of sexual assault complaints that are believed by police to be false (Gregory and Lees, 1999; Jordan, 2004; Kelly, 2002; Lievore, 2005; Temkin, 1997). As well as doubting the veracity of rape allegations, researchers have observed a tendency for many officers to have their thinking dominated by prevalent rape myths and stereotypes (Burgess, 1999; Hinck and Thomas, 1999; Kelly, 1988; Lees, 1997; Regan and Kelly, 2003).

A dominant construct has been that of the ‘real’ or ‘ideal’ rape victim. Typically, this stereotype depicts genuine rape victim/survivors as morally chaste women who are raped by a stranger, and whose resistance results in them being physically injured (Du Mont, Miller and Myhr, 2003). Achieving legitimate victim status and a sympathetic police response has been harder to achieve for women whose morality is viewed questionably (such as sex-workers, hitch-hikers, and women frequenting bars or nightclubs) or who are viewed as having questionable credibility (e.g. those with intellectual impairment and/or psychiatric histories), as well as those who belong to ethnic and sexual minorities (Du Mont, Miller and Myhr, 2003; Jordan, 2004).

Razack (1994, cited in Du Mont, Miller and Myhr, 2003: 470) has argued that ‘race never absents itself from the rape script,’ with Black and Aboriginal women considered ‘less inherently worthy than White women’. This can result in minimisation of sexual assaults committed against ethnic minorities, contrasted with maximisation of media attention to sexual assaults perpetrated by ethnic minorities (Ardovini-Brooker and Caringella-Macdonald, 2002). Translated to the New Zealand context, this could result in an added scepticism surrounding complaints of rape/sexual assault made by members of ethnic minorities.

When rape complainants encounter such scepticism, it impacts negatively on their well-being, as well as increasing the likelihood of their withdrawing the complaint or their co-operation with police (Jordan, 2004).

Cultural awareness
Part of providing a ‘respectful’ environment is ensuring that victim/survivors are treated in a culturally appropriate environment. In New Zealand Māori are over-represented as victims of sexual violation, so it is particularly important that police respond to Māori in a culturally appropriate manner. In the New Zealand ASAI Policy there are several references to police practices being culturally appropriate (e.g. sections 1.5, 2.2.1, 2.2.2, 2.3.1, 2.5.2, 3.1.6 and 5.2.1). Police staff must be able to respond appropriately to Māori victims and those who support them, including whānau, hapū, iwi and Māori agencies.

More recently, the New Zealand Police contributed to the funding of the publication of standards for the screening, risk assessment and intervention for family violence including child abuse and neglect (Screening, Risk Assessment and Intervention for Family Violence Including Child Abuse and Neglect, Standards New Zealand, 2006). Development of these standards aimed to establish the minimum requirements that should be met by individuals and agencies/services, including the police, involved in working with families living with family violence, child abuse or neglect. Within these standards are guidelines for cultural awareness and working appropriately with Māori whānau violence, Pacific peoples and family/fanau violence, and immigrant and ethnic communities. The standards were adapted from the Ministry of Health guidelines on family violence interventions (see section 4.5 of this review).

6.2.6    Consistent and effective investigation practices
Over the years, studies conducted with victim/survivors in New Zealand have revealed widespread inconsistency in the quality of response rape complainants received (Jordan, 1998, 2001, 2004). Partly in response to this research, there have been some significant changes in respect to policies regarding sexual offence investigations, including the development of the ASAI Policy (New Zealand Police, 1998).

The ASAI Policy has a specific section on the investigation procedures that should be adhered to (section 5, Procedures – investigation management). This includes the roles of specific staff, how victim/survivor safety should be ensured, specific procedures for interviews and the investigation in general, and how the medical examination should be carried out.

There is evidence from the United Kingdom that appropriate policies can help to improve investigation practices. London police instigated Project Sapphire to improve victim/survivor care and rape investigations. At the inception of the project, best practice policies and procedures were identified and published. A qualitative review of the three ‘highest’ and the three ‘lowest’ performing boroughs found that greater successes in rape investigations were being achieved in those boroughs where there was adherence to the policies and evidence of strong performances in the identified areas of ‘best practice’ (Metropolitan Police Service, 2005).

Project Sapphire identified the following best practices for the investigation process:

• continuity in investigations, rather than a series of separate stages
• a victim-focused ethos at the core of each investigation
• prosecution teams (specialist officers, inspectors working with the prosecutors)
• post-event analysis and sharing of intelligence to reassure the victim/survivors and to reduce the risk re-offending
• a clear commitment to making offenders accountable and achieving a positive outcome for victim/survivors (Metropolitan Police Service, 2005).

 

As noted earlier, it is adherence to good policy, not the policy itself, which results in positive outcomes for victim/survivors. Overseas researchers have noted that the effectiveness of such policies has not always been successful, and this can often be because they appear to be imposed on a top-down basis (Brogden and Shearing, 1993; Chan, 2003). Thus, one barrier to the New Zealand ASAI Policy achieving significant changes in police practice derives from a lack of support for the policy at all levels, with cynicism and resistance noted by many rank-and-file officers to directives imposed at national level (Bazley, 2007; Jordan, 2006).

Investigative interviewing
Another New Zealand initiative reflecting good practice is the Investigative Interviewing Project that is being introduced by the New Zealand Police. The aim of investigative interviewing is to obtain complete, accurate and reliable information when interviewing victims, witnesses and suspects. This will have the potential to improve rape complainants’ experiences of police interviewing.

An investigative interviewing strategy was developed following a review of international police interviewing techniques (Schollum, 2005). The aim of the review was to benchmark the New Zealand position and to provide a progressive pathway forward for further development and enhancement of police interviewing based on international best practice.

The Investigative Interviewing Strategy covers:

• national ownership and overarching strategy
• policy and guidance
• ethical principles
• internationally affirmed interview model (based on the international best practice British PEACE interviewing model (PEACE = Planning and Preparation, Engage and Explain, Account, Closure, Evaluation)
• national standards
• comprehensive national training framework, structure and programme
• quality assurance regime
• technology
• interview facilities.

 

The Investigative Interviewing Unit was established in 2007 to implement and oversee the Investigative Interviewing Strategy and to provide national ownership for all investigative interviewing–related matters. A key focus of the unit is to implement the comprehensive programme of investigative interview training of which there are four levels. This is under way, with the aim of 6,000 frontline staff receiving level 1 training by 2010 and a further 84 receiving the specialist Level 3 interviewer training for adult sexual abuse interviews by the end of the 2008/09 financial year.

At a general level, the training is practice-based and includes learning about the psychology of memory and other processes essential to ethical interviewing; how to use the free recall, conversation management and enhanced cognitive interview models; and techniques for different types of interviewees. All levels of interviewing are complainant- or witness-centred, so that the most complete accurate and reliable amount of information is obtained. The training is based on empirical research in psychology and investigative interviewing and international good practice. Each level of training then builds on the particular area of expertise required. (Specialist training as good practice is reviewed in more detail in section 6.2.8 of this chapter.)

The Investigative Interviewing Project is being piloted and will need to be evaluated, and the practices appraised in the context of overall support service provision (Personal communication, New Zealand Police, June 2008). There was initially some resistance to the practice of delayed interviewing, with victims and witnesses of serious crime (including adult sexual assault), as it represented a departure from the traditional police emphasis on interviewing victims/witnesses as soon as possible after the event (Jordan, 2001). However, more recently it has been acknowledged that there are advantages to delayed interviewing and that recall may in fact be positively assisted by such a move (Jordan, 2004). This is in part because many sexual offences occur when the victim/survivor is drunk or drugged and/or physically exhausted, and because the immediate impact of shock or trauma can interrupt clear recall.

6.2.7    Police interagency collaboration
In the London-based Project Sapphire (Metropolitan Police Service, 2005), partnership was identified as being a key to successful police investigations and positive outcomes for victim/survivors, with sexual offences investigation teams building and maintaining good links with prosecutors, Sexual Abuse Referral Centres, and forensic services.

In the New Zealand ASAI Policy there are several references to interagency collaboration, including the importance of taking an interagency approach to investigations (section 1.6), ensuring police are trained to work effectively with other agencies (section 2.2.2), while section 2.5 lays out the responsibilities of the various agencies that are likely to be involved.

Based on research carried out in New Zealand it has been argued that the key to improving responses to sexual violence lies in the collaborative partnerships necessary to ensure the provision of holistic, specialist multi-agency services (Beckett, 2007). While moves towards greater victim-centredness and improved collaborative service delivery were strongly advocated, their effectiveness was seen to be dependent on two factors: prioritisation and adequate resourcing.

6.2.8    Police training
Specialist police training on issues surrounding violence against women also features as an important aspect of good practice (Amnesty International Australia, 2008; Epstein and Langenbahn, 1994; Lord and Rassel, 2000; Metropolitan Police Service, 2005).
 
Based on United States law enforcement agencies, Epstein and Langenbahn (1994: 21–22) identified three arenas for police training:

• academy training for new recruits, which would include the rudiments of the law, needs of the victim/survivor and details for the initial interview
• in-house training for investigators, which would include victim/survivor interview techniques, co-ordinating with community support agencies and understanding victim/survivors’ emotional needs
• specialised training for investigators.

 

The New Zealand Police ASAI Policy has a section dedicated to the training requirements of police sexual violation investigators, which includes the development of a specialist training programme (New Zealand Police, 1998).
The New Zealand Police delivers a variety of courses that contribute to the way police respond to reports of adult sexual violation. These include:

• the Adult Sexual Assault five-day course
• the Adult Sexual Assault Initial Complaint course
• investigative interviewing courses
• support services and external training.

 

The Adult Sexual Assault five-day course is seen as the biggest driver of raising awareness, changing attitudes toward sexual violence complaints and complainants, and dealing with these in the most effective manner. This training package was developed in 2002, piloted in 2003 and confirmed in 2004 (Personal communication, New Zealand Police, 12 December 2008).

These courses are presented by non-police specialist practitioners and police staff. Course content includes case studies as well as:

• history, myths and perspectives
• forensics and DNA
• dealing with victims
• drug-assisted sexual assault
• rape trauma and post-traumatic stress disorder (PTSD)
• interviewing (victims and suspects)
• medicals
• criminal profiling
• cultural aspects
• prosecution and court aspects
• offender perspective.

 

Over the past four years, police have been working to build the capacity of the comprehensive training programme to cater for more police staff attendees. To date approximately 50 percent of the CIB have attended the Adult Sexual Assault five-day course and an additional 3,151 police staff have undergone other training that contributes to the police adult sexual assault response. Police are committed to delivering this training to ensure there is a critical mass of appropriately trained staff in the police approach to adult sexual violation. Police envisage that the building of critical mass will take three to four years if all training courses are delivered at their maximum capacity (Personal communication, New Zealand Police, 12 December 2008).

Since that study there has been no further evaluation or research published specifically addressing the adequacy of the New Zealand police training. However, Bazley’s (2007) Commission of Inquiry into Police Conduct, raised concerns over whether there were sufficient resources devoted to the implementation of the ASAI Policy, in particular the delivery of the specialist training of investigators.

6.2.9    Female police officers
Greater deployment of female police officers to sexual assault cases has sometimes been advocated as a good practice measure for police departments to follow (Goodstein and Lutze, 1992; Pike, 1992). In parts of Britain, for instance, dedicated units have been established that are staffed by specially trained officers, most of whom are women, but usually managed by a male detective (Brown and Heidensohn, 2000; Lees, 1997).

However, researchers caution that problems can arise when supervisors assume that female detectives will require less training and less experience than their male counterparts in order to manage sexual assault cases competently (Easteal, 1993; Pollock, 1995).

Contrary to popular assumptions, overseas research has found that rape complainants do not automatically prefer to speak with female officers and, when they do, do not always find them more understanding than their male counterparts (Goodstein and Lutze, 1992; Gregory and Lees, 1999; Heidensohn, 1992; Radford, 1987; Toner, 1982). In a New Zealand study, the negative experiences some women had with hostile and disbelieving policewomen raised doubts regarding assumptions of ‘natural’ sympathy and aptitude (Jordan, 2002, 2004). Conversely, there were also women complainants who rated highly the sensitivity with which some male officers treated them.

However, the gender of the officer is critical when the victim/survivor has strong preferences and requests an officer of a particular gender (Jordan, 2002). Given the difficulty many victim/survivors face in articulating their needs, the responsibility lies with the police to offer them a choice, wherever possible, between equally qualified officers of either gender.

6.2.10    Specialised women’s police stations
Other reforms that have been described in overseas literature include initiatives such as specialised women’s police stations, which have been adopted, for example, in such Latin American countries as Argentina, Brazil, Colombia, Costa Rica, Ecuador, Nicaragua, Peru and Uruguay (Kelly, 2005; Waller, 2003; Morrison, Ellsberg and Bott, 2007). However, evaluations of specialist female stations have unearthed a number of problems (Jubb and Izumino, 2003, and World Bank, 2006, both cited in Morrison Ellsberg and Bott, 2007). These include:

• special stations are often severely under-funded
• officers receive inadequate training
• stations lack equipment, transportation and other key resources
• even when they work well, these officers’ efforts are often undermined by other parts of the criminal justice system that are unable or unwilling to enforce the law
• the existence of women’s police stations encourages regular police stations to abdicate their responsibilities for crimes against women.

 

6.3    Prosecutors and the prosecution service

The role of prosecutors varies across jurisdictions. In New Zealand, all prosecutions under the general criminal law are brought by the police (Crown Law Office, 1992). Crown prosecutors are involved with sexual violation offences only after indictable charges have been laid by the police and a judge has committed the offence to trial. There appears to be no requirement that prosecutors be specially trained in matters related to sexual assault before they act in these cases.
Regardless of the specifics, it is recognised that the successful prosecution of sexual offences is more difficult than for other crimes; less than half the sexual offences that go to trial in New Zealand result in a conviction (Ministry of Justice, 2008). Several factors associated with sexual violation offences can act as barriers to their successful prosecution (see Office for Criminal Justice Reform, 2006; Regan and Kelly, 2003).

• Evidential difficulties and burden of proof – in the majority of sexual violation cases the perpetrator is known to the victim/survivor and the case rests on one person’s word against another. Proving beyond reasonable doubt that sexual violation occurred is difficult, particularly when there are no injuries or forensic evidence available, as is often the case.
• Victim/survivors’ withdrawal from the legal process – due to fear of going through the criminal justice process (recounting traumatic events and having to endure cross-examination, which can include information on their past sexual behaviour).
• Public and juries attitude – continued culture of scepticism, in which women’s accusations are received, and belief in rape myths have implications in relation to a jury’s willingness to convict the accused.
• Defendant’s previous behaviour – relevant evidence about a defendant’s previous behaviour and convictions is kept from juries.

 

These difficulties point to the need for specially trained and experienced prosecutors who will be alert to these potential pitfalls and will have developed skills and expertise in prosecuting sexual violation cases.

 6.3.1    Good practice guidelines for prosecutors
In New Zealand, there are no prosecution guidelines specific to sexual violence offences; the only procedural guidelines are the prosecution guidelines issued by the Crown Law Office (1992). These are generic guidelines that refer to the roles of both police and Crown prosecutors. The guidelines include details of who may institute a prosecution, factors that should be taken into account when deciding whether to prosecute, and procedures to be followed following indictments.
No research was found on how well the practices outlined in the New Zealand prosecution guidelines responded to the specific needs of victim/survivors of sexual violence. However, researchers have identified several factors related to the prosecution phase of sexual offending that were valued by victim/survivors (Jordan, 2008; Kelly, Lovett and Regan, 2005; Lievore, 2005; Orth, 2002). These are presented in Box 14.

Box 14: Good practice guidelines for prosecutors (victim-based)

• given a dedicated policewoman to provide information and emotional support
• provided with regular letters and updates in regards to court dates and time-lines
• given the opportunity to meet prosecutors well before the trial began
• given information regarding court layout, people able to be present etc., and where possible, the women were taken in to view the courtroom before the trial commenced
• able to provide evidence in a customised court layout with the aim of enabling the women to feel safe with the rapist present in court (e.g. the witness box was not in direct line with the defendant, and there were additional security measures)
• given permission to do things to help them feel more comfortable/strong
• (e.g. one woman was given permission to sprinkle what she termed the ‘glitter of courage’ in the witness box, and also put it in the box where the accused stood to assist her in overcoming her fear).

 

Many of these practices and those identified by other researchers (Kelly, Lovett and Regan, 2005; Lievore, 2005; Orth, 2002) mirror some of the ‘best practice’ guidelines for lawyers working with clients who have experienced sexual violence published by Legal Aid Queensland (2007) (see Box 15). It is unclear how these guidelines were arrived at, but there appears to be an emphasis on taking a victim-centred approach.

Box 15: Good practice guidelines for prosecutors

6.3.2    Specialist prosecutors
Commentators have identified specialisation of prosecutors as good practice (Amnesty International Australia, 2008; Cossins, 2007; Kelly, 2005). The key feature of specialist prosecutors is the receipt of specialised training to take into account the unique features of sex offences and the development of expertise in prosecuting sexual offence cases. As noted earlier, New Zealand prosecutors do not specialise.
Promising elements of specialist prosecutors

Several potential benefits of specialist sexual offence prosecutors have been identified (Kelly, 2005; Schonteich, 2001). These include:

• the development of expertise in prosecuting sexual offence cases
• the development of expertise and skills to take on more difficult cases, with successful prosecutions having the potential to challenge rape myths
• more continuity of personnel, with the same prosecutor preparing and managing a case from start to finish
• a more consistent approach to the prosecution
• the reduction of the secondary victimisation of complainants, with prosecutors having sufficient skills to conduct an empathetic yet enquiring consultation with a rape victim/survivor.

 

As a result of these potential advantages, several countries have moved down this path, with specialist prosecutors operating in the mainstream, as part of a specialist prosecuting unit, or within specialised courts.

• Victoria, Australia – The Specialist Sex Offences Unit in the Office of Public Prosecutions was set up in April 2007. Crown prosecutors, solicitors and advocates are located in the same unit and work as a team (Ministry of Justice, 2008). This is a dedicated unit aiming to achieve a more consistent approach to the handling of sexual offence cases as well as making the process less traumatic for victim/survivors (ACSSA, 2007).
• South Africa – The Sexual Offences and Community Affairs Unit was set up in September 1999. This is one of several specific investigating directorates set up in South Africa to deal with a range of serious crimes (e.g. organised crime, corruption, and serious economic offending). These units conduct prosecution-driven investigations, with oversight from a senior prosecutor. In addition, they aim to determine policy and set minimum standards for service provision by the criminal justice system to women. They also offer training courses for other prosecutors and have assisted in the setting up of specialist courts and the country’s first one-stop-centre (Schonteich, 2001).
• United Kingdom – Specialist rape prosecutors have been introduced across England and Wales. There were 520 in 2006 (Office for Criminal Justice Reform, 2006). A commitment to introduce specialist training for police, prosecutors, and barristers acting in rape cases has also been announced (Baird, 2007).

 

No evaluations of these initiatives were located, although the high conviction rates that are achieved in South Africa by specialist courts with specialist prosecutors (as reviewed in section 6.4) could be seen as partial evidence of their success.

 

6.4    Specialist courts

In New Zealand, there are several specialist courts, including Family Violence Courts and a Youth Drug Court in Christchurch, but no specialist court for sexual violence offences.

Elsewhere, specialised offence courts and specialised court procedures have been advocated as a way both to increase rates of conviction and to reduce secondary victimisation of victim/survivors (Amnesty International Australia, 2008; Cossins, 2007; Walker and Louw, 2003).

The primary rationale for specialist courts is that a degree of specialisation is deemed necessary in order to effectively address cases that are legally and factually complex (Walker and Louw, 2003). This principle has been applied to a range of different types of offences, resulting in drug courts; child sexual assault, domestic or family violence courts; mental health courts; and community courts. Intended outcomes of specialist courts include benefits for victim/survivors, the community and the offender (Lexicon Ltd, 2005).

Promising elements of specialist courts
Several potential benefits of specialised sexual offences courts have been identified (see Kelly, 2005; Ministry of Justice, 2008; Rasool, 2000) and include:

• the ability to draw special attention to a class of offence
• the ability of lawyers and judges to be appropriately trained and develop subject expertise, which can lead to greater efficiency and a higher quality of service (e.g. greater consistency in court processes for specific offences, efficient case processing, increased rates of conviction)
• the provision of continuity of court personnel
• the potential to customise procedural and evidential rules
• the potential to customise facilities to specific complainant needs (e.g. separate waiting rooms, closed-circuit television equipment)
• greater co-ordination of social and support services.

 

Specialised sexual violence offence courts appear to be unique to South Africa.
The first one was set up in Wynberg in 1993 to deal with sexual offences against both women and children; 62 are now in operation (Ministry of Justice, 2008).

These courts have been the subject of a number of studies, including the evaluation of two courts (Wynberg and Bloemfontein), revealing positive and negative outcomes (Moult, 2000; Walker and Louw, 2005a, 2005b, 2007).

The aim – to increase the rate of conviction of sexual offences – appears to have been achieved in these courts: conviction rates of 50–70 percent for the court at Wynberg (Moult, 2000) and 52 percent for the court at Bloemfontein (Walker and Louw, 2005a) are well in excess of the national average of 10 percent.
Researchers surmised that the courts were viewed in a positive light by the legal personnel involved (Walker and Louw, 2007); the families of the victim/survivors (Walker and Louw, 2005b) and the victim/survivors themselves (Walker and Louw, 2005a). Victim/survivors were satisfied with their dealings with the police service and interactions with state physicians and medical staff. And the families were generally positive in regard to the specialist court helping to reduce secondary victimisation. Procedural improvements, such as courts being equipped with video-link equipment and separate waiting rooms, have also been noted (Sadan et al., 2001, cited in Kelly 2005).

However, despite these achievements, the research has pointed to some flaws and areas for improvement in the specialist sexual offence courts.

• Not addressing the needs of victim/survivors – concern of secondary victimisation and insufficient provision of support and counselling pre- and post- trial (Moult, 2000; Rasool, 2000; Walker and Louw, 2003, 2005a, 2005b, 2007).
• Capacity issues – shortage of trained staff. Cases subjected to delays and postponements, with 76 percent of victim/survivors having to wait in excess of six months for a court hearing (Moult, 2000; Vetten, 2001).
• Issues of justice – questions over the impartiality of the court set-up, as well as credibility of decisions within the broader legal context due to the narrow caseload of judges limiting their general experience (Walker and Louw, 2003, 2007). No procedural guidelines for officials means women do not receive consistent and reliable service (Rasool, 2000).
• Insufficient infrastructure – insufficient space at some courts means that court rooms or waiting rooms cannot always be set aside (Rasool, 2000; Vetten, 2001).

On one level, these specialised courts could be seen as good practice, particularly with respect to those outcomes most desired by government, police and prosecution agencies (i.e. improved rates of conviction). There is also consensus that the primary objective of these courts, the welfare of the victim/survivor, and the move towards a victim-centred justice system, is a move in the right direction. Where opinion is divided is how well the current system is actually meeting this primary objective and whether high conviction rates are being achieved at the expense of the welfare and needs of the victim/survivor (Moult, 2000).

Good practice guidelines for specialist courts
The research on these specialised sexual violence courts has not yet reached the point of arriving at good practice principles, although the areas for improvement listed above would be important considerations in any future development of such courts.
Reviews of other types of specialist courts have progressed further, and lessons learnt would have applicability to specialist sexual violence courts. A review by Lexicon Ltd (2005) of specialist courts (drug, mental health, and domestic violence and community courts) across three jurisdictions identified three features associated with successful outcomes:

• a flexible judicial attitude with a willingness to participate in the ongoing monitoring of offenders’ behaviour and to communicate to others the benefits of the work they do
• an adequate pool of committed and trained professionals (e.g. lawyers, administrators, probation officers and others supervising court programmes)
• budget-holders with vision who are willing to invest resources in an enterprise that is likely to deliver tangible benefits only in the longer term.

 

6.5    Criminal justice system victim advocates

In New Zealand, criminal justice system advocacy is provided to victim/survivors by ‘victim advisers’. The court victim adviser service was introduced as a pilot in four courts in 1993 and extended to a further ten courts in 1996, and in 2001 was further extended and renamed ‘Court Services for Victims’. Victim advisers are specialist court staff employed to support victim/survivors through the court process, including the provision of case information; facilitation of their safety and protection of victims in court; and liaison with police, prosecutors, the judiciary and community organisations. They also inform the court of the victims’ views and ensure that victims of crime are informed of their rights under victims’ legislation.

There can be confusion over the role of victim advisers compared with others who provide support and advocacy to victim/survivors during the court process. Victim/survivors may also receive support and advocacy from community-based specialist sexual violence support services (e.g. Rape Crisis workers) or Victim Support (a nationwide non-specialist support group for victims). When the general meaning of the word ‘advocate’ is considered (i.e. someone who represents or speaks on behalf of another), it would be appropriate for all of these groups to be described as ‘victim advocates’. However, there is a difference in the services they provide to victim/survivors.

The support services provided by community agencies are considerably broader than those provided by victim advisers. Contact with community agencies can commence from the time of the assault and be ongoing throughout police and court processes. Support, advocacy and counselling can also be provided regardless of whether the victim/survivor enters into the criminal justice system. The role of victim advisers is more limited, applying primarily to the victim/survivors’ interaction with the court; and only the victim advisers have a statutory role that is set out by the courts.

In New Zealand, there has been very little evaluation of the services provided by victim advisers (Church et al., 1995; Crooks and Jefferies, 2003). Crooks and Jefferies (2003) looked at court services for victim/survivors provided by victim advisers, in relation to meeting the needs of Māori and Pacific victims of crime.
The report was not specific to victim/survivors of sexual violence, but the findings are likely to have relevance to Māori and Pacific victim/survivors who go through the legal process.

The main recommendation of Crooks and Jefferies (2003) was that court services should be improved to meet the needs of Māori and Pacific victims. The report concluded that this could be achieved by implementing robust recruitment and training procedures; formulating a strategic commitment to these communities; promoting the service nationwide (e.g. translating current publicity material); introducing interpreters; and ensuring that court environments and services respect the privacy, security and culture of these groups.

A pertinent point, however, was made about court services: many of the advisers found it difficult to pinpoint how successful their level of service was to any of their clients. Not receiving complaints was seen as being ‘success enough’.

It is noteworthy that a recent report published by the Ministry of Women’s Affairs (2008) proposed the introduction of ‘independent victim advocates’ to courts to complement the services already provided to victims of family violence by victim advisers and family court co-ordinators. The report supported the development of the role of independent victim advocates and indicated they were likely to be introduced in all Family Violence Courts from July 2008. It was suggested that consideration should be given to whether independent victim advocates would also be appropriate for victim/survivors of sexual violence.

Legal representation for victim/survivors
These discussions are premised on the idea that in an adversarial criminal justice system the victim/survivor is only a witness to a crime, and the main protagonists are the prosecutors and the defendant. It is noteworthy that in France, which has an inquisitorial system, the victim of the crime has legal representation in court and their interests are protected to a greater extent by a lawyer (Waller, 2003). 

The question of advocacy in that context is not about protecting victim/survivors’ ‘interests’ but a much more assertive and radical stance of protecting victim/survivors’ legal rights.

In common law jurisdictions, such as the United Kingdom, the United States and New Zealand, victim/survivors do not have legal standing in court – they are not parties to proceedings (Murphy, 2001). This means they have no representation when submissions are made for judicial decision in matters that not only affect the trial but may also affect them – for example, in issues regarding whether or not a victim/survivor can continue to have a formal support person in the court, the possibility of alternative modes of evidence and so on. There is also no right of appeal from victim/survivors in situations where they consider an injustice to have occurred.

One United States initiative that is actively campaigning to provide legal advocacy services to victim/survivors is called the Victim Advocacy and Research Group.
It supports ‘lawyers for victims at both the trial and appellate levels of the criminal justice system … to ensure respect for fundamental constitutional principles. And to identify and eradicate gender bias in the criminal common law’ (Murphy, 2001: 123). This type of victim advocacy goes much further than that which is commonly discussed in the literature.

6.6    Statutory reform

While many countries, including New Zealand, have introduced statutory reforms, there has been little research to date to assess the relative merits of these. What have been identified are ‘promising practices’ that may not have been proven to be effective, but that reflect both human rights concerns as well as current knowledge and understanding regarding sexual violence (Kelly, 2005).  Some of those identified include measures already introduced in New Zealand, such as criminalising rape in marriage and setting the age of consent for those involved in the sex industry at 18 years (see section 2.3).

A recent review in the United Kingdom of rape law and trial procedures identified key areas for reform relating to evidential law and issues of consent in particular (Temkin and Krahé, 2008). Greater recognition is also being given in law to mandating victim/survivors’ rights.

6.6.1    Proposed legislative amendments in New Zealand
In New Zealand, mounting concern has been raised regarding the ways in which crimes of sexual violence are dealt with in the criminal justice system. While there is some agreement about the need for change, the best way to proceed has not yet been determined and various options exist. Recently, the Ministry of Justice (2008) issued a discussion paper to solicit the public’s views about proposed legislative amendments to the current law on sexual violence, including:

• adding a definition of consent to current legislation
• extending the provisions protecting victim/survivors from questions concerning their sexual history
• defining the actions required in relation to the defence of ‘reasonable belief in consent’.

 

In addition, the public has been asked to present their views about more systemic changes to the criminal justice system’s procedures in respect of sexual violence. Topics for discussion include: consideration of an inquisitorial system of justice; the development of specialist sexual offence courts and specialist prosecution units; as well as a discussion about the feasibility of multi-agency models of handling rape complaints, for example, Sexual Assault Referral Centres (Ministry of Justice, 2008).

Many of the key areas presented in the discussion document are reviewed in the remainder of this statutory reform section.

6.6.2    Legal definitions of rape
As noted earlier, significant changes to the definition of rape were enacted in New Zealand in 1985 (see section 2.3). These changes are consistent with reforms advocated internationally. For instance, making rape a gender-neutral offence, removing the rape in marriage exemption, and extending the definition of rape to include other forms of penetration all reflect common changes in many European countries (Regan and Kelly, 2003). Some countries such as Canada and states in the United States have moved towards defining levels of rape/sexual assault (Kong et al., 2003; Regan and Kelly, 2003), a change not currently followed by European countries with the exception of Finland (for further discussion, see Regan and Kelly, 2003).

6.6.3    Legal definitions of consent
In New Zealand, the Crimes Act 1961 does not define what constitutes consent, but provides a negative definition of consent by listing circumstances that should not be taken as signifying consent (section 128A of the Crimes Act 1961). These circumstances include the victim/survivor being asleep; unconscious; or intellectually or mentally impaired. Judges have directed juries to determine that consent needs to be ‘freely and voluntarily given’ (Ministry of Justice, 2008). These conditions of consent include some of those identified as good practice by Amnesty International Australia (2008).

In New Zealand and the United Kingdom, the prosecution needs to prove that the accused did not believe, on reasonable grounds, that the complainant was consenting, while Canada and some states and territories in Australia are among those jurisdictions that have moved in recent years towards defining what constitutes consent. The latter require the court to consider the steps taken by the accused to determine that consent was given (Ministry of Justice, 2008). This latter move has been incorporated to some extent in the United Kingdom’s Sexual Offences Act 2003, which explicitly states that when determining ‘reasonableness’, all the surrounding circumstances need to be considered, including any steps taken by the accused to ascertain consent has been given. Such moves internationally have prompted the inclusion of this issue in the Ministry of Justice (2008) discussion document relating to New Zealand‘s current consideration of improvements to sexual violence legislation.

6.6.4    Extending the rape shield
The Ministry of Justice, in its public discussion document (Ministry of Justice, 2008), has a preliminary proposal to amend the rape shield so that evidence about previous sexual experience between the complainant and any person, including the accused, is inadmissible without prior agreement of the judge. This reflects the view that the prior sexual relationship between the complainant and accused is never relevant, since consent to sexual activity on one occasion does not imply that a person automatically agrees to sexual activity on another occasion. Such an extension is viewed problematically in some quarters as preventing an accused from being able to comment or answer questions regarding previous occasions could impact unfairly on the decision to run an effective defence (Buckingham, 2008). It is also possible that the complainant may wish to contrast previous occasions with the specific occasion in dispute (Buckingham, 2008).

6.6.5    Procedural reforms
In a review of procedural reforms across European countries, Regan and Kelly (2003) reported that there was no common ‘good practice’ across Europe that enabled complainants to give their best evidence in court, whilst protecting their dignity and integrity and limiting the extent of secondary victimisation. Procedural reforms that some countries have incorporated include:

• introducing screens in courts to enable victims/witnesses to give evidence without having to see their attacker
• removing the right of the accused to be able to cross-examine the victim/witness
• ensuring the right of the victim/witness to have a support person present when they give evidence
• allowing video and other forms of technical equipment to enable the victim/witness to be cross-examined when outside the courtroom
• removing unnecessary people, including the offender, when the victim/witness gives their evidence
• ensuring name and address suppression for the victim/witness
• ensuring the right to legal assistance before, and representation during court cases
• allowing a non-government organisation to be party to the case (Regan and Kelly, 2003: 17).

 

The first three points listed above are provided for in the New Zealand criminal justice system. There are also calls from some quarters to allow video-recorded victim/survivor statements as evidence in trials, reflecting recent reforms in the United Kingdom (Baird, 2007).

While procedural reforms are important, their effectiveness is likely to be limited because, as even legal commentators have observed, one of the main barriers to achieving justice for rape victims lies in the attitudinal views and biases that are still entrenched in both criminal justice system practitioners and the public at large (Kelly, 2005; Temkin and Krahé, 2008). A further challenge is achieving a balance between the needs of a victim/survivor with the evidential needs of a justice system that has been designed to determine the criminal liability of the accused (Flatman and Bagaric, 2001; Wang and Rowley, 2007).

6.6.6    Victims’ rights
Kelly (2005) suggests the right to anonymity for victim/survivors is critical. She notes that in the United Kingdom, even at the initial investigations stage, a woman’s name, picture and workplace can appear in salacious media coverage. In New Zealand, this is less of a risk because of suppression orders and limits on media coverage.

Increasing pressure has been placed on the criminal justice system to make victim/survivors more central within its processes, evident in New Zealand first in the Victims of Offences Act 1987, later replaced by the Victims’ Rights Act 2002. This legislation imposes clear obligations on specified agencies to provide information and offer assistance to the victims of criminal offences, including victim/survivors of sexual violence. It also prohibits the disclosure in court of the victim/survivor’s address except in particular circumstances, and increases the scope for victim/survivors to have their views represented in relation to such matters as how the offence impacted on them, their views regarding the accused’s release on bail and so forth. More recently (September 2008) the Government introduced the Victims Charter, which sets out the standard of service that a victim/survivor can expect from government agencies if a crime is committed against them or their family/whānau. For more details, see Ministry of Justice (no date).

The introduction of the Victims Charter was accompanied by the launch of a website specifically oriented towards providing information for crime victims, as well as an 0800 number available seven days a week from 9 am to 11 pm to provide information for people affected by crime about the justice system and support services available.

The introduction of these resources for victim/survivors reflects internationally accepted indicators of ‘good practice’ aimed at increasing the levels of support and information available and mandating compassionate and respectful treatment of victim/survivors throughout their interactions with the criminal justice system.

6.6.7    Adversarial or inquisitorial approach?
Countries around the world tend to have one of two systems of justice: an ‘adversarial’ or ‘inquisitorial’ system. An adversarial justice system of law is generally adopted in common law countries, including New Zealand and the United Kingdom, while the inquisitorial justice system is found in Europe among civil law systems (i.e. those deriving from Roman law or the Napoleonic Code). Key characteristics of these two systems are in Table 6.

The possibility that all, or some, of the aspects of an inquisitorial system could be incorporated into sexual violence legislation in New Zealand is one of the issues opened up for public discussion by the Ministry of Justice (2008).

The brutal impacts of the traditional, adversarial justice system on rape victim/survivors have been increasingly acknowledged by overseas and New Zealand researchers, with rape trial experiences likened to a ‘second rape’ (Koss, 2000; Lees, 1996; McDonald, 1997; Scutt, 1998; Thomas, 1994). Research data obtained from nearly 1,000 criminal trials in the United States showed that the majority of rape victim/survivors believed that rapists had more rights than they did, that the criminal justice system was unfair, and that they were not given adequate information about their case, nor input and control into its handling (Frazier and Haney, 1996).

Table 6: Inquisitorial and adversarial justice systems

Inquisitorial justice system	Adversarial justice system
Principle
Aims to get to the truth through extensive investigation and examination of all evidence	Assumes that truth is most likely to result from open competition between the prosecution and defence
Key features
Investigating magistrate: responsible for supervising and actively gathering evidence; questioning witnesses; deciding whether charges should be brought. Judge presiding over trial will be a different person to the investigating magistrate. Judges have increased judicial discretion and exercise a larger and more active role. Rules around admissibility of evidence are significantly more lenient. Who holds the burden of proof and level of proof required varies in different countries.	Lawyers for each party present arguments and question and cross-examine witnesses. Offers stronger protection for defendants in their interpretation of right to silence. Presumption of innocence. Burden of proof on prosecution to prove accused’s guilt beyond reasonable doubt.

Source: Adapted from Ministry of Justice (2008) Improvements to Sexual Violence Legislation in New Zealand: public discussion document. Wellington: Ministry of Justice, pp. 27–28.

 

A recent book reviewing data relating to sexual assault trials concluded:

Despite all the efforts and undoubted improvements over the past thirty years, the rape trial as it is configured in the common law world is frequently not up to the task of delivering justice for rape victims. (Temkin and Krahé, 2008: 209)

Concerns such as these, coupled with increasing rates of attrition with sexual violence cases, have prompted greater debate over the issue of whether or not legal reform measures are able to improve the current system, or whether an alternative approach needs to be developed (Bronitt, 1998; Henning and Bronitt, 1998; Taslitz, 1999; Thomas, 1994; van de Zandt, 1998). The inquisitorial approach, common in many European countries, is offered as a possibly more suitable approach for sexual offences.

There is no clear evidence that an inquisitorial system is superior in the case of sexual violence offences, although, in a review of attrition in reported sexual violence across several European countries, Regan and Kelly (2003) reported, with the exception of Sweden, that countries with adversarial legal systems tended to have the highest attrition rates. It has also been suggested that the less restrictive approach to evidence of the inquisitorial system may be more suited to sexual offences, and in particular historical offences (Ministry of Justice, 2008).

6.7    Restorative justice debate

Among common law jurisdictions, New Zealand has been at the forefront of developments in the delivery of restorative justice processes and, in 2008, the Ministry of Justice opened up for discussion whether restorative justice processes should be available in cases of sexual violence (Ministry of Justice, 2008).

While it is considered as an appropriate practice for most offending, the use of restorative justice with adult cases of sexual violence is a contentious issue. Hence, while restorative justice for sexual violence cannot yet be identified as ‘good practice’, it is ‘worth watching’, particularly for use with Māori victim/survivors of sexual violence. For this reason, this section provides some context to the use of restorative justice in New Zealand together with some of the issues being debated.

6.7.1    Restorative justice in New Zealand
In New Zealand there is legislative provision for the use of restorative justice at various points in the criminal justice system, including pre-sentence, following a guilty plea, post-sentence, and as part of the Police Adult Diversion Scheme (Ministry of Justice, 2008: p. 28).

New Zealand introduced the first community panel restorative justice adult diversion programmes in 1996 with the support of the Ministry of Justice’s Crime Prevention Unit (Paulin, Kingi and Huirama, 2005). Further expansion occurred in 2001 with the introduction of ‘court-referred’ restorative justice conferences at four courts. 

The schemes dealt with adult offenders and relatively serious offences (Morris et al., 2005). Meanwhile, the number of community-based programmes based on the initial community panel model for adult offenders has continued to grow (Kingi, Paulin and Porima, 2008). Some of these programmes deliver restorative justice processes in family, domestic and sexual violence cases.

The Ministry of Justice recognised the need for some operational guidance and, following an extensive consultation process with restorative justice practitioners, published a set of principles of good practice identifying how and when restorative justice processes should be used in criminal cases (Ministry of Justice, 2004). In relation to sexual violence these guidelines state, ‘the use of restorative justice processes in cases of family violence and sexual violence must be very carefully considered’ (p. 19).

More recently, the Ministry of Justice (2008) has indicated that while restorative justice processes may not be appropriate in all sexual violence cases, they could provide a useful approach to sexual offending with the development of specific service standards drawing on specialist knowledge in the service sector.

6.7.2    Models of restorative justice
In traditional criminal justice systems, professionals representing the state make the decisions on how to respond to an offender’s behaviour. Restorative justice processes, in contrast, aim to involve victims, offenders and their ‘communities of care’ in the decisions (Braithwaite, 1989; Hudson, 2003).

Restorative justice processes operate differently within and across different countries, although a common prerequisite for restorative justice processes to operate is that the offender must admit their guilt. Allison Morris (2002) has argued that there is no single ‘right way’ to deliver restorative justice. She states that the essence of restorative justice is not the adoption of one form rather than another; it is the adoption of any form that reflects restorative values and aims to achieve restorative processes, outcomes and objectives (Morris, 2002). New Zealand has followed along similar lines identifying core values and suggesting that to be ‘restorative’, processes and outcomes need to reflect these values (Ministry of Justice, 2004).

6.7.3    Restorative justice processes with sexual violence offending
There is a much contested debate around the use of restorative justice processes in ‘gendered violence’ (partner, family and sexual violence) (Cossins, 2008; Daly, 2002, 2008; Strang and Braithwaite, 2002; Stubbs, 2007). Some advocates envisage these processes as having the potential to increase women’s choices, provide women with a voice, and draw on the support of family/whānau and friends in a way that may increase their safety (Morris and Gelsthorpe, 2000). Daly (2006) has also recently argued, based on an Australian study of victim/survivors of young sexual offenders, that restorative justice processes may be less victimising than the court process for victims. Opponents draw attention to the unequal power relationships between victim/survivors and perpetrators, and raise concerns that restorative justice processes may compromise women’s safety and expose them to further victimisation (Busch, 2002; Lewis et al., 2001; Stubbs, 2002).

The main arguments for and against the use of restorative justice processes with sexual violence case are set out in Table 7.
 

Table 7: Arguments for and against the use of restorative justice

Arguments for restorative justice	Arguments against restorative justice
Only a minority of sexual assault cases are dealt with by the criminal justice system – a different process may encourage victim/survivors to report. Low prosecution rates and low conviction rates (especially for young offenders) in criminal justice system. Can address a need for non-punitive retribution. Ensures other people are protected from the offender.	Sexual violence is a serious crime– using restorative justice processes may undermine that message. Sexual offending needs to be strongly condemned – restorative justice process may be seen as implicitly condoning or treating the offending as minor. Because of its ‘closed’ nature, the restorative justice process might result in sexual offending becoming less visible. Government may redirect funding into restorative justice programmes and away from services to victims.
Relating to offenders
Assists the offender to receive appropriate treatment. Understanding the harm they have caused may create greater empathy in offenders.	Offenders will not be deterred by the restorative justice process. Offenders may use the process to blame the victim.
Relating to victim/survivors
Provides victim/survivors with more information about the process. Ensures victim/survivors are treated respectfully and fairly. Acknowledges the wrong victim/survivors have suffered. Affords an opportunity for victim/survivors to tell their story. Ensures that the people of significance to the victim/survivor know about the wrong.	Victim/survivors may be re-victimised by the process. Offenders are often family members and pressure may be exerted on victim/survivors to participate in restorative justice.

Source: Adapted from M. Neave (2004) ‘Restorative justice: when is it appropriate?’ Paper presented at Victorian Law Reform Commission, La Trobe University Law School, 6 October.

 

Mary Koss (2000, 2006a), while supportive of the use of some types of restorative justice in relation to sexual offending, has criticised the use of victim–offender mediation type of restorative justice in such circumstances (Koss, 2006a). She writes that ‘mediation is thoroughly discredited for gender-based violence’ (p. 222).

Instead, Koss supports the concept of restorative justice using a community panel model. Koss gives the example of the RESTORE programme in Arizona. 

The criteria for the acceptance of cases are set out in Table 8.

Table 8: RESTORE restorative justice programme

Accepts cases	Excludes cases
Where there has been a guilty plea for a misdemeanour sex offence.1 Where the victim/survivor and the offender have agreed to take part. Where the matter has been court ordered.	Where those involved are aged under 18 years. Where cases involve a repeat offender. Where the sexual assaults are part of ongoing intimate partner violence. Where severe levels of violence are involved.

Note

1. In the United States a misdemeanour is a ‘lesser’ criminal offence, punishable by a year or less in prison and would be similar to a ‘summary offence’ in New Zealand.

 

A typical referral would be an acquaintance rape, where both parties had been drinking (Koss et al., 2004; Koss, 2006b). The programme has not been subject to an independent evaluation.

Based on Koss’s work in the United States, Project Restore was launched in Auckland, New Zealand in August 2005 (DSAC, 2005; Ministry of Justice, 2008). The project provides a restorative justice option for victim/survivors of sexual offending and is run by an executive committee drawn from groups such as Auckland Sexual Abuse HELP, SAFE Network, Rape Prevention Education, and Restorative Justice Auckland Trust. The focus of the project is sexual assaults in which the victim/survivor and attacker are known to each other. It is intended to meet the victim/survivor’s need for the attacker to acknowledge wrongdoing. Cases are referred through community groups or the court (after a guilty plea). Best practice guidelines are being developed and an evaluation is being undertaken (Ministry of Justice, 2008).

Firm research evidence on the effectiveness of restorative justice processes in ‘gendered’ violence cases is scant, and such pointers as exist are somewhat contested (Stubbs, 2004). In New Zealand, Kingi, Paulin and Porima (2008) studied five restorative justice programmes that use a mix of victim–offender conferencing and community panel models; and in South Africa, a victim–offender conferencing restorative justice programme was evaluated (Dissell, 2005). In both these countries, the cases dealt with by restorative justice mainly involved assaults and other violence (South Africa) or family violence specifically (New Zealand). Both programmes dealt with just a small number of sexual offending cases (one percent in both) and there was insufficient evidence for the researchers to come to any specific conclusions about the quality of the service provided for victim/survivors of sexual violence.

Judith Herman (2005) conducted research in the United States with 22 victim/survivors of sexual and domestic violence. She argued that survivors’ views of justice do not fit well into either retributive or restorative models.
The important points highlighted were that victim/survivors wanted vindication, validation and community denunciation of what had happened to them, so that the burden of disgrace would be transferred from them to the offender. A common objective of public exposure cited by the victim/survivors was to ensure safety for themselves and other potential victims. Herman argues that adapting restorative justice models with feminist leadership, extensive community organising, and close and active collaboration with state authorities could create a reliable context for supporting victim/survivors and would send a clear message that these crimes are taken seriously.

The use of restorative justice processes with sexual violence cases is clearly still up for discussion. The current debate is still around whether or not it should be used, rather than what are the good practice guidelines. Those who advocate its use generally agree it is not appropriate in all sexual violence cases, but suggest that with careful selection, planning and the use of facilitators skilled in restorative justice processes, it can provide a forum for addressing victim/survivors’ needs (Daly, 2006; Morris and Gelsthorpe, 2000; Zehr, 2007).

 

6.8    Responding to the needs of diverse groups – criminal justice system

6.8.1    Māori victim/survivors
There has been much discussion on how appropriate the existing New Zealand criminal justice system is for Māori people, with strong advocacy for a separate Māori system of justice (Jackson, 1987, 1988, 1989, 1995). These debates centre on fundamental differences between the approach of the current criminal justice system and the traditional Māori world view of justice; and the implications of these differences for the promises and rights given to Māori on signing the Treaty of Waitangi (i.e. the right and ability of Māori to have control over decisions that affect Māori).

Most of what has been written has focused on the failure of the current New Zealand system in relation specifically to Māori offenders. However, its relevance extends also to Māori victims, as within traditional Māori society the offender and the victim, together with their whānau, are inextricably linked (Cram, Pihama and Karehana, 1999; Jackson, 1988, 1989; Ministry of Justice, 2001). The key failures that affect the role and treatment of Māori victim/survivors are considered below. For a full understanding of Māori perspectives on justice, see Moana Jackson’s work The Māori and the Criminal Justice System: a new perspective: He Whaaipaanga Hou  (1987, 1988, 1989) and the Ministry of Justice’s (2001) He Hinatore ki to Ao Māori – A Glimpse into the Māori World: Māori perspectives on justice.

This review found very little material on the appropriate way of responding to Māori who have been victim/survivors of sexual violation. The New Zealand Police ASAI Policy was the only criminal justice guideline specifically related to sexual violence located as part of this review (see section 6.2). There are multiple references in this policy to the importance of police working in a culturally appropriate manner when investigating reports of sexual violence (see section 6.2.5). However, details on how this might be achieved were limited.

The only other document located that discussed appropriate ways of responding to Māori victims was the non-specific sexual violence report by Cram, Pihama and Karehana (1999) Meeting the Needs of Māori Victims of Crime. Conclusions made in this report were based on interviews with Māori key informants (n=10) and Māori victims of crime (n=70). The report outlined appropriate support services for Māori, which are reviewed in section 7.5.1. The main content of the report focused on Māori approaches and experiences of justice, and through this the term ‘victim’ itself was found to be problematic from a Māori perspective.

‘Victim’ was seen to imply an individual experience, whereas in Māori society whakapapa links mean that a transgression (or crime) will affect the whānau of both the ‘victim’ and the ‘perpetrator’ and their wider communities (Cram, Pihama and Karehana, 1999). This mirrors one of the key failures of the current criminal justice system raised by Jackson (1987, 1988, 1989), that of the current system being centred on an individual offender and victim. In contrast, in a traditional Māori system, an offender was never regarded as solely to blame for their crimes. Rather the offender’s whānau was deemed equally liable for the offender’s actions, which were held to have aggrieved not just another individual but another whānau (Jackson, 1988, 1989).

Cram, Pihama and Karehana (1999) also criticised the term ‘victim’ for implying a powerlessness that was viewed as likely to hinder resolution of the individual and their wider networks. This is important, as rather than seeking revenge, restoration and the need to get on with life and to restore balance are key aims of Māori justice (Cram, Pihama and Karehana, 1999). This highlights another key difference in the existing system and that of a Māori approach to justice. A Māori justice system would focus on restitution and compensation rather than on retribution, and would be shaped by traditions of mediation, rather than simply punishing offenders often by imprisonment, which is the focus of the existing system (Cram, Pihama and Karehana, 1999; Jackson, 1989). Within the latter system, the primary role of ‘victim’ is as a witness to crime, with healing and resolution a lower priority (Cram, Pihama and Karehana, 1999).

Whilst acknowledging the diverse realities within any group (Durie, 1995), in considering the points above, it appears that in responding to the needs of Māori victim/survivors inclusion of the victim’s and offender’s whānau and their wider communities would be good practice. A focus on how to achieve restoration and healing rather than how to convict the offender may also be more appropriate. McElrea (1995), in fact, draws attention to the ability of restorative justice frameworks to allow culturally sensitive responses to crime within the current criminal justice system.

This is clearly a complex topic, and full coverage is beyond the scope of this report. However, an important point to note is the limited amount of published material on the appropriate way for criminal justice systems to deal with Māori.

6.8.2    Pacific victim/survivors
Epati (1995) notes that, in Samoan culture, traditional systems of cultural and social justice are based on the notion that communal interest overrides that of the individual. He states that in the main this is true for most of the Pacific cultures, with any differences among individual Pacific cultures, being only a matter of degree. This Pacific view aligns with traditional Māori systems of justice, both of which conflict with the concepts underpinning Western law and legal systems.
There is little published material in relation to Pacific peoples and their involvement in the criminal justice system. Research is scarce and tends to focus on the generic needs of victims of crime (see Koloto, 2003). As mentioned previously, Koloto’s study focused on the needs of New Zealand Pacific victims of crime, including some victims of family violence where sexual offending occurred. In relation to the criminal justice system, the interviewees wanted:

• more information on formal support services: in particular someone to explain legal terminology and their rights as a victim of crime (Koloto, 2003, p. 51)
• more Pacific support organisations: information in Pacific languages and translation of legal terminology; not only asking for more Pacific services by and for Pacific people, but also more Pacific personnel in existing services such as Victim Support (Koloto, 2003, p. 52).

 

In line with McElrea’s (1995) assertion that restorative justice frameworks allow culturally sensitive responses to crime, Epati (1995) sees the utilisation of restorative justice as a step in the right direction in responding in a culturally appropriate manner to the needs of Pacific peoples. However, he goes on to say that when and how this could occur within the formal judicial process needs further contemplation. Koloto (2003) also agrees with the potential of the use of restorative justice to address the needs of Pacific victims, but found that participants in her study were not aware of this as an option.

6.8.3    Sex-worker victim/survivors
Historically it has been difficult for sex-workers who were raped to feel confident about reporting such attacks to the police (Hester and Westmarland, 2004). In countries where prostitution is criminalised, sex-workers often resist or avoid interactions with law enforcement agencies, and may also be wary of encountering stigmatising or victim-blaming attitudes (Penfold et al., 2004). Early indicators in New Zealand following the Prostitution Reform Act 2003 suggest that in a decriminalised environment there is still considerable reluctance on the part of sex-workers to report violent incidents to the police (Abel, Fitzgerald and Brunton, 2008; Prostitution Law Review Committee, 2008). The preferred option is still to confide in fellow workers, or sometimes management in the case of brothel workers, or consult with the New Zealand Prostitutes Collective (Abel, Fitzgerald and Brunton, 2008; Prostitution Law Review Committee, 2008).

Writing within the Australian context, Quadara (2008: 23) noted that, ‘misperceptions about sex work and sex workers impact on systemic responses to victim/survivors of sexual assault who are also sex workers’. Her overview identified a failure on the part of some agencies to conceptualise sexual assault as a form of harm for sex-workers, and advocated that it would be good practice for legislative and industry protocols to prioritise sex-workers’ personal physical safety and sexual autonomy, not just their sexual health and occupational health.

6.8.4    Victim/survivors with disabilities
Researchers have identified a lack of responsiveness by law enforcement agencies to victim/survivors with disabilities (Hoog, 2004; Lievore, 2005). Issues faced by this group are around judgments to their credibility in either being believed by police in the first instance or prosecution decisions about their status as witness.

In the United States, Lang and Brockway (2001) suggested good practice for criminal justice personnel working with victim/survivors with disabilities is to ensure, if an interpreter is required, that this person be independent. This is because the abusers of people with disabilities are often caregivers or family members, and thus the perpetrator may be the person who is accompanying the victim/survivor to an interview. If this person interprets for the client, there is unlikely to be a full, open disclosure of the facts.

Also, in the United States, the California legislature amended its penal codes in 1998 to provide alternative methods of presenting the testimony of people with cognitive disabilities who are the witnesses/victims of violent and/or sexual crime. These alternatives include the use of video-taped testimony and closed-circuit television, as well as provisions aimed at assisting and reassuring the victim/witness (e.g. allowing breaks from the stand and the presence of support people, and accommodating specific requirements to aid communication) (Petersilia, 2001).

In Australia, although the same laws around sexual assault apply to adults irrespective of whether they have a disability, some additional laws apply specifically to sexual assault against people with intellectual disabilities (Blyth, 2002: 60).

We were unable to locate any references to criminal justice approaches taken in New Zealand that specifically responded to the needs of victim/survivors of sexual violence who have intellectual or other disabilities.

 

7    Support services

 

7.1    Introduction

This section reviews the literature on how the support needs of victim/survivors can best be met. This includes those services that specialise in supporting victim/survivors of sexual violence, and non-specialist services where victim/survivors can also turn to for support. While there is a growing body of research assessing the impacts of engagement with the criminal justice system, fewer studies have been conducted into how well support services meet the needs of victim/survivors (Campbell, 2006; Lievore, 2005; Lovett, Regan and Kelly, 2004).

In New Zealand these support services are predominantly delivered in the community by non-government organisations (NGOs). However, overseas support services can also be provided though government-funded initiatives (e.g. sexual assault referral centres (SARCs)) based in either a hospital or the community.

7.2    Specialist sexual violence services

In this section we review specialist models of service delivery for victim/survivors of sexual assault: NGO-specialised sexual violence support services, state-funded SARCs.

7.2.1    Specialised sexual violence support services (non-government organisations)

Background to specialised sexual violence support services
In New Zealand, specialised sexual violence support services (SSVSs) are delivered by a variety of NGOs, including rape crisis centres, HELP Foundation Sexual Abuse Centres, and other independent rape and/or sexual assault centres.

The first SSVSs were the rape crisis centres that emerged in many countries, including New Zealand, in the 1970s and early 1980s as part of the radical feminist movement’s desire to eliminate rape and violence against women (Beckett, 2007). In contrast to traditional social service agencies, many of these centres were run as feminist collectives where power and decision-making were shared among all members of the organisations. Although each centre was independent, they operated along similar lines, offering 24-hour crisis lines to provide information, referrals and crisis counselling. These centres also trained volunteers as legal and medical advocates to accompany and support victim/survivors through the police, medical and justice systems (Campbell and Martin, 2001).

In documenting the anti-rape movement, Campbell and Martin (2001) describe a process evident in many countries, including New Zealand, of a shift away from feminist activism towards professionalisation as SSVSs sought and won government funding. Whereas the political activism of the SSVSs has tempered over time, the direct services these agencies provide to victim/survivors remained essentially the same: a 24-hour hotline; counselling (individual, group support groups), and legal and medical advocacy. An Australian evaluation by Lievore (2005) found the specialist help provided by counsellors from SSVS organisations was rated more highly by victim/survivors than that provided by other formal helping agencies (e.g. medical and mental health services and not-for-profit community organisations that offer counselling, and crisis helplines).

Recently in New Zealand, a national collective of NGOs working in this sector has been formed, named Te Ohaakii a Hine – National Network Ending Sexual Violence Together.

Evaluations
No evaluations of New Zealand services were located, although, in a comparison of models of service delivery across countries, positive characteristics of the New Zealand SSVSs were commented on by Kelly (2005). SSVS-type agencies in New Zealand and North America were judged to have particularly strong links with other agencies, with SSVS advocates expected to be linked in with victim/survivors at the earliest point.

Campbell and Martin (2001) claim that few studies have explicitly examined if and how SSVSs benefit victim/survivors. Researchers and anti-rape activists have assumed that SSVSs help survivors ‘precisely because the job of rape victim advocates is to intervene and prevent victim-blaming harm to survivors’ (Campbell and Martin, 2001: 234). While some research does show that SSVS advocates appeared to be successful in helping victim/survivors obtain needed resources from community systems (e.g. Campbell, 1998, Campbell and Bybee, 1997, both cited in Campbell and Martin, 2001), few studies included victim/survivors who did not receive help from SSVSs.

In an attempt to answer whether survivors who received help from SSVS advocacy were better off than those who did not, in the United States Campbell and Raja (1999) interviewed 102 rape survivors recruited through a variety of neighbourhood contexts (e.g. public transportation, bookstores, beauty and nail salons). They found only one in five victim/survivors had worked with an SSVS advocate; but that working with an SSVS advocate was associated with reduced victim/survivor distress, particularly for victim/survivors of non-stranger sexual violence (acquaintance rape, date rape and marital rape).

In a further study, Rebecca Campbell (2006) interviewed 81 sexual violence victim/survivors, 36 of whom were treated at a hospital where rape victim advocates from a local SSVS worked, and 45 from a hospital where rape victim advocates did not work. The hospitals were similar in all other aspects:

The study found that victim/survivors who worked with an advocate during their emergency:

• were significantly more likely to have police reports taken
• were less likely to be treated negatively by police officers
• reported less distress after their contact with the legal system
• received more medical services, including emergency contraception and sexually transmitted disease prophylaxis
• reported significantly fewer negative interpersonal interactions with medical system personnel
• reported less distress from their medical contact experiences.

 

In her study in New York City, Fry (2007) found that of all the sectors (hospital, rape crisis/victim assistance, law enforcement and criminal justice systems), victim/survivors were most satisfied with the care they received at rape crisis programmes. Fry concludes that this is likely because, in New York city, rape crisis programmes are mandated to deliver victim-centred care and to promote healing and recovery, where other victim service sectors may operate under different mandates such as providing medical care, enforcing the law and ensuring community safety.

Campbell and Martin (2001) drew attention to a negative finding in relation to SSVSs. They found that access to rape crisis centres in Chicago varied as a function of race, with ethnic minority groups being less likely to contact an SSVS. While there are no similar studies in the New Zealand context, the access of Māori, Pacific peoples and other ethnic minorities to SSVSs is an area that needs to be researched.

Only two sets of guidelines for SSVSs were located. A comprehensive set of national standards of practice developed for Australian services against sexual violence (Dean, Hardiman and Draper, 1998) and those compiled by the Rape Crisis Network Europe (2003) for NGOs supporting women who have experienced sexual violence. The Rape Crisis Network Europe guidelines were based on information from 14 member organisations that completed a survey. Rape Crisis Network Europe defined good practice as action that proved successful or achieved positive outcomes for users of their services. The study does not provide details on how the rape crisis groups measured their success, but drew up a list of what it identified as the key dimensions of good practice. Guidelines appear in Box 16.

Box 16: Good practice guidelines for non-government organisation specialised sexual violence support services

 7.2.2    Sexual assault referral centres
There are no SARCs in New Zealand, but they have become popular in several countries overseas, including Australia, the United Kingdom, the United States and South Africa.

SARCs are centres that bring together all of the different legal and medical agencies in one place and provide a variety of medical, legal, counselling and support services to victim/survivors. Several countries have developed SARCs in an attempt to improve the care of sexual violence victim/survivors so that they are less traumatised by the need to access all the various services and have forensic evidence and police statements gathered efficiently at the same time. They are typically state funded, either through victim services or health care budgets, or in the United Kingdom through police budgets (Kelly, 2005).

These centres are also known as sexual assault centres, sexual assault treatment units, and in South Africa as Thuthuzela Care Centres. Although SARCs are based in hospitals in most countries, some in the United Kingdom and those in Australia are community based. Common characteristics of SARCs include:

• integrated and co-ordinated services, so victim/survivors do not have to deal with different agencies in different locations
• comprehensive care to anyone who has experienced recent sexual assault (sometimes limited to the previous two weeks)
• development of expertise in responding to sexual assault
• availability to women, men and in some instances children
• access is usually through the hospital emergency room, where necessary medical care is provided
• forensic examinations are provided
• immediate support and follow-up
• shower facilities for the victim/survivors.

Evaluations
An evaluation of SARCs in the United Kingdom by Lovett, Regan and Kelly (2004), reported that victim/survivors valued highly the services provided by SARCs. Aspects they particularly appreciated included:

• the automatic provision of female examiners and support staff
• proactive follow-up
• advocacy and case tracking
• ease of access to advice and information by telephone.

 

SARCs were seen to combine the needs of victim/survivors and those of the criminal justice system. Service provision in areas without SARCs was more likely to be driven by the criminal justice system’s needs. Areas where there were SARCs provided a greater range of support and referral networks were more formalised.

Further aspects of good practice within SARCs identified by Kelly (2005) included:

• services are provided regardless of whether a report will be made to the police
• victim/survivors are offered the option of having samples taken and having these stored for a period, so that the decision about reporting can be taken at a later date.

 

Several criticisms of SARCs are as follows.

• SARCs do not work with victim/survivors of historical sexual violence.
• SARCs work with a very small percentage of sexual violence victim/survivors. In the United Kingdom, on average only 10 percent of victim/survivors reported their experiences to the police.
• There are questions over the out-of-hours access to SARCs (Lovett, Regan and Kelly, 2004; Kelly, 2005).
• SARCs predominantly use a medico-legal model of delivery of services, although in Canada, SARCs offer a more holistic service because they are strongly influenced by feminist perspectives (Kelly, 2005). Fry (2007) found that victim/survivors were more satisfied with care received at SARCs that operated from a victim-centred approach.
• SARCs are relatively expensive to run in the United Kingdom. Rape crisis centres receive only 20 percent of the funding received annually by SARCs (Rape Crisis (England and Wales) and Women’s Research Centre, 2008). In the United Kingdom SARCs have effectively reduced the funding available to rape crisis groups, which has resulted in rape crisis centres in the United Kingdom closing or reducing services (Rape Crisis (England and Wales) and Women’s Research Centre, 2008).

How can sexual assault referral centres and sexual violence support services work together?
A document published in the United Kingdom by End Violence against Women, Rape Crisis (England & Wales), the Child & Woman Abuse Studies Unit and Fawcett (2008) entitled Not ‘Either/Or’ but ‘Both/And’: why we need rape crisis centres and sexual assault referral centres weighs up the merits of SARCs against rape crisis centres. It was strongly argued that each type of service had particular strengths and roles. Hence, it was vital that both types of service were available, and one should not be implemented at the expense of the other. The authors concluded:

Those who report sexual assault deserve high-quality responses – forensic medical examinations, follow-up and support and advocacy – which only a well-funded SARC can provide. Those who choose not to report, or who have unresolved issues from historic assaults, also need access to high-quality responses – long-term practical and psychological support and advocacy – which a RCC [rape crisis centre] can deliver expertly. If we are ever to meet the needs of survivors better we need RCCs and SARCs. (End Violence against Women, 2008: 7)

In New Zealand it could be argued that some of the NGO SSVS centres are incorporating aspects of the SARCs into their own models of service delivery, combining the positive aspects of both. For example, the Hutt Rape Counselling Network in Wellington works with police and Doctors for Sexual Abuse Care doctors, and has a custom-made room on-site in which forensic medical examinations can be carried out.

7.2.3    Examples of good practice sexual assault referral centre initiatives
The Australian Centre for the Study of Sexual Assault has been proactive in identifying promising practice and has developed a database containing a national collection of programmes and/or approaches that aim to improve understanding of, and response to, sexual assault (child and adult). Such initiatives are worth watching as they demonstrate promising practice in an environment that is similar to New Zealand. Three initiatives are described in Boxes 17–19.

Box 17: Australian Centre for the Study of Sexual Assault – Rape Crisis Online initiative

 Box 18: Australian Centre for the Study of Sexual Assault – ‘Another layer of trauma’ workshop

‘Another layer of trauma’ workshop Another community service that is worth watching is the Western Australian full-day workshop ‘Another layer of trauma’, which meets the seven criteria of good practice established by the Australian Centre for the Study of Sexual Assault. The workshop focuses on the traumatic impact of sexual abuse on Aboriginal communities. It analyses and discusses this in the context of the multiple layers of trauma, both historical and current, that Aboriginal people have experienced. This validates the experience of Aboriginal people, and recognises the historical issues of dispossession and assimilation that they have suffered. Although Māori experiences of colonisation, dispossession and assimilation were different to those of Aboriginal people, within a Māori context sexual abuse may also be experienced as ‘another layer of trauma’. (ACSSA, 2005)

Box 19: Australian Centre for the Study of Sexual Assault – co-ordination of community services

7.3    Non-specialist sexual violence victim support systems

Non-specialist sexual violence victim support services are those that provide support services for a range of individuals of whom victim/survivors of sexual violence are just one group.

7.3.1    Women’s refuges and shelters
Women’s Refuge provides 24-hour support, advocacy and accommodation for women and their children who are experiencing family violence. There is a National Collective of Independent Women’s Refuges, which is the umbrella organisation for around 50 refuges across New Zealand. There are also refuges, not affiliated with National Collective of Independent Women’s Refuges, funded by government, church and community groups (Lievore and Mayhew, 2007).

No evaluations or good practice guidelines were found in relation to women’s refuges or shelters and service provision for victim/survivors of sexual violence. However, these services, developed for victim/survivors of domestic violence, appear to play an important role in providing services for victim/survivors of sexual violence, providing counselling, advocacy and temporary accommodation in cases of marital rape and date rape (Howard et al., 2003).

A study by Howard et al. (2003) explored the intersection between rape and domestic violence. They reviewed several studies that showed battered women were at risk of rape, with 32 percent to 39 percent of battered women reporting at least one, if not many incidents of rape by their partners (Bowker, 1983, Campbell 1989, Campbell and Soeken, 1999, Freize 1983, Mahoney 1999, Randall and Haskings 1995, Sheilds and Hannneke 1983, Walker 1984, all cited in Howard et al., 2003).

The results of a large-scale New Zealand study on violence against women also demonstrated that sexual violence is an often hidden aspect of family violence, with 42 percent of women who had experienced moderate or severe physical violence also having experienced sexual violence (Fanslow and Robinson, 2004).

Tutty, Weaver and Rothery’s (1999) nationwide Canadian study of women staying in shelters or refuges for victim/survivors of domestic violence found that 20 percent of the women reported sexual violence by their current partners (64 percent) and
ex-partners (21 percent).

In the United States, Campbell and Ahrens (1998) found that many rape victim/survivors did not feel safe in their homes following a sexual assault regardless of whether the assault was committed by someone known to them or a stranger.
In response to these needs, some SSVSs negotiated for domestic violence refuges to provide safe housing, counselling and advocacy for victim/survivors of sexual violence regardless of whether they were in a battering relationship. These arrangements provided additional services to rape victim/survivors. However, because of a huge demand for these services, the refuges were overwhelmed and unable to meet the needs of all the women requesting help (Campbell and Ahrens 1998).

7.3.2    One-stop shops
One-stop shops provide integrated services that can respond to both adults and children and/or across sexual and domestic violence or any form of violence against women. They are distinguished from SARCs by this broader focus, with SARCs limited to recent sexual assaults. However, like SARCs, the integrated model of one-stop shops aim to assist service users through the provision of a range of related services under one roof and increase effectiveness of services through inter-agency collaboration.

In New Zealand, Beckett (2007) identified the Kimiora sexual assault centre in New Plymouth as having elements of good practice. This sexual assault centre appeared to be based on this one-stop shop model. She described it as a specialist facility, containing a reception area; an interview room with recording facilities; three offices; a lounge; a kitchen; a medical/forensic examination room; and showering facilities. 

It houses police on their year-long sexual crimes rotation and delivers specialist services through DSAC-trained doctors and specialist support/advocates. Plus factors included the positive and relaxed atmosphere, provision of privacy and safety.

A press release in May 2007 suggested a similar initiative was to be set up under one roof in South Auckland, which was described as a ‘one-stop shop’ bringing together specialists from Child, Youth and Family Services, the Counties Manukau District Health Board and some community agencies (Mangnell, 2008). It was reported to be a multi-agency service for victims of child abuse, adult sexual assault and family violence, housing medical staff and facilities, family safety teams with members from the police, Child, Youth and Family Services and Women’s Refuge, as well as police evidential, child abuse and adult sexual assault teams.

No evaluations of these New Zealand one-stop shop initiatives were located. If evaluations are undertaken, there will need to be special attention to whether the needs of adult versus child sexual violence victim/survivors are appropriately prioritised.

One-stop shops are a model of provision developed primarily in the Third World to maximise scarce resources. The most well-known and promoted good practice example of a one-stop shop is the overseas model developed in Malaysia, which is being replicated in much of Asia (Kelly, 2005). An evaluation of this model found implementation outside of the major metropolitan areas often lacked vital components and were frequently ‘done on the cheap’. Also missing was the partnership with women’s NGOs to provide support and counselling (Siti Hawa, 2000, cited in Kelly, 2005).

Whilst many practitioners support the idea of one-stop shops in principle, recognising the connections between forms of violence, there are also concerns that:

• child victim/survivors could be prioritised for services before adult victim/survivors
• domestic violence victim/survivors could be prioritised for services before sexual violence victim/survivors (Kelly, 2005).

7.3.3    Multi-service centres
Multi-service centres are another form of integrated service delivery, where SSVSs have merged with other related community agencies or services as a way to maximise scarce funding (e.g. domestic violence, drug and alcohol services), or where SSVSs extend their services to victims of other crime (O’Sullivan and Carlton, 2001). They are distinguished from SARCs and one-stop shops as their services extend to victims/individuals who have not experienced any type of sexual victimisation. We are not aware of this type of service centre in New Zealand.

There have been mixed research findings in relation to this model of service delivery. A study conducted by O’Sullivan and Carlton (2001) examined three models of sexual assault programmes in North Carolina, one of which was a ‘multi-service’ model. These included:

• independent specialist sexual assault services
• combined sexual assault/domestic violence programmes
• sexual assault programmes embedded in family or drug and alcohol organisations.

 

The researchers were struck by two findings. First, of the three types of service models, the independent centres were the only ones that advanced inclusive definitions of sexual assault, incorporated cultural concerns in assessing their services and outreach, used volunteers as community educators, and targeted community education to young people and males. Second, embedded centres, particularly ones with domestic violence programmes, seemed to under-serve sexual assault victim/survivors in their communities. They found that domestic violence victim/survivors typically had serious, complicated and immediate needs that could place a burden on resources that could have been used to promote sexual assault services.

Another study (Campbell and Ahrens, 1998), however, argued that although there were occasionally ‘turf wars’ between SSVSs and other agencies (e.g. drug and alcohol services), the integrated programmes enhanced service provision and brought rape crisis services to people who would not otherwise have accessed them.
Zweig and Burt (2007) further note there is a high co-occurrence of domestic violence and sexual assault with other issues such as substance abuse or mental health issues, yet few programmes provide services that formally address these multiple issues. Multi-agency centres might be one way to address this gap.

7.3.4    Other non-specialist services

Victim Support
In New Zealand, support is available to all victims of crime, including victim/survivors of sexual violence, by the nationwide NGO called Victim Support. Victim Support offices are located in police stations around New Zealand. Victim Support workers are volunteers and can play a leading role in supporting victim/survivors of sexual violence in areas where there are no SSVS centres. An early New Zealand evaluation of Victim Support schemes provided some general guidelines on ways the service could be improved, including the establishment of a national
co-ordinating body (Neale and Gray, 1990). There was also a recommendation that this national co-ordinating body could negotiate with other service agencies in supporting victims of specific crimes. It is unknown whether this recommendation has been carried out, but this could have the potential to impact on the quality of their service to victim/survivors of sexual violence. A recent thesis suggested the lack of specialised knowledge and training for dealing with rape can reduce the effectiveness of the assistance provided by Victim Support (Beckett, 2007).

Hotlines
Several organisations in New Zealand operate hotlines that offer accessibility and may be a point of contact for victim/survivors of sexual violence, including Lifeline, Youthline, Samaritans, Mensline, OUTline NZ (gay, lesbian, bisexual, transgender and intersex). However, no literature was located that evaluated these services in relation to victim/survivors of sexual violence.

 

7.4    Community collaboration

Community collaboration is often viewed as a positive aspect of effective service delivery. The establishment of SARCs, one-stop shops and multi-service centres are examples of community collaboration to provide an integrated service to victim/survivors of sexual violence. Research in New Zealand on pre-court interventions for victim/survivors concluded that the most effective forms of service delivery to victim/survivors result from specialist, multi-agency collaboration, reflecting high levels of co-operation and co-ordinated working relationships (Beckett, 2007).

The literature described some other models that have developed to meet specific needs in communities. For example, in the United States Campbell and Ahrens (1998) described a partnership rape crisis centres formed with local churches, as some survivors of sexual violence never report the rape to the police or seek medical treatment (see also section 2.2.2), preferring to turn to their churches for support. Rape Crisis was concerned that clergy may not have adequate information for working with rape survivors. As a result they created a church outreach worker position, employed by the Rape Crisis centre, but working in different churches across the community to provide on-site assistance to women.

An Australian collaboration between domestic violence, sexual violence and mental health organisations, called the Partnership project, identified systemic issues that worked against successful collaboration.

• Collaboration takes time and resources. Small organisations such as sexual assault services have limited resources, while most clinical mental health professionals have very high caseloads.
• When organisations are under pressure they tend to be crisis-driven, reactive and rigid.
• Few positions are specifically funded to create links between organisations.
• Rigid funding arrangements contribute to services operating in silos.
• Fragmentation of services and ‘over-specialisation’ results in narrow targeting of services or long waiting lists (Victorian Government, 2006).

 

In contrast, Campbell and Ahrens (1998) identify three key practices for successful community co-ordination in the delivery of support to victim/survivors of sexual violence:

• changing the competitive model to a collaborative model with excellent communication between agencies;
• making the focus of collaboration and communication the improvement of service delivery to the victim/survivors of sexual violence;
• understanding the larger social context of rape itself, and promoting effective community responses to rape.

 

7.5    Responding to the needs of diverse groups – support services

Support services provide services or assist victim/survivors in terms of their medical, criminal justice and mental health needs. Hence, many of the points already raised in the previous three sections in relation to the specific needs and ways to respond to diverse groups also apply to this section. To avoid repetition only new issues have been covered below.

The material covered in the ethnic, migrant and refugee section below also has relevance to Māori and Pacific peoples, as it includes Australian research on sexual violence in relation to ethnic minorities and indigenous peoples.

7.5.1    Māori victim/survivors
Māori women have been working in the field of sexual violence for many years. The Māori women’s welfare league was set up in the early 1950s and Te Kākano o te Whānau, a national rape and sexual abuse movement, was established in the mid-1980s to provide services for Māori women who are victims of incest, rape, sexual abuse and related violence (Balzer et al., 1997).

This could explain why in many respects community support services are further ahead than medical or criminal justice systems in responding to the need of Māori victim/survivors. There are several kaupapa Māori agencies (guided by Māori philosophies and principles)that offer specialist support to victim/survivors of sexual violence, including Te Puna Oranga in Christchurch, Awhina Wahine in Wellington and Tu Wahine in Auckland.

No guidelines were located that dealt specifically with good practice in provision of community support services for Māori who had been victim/survivors of sexual violence. However, as noted in the introduction above, many of the points included in other guidelines reviewed under other systems would have relevance.
For example:

• Family Violence Intervention Guidelines: child and partner abuse (Ministry of Health, 2002)
• Screening, Risk Assessment and Intervention for Family Violence Including Child Abuse and Neglect (Standards New Zealand, 2006)
• Sexual Abuse and Mental Injury: practice guidelines for Aotearoa New Zealand (ACC, 2008).

 

Cram, Pihama and Karehana (1999) researched the needs of support systems for Māori victims of crime in general (i.e. not specifically victim/survivors of sexual violence). The central place of whānau in supporting the victim/survivor was highlighted, and also the importance of providing support for the whānau, ensuring both the needs of the individual and the whānau were met. Support groups rated highly by Māori were:

• easily contactable
• willing to give as much support as needed
• followed up clients and offered ongoing support
• were Māori-friendly.

 

A model illustrating a continuum of support services for Māori was presented (see Table 9).

Table 9: Continuum of service delivery: support services.

Mainstream	Taha Māori	Kaupapa Māori
Involving Māori These services have a responsibility to deliver services to Māori – but have no explicit approach.	Focus on Māori Māori issues are treated to one side of mainstream service provision. A Māori-friendly service with internal Māori staff.	Kaupapa Māori A ‘for Māori by Māori’ approach that is under Māori control.

Source: Adapted from F. Cram, L. Pihama and M. Karehana (1999) Meeting the Needs of Māori Victims of Crime. Report prepared for Te Puni Kōkiri. Auckland: University of Auckland, p. 75.

 

Participants interviewed by Cram, Pihama and Karehana (1999) clearly favoured kaupapa Māori services, but attempts by other ‘mainstream’ services to provide a more Māori-friendly approach were also acknowledged. A continuum of service provision from which Māori can then choose services most appropriate for them is similar to that advocated by Durie (2003).

7.5.2    Pacific victim/survivors
No information was located on community support services that respond specifically to need of Pacific victim/survivors of sexual violence. However, as has already been noted, Pacific victims of crime (including family violence of a sexual nature) tended not to access formal support services, preferring informal support systems, such as family, friends, and church ministers and members (Koloto, 2003).

Koloto (2003) points out that a Pacific victim of crime (including sexual violence) is a member of an extended family/aiga/kainga and the victim’s help-seeking behaviours reflect cultural and social practices and knowledge and awareness of available support services. The impacts of crime are not limited to the individual. Therefore, as with Māori, it is important for Pacific victim/survivors of sexual violence to be able to choose from a range of services that which most suits their need.

Koloto’s research with Pacific victims of crime found, in terms of formal support, interviewees said they wanted:

• more information on support services
• provision of and access to formal Pacific services by and for Pacific peoples (although some raised concerns about confidentiality within their communities)
• more Pacific staff in services who could speak their language.

 

As with Māori, no guidelines were located that dealt specifically with good practice in provision of community support services for Pacific victim/survivors of sexual violence. However, the guidelines described in the previous section can be deemed as having relevance not only for Māori but for Pacific peoples also (Ministry of Health, 2002; Standards New Zealand, 2006; ACC, 2008).

ACC (2008) guidelines advise that there is no one model that meets the needs of all Pacific peoples and as with Māori it should not be assumed that Pacific people would prefer to work with people of the same ethnicity. However, it should be recognised that the church, Christianity and spirituality are elements of both the family and the community, and that those who work with Pacific peoples must be prepared to visit clients in their own homes where appropriate.

7.5.3    Sex-worker victim/survivors
Abel, Fitzgerald and Brunton (2008) describes how in New Zealand sex-workers’ rights and grassroots organisations such as the New Zealand Prostitutes Collective have become increasingly important in recent years, offering drop-in as well as community-based outreach options for the delivery of health services, including sexual health clinics, advocacy and support services. Many combine with other agencies to work together to provide a more integrated, holistic service for sex-workers to keep them safe.

7.5.4    Victim/survivors with disabilities
In 1998 a United States symposium was co-ordinated by the National Organisation for Victim Assistance to address the issues of victims of crime with disabilities (Tyiska, 1998). Developing good relationships between victim support groups and disability advocates was seen crucial in order for people with disabilities to access justice, and quality, comprehensive services.

A partnership between the victim assistance and disability advocacy fields needs to be built that fosters mutual respect and sharing of ideas, knowledge, capabilities, successes, and collaborative efforts in order to develop strategies to address the problems. (Tyiska, 1998: p. 14)

7.5.5    Ethnic, migrant and refugee victim/survivors
Overseas statistics indicate that usage of specialist sexual violence services by indigenous women and those from ethnic minority communities is unlikely to match the real extent of sexual violence experienced within those communities (Weeks, 2001). Recent workshops conducted in New Zealand with diverse population groups suggest the situation is no different here. This raises questions around the access and equity practices of services that respond to sexual violence survivors.

Accessible services are underpinned by recognition of diversity and identification and disbanding of barriers, including:

• victim/survivors’ lack of knowledge about the issue
• lack of information about services
• physical barriers to access
• inappropriate services
• inappropriate values or philosophy of management
• unsympathetic community attitudes (Office of the Status of Women, 1993, cited in Weeks, 2001).

 

In the context of cultural diversity, these barriers may also include ignorance of cultural values and practices, language and racism.

Mainstream services and workers seeking to provide access and equity to survivors from diverse population groups may be faced with a number of dilemmas. Acquiring in-depth knowledge of and sensitivity to other cultures can take years, and it is difficult for workers in small services to become experts in a range of cultural backgrounds. Added to this, it is clear that sexual violence within diverse communities is also the concern of those communities, and not simply mainstream services. Ethno-specific sexual violence services may be desirable, but small ethnic communities are unlikely to be able to support the development of the specialist knowledge and skills required to respond to sexual violence survivors.

An Australian survey of 54 services, completed in 2000, found that eight major strategies, listed below, were used to provide accessible and equitable services (Weeks, 2001). Strategies to incorporate cultural diversity into daily operations were slightly more likely to be ongoing initiatives, rather than time-limited projects. Some involved securing extra funding or staff. While few initiatives had been formally evaluated, all had been verbally evaluated and reported on outcomes as part of service planning.

• Outreach and community development projects established community needs, the absence of service users in communities, and built relationships with specific communities. These projects ranged from working with women in prison, to flexible delivery for Aboriginal women in provincial and remote areas, and establishing links with and developing resources for ethnic communities.
• Media, communication and educational strategies often used radio programmes and publications in community languages to share knowledge. Some engaged in a two-way process to establish what sexual violence meant for that community and used the information to develop educational resources, such as videos.
• Some services reorganised staffing to designate an access and equity worker, who works in collaboration with other community organisations to develop access and equity for minority groups.
• Services with community or collective management structures have designated positions on the management group for representatives from particular cultural and other groups. Others call on cultural consultants to advise and oversee particular projects.
• Several services employed Aboriginal women, not necessarily in specially designated positions. At least one service reported a steady increase in Aboriginal women using the service.
• Some services employed ethnic minority workers or bilingual workers for specific cultural projects. However, unless there are dedicated positions for women from diverse communities, jobs often cease when the project ends.
• Collaborative projects enable sexual violence services to combine their specialist knowledge with the cultural knowledge and experience of generalist organisations representing specific cultural groups.
• The Queensland Government funded specialist organisations for Aboriginal and immigrant women, which have sexual violence workers within them.
• Weeks (2001) concluded that the most effective way of providing access and equity is to:
• move beyond short-term projects
• incorporate diversification throughout all tiers of service operation, as well as in policies, protocols and practices
• use a combination of strategies, because initiatives such as cultural consultants, outreach and community development are mutually reinforcing
• develop separate strategies to respond to indigenous women and women from different ethnic communities, as the issues will vary across communities.

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Disclaimer

This report was commissioned by the Ministry of Women’s Affairs. The views, opinions and conclusions expressed in the report are intended to inform and stimulate wider debate. They do not represent government policy.
 

Published in October 2009
by the Ministry of Women’s Affairs | Minitatanga Mō Ngā Wāhine
PO Box 10 049, Wellington, 6143, New Zealand
Phone: 0064 4 915 7112
Fax: 0064 4 916 1604
Email: mwa@mwa.govt.nz
Website: www.mwa.govt.nz

ISBN 978-0-478252-43-9 (Print)
ISBN 978-0-478252-44-6 (Digital)