RAPE AND SEXUAL ASSAULT

Rape
• Rape is the perpetration of an act of sexual intercourse with a person against his or her will and without her
consent, whether that will is overcome by force, fear of force, drugs, or intoxicants. Rape is a crime of violence
and humiliation of the victim expressed through sexual means.
• It is also considered rape if the victim is incapable of exercising rational judgment because of mental deficiency
or because he or she is younger than the age of consent (which varies among states from 14 to 18 years;
Stromberg, 2017).
• Rape can occur between strangers, acquaintances, married persons, and persons of the same sex, though seven
states define domestic violence in a way that excludes same-sex victims.
• A phenomenon called date rape (acquaintance rape) may occur on a first date, on a ride home from a party, or
when the two people have known each other for some time.
• Rape is a highly underreported crime; less than one half of all rapes are estimated to be reported.
• Male rape is also a significantly underacknowledged and underreported crime.

Dynamics of Rape

• Women who are raped are frequently in life-threatening situations, so their primary motivation is to stay alive.
At times, attempts to resist or fight the attacker succeed; in other situations, fighting and yelling result in more
severe physical injuries or even death. Degree of submission is higher when the attacker has a weapon such as a
gun or knife. In addition to forcible penetration, the more violent rapist may urinate or defecate on the woman
or insert foreign objects into her vagina and rectum.
• The physical and psychological trauma that rape victims suffer is severe. Related medical problems can include
acute injury, sexually transmitted diseases, pregnancy, and lingering medical complaints. Many victims of rape
experience fear, helplessness, shock, disbelief, guilt, humiliation, and embarrassment. They may also avoid the
place or circumstances of the rape; give up previously pleasurable activities; experience depression, anxiety,
PTSD, sexual dysfunction, insomnia, and impaired memory; or contemplate suicide (Ba & Bhopal, 2017).

Common Myths of Rape

• Rape is about having sex. FALSE!!!! Rape is not about sex; it is about power, control, and violence. Perpetrators
use sexual violence to dominate and humiliate victims.
• When a woman submits to rape, she really wants it to happen. FALSE!!! Submission is not consent. Victims may
comply out of fear, coercion, or threat of harm, but this does not mean they wanted it.
• Women who dress provocatively are asking for rape. FALSE!!! No one 'asks' to be raped. Sexual violence is the
fault of the perpetrator, not the victim’s clothing, behavior, or appearance. People of all ages, backgrounds,
and dress styles experience rape.
• Some women like rough sex but later call it rape. FALSE!!! Consensual rough sex is different from rape. If there
is no consent, it is rape, regardless of whether force or violence was used.
• Once a man is aroused by a woman, he cannot stop his actions. FALSE!!! Men are capable of self-control.
Arousal does not justify or excuse sexual violence. This myth wrongly implies that men have no responsibility
for their actions.
• Walking alone at night is an invitation for rape. FALSE!!!! No one invites rape. People should be able to walk
freely without fear of being assaulted. Rape is caused by perpetrators, not by victims’ actions or location.
• Rape cannot happen between persons who are married. FALSE!!! Marital rape is real and illegal in many
countries. A spouse does not have the right to force sex without consent.
• Rape is exciting for some women. FALSE!!! Rape is an act of violence, not a source of pleasure. This myth is
harmful and dismisses the trauma victims experience.
• Rape occurs only between heterosexual couples. FALSE!!! Rape can happen to anyone, regardless of gender or
sexual orientation. Male victims, LGBTQ+ individuals, and non-binary people can all experience sexual
violence.
• If a woman has an orgasm, it can’t be rape. FALSE!!! A physiological response does not mean consent. The
body may react to stimuli involuntarily, but that does not mean the person wanted or consented to the act.
• Rape usually happens between strangers. FALSE!!! Most rapes are committed by someone the victim knows
(e.g., a partner, friend, colleague, or family member). The "stranger in the dark alley" stereotype is
misleading.
• Rape is a crime of passion. FALSE!!! Rape is a crime of power, control, and entitlement, not passion or
uncontrollable desire. Perpetrators use it as a means of dominance, not because they are "overcome by
passion."
• Rape happens spontaneously. FALSE!!! Many rapes are premeditated. Perpetrators often plan their actions,
choose vulnerable victims, or create situations where they can take advantage of someone.
Assessment

• The physical examination should occur before the victim has showered, brushed teeth, douched, changed
clothes, or had anything to drink. Washing, brushing, or douching can remove crucial DNA evidence, such as
semen, saliva, skin cells, or other biological material from the victim’s body. Changing clothes may cause loss of
fibers, hair, or bloodstains that could be used to identify the perpetrator.
• To assess the patient’s physical status, the nurse asks the victim to describe what happened. If he or she cannot
do so, the nurse may ask needed questions gently and with care.
• Rape kits and rape protocols are available in most emergency department settings and provide the equipment
and instructions needed to collect physical evidence.
• The physician or a specially trained sexual assault nurse examiner is primarily responsible for this step of the
examination.

Treatment and Intervention

Rape treatment centers (emergency services that coordinate psychiatric, gynecologic, and physical trauma services in
one location and work with law enforcement agencies) are most helpful to the victim. In the emergency setting, the
nurse is an essential part of the team in providing emotional support to the victim.

• The nurse should allow the victim to proceed at his or her own pace and not rush through any interview or
examination procedures.
• Allow him or her to make decisions when possible about whom to call, what to do next, what he or she would
like done, and so on.
• The victim must sign consent forms before any photographs or hair and nail samples are taken for future
evidence.
• Prophylactic treatment for sexually transmitted diseases is offered. Doing so is cost-effective; many victims of
rape will not return to get definitive test results for these diseases.
• HIV testing is strongly encouraged at specified intervals because seroconversion to positive status does not
occur immediately.
• Therapy is usually supportive in approach and focuses on restoring the victim’s sense of control; relieving
feelings of helplessness, dependency, and obsession with the assault that frequently follow rape; regaining trust;
improving daily functioning; finding adequate social support; and dealing with feelings of guilt, shame, and
anger.

LEGAL ISSUES
Legal Considerations
Rights of Clients and Related Issues
Clients receiving mental health care retain all civil rights afforded to all people except the right to leave the hospital in
the case of involuntary commitment. They have the right to refuse treatment, to send and receive sealed mail, and to
have or refuse visitors. Any restrictions (e.g., mail, visitors, clothing) must be made for a verifiable, documented reason.
These decisions can be made by a court or a designated decision-making person or persons, for example, a primary
nurse or treatment team, depending on local laws or regulations. Examples include:

• A suicidal client may not be permitted to keep a belt, shoelaces, or scissors because he or she may use these
items for self-harm.
• A client who becomes aggressive after having a particular visitor may have that person restricted from visiting
for a period of time.
• A client making threatening phone calls to others outside the hospital may be permitted only supervised phone
calls until his or her condition improves.

A. Involuntary Hospitalization
• Health care professionals respect these wishes unless clients are dangers to themselves or others (i.e., they
are threatening or have attempted suicide or represent a danger to others). Clients hospitalized against their
will under these conditions are committed to a facility for psychiatric care until they no longer pose a danger
to themselves or to anyone else.
• A person can be detained in a psychiatric facility for 48 to 72 hours on an emergency basis until a hearing
can be conducted to determine whether or not he or she should be committed to a facility for treatment for
a specified period.
B. Release from the Hospital
• They can sign a written request for discharge and can be released from the hospital against medical advice.
If a voluntary client who is dangerous to him or herself or to others signs a request for discharge, the
 psychiatrist may file for a civil commitment to detain the client against his or her will until a hearing can take
place to decide the matter.
• While in the hospital, the committed client may take medications and improve fairly rapidly, making him or
her eligible for discharge when he or she no longer represents a danger. Some clients stop taking their
medications after discharge and once again become threatening, aggressive, or dangerous. Mental health
clinicians increasingly have been held legally liable for the criminal actions of such clients; this situation
contributes to the debate about extended civil commitment for dangerous clients.
C. Mandatory Outpatient Treatment
• This may involve taking prescribed medication, keeping appointments with health care providers for follow-
up, and attending specific treatment programs or groups.
• Benefits of mandated treatment include shorter inpatient hospital stays, though these individuals may be
hospitalized more frequently; reduced mortality risk for clients considered dangerous to themselves or
others; and protection of clients from criminal victimization by others. In addition, after an initial financial
investment, assisted outpatient treatment is more cost-effective than repeated involuntary hospital stays.
• Mandated outpatient treatment is sometimes also called conditional release or outpatient commitment.
• Court-ordered outpatient treatment is most common among persons with severe and persistent mental
illness who have had frequent and multiple contacts with mental health, social welfare, and criminal justice
agencies. This supports the notion that clients are given several opportunities to voluntarily comply with
outpatient treatment recommendations and that court-ordered treatment is considered when those
attempts have been repeatedly unsuccessful (Kisely, Campbell, & O’Reilly, 2017).
D. Conservatorship and Guardianship
• People who are gravely disabled; are found to be incompetent; cannot provide food, clothing, and shelter
for themselves even when resources exist; and cannot act in their own best interests may require
appointment of a conservator or legal guardian. In these cases, the court appoints a person to act as a legal
guardian who assumes many responsibilities for the person, such as giving informed consent, writing checks,
and entering contracts.
• The client with a guardian loses the right to enter into legal contracts or agreements that require a signature
(e.g., marriage or mortgage).
• In some states, the term conservator refers to a person assigned by the court to manage all financial affairs
of the client. This can include receiving the client’s disability check, paying bills, making purchases, and
providing the client with spending money.
E. Least Restrictive Environment
• It also means that the client must be free of restraint or seclusion unless it is necessary.
• Short-term use of restraint or seclusion is permitted only when the client is imminently aggressive and
dangerous to him or herself or to others, and all other means of calming the client have been unsuccessful.
• For adult clients, use of restraint and seclusion requires a face-to-face evaluation by a licensed independent
practitioner within 1 hour of restraint or seclusion and every 8 hours thereafter, a physician’s order every 4
hours, documented assessment by the nurse every 1 to 2 hours, and close supervision of the client. For
children, the physician’s order must be renewed every 2 hours, with a face-to-face evaluation every 4 hours.
F. Confidentiality
G. Duty to Warn Third Parties

Rights of Clients and Related Issues