PONE-D-19-28688

The identification and treatment of mental health and substance misuse problems in Sexual Assault Referral Centres (SARCs): A systematic review

PLOS ONE

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Reviewer #2: Yes

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Reviewer #1: Major comments:

Abstract: The fact that stakeholders and guidelines also recommended referral to and partnership with local counselling services should be mentioned since these recommendations are essential.

Introduction

The reader may get the impression that suggestions from stakeholders and national guidelines give correct and complete recommendations. A description of evidence based methods is lacking, although mentioned in the discussion. After the section on sexual violence in the introduction, present evidence based recommendations on how to identify, follow up and treat mental illness and substance use following sexual violence should be stated/exemplified: standardised screening tools to identify acute stress disorder, PTSD, depression, anxiety, substance abuse disorders, and risk of suicide and examples of structured psychological therapies.

Aims

The second aim should clarify that the study included routines for referral and follow up.

Discussion

The comments (line 524) on the stakeholder should include their mentions of the importance of referral, integration and partnership between SARCs and local counselling services for mental health and substance misuse.

The conclusion (line 529) that ”the lack of specificity in government and policy guidance …. may reflect the lack of available evidence” is doubtful since evidence based therapies exist.

Implications for research

i) SARCs can increase the uptake of mental health ……..

ii) The suggestion to study provision of mental health support provided by SARCs contra routine referral to external services depends of what kind of support that is provided. The question is rather, which therapies should be done within SARCs and by external services respectively and to define criteria for referral.

The last section, line 608-16 seems less relevant. A reflection on the role of psychiatric and substance abuse treatment clinics on the treatment of victims of sexual violence may be of interest. Is there a sufficient awareness among psychiatrists of the long term effects of sexual violence? Are patients with mental illness and/or substance misuse routinely asked about experience of sexual violence? There is a need of common knowledge development.

Minor comments:

Title: In the title change SARCs to Sexual Assault Services since the designation SARC is specific for UK (also commented under AIMs)

Aims

In order to know when the paper discusses SARCs in UK or includes corresponding units internationally it would help to name them SARCs and “sexual assault services" respectively.

Introduction

Long-term effects of sexual violence: Sex as self‑injury should be included since it is a specific form of self-harm and the risk of re- victimization needs to be mentioned. Sexual violence is also associated with physical illness.

Reviewer #2: This is a well-written systematic review addressing the identification and treatment of mental health and substance misuse problems in Sexual Assault Referral Centres (SARC). The authors have adhered to recommended methodology for SRs and described their methods clearly. The conclusions appear robust and the recommendation in the discussion on future research is clear and helpful.

There are a few points to make:

1. The abstract does not make clear that there was very little evidence found regarding interventions or support for substance misuse. They refer to 'post-rape psychopathology' but the absence of consideration of drug misuse (one of the key objectives in the review) should be highlighted in the abstract.

2. For question 2, they have not excluded any papers on quality grounds. While this may be less of an issue if there is no attempt at metanalysis, the inclusion of low quality papers needs to be qualified by appropriate levels of emphasis, lest erroneous conclusions be drawn. This could be made clear.

3. There is comment made in the discussion about whether SARCs are the right setting to provide follow-up for either substance misuse or other mental health issues. I could not see if this issue addressed in the results, unless I missed it. It would be important to highlight this.

There are few typos etc:

SANE is not defined in the text when is appears (except via the Box).

Line 572 - delete 'can'

Table 1 - footnotes to this table should include a explanation of the acronyms

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The identification and treatment of mental health and substance misuse problems in Sexual Assault Services: A systematic review

PONE-D-19-28688R1

Dear Dr.Lloyd-Evans,

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Karen-Leigh Edward

Academic Editor

PLOS ONE