General recommendations

• Preventative measures

Providing psycho-education for males and females in Primary Schools so that appropriate understandings of relationships, boundaries and risks are available systematically on a national level. The World Health Organisation addresses these issues on a global level but more focus could be made for vulnerable groups such as minority groups, refugees and asylum seekers (WHO, 2016).

The World Health Organisation is addressing the collection of data on a global level but national databases require a systematic approach to clearly indicate where resources are required (WHO, 2016).

• Ensuring victim empowerment and choice

Complainants who become part of the CJS are given realistic expectations regarding the outcome of cases if they go ahead with the court process. Although this is part of the guidance at present, in practice this is not always clear.

• Professional support for professionals

Police are able to access support when dealing with traumatic sexual violation and have increased learning regarding vicarious traumatisation, secondary stress related disorders or other work related mental health problems. However, the police participants in this current research suggested that they relied on their peers for support. It may be beneficial to adopt more formal systems that specifically deal with some of the problems when exposed to continuous forms of trauma.

• Clarity and systematic identification of trauma related disorders

As there is currently a lack of agreement as to what constitutes PTSD (DSM-V AND ICD-11) a recommendation is that there is some consistency in classification systems. There are added complexities to the diagnosis of PTSD since DSM-V amended the criteria. There is more flexibility around the disorder that can have legal implications. Zoellner et al. (2013) suggest that this can make malingering and misdiagnosis more possible. Arguably, if there are discretions between professionals in fully categorising the disorder, this is going to be even more difficult for other professionals within the legal system and the jury.

For initial purposes the screening tool could be utilised in order to indicate possibility of PTSD. The Trauma Screening Questionnaire (TSQ10) can measure

symptoms of hyperarousal and intrusive re-experiencing related to the traumatic event (Brewin, 2005). Following a systematic review of the different screening tools available to measure symptoms of PTSD, the TSQ was considered as effective as longer screening tools and provided a good indicator of PTSD in patients with whom it was administered. Although the efficacy of the TSQ is high, it has limitations. It is often difficult to pick up more shame based PTSD or chronic PTSD where an individual has a more prominent comorbid diagnosis or when symptoms are masked by the use of drugs and alcohol. The TSQ10 is a patient self-report questionnaire and can have a degree of subjectivity (Brewin, 2005). However, this would aid as a good marker for individuals who have been traumatised and may be vulnerable to PTSD and requiring appropriate interventions both psychological and in respect of giving evidence.

Updating the Crown Prosecution Guidelines in relation to accessing therapy prior to commencing criminal trial (2001)

As these guidelines are out-dated and are based on research that primarily focused on childhood sexual abuse the recovery of memories, further consideration should be given to acute cases that are less likely to have these difficulties. Updated guidelines could accommodate this new understanding. A lot of research has been completed that now explains the existence of recovered memories and this is a different concept than the implanting of false memories (Dell and O’Neil, 2009).

If therapists were specifically trained in providing therapy within a criminal justice context, then safeguards could be in place that would limit the possibility of any leading or interpretive accounts. Only evidence based therapy to be provided for individuals who have developed PTSD and this should not be detrimental to the court case. A better understanding of what therapy entails could alleviate any concerns about it.

If a case is one that is complex, there is a need for an ‘expert witness’ to provide a fair and neutral educative element to the jury. In some cases it may be useful to have a number of professionals with expertise to consider the case and provide an informative report that would highlight any mental health difficulties that may be detrimental to the case or prevents the individual from engaging with the CJS.

Policy changes

Since 2011 more attention has been given to the exploitation of children. Increased multiagency working and robust safeguarding policies holding professionals accountable for lack of reporting have become the strategic objectives. However, information sharing appears to still be problematic. This can often be because of time restraints, lack of resources, and lack of shared information technologies. Although there have been some moves to provide police with access to patient information systems, there is a need for all those within health to be able to access it also. There would then need to be clear guidelines as to what information is available and what remains protected and confidential, who is able to access information and for what purpose it will be used.