3. There are a number of ways in which victims and survivors of child sexual abuse can access support services. These include services for those involved in the criminal and civil justice process. Victims and survivors can also access support from health services or specialist voluntary sector organisations and, on occasion, services may be accessed via the institution where the sexual abuse occurred.
4. Accessing the right support at the right time from the most appropriate service can be difficult for both adult and child victims and survivors. One victim and survivor described the process of trying to access support as a “nightmare merry-go-round”.[1]
5. The Code of Practice for Victims of Crime in England and Wales (Victims’ Code) states that victims and survivors have the right to be referred to services that support victims and have services and support tailored to their needs.[2] Despite this, the quality and availability of support varies considerably between local areas.[3]
6. Support provided via the criminal justice system includes support for those who attend sexual assault referral centres (SARCs), which are commissioned by NHS England and in Wales by the NHS and Police and Crime Commissioners. SARCs provide services to child and adult victims and survivors of sexual assault and rape. Across England there are a number of paediatric SARCs along with adult SARC services.[4] They provide healthcare and treatment and, where appropriate, forensic medical examination. Where victims and survivors have ongoing needs for support or treatment, SARCs will make referrals to other services, including specialist sexual violence and abuse support services.[5]
7. SARCs also offer access to specialist independent sexual violence advisers (ISVAs). Introduced in 2005, ISVAs work with people who have experienced rape and sexual assault, irrespective of whether they have reported the matter to the police. The majority of funding for these roles is provided by local commissioners, including NHS England, local authorities, police and crime commissioners and charitable trusts.[6]
8. An ISVA’s role is to provide victims and survivors with impartial information about the process and the options that are available to them, which can include guidance on accessing therapeutic support, police reporting and what to expect in court.[7] Some areas now also have access to ISVAs for children.[8] Participants in the Inquiry’s Criminal Justice System Seminar said that ISVAs provide “crucial support and liaison with other organisations”.[9] One participant described her ISVA as “brilliant from start to finish. They were absolutely fantastic”.[10] Another said that her ISVA had supported her “every single step of the way”.[11]
9. Participants in the Criminal Justice System Seminar expressed concerns, however, about the lack of availability of male ISVAs.[12] This echoes comments made by the Centre for Social Justice which, in its 2021 report Unsafe Children, noted that:
“Special attention should be paid to organisations focused on supporting men and boys and Black and minoritised victims/survivors given the indication that there is a paucity of ISVAs currently available from those groups.”[13]
There is also concern that access to ISVAs with experience of working with people with learning disabilities was “stretched”.[14]
10. In relation to rape allegations more generally, a 2020 survey by the Victims’ Commissioner found that 20 percent of respondents who received no support withdrew their allegations, compared with 9 percent of those who received support from an ISVA. Other research has shown that a victim with specialist support like an ISVA is 49 percent more likely to remain engaged with the process.[15]
11. In its Tackling Child Sexual Abuse Strategy (January 2021), the government stated that the Ministry of Justice has allocated an additional £4 million per year to recruit more ISVAs across England and in Wales, including the recruitment of children and young people’s ISVAs.[16] ISVAs are generally regarded as a positive measure in assisting victims and survivors, so it is important that there is sufficient continued funding available for this important supportive role. In March 2022, the Ministry of Justice announced it would be increasing funding for victims of crime which would take the number of funded ISVAs and independent domestic violence advisers (IDVAs) to more than 1,000.[17]
12. Another way to access support in the criminal justice system is through the use of the ‘Barnahus’ or Child House model. Based on the Icelandic model, this focusses on the holistic needs of child victims and survivors and aims to respond to the special needs of a child in cases of suspected violence or abuse. Each Child House provides a single service, which includes forensic interviews with the child, medical examination, therapeutic services and family counselling/support in a child-friendly environment. This model has five key features:
13. Use of this ‘one-stop shop’ approach is not uncommon.[19] In 2018, a similar model was trialled in five North London boroughs. Known as The Lighthouse, it is available for children and young people who have experienced sexual abuse, and provides:
“a holistic service all under one roof in a place where [children] can really feel safe to talk. So we aim to allow them to tell their story and gather the best evidence, whether that’s through a forensic examination … or through a video-recorded interview. We want to help them get the best out of the criminal justice process by supporting them through that, to give them a really holistic medical and then provide the emotional and well-being support not only for them, but also for their family as well.”[20]
14. Children and parents spoke in positive terms about the benefits of The Lighthouse and, in particular, the significant positive impact on children’s well-being.[21] Children who had used The Lighthouse complimented the care and respect they had received from staff. Being able to go ‘at their own pace’, with choice and control, was described as very valuable. Children also emphasised the positive impact of the homely atmosphere and environment that was created by the ‘little things’, such as being offered a hot drink and police officers not wearing uniforms.[22]
15. In addition, the model addresses concerns that children who reported sexual abuse often faced multiple interviews with social workers, the police and other professionals. In 2016, the then Children’s Commissioner for England, Ms Anne Longfield, noted that the current system was not “child-centred”. She commented that:
“Interviews are often the only source of evidence in sexual abuse cases, yet for many children the interviews led by the police do not enable them to provide the best possible evidence. Repeat interviews can be confusing and cause children, particularly young children, to give inconsistent evidence which, in many cases, will lead to the perpetrator not being charged. Children can be traumatised by having to give an account of their abuse to multiple professionals in multiple locations.”[23]
She proposed a reconsideration of the system based on the Barnahus model.
16. Reducing the number of times a child victim is interviewed about the abuse and providing easy access to support is an important aspect of the institutional response. It is important that this type of initiative is monitored and sufficient funding is put in place to ensure that similar models are introduced. The government’s 2021 Tackling Child Sexual Abuse Strategy committed to providing support and guidance to local areas seeking to introduce similar Child House models elsewhere in the country.[24] The guidance is now available online.[25] The Children’s Commissioner for Wales is also exploring creating a similar service in Wales.[26]
17. Civil litigation and the assessment of compensation claims can be a lengthy process. Evidence heard by the Inquiry suggests that victims and survivors will not always have access to the support they need during civil proceedings.[27]
18. The Inquiry was told that many people did not come forward and discuss their experiences of abuse in part because of the inadequacy of support services.[28] The experience of victims and survivors in terms of accessing therapeutic support during civil claims was generally poor. Many went through the process with no professional therapeutic support. Lawyers representing victims and survivors also told the Inquiry that very little support is available in the civil process.[29]
19. In 2019, the Inquiry recommended the introduction of a code for claimants bringing civil claims for child sexual abuse. One of the code’s objectives was to ensure that victims and survivors of child sexual abuse could access the therapy and support they needed as soon as possible.
20. The International Underwriting Association (IUA) of London initially took the lead in producing the code.[30] In March 2020, the IUA informed the Inquiry that:
“Broadly speaking, we agree that there would be value in the production of a claimant code for child sexual abuse victims and survivors.”
However, it did not feel that the IUA was the correct institution to lead in the development of a code for claimants.[31] Subsequently, in December 2020, a working party known as the IICSA Rehabilitation Working Party was established to develop the code.[32] In December 2021, the IUA stated that in developing the new code, the IUA was engaging with a group of survivors for feedback in relation to the aims of the code, as well as the suitability and appropriateness of the language used.[33] In its most recent update in April 2022, the IUA provided further information about its engagement with survivors.[34] It is hoped that the code can be issued in the near future and will ensure that all victims and survivors who bring civil claims can access good quality support.
21. Support can be provided by the NHS, principally through GPs and Children and Young People’s Mental Health Services (CYPMHS, but referred to in this report by its previous acronym CAMHS).
22. However, victims and survivors told the Inquiry that health services were only accessible if the impacts of child sexual abuse that they experienced matched a specific physical or mental health problem recognised by the NHS.[35] There was also often a high threshold for treatment.[36] One young person told the Inquiry they had thought about seriously harming themselves in the hope that they would then meet the threshold to be treated by CAMHS.[37]
23. A 2020 All-Party Parliamentary Group for Adult Survivors of Childhood Sexual Abuse survey of victims and survivors found that although NHS mental health services were identified as the second most important form of support by respondents, only 16 percent said that NHS mental health services met their needs.[38]
24. The Inquiry’s research on support services for victims and survivors of child sexual abuse found mixed views about the utility of counselling provided through health services. Some victims and survivors considered it to be the least helpful service overall, while others considered it to be the most helpful service overall.[39] In part this may be explained by the fact that the type of counselling provided by the NHS ranges from short-term cognitive behavioural therapy to longer-term trauma-informed approaches. Those who had a negative experience of counselling often described being treated by people with no understanding or specialist training in child sexual abuse.
25. Wider cope and recover services include therapy as well as support aimed at other areas of life, such as advocacy and employment advice. They are typically offered by charity and voluntary organisations (including associations, self-help groups, community groups, social enterprises, mutuals and cooperatives), often referred to as the third sector.
26. Counselling and rape support services provided by organisations specialising in child sexual abuse and sexual abuse in general were rated most highly by victims and survivors who participated in the Inquiry’s research on support services.[40] Participants stressed the importance of such specialist support being from counsellors and therapists who had training in, and particular knowledge of, trauma generally and child sexual abuse specifically. One victim and survivor stated that there should be more “people that are trained in child sexual abuse. Not a generalised counsellor”.[41]
27. Although the services provided by the third sector are often highly rated, they can be difficult to access. Many suffer from short-term funding. Availability varies considerably between local areas. Victims and survivors expressed concern about the lack of services available locally, with some having to travel over 200 miles to access support.[42] Most victims and survivors in England and in Wales do not have access to specialised independent support services, and many have to rely on independent, community-based specialist support and counselling services in “a postcode lottery”.[43]
28. While some victims and survivors do not wish to access therapy from the institution where the abuse may have occurred or from the organisation responsible for it, some institutions offer formal support in the form of access to advice, therapy and counselling.
29. For example, the Church of England, the Church in Wales and the Roman Catholic Church fund ‘Safe Spaces’, which is a free and independent support service operated by Victim Support.[44] The service offers a confidential, personal and safe space for anyone who has been abused by someone in the Church or as a result of their relationship with the Church of England, the Roman Catholic Church in England and Wales or the Church in Wales. The Church in Wales has also committed to offering funding towards such counselling as may be recommended by ISVAs, where the abuse was committed by clergy in the Church in Wales or in a church context.[45] In response to another of the Inquiry’s recommendations, the Church of England revised its guidance Responding Well to Victims and Survivors of Abuse.[46] The new guidance came into effect in April 2022 and makes provision for mandatory support to be offered at a local and national level for victims and survivors of Church-based abuse.[47]
30. Such initiatives are welcome, but the Inquiry heard examples of inconsistent and inadequate provision of professional counselling and therapy or referrals to formal support services by institutions.[48] As a reflection of responsibility for abuse, institutions should provide – either directly or by funding – accredited therapeutic support for victims and survivors who would like to be provided with support by them. Wherever possible, a victim should be given the choice of provider, whether in the statutory sector or independently. Institutions also need to be aware that victims and survivors may not wish to access support services in the immediate aftermath of abuse but may need support later in their lives. Institutions should be supportive of victims and survivors on a long-term and sustained basis.