Patient Care

Commentary: Helping Ease the Pain of Sexual Assault in the Military

January 2013Helen Smith

A soldier in the US military is more likely to be raped or sexually assaulted by a fellow military comrade than killed by enemy fire. Despite the Department of Defense’s zero tolerance policy, 3,192 military sexual assaults were reported in 2011. Bearing in mind that sexual assault is notoriously underreported, in January 2012 Secretary of Defense Leon Panetta estimated that the actual number may be closer to 19,000.

The numbers inspire two questions. First, isn’t there more we can do to prevent this? And second, as health care providers – including providers who are treating returning vets in civilian settings – how can we best meet the mental health needs of these individuals? After all, isn’t it our moral obligation to protect their safety and health since they are or were fighting for ours?

Helen Smith Despite increasing media attention over the last couple of years, military sexual trauma is by no means a new issue. For example, a number of recent stories have portrayed women who suffered vicious attacks from a trusted fellow serviceman and reported the incident to their chain of command only to be blamed for the assault, dismissed as a liar and labeled promiscuous. (A report in the New York Daily News indicated that the majority of sexual assaults may actually be against men – though they occur at a lower rate than those against women.)

This is unacceptable. Rape assaults our most intimate and fundamental feelings of trust and safety. It is violent, hidden and isolating. Having the allegations dismissed only compounds the trauma. Rape in any context is brutal, but for members of the military the effects may be particularly devastating. As civilians we have some power to remove ourselves from further danger or distress by leaving our jobs, moving to another area, changing schools and so forth. Those in active duty often have no choice but to suffer silently and continue to work beside their attacker. Fear of embarrassment and of not being believed often dissuade rape victims from seeking help, but those serving in the military often fear losing their jobs as well.

We’ve come a long way in our perceptions of gender and sexual violence, but rape myths still permeate our culture. Perhaps that’s why, for example, some still argue that sexual assault against women in the military is an unfortunate consequence of close quarters, ample opportunity and “boys being boys.” Prevention efforts must therefore focus on education. We need male veterans to come forward to act as role models and to create a safe space to discuss issues of sexual violence in the military.

We also must give sexual assault victims options beyond the ability to request a transfer from their unit. They need the confidence that their reports will be taken seriously, that there will be no retribution for reporting the assaults and that their attackers will be held accountable. Taking sexual assault investigations out of the hands of the military and transferring this responsibility to a private outside organization may be a necessary step in achieving this goal.

But change takes time. Meanwhile, as health care providers we have an immense opportunity to help individuals in the military and veterans begin to recover from the trauma they experienced during their tours of duty. It is imperative that we get it right.

Conducting a careful mental health assessment is crucial. We must provide a safe environment that is free from assumption, judgment and intimidation. In performing an effective assessment, we must normalize and contextualize questions surrounding history of sexual trauma; our interviewing techniques must come from a place of empathy that recognizes the individual needs and preferences of our patients. For example, simply starting a conversation with the statement “I ask all my patients about their relationship history because it affects their health” can help to alleviate some of the stigma and fear associated with questions of this nature.

Finally, we must always remember to meet these individuals wherever they are in their recovery process and understand that it may take a series of conversations with multiple providers to persuade a victim of sexual assault to come forward and begin to advance on the road to recovery. We must remain alert to those powerful moments when we make the essential connection that inspires our patients’ first steps toward healing.

Helen Smith is a psychiatric/mental health nurse practitioner student at UCSF School of Nursing.