Introduction
Sexual violence is common in Ireland and worldwide. Sexual violence has many consequences, including significant implications for physical and mental health. This paper examines the incidence of sexual assault in Ireland and services currently provided; the psychological and psychiatric consequences of sexual violence internationally and in Ireland; psychological and psychiatric services provided following sexual assault in Ireland; and suggestions for developments in the future.
Sexual assault in Ireland and services provided
Sexual violence is common. In Ireland, four in ten adults (40%) have experienced sexual violence, defined as a range of non-consensual experiences from non-contact experiences to sexual intercourse, at least once in their lifetime, including two thirds (65%) of women aged 18 to 24 years (CSO 2022). In general, younger people report experiencing sexual violence at a higher rate than older people. Over five in ten (52%) younger people aged 18 to 24 years report sexual violence in their lifetime compared with almost three in ten (27%) people aged 65 years and over.
Sexual Assault Treatment Units (SATUs) provide medical and forensic care to patients who have experienced recent sexual violence. The first European center for medical care of these patients was established at the Rotunda Hospital in Dublin in 1985. In 2006, Sexual Assault Treatment Services: A National Review laid out the minimum services that should be available to all victims of sexual violence regardless of their geographical location (O’Shea and National Steering Committee on Violence Against Women Reference O’Shea2006). This report defined a SATU as a dedicated, forensically secure facility, integrated with hospital services, accessible 24 hours a day, 365 days a year.
Ireland now has six SATUs located in Dublin, Cork, Waterford, Mullingar, Galway, and Letterkenny (Health Service Executive 2025), providing medical and forensic care to patients aged fourteen years and above. Medical care at SATU includes management of injuries, provision of emergency contraception, HIV post-exposure prophylaxis (where indicated), and screening and treatment for sexually transmitted infection. Forensic examination includes collection of samples from areas of possible DNA contamination.
A total of 1,077 attendances were recorded in SATUs in Ireland in 2025 (Health Service Executive 2026). 55% of patients attending do so within 72 hours of their experience of sexual violence, and a large majority (87%) of attendees are seen within three hours of a request for forensic clinical examination. A majority are female (89%), 10% are male, and 1% identify as another gender or none. Half (49%) of attendees are under 25 years of age. Most commonly, the assailant is a stranger (31%), followed by an acquaintance of more than 24 hours (18%), an acquaintance of less than 24 hours (10%), or a friend (10%). Assault by an intimate partner accounts for 7% of presentations.
Kane and colleagues, in a 7-year review of 5,942 female attendances at SATUs in Ireland, found significant associations ‘between the presence of bodily injuries and some incident details, including alcohol consumption or drug use disclosure, time of attendance to SATU [i.e., within 24 hours of the incident] and the location of the incident [i.e., outside]’ (Kane et al. Reference Kane, Walshe, Maher, Pucillo, Richardson, Holmes, Flood and Eogan2025; p. 1279).
Patterns differ across groups. Compared to younger adults (<65 years), older adults (>65 years) who present are more likely to be uncertain whether a sexual assault has occurred, to report the incident to the police, to be assaulted by a person in authority, and to be assaulted in their own home or in ‘other-indoors’ settings (e.g., nursing home or hospital) (Kane, Gill et al. Reference Kane, Gill, Walshe, Fallon, Flood and Eogan2024). As a result, there is a ‘necessity for tailored interventions and effective support systems for reporting and addressing this vulnerable demographic’, especially ‘in healthcare environments, where a notable proportion of cases occur, frequently involving individuals with dementia and requiring care assistance’ (Kane, Gill et al. Reference Kane, Gill, Walshe, Fallon, Flood and Eogan2024, p. 1).
Compared to adults (>18 years) who present to SATU, female adolescents (<18 years) are more likely to disclose being assaulted outdoors and during the day and more likely to report being assaulted by a friend or family member (Kane and Eogan Reference Kane and Eogan2024a). Female adolescents are less likely to have consumed alcohol prior to the incident, to have physical injuries, or to attend SATU within seven days of the incident. Again, ‘knowledge of these factors support appropriate tailoring of treatment, prevention, and awareness strategies to help modify the impact and reduce the incidence of [sexual assault] in the vulnerable adolescent cohort’ (Kane and Eogan Reference Kane and Eogan2024a, p. 1).
Male patients are a distinct group that are increasingly attending SATU (Kane, Kennedy et al. Reference Kane, Kennedy, Flood and Eogan2024). They are less likely than female patients to experience assault by an intimate partner, and, while significantly more likely than females to be the victim of a multi-assailant assault, they are less likely to report the crime to the police.
Particular considerations also apply to assaults by females, which account for less than 2% of attendances but nevertheless constitute a distinct entity (Kane and Eogan Reference Kane and Eogan2024b). People who experience sexual assaults by females are likely to be female, to be assaulted by a single female perpetrator whom they know, and to attend SATU within 72 hours of the assault. These findings highlight the need for tailored responses to different groups attending SATUs.
Psychological and psychiatric consequences of sexual violence
Sexual assault is strongly associated with subsequent mental ill-health, especially post-traumatic stress, depressive disorders, and suicidality (Dworkin et al. Reference Dworkin, Menon, Bystrynski and Allen2017; Dworkin Reference Dworkin2020). This is a complex area owing to the frequent occurrence of multiple traumas. In England and Wales, one study of over 300 survivors of sexual violence and abuse who attended Sexual Assault Referral Centres (SARC) found high levels of adverse childhood experiences (ACEs) and pre-existing mental health problems in this group: ‘Notably in our study, three-quarters of participants had four or more ACEs, contrasting sharply with rates of approximately 10–15% reported in population-based studies […] Nearly half of the survivors had pre-existing mental health problems at the point of accessing SARC, more than half had lifetime experience of attempted suicide, 56% had been prescribed psychotropic medications’ (O’Doherty et al. Reference O’Doherty, Carter, Sleath, Brown, Brown, Lutman-White, Jackson, Heron, Kalsi, Ladeinde, Whitfield, Caswell, Gant, Halliwell, Patel and Feder2024; p. 43).
One hundred days after accessing SARC in England and Wales, 71% of participants in that study met criteria for probable post-traumatic stress disorder (PTSD), decreasing to 55% at one year. The study concluded, ‘Sexual assault referral centres must recognise the high burden of lifetime trauma and chronic mental problems that affect most service users accessing this service. There is evidence that these factors, together with socio-economic status, affect people’s PTSD presentation to a greater degree than aspects of the offence (perpetrator and time since trauma), although these were still important […] Every recovery journey following a sexual assault or abuse is different, and both formal and informal sources of support are important. A consistent trauma-informed societal response to sexual violence is needed’ (O’Doherty et al. Reference O’Doherty, Carter, Sleath, Brown, Brown, Lutman-White, Jackson, Heron, Kalsi, Ladeinde, Whitfield, Caswell, Gant, Halliwell, Patel and Feder2024; pp. xxvii–xxviii).
In Ireland, Vallières and colleagues studied a nationally representative sample of 1,020 Irish adults who completed self-report measures of history of sexual violence and mental health (Vallières et al. Reference Vallières, Gilmore, Nolan, Maguire, Bondjers, McBride, Murphy, Shevlin, Karatzias and Hyland2022). Results suggest that approximately one-in-three (34.4%) Irish adults experience some form of sexual violence, defined as any sexual act, or attempt to obtain a sexual act, directed against an individual’s sexuality, against someone’s will, where one is forced to participate in a sexual act without their consent, including 14.8% who report being sexually assaulted (raped) and 31.1% who report being sexually harassed.
The study also found that people who had experienced sexual violence in Ireland were at increased risk of serious mental health problems compared to people who had not experienced sexual violence. Specifically, people who had experienced any form of sexual violence were significantly more likely to meet diagnostic criteria for post-traumatic stress disorder, complex post-traumatic stress disorder, depression, and generalized anxiety. They were also significantly more likely to have received a psychiatric diagnosis compared to people who had not experienced sexual violence.
Psychological and psychiatric services following sexual assault in Ireland
In light of the prevalence of sexual violence and its strong association with poor subsequent mental health, Ireland’s SATUs provide psychological support to attendees. In 2025, 63% of attendees at the six SATUs had the opportunity to meet with a psychological support worker during their first attendance (Health Service Executive 2026; p. 13). The SATU Annual Report 2024 emphasizes the importance of this: ‘Efforts are made to ensure that a support worker from the affiliated Rape Crisis Centre (RCC), Sexual Violence Centre (SVC), or ASSC [Accompaniment Support Service for Children] is available either in person or remotely (via phone or video call). This provides survivors/victims with practical and emotional support, including counseling and court accompaniment services if required. Additionally, they offer information on other available services and how to access them. The accompaniment services are free and confidential’ (Health Service Executive 2025; p. 11).
The SATU Annual Report 2024 notes that Dublin and Tullamore Rape Crisis Centres have introduced extended support services within the Rotunda and Mullingar SATUs to include an on-site RCC presence during certain follow-up appointments. Early implementation has been reported positively (Health Service Executive 2025, p. 11). In addition, some SATUs (Rotunda since 2024; Cork since 2025) now have a Medical Social Worker working on the team providing psychosocial, emotional, and practical support to patients.
Each individual’s needs will differ. In 2025, 10 SATU patients (1% of 1,077, in a cohort where 46% of patients had no documented physical injury) were hospitalized due to a physical injury, and 5 patients were ‘hospitalised due to mental health’ (Health Service Executive 2025, p. 19). It is likely that many others had different mental health needs that required follow-up with, for example, the Rape Crisis Centre or other support services appropriate to their psychological requirements.
These figures underline an important distinction: SATUs provide essential acute medical, forensic, practical, and emotional support, but they are not designed to provide comprehensive ongoing psychological or psychiatric care. For many attendees, the initial SATU contact is therefore only the first step in a longer process of recovery. Some will require information, reassurance, and access to community-based supports; others will require structured psychological therapy, psychiatric assessment, or specialist intervention for post-traumatic stress, depression, anxiety, self-harm, substance misuse, or pre-existing mental illness. This range of needs highlights the importance of clear, timely, and well-resourced referral pathways from SATUs to Rape Crisis Centres, Sexual Violence Centres, primary care, community mental health teams, child and adolescent services, and emergency mental health services where required.
This is especially important because the psychological consequences of sexual violence can emerge immediately, persist over time, or become apparent only after the acute crisis has passed. A trauma-informed response should therefore combine compassion at first contact with continuity thereafter: careful assessment of risk, attention to prior trauma and existing mental health difficulties, practical information about available supports, and active facilitation of follow-up. In this context, psychological and psychiatric care following sexual assault in Ireland is best understood not as a single intervention or appointment, but as a coordinated pathway of support, beginning at the SATU and extending across voluntary agencies, primary care, and specialist mental health services.
Conclusions and suggestions for development in the future
Overall, it is clear that sexual violence is common in Ireland, that it is associated with substantial psychological and psychiatric morbidity, and that Ireland has developed a strong national SATU network to provide acute medical and forensic care following sexual assault. The SATU model is a major strength of current service provision. It offers timely, specialist, compassionate care at a point of great vulnerability, and it provides an essential bridge between healthcare, forensic processes, and voluntary-sector support.
At the same time, the evidence reviewed in this paper points to a further challenge. Sexual assault is not only an acute medical or forensic event but also a potentially life-altering psychological trauma. For some people, distress will reduce with time, safety, social support, and practical assistance. For others, sexual violence will be followed by post-traumatic stress symptoms, depression, anxiety, self-harm, substance misuse, deterioration in pre-existing mental illness, or complex interactions between new trauma and earlier adversity. This means that care following sexual assault needs to be understood as a pathway, rather than as a single appointment, intervention, or referral. The acute SATU encounter is a vital starting point, but it cannot, by itself, meet the full range of longer-term psychological and psychiatric needs.
Against this background, we have three proposals.
First, the initial point of contact with SATU for forensic examination is a unique opportunity to provide immediate mental health care. There is a small but promising evidence base for early interventions which can be delivered by staff who are not mental health specialists in these settings. Most evidence to date centers on a video intervention implemented prior to the forensic medical examination and within 72 hours of the sexual assault, aimed at reducing PTSD and other mental health problems (Resnick et al. Reference Resnick, Acierno, Waldrop, King, King, Danielson, Ruggiero and Kilpatrick2007). We are currently exploring this possibility further for Ireland.
Such interventions should not be overcomplicated or medicalise understandable distress. Their value lies in offering immediate, evidence-informed psychological support at a moment when the person is already in contact with services. This might include brief psychoeducation about common responses to trauma, normalization of acute distress, simple grounding strategies, information about sleep and safety, encouragement to access informal and formal supports, and clear advice about when to seek further help. The aim would not be to provide therapy in the SATU setting but to reduce isolation, enhance agency, support early coping, and create a clear link to ongoing care where needed. Any such intervention would need to be carefully adapted to the Irish context, acceptable to attendees and staff, sensitive to diversity, and designed so that it does not interfere with the medical or forensic process.
Any early psychological intervention should be integrated with, rather than replace, the psychological and psychosocial supports already available within SATUs from Rape Crisis Centre and Sexual Violence Centre volunteers and Medical Social Workers. Brief early psychological interventions would provide evidence-based psychoeducation and coping support, while the existing accompaniment and support services would continue to deliver emotional support, information, and facilitation of onward referral. Integration of these elements would avoid duplication and ensure continuity of patient care.
Second, existing allied agencies require greater funding to provide prompt ongoing care for this population. As the SATU Annual Report 2024 notes, ‘it remains crucial for SATUs and partner agencies to continue promoting awareness of these allied support services, ensuring that individuals can access them, in a timely fashion, as needed’ (Health Service Executive 2025; p. 11). It is similarly essential that such services, such as the Rape Crisis Centre, are resourced to meet this need fully.
This is especially important because voluntary-sector and community-based services often provide precisely the kind of care that many people need after sexual assault: emotional support, counselling, accompaniment, advocacy, information, and continuity. These supports can be less intimidating than formal psychiatric services and may be more acceptable to people who do not identify as having a mental disorder but nevertheless need help. They also have expertise in the specific dynamics of sexual violence, including shame, self-blame, fear of not being believed, fear of legal processes, and the impact of assault on relationships, sexuality, work, education, and family life.
Timely access is therefore essential. Long waiting lists risk allowing distress to become entrenched, while uneven geographical access risks deepening existing inequities. Funding should support not only counselling hours but also staffing, training, supervision, out-of-hours availability, outreach, interpreter access, disability-sensitive provision, and sustained liaison with SATUs, general practice, mental health services, and An Garda Síochána where appropriate.
Third, Ireland should develop a more explicit, integrated pathway for psychological and psychiatric care following sexual assault. At present, SATUs, Rape Crisis Centres, Sexual Violence Centres, primary care, emergency departments, community mental health teams, child and adolescent mental health services, and voluntary supports all have important roles. The challenge is to ensure that these services connect in a way that is clear to attendees, workable for professionals, and reasonably consistent across the country. A national pathway would not require every person to see a psychiatrist or psychologist. Rather, it would set out proportionate, stepped levels of care based on need, risk, preference, age, existing mental health history, and safeguarding concerns.
Such a pathway might include routine information for all attendees; active follow-up for those who consent to it; clear criteria for urgent mental health assessment; rapid access routes for people with suicidality, psychosis, severe depression, substance misuse, or acute risk; and agreed referral processes for people requiring trauma-focused psychological therapies. It should also include specific provisions for adolescents, older adults, men, people with intellectual disability, people with dementia, migrants, LGBTQ+ people, and those assaulted in institutional or care settings. The Irish SATU literature already demonstrates that different groups present with different circumstances and needs (see above). Service pathways should reflect this diversity.
These proposals are not mutually exclusive. They represent complementary components of a model of trauma-informed care. Early psychological intervention at first contact, adequately resourced allied support services, and an integrated national pathway each address different stages and aspects of recovery.
Finally, any development of services should be accompanied by evaluation. Ireland now has a mature SATU network and a national evidence base on presentations to SATUs (e.g., Kane et al. Reference Kane, Walshe, Maher, Pucillo, Richardson, Holmes, Flood and Eogan2025). This creates an opportunity to move beyond describing need towards testing and improving responses. Future work can examine not only attendance numbers and forensic outcomes but also access to psychological support, referral completion, waiting times, patient experience, mental health outcomes, and equity of provision across regions and groups.
The goal is not to make SATUs responsible for all subsequent care but to ensure that the first contact after sexual assault opens the door to the right support at the right time. In this way, Ireland can build on the strengths of its SATU system while developing a more complete, trauma-informed model of psychological and psychiatric care following sexual assault, in which early intervention, specialist support services, and integrated care pathways work together to meet the individual needs of patients.
Funding statement
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Competing interests
The authors declare none.
Ethical standards
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The authors assert that ethical approval for the publication of this perspective piece was not required by their local ethics committee.
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