Survival mechanisms: How a health-centred approach is revolutionising the way Scotland deals with rape

It was Emily’s husband who called the police. They’d been celebrating her birthday with a party in their home and, after she’d been helped to bed, a man they thought was a friend came into the room and raped her. It was, she says, the beginning of a journey over which she felt she had no control.

“The next thing I remember, there was a police officer in my room asking me questions,” Emily says. “So, she obviously asked, did I want to take this further? I sat and I looked out the window for what seemed like forever, and I turned to her, and I said, ‘I don’t want this happening to anybody else, let’s go and do what we need to do’.”

It was not an easy, or comfortable, process. After being examined by a male doctor, Emily had to answer question after question after question – “like when was the last time I had sex with my husband, like when was the last time I’d gone for a shower” – when all she wanted to do was brush her teeth. “And they’re like, no, you can’t do anything, you need to just be the way you are,” she recalls.

I don’t want this happening to anybody else, let’s go and do what we need to do

When Eve was attacked by a neighbour who forced his way into her home in the early hours of the morning, she had no choice about involving the police – they had already been called after witnesses saw her being chased into the street. Several police cars and a van arrived on the scene within minutes and, after giving a brief statement, Eve was taken to the local police station where she “sat for a long time and swabs were taken”.

“A paramedic examined me for possible stab injuries and gave me a blanket as I was very shaky,” she goes on. “A Solo [sexual offences liaison officer] arrived, and I was told she would be with me for the rest of the day. We were driven to the sexual offences unit some distance away. A forensic examination and questioning took place. Further swabs were taken from my mouth, but by this time, I’d had coffee. The statement took six or seven hours of repetition that seemed endless.”

Eventually, after fingernail scrapings had been taken despite her having washed her hands several times, Eve was driven home. The whole process was, she says, gruelling.

That’s not how things go at Archway, Glasgow’s Sexual Assault Response Coordination Service (Sarcs). As of last year every health board in Scotland has a legal duty to provide a Sarcs, but Archway has been around since 2006, initially housed in the Sandyford sexual health clinic on Sauchiehall Street before moving to bigger, standalone premises a few streets away last October. Its longevity has given it time to perfect its service and when I visit on a chilly Thursday morning in early March the women who run it – service manager Debbie Ambridge, sexual health consultant Dr Deb Wardle and lead nurse Gaynor Steele – are so comfortable in each other’s company they finish each other’s sentences as they explain why Sarcs are so important as a response to sexual assault.

Dr Deb Wardle is sexual health lead consultant at Archway in Glasgow. Picture: Gordon Terris/Herald and Times

“Adults were examined in police stations and it wasn’t trauma informed,” says Steele of the way things were done prior to the roll-out of Sarcs. “They were examined by the police surgeon on duty and at that time the majority were male and no choice was offered,” continues Wardle. “Now we have a female-only service.” Wardle adds that since the Forensic Medical Services Act came into force last year, people can also self-refer to the service. The majority of people arriving at Archway are still brought after making a police complaint, with Police Scotland Detective Chief Superintendent Sam Faulds noting that the force now “works closely with NHS Scotland and the health boards across the country” rather than carry out forensic examinations itself. But Ambridge says self-referral is a real game-changer because it means forensic evidence can be gathered without newly traumatised people having to make a police report that would start a criminal justice journey they may ultimately have very little power to control.

“The concept behind self-referral is to give people the time to decide,” Ambridge says. “Some people decide they don’t ever want to go to the police, but they can get a forensic examination because they may want to go to the police at some point. The evidence is held here for up to 26 months and they can at any time decide to have the evidence destroyed or returned.”

We are speaking over coffee in a fresh, bright room overlooking a tidy garden whose privacy is assured by fencing and shrubs and a wall of sound from the nearby M8 motorway. We are clearly in a medical setting and, when we don PPE to visit the forensic suite, it is obvious that the stakes are high. But everything from the discreet entranceway to the friendly female staff to the photographs lining the corridor walls is designed to, in Steele’s words, make the experience as pleasant as it can be. Though rape and sexual assault are very serious crimes – very serious crimes that remain under-reported, under-prosecuted and under-convicted – the point is to put the needs of the person who has been assaulted first rather than the needs of a criminal investigation.

“If someone has been sexually assaulted their first thoughts are pregnancy, sexual health, where do I go,” says Steele. “We’re looking after health needs and emotional needs and providing a forensic service where they can then report to the police. There’s no pressure to go to the police. They can wash, brush their teeth – they might have other things going on. They might want to be in a better place and get some support to get their head round things before going to the police.”

Wardle continues: “There are all sorts of reasons why people defer going to the police. There was one [woman] the other week where everything was exploding. She could navigate the internet, but she was getting overwhelmed with all the information she was finding. She was trying to decide what to do but [coming here meant] she could park it, then decide what to do with the [forensic] samples.”    

Steele goes on: “From our point of view the most important thing is the health of the patient and that they feel safe and able to make a choice. We ensure that any evidence we gather is gathered under the best circumstances and either given to the police or stored. If we can do that to the best of our ability, it’s important to the prosecution service and the police [because they can] take that evidence and work with that to put a case together. It’s equally important to us to make sure that the patient has no negative effects, such as an unintended pregnancy, a sexually transmitted infection.”

As few as seven years ago women in many areas of Scotland were having to go to a police station to be seen by a male duty surgeon

Sandy Brindley, chief executive of Rape Crisis Scotland, says the roll-out of Sarcs represents “a transformation in how we respond to rape in Scotland”, though she stresses that it is coming from “a particularly low bar”. The first ever Sarcs in the UK – St Mary’s in Manchester – was set up in 1986 and they have been the norm across England and Wales for many years. Meanwhile, Brindley says, “as few as seven years ago women in many areas of Scotland were having to go to a police station to be seen by a male duty surgeon”. “If they needed the morning after pill they had to organise it themselves. It was really unacceptable,” she adds.

Steele stresses that the absolute priority of any Sarcs is “the health of the patient and that they feel safe and able to make a choice”. Given the forensic aspect of the work they do, proceeding to prosecution and possible conviction is always a consideration too, though. Convictions in sexual cases are notoriously difficult to secure, with the ‘he said, she said’ nature of the evidence presented often leading juries to – in the most generous reading of it – err on the side of caution and acquit.

Scottish Government figures show that conviction rates for all offences hovered between 84 per cent and 90 per cent in the ten years to 2020-21. The proportions may seem large, but are hardly surprising given the high evidential hurdle the Crown sets in order for cases to proceed. Yet when it comes to crimes of a sexual nature, conviction rates were notably lower during the same period, hitting a high of 81 per cent in 2011-12 and a low of 69 per cent in both 2016-17 and 2018-19. When it comes to rape and attempted rape, they fell off a cliff, with the ten-year average sitting at just under 47 per cent, a high of 56 per cent (2012-13) and a low of 39 per cent (2016-17). Those figures are reflected in microcosm in the experiences of Emily and Eve: Eve’s attacker, who had a sexual offending history stretching back 40 years, was convicted after pleading guilty at trial; Emily’s was not, with the case collapsing on the first day in court because although she could not say with absolute certainty that she had consented, neither could she say that she had not.

It is something that Lord Advocate, Dorothy Bain KC, who earlier in her career carried out a review that led directly to the formation of Scotland’s National Sexual Crimes Unit, is acutely aware of. With statistics showing that 70 per cent of High Court cases are of a sexual nature, Bain has tasked Assistant Principal Crown Counsel Susanne Tanner KC with carrying out another review into how these cases are handled by the prosecution service. Tanner is gathering information on how everyone from victims and witnesses to support services and lawyers experience the system. The aim is to determine whether there is a better way to do things.

Bain has also been outspoken about the role juries have to play in sexual cases, highlighting research from University of Glasgow academics Fiona Leverick and James Chalmers that found “overwhelming evidence” that jurors hold “prejudicial and false beliefs” about rape that affect their evaluation of evidence presented at trial. She has given her backing to Lord Justice Clerk Lady Dorrian’s suggestion that judge-only trials at least be investigated and, though that is vociferously opposed by the defence bar, Brindley at Rape Crisis Scotland says she is hopeful a juryless-trial pilot will be included in the Scottish Government’s upcoming Criminal Justice Reform Bill. The bill, which Bain, as the government’s chief legal adviser, will have been heavily involved in, is also expected to make provision for the establishment of a trauma-informed specialist sexual offences court and the abolishment of the not-proven verdict, which is disproportionately used to acquit the accused in rape cases.

It is, says Brindley, a “once in a generation opportunity in Scotland that could potentially lead to huge changes and improvements to how our justice system responds to rape”. “Some really radical and progressive changes are being considered,” she adds.

Though they are very firmly part of the health service rather than the justice system, Sarcs clearly have a role to play in all this. Wardle says Archway and other Sarcs work closely with the Crown Office to provide the “best evidence” should a case proceed to court, but stresses “it would be unsafe to say that the aim is to increase convictions”. Yet Brindley says the two things go hand in hand. 

“The key thing is to improve survivors’ experience but that is linked to the quality of evidence and the quality of prosecutions too,” she says. “The better they are treated, the more likely they are to engage with the justice process and stay with the justice process. Sarcs are not going to magically improve conviction rates, but they are an important part of the picture to make sure that the structures are in place to support survivors.”

Debbie Ambridge is service manager of Archway in Glasgow. Picture: Gordon Terris/Herald and Times.

The possible legislation and the roll-out of Sarcs does not mean Scotland has found all the answers when it comes to dealing with crimes of a sexual nature, though. Indeed, Brindley notes that there’s still a geographical gap that means women like Jane, who lives in Argyll and Bute and was raped on her way home from a night out, had to travel to Glasgow for a forensic examination rather than be seen locally. The friend who was supporting her had to work so couldn’t make the long journey with her and Jane had to travel to Archway with the police. She had been awake for over 48 hours by the time she was eventually dropped back home and, she says, was left feeling “very out of control, overwhelmed and alone”.

“As a general rule people shouldn’t be travelling significant distances,” Brindley says. “Having to sit in a police car for three or four hours to be driven to an examination isn’t acceptable.”
At the same time, with Tanner’s review not expected to report until later this year, any changes that might improve how cases are prosecuted and how victims experience the justice system are still a considerable way off.

Back at Archway, Ambridge is proud of the way the service has expanded. In 2019-20, before things were disrupted by Covid, a total of 372 people came through its doors; by the end of February this year the number was already sitting at 370. Archway is, Ambridge says, “heading for its highest number this year”. As we chat behind masks in the forensic suite, hair covered, protective aprons on, Steele and Wardle are clearly just as proud of the fact it is not just men, women and teenage girls who have been through those sterile rooms before us, but adolescent boys and trans men and women now too. 

It’s not that the evidence is showing more people are being attacked – and certainly no one here would be celebrating if it did. Rather, it shows that more people are aware of the kind of service units like Archway offer and feel comfortable enough to put their trust in them when they are at their most vulnerable. “The iceberg is the same size it’s always been,” Wardle says. “We’re just seeing more of it.” No matter how grim the implications of that are, it is a measure of success in and of itself.