Examining the prevalence of sexual safety incidents and effectiveness of sexual safety prevention and management strategies in mental health, disability and older adult settings

Sexual safety in health and social care involves protecting vulnerable populations in various
care environments from a wide range of inappropriate and harmful sexual behaviours,
including non-consensual acts, harassment, and exploitation. Despite the lack of national
standards in Ireland, there is a growing recognition of the need for comprehensive policies
and frameworks to prevent, report, and manage these incidents, as evidenced by
international efforts and forthcoming initiatives by the HSE.
This study aims to estimate the prevalence of sexual safety incidents in HSE managed centres
in Ireland for older persons, adults with disabilities, and inpatient mental health units, and
evaluate the effectiveness of prevention and management strategies. Using data from HIQA
NF06 reports and the National Incident Management System, together with capacity data,
prevalence was estimated per 1000 beds. A scoping study of empirical peer reviewed and
grey literature provides a detailed understanding of definitions, prevalence, prevention
strategies, reporting mechanisms, and management of sexual safety incidents in health
services similar to Ireland.
The scoping review highlights the variability and lack of consensus in defining 'sexual safety'
and 'sexual safety incidents' in empirical literature, noting that while empirical definitions
emphasise subjective experiences and individual perceptions, the grey literature, especially
from the UK and Australia, offers more explicit, practice-oriented definitions. This analysis,
which includes complex terms like 'sexualised behaviour', 'sexual harassment', and 'sexual
assault', highlights the need for clear, inclusive, and context-sensitive definitions to inform
the development of a comprehensive sexual safety framework in healthcare settings in
Ireland. The existing international evidence on the prevalence of sexual safety incidents is
limited and lacks generalisability, with varying rates and types of abuse reported. Studies
highlight the need for standardised definitions and measurement methods yet provide no
specific recommendations to enhance the accuracy of prevalence measurement in the future.
A review of the studies relevant to prevention highlight the importance of staff training,
management models, and various prevention strategies and while some training
interventions show promise in increasing staff knowledge and incident reporting, the overall
evidence for effective prevention methods is limited, with a need for more comprehensive
research and standardised approaches. The evidence highlights the complexity of postincident risk reduction and the need for comprehensive strategies to ensure the safety and
dignity of individuals in older persons, disability, and mental health care settings.
The importance of effective reporting, response, and prevention measures for sexual safety
incidents is emphasised in the literature. Despite the mandatory reporting of such incidents
in many jurisdictions, existing literature highlights challenges in reporting mechanisms and
investigative outcomes. Concerns about compliance with compulsory reporting have led to
calls for standardisation and improvement in reporting practices. Challenges such as the
absence of consistent data on the nature and severity of abuse, the harm inflicted on victims,
and other variables significantly impact the course of investigations and subsequent
outcomes. This not only affects the impact on alleged perpetrators and victims but also
hinders the ability to learn from incidents. Various sources stress the need for enhanced
reporting standards to better address the complexities of sexual safety incidents.
The grey literature reveals an emphasis on safeguarding policies, data analysis, and reporting
strategies for sexual safety incidents, advocating for zero tolerance of abuse and a traumainformed approach, particularly in mental health services in Australia and the UK. It highlights
the importance of implementing training, leadership support, and regular risk assessments,
although the evidence supporting these practices is not fully established.
The analysis of sexual safety incident prevalence in Irish HSE designated centres for older
persons, adults with disabilities, and inpatient mental health units, based on data from the
past five years, reveals fluctuating reporting rates across care settings, including significant
increases in some years possibly due to historical case reporting. This variation in incident
reporting, alongside the ambiguity in interpreting higher or lower rates as either actual
changes in incidents or differences in reporting practices, highlights the need for more
effective reporting mechanisms and careful data interpretation. Comparisons with
international data show mixed prevalence rates, highlighting the need to contextualise Irish
data globally, while identified data collection limitations suggest a need for more nuanced
metrics in understanding these trends.
To move toward meeting the identified challenges in sexual safety within Irish healthcare
settings, this study presents recommendations focused on enhancing data collection
prevention, reporting, and management of sexual safety incidents. Drawing from limited
international best practices, these recommendations emphasise the need for standardised
definitions, improved data methodologies, trauma-informed approaches, and comprehensive
staff training to support a consistent, effective, and respectful approach to sexual safety
across various healthcare environments. Several recommendations are being proposed as a
direct result of the findings which are synopsised here and described in more detail in Chapter
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