Sexual Assault Treatment Unit

What is a SATU?
Sexual Assault treatment Units are specially designated units that provide forensic medical examinations for victims who have been raped or sexually assaulted. The examination is (currently) carried out by a medical doctor and evidence from the examination can in turn assist in the detection and /or prosecution of a case against the perpetrator of a sexual assault. (In a criminal trial the only time evidence from a forensic medical examination is not required is when the perpetrator pleads guilty to the crime) The SATU's can also link victims with counseling services to assist victims in overcoming their trauma. Most units also provide medical follow up in the form of "morning after pill" and screening / treatment for sexually transmitted infections which occur as a result of sexual assaults.

Current situation in relation to SATU's in Ireland
There are four SATU's existing in four HSE regions, Eastern, South Eastern, Southern and North Western. These four centers serve a population of 4,234,925.

Rotunda, Dublin.
Open since 1985, has gained international recognition as a "center of excellence"; currently surviving on monies made available from the hospital main budget.

South Infirmary/Victoria Hospital Cork.
Established in 2001. is the only SATU currently in receipt of "ring fenced" funding (secured my Minister Micheal Martin)

Waterford Regional Hospital.
Set up in 2004. Medical personnel currently providing this service do so based on altruism with the only remuneration being in the form of payment for medical reports issued to Gardai. Retention of Doctors to provide this service poses a serious threat to the sustainability of this service.

Letterkenny General Hospital.
Established in 1998. Funding to equip and furnish the unit was raised locally by concerned individuals. Has limited its provision of services to the Donegal area due to medical staffing issues. The budget for the Letterkenny Unit is sufficient only to cover on-call nursing costs. Unit is struggling to remain open with only two doctors providing forensic medical examinations on an ad-hoc basis. Unit looks likely to close unless immediate steps are taken to address the funding crisis.

Tralee General Hospital.
E stablished in 1999 but ceased to operate in 2004 due to lack of funding for nursing personnel to work with the medical staff. While on its initiation the medical service was being provided by one doctor, a rota of twelve interested doctors was available at the time of its dissolution. The unit was strongly supported by the Kerry Rape Crisis and local Garda Siochana who had an excellent detection rate. Currently victims are forced to travel to Cork and this has resulted in a decrease in the number of victims reporting to the Gardai. It has been estimated that 200,000euro would provide nursing staff to work in this unit.

Number of Rape cases in Ireland
In Ireland there is limited research on the prevalence of rape/sexual assault. Many factors militate against the disclosure of these offences to the Gardai or support organizations. Until recently the main source of quantitative data has been the official crime statistics.

Figures available for year 2003 are:

The National Average for 2003 were 9 reported cases per 100,000 population

The level of convictions for reported rape cases is frighteningly small. Figures from the court services reveal that the number of rape/sexual assault cases brought to trial at the Central Criminal Court has fallen from 130 cases in 1999 to only 37 cases in 2004. Along with the 40% acquittal rate in contested rape trials, it is understandable who few engage in and stay with the prosecution process (RCNI, 2005).

The Sexual Abuse and Violence in Ireland Study (SAVI) found that 42% of women and 28% of men experience some form of Sexual assault in their lifetimes yet only 7.8% of women and 1% of males reported to Gardaí.

Relationship between SATU's and convictions for rape/sexual assault.
The lack of services for victims of rape/sexual assault further compounds the sense of guilt and self blame, which acts as a deterrent to them reporting the crime. Evidence from other countries has shown that where structured services exist the level of reporting increases. In Ireland a significant increase in the numbers of reported cases occurred when the Rotunda Unit was established.

Why numbers of SATU's in Ireland are inadequate to deal with demographics and geography.
Currently there are no functional SATU services in the Mid-Western, Western, Midland or North Eastern HSE region

Victims if rape/sexual assault from these regions are therefore dependant on ad-hoc arrangements where there are often long delays between the time the crime is reported to the Gardai and the carrying out of a forensic medical examination. If forensic examinations are carried out by medical staff without adequate training, there are likely to be deficits in the quality of evidence. In addition, such examiners are likely to be torn asunder in our adversarial legal system- thus reducing the likelihood of a conviction. Many doctors from overseas will have left the jurisdiction by the time cases come to court.

In failing to identify a local GP who is available to carry out the examination, the Gardai are frequently required to transport victims to a designated SATU elsewhere, often taking 12 hours or more to make the round trip.

When reviewing reporting rates to the Gardaí for 2003 it was noted that the HSE Western and Midland Regions had particularly low rates of 3.6 and 4.4 cases per 100,000 population respectively in comparison with the national average for that year of 9 cases per 100,000. Hence the alarming low reporting rates to the Gardai is likely to be evidence of attrition caused by the lack of dedicated services in the region.

Young Fine Gael are calling for:

• The immediate allocation of Funding for a comprehensive SATU service for the whole country.

• The re-opening of the SATU in Tralee General Hospital which ceased operation in 2004 due to lack of funding.

• That the provision of a SATU should be decided on a geographical basis and time taken to travel to the nearest SATU. As previously stated, the length of time taken to attend a SATU can be up to 12 hours from the time of assault.

• The establishment of 4 SATU's initially to be located in
  - Limerick (to service the Limerick, Clare and North Tipperary region),
  - Galway, (to service the Galway, Mayo and Roscommon Region),
  - Mullingar (to service the Longford, Westmeath, Offaly and Laois Regions)
  - and a SATU in the Monaghan, Louth and Cavan region.
  This would result in a total of 9 fully operational and adequately funded SATU's. The estimated cost of running a SATU is 200,000 Euro an overall cost for all units to be fully operational coming in at a cost of less than 2 million euro.

• The provision of a Forensic Nursing Higher Diploma in conjunction with the current nurse training centers in the country. This step would ease the functioning of the running and maintenance of SATU's in the long term. It would allow nurses who had undergone such training to carry out forensic examinations; firstly increasing the numbers of persons qualified to carry out such examinations and secondly allowing nurses to provide the courts with evidence leading to prosecutions. (Doctors are reluctant to become involved in SATU's due to the time taken from their day-to-day work to give evidence in court.). There is also a greater pool of nurses.

• In line with this, YFG call for the required changes to be put in place in the Criminal Justice System to allow the evidence of a Forensically trained nurse to be admissible in evidence. This also involves a change in the attitude of the judiciary.