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‘Now I’ve opened up, there is no one to help’: how the burden of sexual crime lies on survivors’ shoulders

A quarter of women and one in 18 men have experienced sexual assault as an adult. Therapy is crucial for survivors – but accessing it can be a further struggle at the worst possible time.

One in four women have experienced sexual assault as an adult (illustration: Sophia Checkley)

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“The nurse was very experienced and reassured me that what happened wasn’t my fault – which seems obvious, but I was still struggling with processing what had happened.”

It had taken Lily* five months to be contacted by an NHS sexual assault support team after a referral from an Exeter walk-in centre.

“This session clarified a lot,” says Lily. “[The nurse] labelled it as an assault, stated that according to the law it would be classed as ‘rape’, [and] labelled [her assailant’s] continued attempts to contact me as ‘harassment’, which gave me strength in knowledge.”

Last year, the police recorded the highest-ever number of rapes in a 12-month period in England and Wales. According to the Office of National Statistics, one in four women and one in 18 men have experienced sexual assault as an adult.

These numbers have been increasing over the past decade. The ‘Me Too’ movement may have contributed to reducing the stigma for sexual violence survivors. But figures still show that fewer than one in six women and fewer than one in five men report their assault to the police.

In a society where sexual crime is so widespread, counselling for survivors needs to be accessible and reliable – but is it? We investigated support systems in Bristol and the South West to find out where sexual assault survivors can turn to for help.

‘Traumatic and triggering’ online therapy

For many survivors – like Lily – the first port of call is the NHS, which offers ‘talking therapies’ as part of its mental health provision. This counselling service is publicised as effective, confidential and, most importantly, free.

It is unclear why Lily had to wait five months for her initial assessment, in February 2020. Data from a freedom of information request shows the mean waiting time from referral to first appointment was 34.7 days for the South West during 2019-20. 

This was the highest figure for any English region at the time. According to the data, that figure had fallen to 19 days by 2021-22.

During this first appointment, survivors’ mental states are simply assessed. When asked how long they would have to wait after this to start one-to-one therapy, the NHS said it did not have that data.

But a House of Commons report published this year found the average wait between this initial assessment and a second appointment is 50 days, the longest wait being in South Sefton, Merseyside, at 291 days. 

This second appointment is when survivors reportedly begin treatment, but this is rarely one-to-one therapy. More often than not patients are offered group work to begin with, or an online course. 

As with most NHS services, talking therapies suffer from underfunding and understaffing. According to a Trades Union Congress report, by the end of June 2018, one in 10 mental health positions in the NHS were unfilled, with mental health trusts getting £105 million less in real terms than in 2011-12. A National Audit Office report from this year confirmed that 12% of staff left the NHS mental health workforce during 2021-22.

After her initial assessment, Lily waited another five months to begin remote counselling.

“When lockdown hit, the counselling service was delayed, and I didn’t have any contact from mental health services until July [2020],” she explains. “These online Zoom sessions were traumatic, and really set me back. 

Lily says the counselling was designed to cope with PTSD symptoms – such as night terrors, intrusive thoughts and flashbacks – without talking directly about the incident, using drawings and eye movements while repeating phrases. “It might have worked over a longer period of time and in-person, but personally, I found them triggering and useless,” she says.

Lily is not alone in this experience. Mental health organisation Mind conducted a study in 2021 that found one in four people thought their mental health got worse after remote therapy. Many NHS patients’ counselling continues to be online, despite an end to Covid-19 restrictions.

Waiting lists ‘off the scale’ at overstretched charities

Besides the NHS, charities across the UK offer free confidential counselling to sexual assault survivors. The Cable contacted 16 in the South West requesting the length of their waiting lists, with half responding. 

The average wait for one-to-one therapy was around 8.5 months, with the longest waiting list at Kinergy, here in Bristol, at 16 months. This issue is not unique to sexual violence charities, with Off the Record, a charity that offers general mental health support to young people in Bristol, currently has a waiting list of eight to 11 months for one-to-one therapy at its centre in Old Market.

I just didn’t really want to talk or think about the trauma. I told myself it’s fine, it will go away – but it wouldn’t.

The shortest waiting list by some distance was three to four months at Cornwall-based charity CLEAR. The CEO, Carolyn Webster, explains this is a result of closing CLEAR’s waiting list for three months last year.

“Pre-pandemic, it was approaching two hundred people with almost a year’s wait,” she says. “Last year, we supported twice as many people as the previous year.

“Feedback we’ve had indicates that the length of the waiting list has a real impact on mental health and risk to self,” Webster says.

Bristol’s Southmead Project, which offers specialised counselling for abuse and addiction survivors, also closed its referral service for the past year due to the length of the waiting list. 

“We didn’t anticipate having to close it so long,” says Imogen McCabe, who took over as CEO during the pandemic. “Our waiting list [since reopened] now is about a year, [but] was just over two years before.”

McCabe says it would be “just unethical” to continue operating with such a long list – over 300 people. 

Meanwhile in Devon, Josephine Knight, CEO of Survivors Alliance, says she is also considering closing her waiting list, which has crept up and is now between seven and nine months.

Numbers are going off the scale right now with sexual violence and domestic abuse,” she says. “Lockdown exacerbated abusive relationships and stopped people asking for help.”

Knight explains that charities like hers rely heavily on grants, such as the Ministry of Justice Victims Fund. According to her, they’re simply not enough.

McCabe adds that only about 15% of the Southmead Project’s income comes from statutory funding – government grants, contracts or initiatives – and talked about the challenges presented by many funding bids. Small charities also depend on sources such as donations and fundraising events, making their existence a precarious one.

“We’ve got very scarce resources and capacity,” McCabe says. “So, when it comes to writing funding bids, particularly for statutory funding, sometimes it can be quite onerous, the requirements you have to go through to get that funding.”

The pressure faced by charities means that paying out of pocket for appointments with a private counsellor is the final resort for many survivors of sexual assault.

‘I didn’t want to live like this’

But even going private – something not many can afford – does not necessarily mean getting the therapy you need. Rose, who lives in Bristol, decided it was time to get help when the trauma she’d experienced made it impossible for her to go through with a routine smear test.

“I just didn’t really want to talk or think about it,” says Rose. “I told myself it’s fine, it will go away – but it wouldn’t.”

She attended three different unsuccessful smear test appointments before a nurse suggested she get psychological help. “That was kind of the push to realise [this] wasn’t how I wanted to be living my life,” Rose says.

The nurse said then – in November 2022 – that she would put Rose on the NHS therapy waiting list. But she has heard nothing since.

Rose is hesitant to ask her GP how far her referral has progressed on the waiting list. She worries about her patient notes not being up to date, and being asked to recount the event again.

“It’s hard because it is such a sensitive thing. It’s difficult because it takes you so long to open up about it, to then feel like you have to keep repeating it again and again and again,” Rose says.

Keen for a path forward, she has been looking for private therapy. But the option, which presents her with money worries, is by no means a silver bullet (see box, below).

“I messaged someone from the College of Sexual and Relationship Therapists about what had happened to me and they responded that they didn’t think they were qualified to deal with my case,” Rose says. “It makes it feel like my problem is too big – and if they aren’t qualified, who is going to be?

Rose adds that any local therapists she’s found who charge what she can afford – around £40 an hour – aren’t taking new patients, or only deliver therapy online. “Even some of those charging £90 or £100 get back saying they are full,” she says.

Faced with limited options and limited funds, the solution for Rose is unclear. “It takes such a long time to feel ready to speak about it – you can easily lose your confidence again,” she says. “It feels like now I’ve opened up, there isn’t anyone professional there to help me with the feelings.”

*survivors’ names have been changed

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Comments

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  • I do not know whether they deal specifically with sexual violence issues, but I have managed to source one to one in person counselling for myself from Womankind in Bristol City Centre. They are a charity who do a sliding scale of fees (very low) for women on low incomes. They only accept female clients and all their counsellors are female. They are a lovely group of women, very understanding and compassionate. Any woman who is struggling to find counselling, it may be worth contacting them to see if they can help – or can suggest a more suitable alternative service. Waiting list is not long, weeks rather than months. I went down this route as, being severely depressed, I could not afford to wait months for free NHS counselling which would only be 6-8 sessions, Womankind offer 24 weekly sessions plus follow ups. My female GP praises them highly as well. https://www.womankindbristol.org.uk/

    Reply

    • The main thing is to heal properly.
      To do this there are a number of activities we can engage in all of which have the very real effect of processing the trauma or ‘removing it from ones conscious awareness’. This is a very real process.
      However, in the case of some, who have experienced this, the cause may be that though they have taken the first steps to heal the trauma they are still in the same environment with people who have not decided to grow or change. Thus, they are constantly triggered.
      A solution is to move away far from the ‘triggers’.
      Healing may be possible ‘in’ that particular situation but it may well be, the whole ‘growth path’ requires moving. Then, the person can grow and flourish.
      For complete healing I would really recommend a path such as Buddhism. Buddhism offers a set of practices which touch and heal the whole person, at the same time offering conversion to a new life in, what we could perhaps only describe as ‘the light’. There are many meditation practices within the Buddhist path and many practices which do not involve meditation. However, the parallel between healing and meditation is very clear. One such exercise, is the Metta Bhavana. This means the development of Loving Kindness. In this practice we develop loving kindness to self and other. It is radical in this sense. Few people can really say they deeply love themselves in a non-egoistic way, however, this exercise develops that faculty. When this is develeoped it is impossible to experience trauma for all trauma occurs only in relation to the degree of ‘lack of love’ we have towards our own ‘self-image’.
      Much kindness.

      Reply

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