Trauma informed response to reports of sexual assaults in hospitals
Patient Ombudsman received 29 complaints reporting sexual assaults by other patients or staff in public hospitals, mostly on mental health units.
How can hospitals do better?
In years 4 and 5, Patient Ombudsman received 29 complaints reporting sexual assaults by other patients or staff in public hospitals. Most of the complaints occurred on mental health units or involved patients with a history of mental health or addictions problems, developmental disabilities, or other vulnerabilities.
Many people continue to believe that sexual assault necessarily involves violence or force, or that acquiescing to a sexual act always implies consent. This can affect the way people interact with those who report sexual assault, the kinds of questions they ask, and their responses to the answers.
This is further complicated in mental health settings, where reports are more likely to be perceived as lacking credibility or be attributed to symptoms of a patient’s psychiatric condition. Depending on how the incident is discussed with patients who are reporting assault, the patient may feel interrogated or sense that the person they are reporting the incident to does not believe them.
Trauma and violence-informed approaches are not about 'treating' trauma…Instead, the focus is to minimize the potential for harm and retraumatization, and to enhance safety, control and resilience for all clients involved with systems or programs. These approaches benefit everyone, whether or not they've experienced trauma in their lives or their personal history is known to service providers.
Sexual assaults are avoidable and HSOs should take every reasonable precaution to provide safe and secure environments for their patients, staff, and visitors. All reports of sexual assault should be taken seriously and undergo an appropriate investigation. Mental health status is not a reason to approach a report of sexual assault differently than for any other patient.
When receiving a report, it is important to recognize that it’s not up to a staff member or physician to believe or disbelieve a report of sexual assault or threat, but to follow a respectful and sensitive approach to receiving the information, an objective process for investigating what transpired, and to assess the safety of the care setting.
In addition to complaints about sexual assaults in hospital, Patient Ombudsman also received 18 complainants from patients who had experienced sexual assaults prior to their hospital admission and reported that insensitive care in hospitals had left them feeling retraumatized. Health care providers may not be aware of a patient’s history of trauma and how past trauma can affect their experience of care, for example, when undergoing a sensitive procedure such as an anal swab, vaginal examination, or catheterization.
Adopting trauma-informed approaches to care can reduce the risk of causing further harm to patients who have experienced sexual trauma. It is particularly important to imbed trauma-informed principles and approaches in policies and practices that guide HSOs’ responses to reports of sexual assault, including how complaints are managed.
How Patient Ombudsman is responding
Patient Ombudsman identified a cluster of complaints involving reports of sexual assault and insensitive care for patients with past sexual trauma. Patient Ombudsman also identified serious concerns with hospitals’ responses to a number of these complaints, including:
Failure to conduct investigations following reports of sexual assault or insensitive care.
Lack of policies and procedures to ensure appropriate follow-up on reports of sexual assault.
Minimizing or ignoring complaints based on patients’ mental health status.
Lack of engagement with patients and limited transparency about the hospital’s response.
Insensitive communication, including blaming patients or thanking them for their feedback.
Threatened or actual retaliation against patients who reported sexual assaults or complained to a health professions regulatory college.
In response, Patient Ombudsman dedicated one of its three investigators to review and attempt to resolve all complaints related to sexual assaults in HSOs. The goal was to ensure that complaints were addressed in a consistent, sensitive way and identify system-level opportunities to improve the response to complaints about sexual assaults.
When exploring a complaint involving sexual assault or insensitive care of a patient with past sexual trauma, the Patient Ombudsman investigator will typically begin with the Patient Relations representative and then engage any other staff, as appropriate. The investigator will explore the HSO’s awareness of trauma-informed care (TIC) approaches and whether the principles of TIC are reflected in their policies and procedures, particularly policies and procedures for addressing reports about sexual assaults.
If requested, Patient Ombudsman will share resources on TIC and may suggest that the HSO consider staff and physician education on TIC. Online learning tools are available to enhance understanding of TIC policies and procedures and to ensure that TIC approaches are adopted by staff members or physicians who may hear reports of sexual assaults.
Key principles of trauma-informed care and examples of how they can be used in responding to reports of sexual assaults or insensitive care for patients with past trauma:
Provide safe space for a patient to report what occurred.
Listen without judgement, probe without interrogating.
Engage the patient in decisions about conducting a rape kit, police involvement, support person involvement in the review process. Offer supportive care and/or resources.
Seek understanding of what transpired and how with input from patient and share information with patient transparently about what happened.
Acknowledge the patient’s courage, contribution to create a sexually safe environment, and potential and strength to heal.
- BC Provincial Mental Health and Substance Use Planning Council, Trauma Informed Practice Guide, May 2013.
- Public Health Agency of Canada, Trauma and violence-informed approaches to policy and practice, February 2018.
- Barnes, B., Addressing Sexual Violence in Psychiatric Facilities, Psychiatric Services 71:9, September 2020.
- Lawn, T. and McDonald, E., Developing a policy to deal with sexual assault on psychiatric in-patient wards, Psychiatric Bulletin, 33, 108-111, 2009.
- Care Quality Commission, London, Sexual Safety on Mental Health Wards, 2018.
- Emanuel LL, Taylor L, Hain A, Combes JR, Hatlie MJ, Karsh B, Lau DT, Shalowitz J, Shaw T, Walton M, eds. The Patient Safety Education Program – Canada Curriculum Module 13: Patient Safety & Mental Health, PSEP-Canada in collaboration with the Ontario Hospital Association, 2013.