By Elyse N. Mowle, Ph.D.
April 19, 2021
PHCoE graphic
What should I do if my patient tells me they are experiencing sexual harassment?
This is a frequent question among military mental health providers. In fact, PHCoE regularly receives requests for more information and resources focused on sexual harassment.
DOD defines sexual harassment as conduct that involves unwelcome sexual advances, requests for sexual favors, and deliberate or repeated offensive comments or gestures of a sexual nature (DOD Instruction 1020.03, "Harassment Prevention and Response in the Armed Forces"). A person with authority may implicitly or explicitly condition a subordinate's career opportunities on submission to unwanted advances. Even when submission is not made a term or condition of someone's career, this conduct is sexual harassment whether severe or pervasive, and creates a hostile or offensive work environment that may damage unit morale as well as individual productivity and readiness.
The DOD Sexual Assault Prevention and Response Office (SAPRO) works with the services to develop and implement prevention and response programs for sexual assault. Although sexual assault may occur in the context of sexual harassment, sexual harassment policy is addressed by the Office for Diversity, Equity, and Inclusion within the Office of the Secretary of Defense. Military sexual harassment complaints are addressed through the Military Equal Opportunity (MEO) Program in the Navy, Marine Corps, and Air Force, and by the Sexual Harassment and Assault Response and Prevention (SHARP) Program in the Army. Civilian sexual harassment complaints are addressed in accordance with 29 CFR 1614. While approaches vary by service, military members have multiple ways to address sexual harassment they experience, including:
- Addressing the harassment themselves by speaking with the offending party and asking him or her to stop.
- Making an anonymous complaint to command.
- Making an informal complaint/requesting assistance from MEO to mediate with the offending party.
- Making a formal complaint of sexual harassment. Formal complaints are investigated by command and do not typically involve the independent military criminal investigative organizations.
Contact your MEO or SHARP representative to understand available options in your patient's military service.
Fast facts about sexual harassment in the military:
- SAPRO's 2019 Annual Report on Sexual Assault in the Military found that 1,021 reports of sexual harassment were received from the military services in 2019.
- Sexual harassment affects all service members. In fact, in fiscal year 2019, 18 percent of formal complaints of sexual harassment in the military were made by male service members.
- An estimated 24.2 percent of active duty women and 6.3 percent of active duty men indicated experiencing sexual harassment in the 2018 Workplace and Gender Relations Survey of Active Duty Members Overview Report. These rates suggest that more than 116,000 service members (50,000 women; 66,000 men) may have experienced at least one sexual harassment incident in fiscal year 2018.
- Harassment may occur in the workplace, but it may also occur through electronic communications, including social media (DoDI 1020.03) – for example, sending illicit photos through a messaging application.
- Sexual harassment exists on a continuum of harm that includes more severe behaviors such as assault or rape. In 2018, active duty women who experienced sexual harassment were at three times greater risk for sexual assault; men who experienced sexual harassment were at 12 times greater risk for sexual assault. About half of men and women who indicated an experience of sexual assault in 2018 also indicated that they also experienced sexual harassment before and/or after the alleged incident.
There is no requirement of psychological harm to the victim for the behavior to constitute sexual harassment. However, threats to pay or career, repeated unwelcome advances, and a hostile work environment are all likely to impact service members's wellbeing. One study of former reservists found that sexual harassment was associated with poorer mental health and symptoms of depression and posttraumatic stress disorder for both men and women. It is important for providers to know what resources are available to victims of sexual harassment.
For patients accessing care, assessing for a history of sexual harassment may help identify areas for clinical attention. Providing treatment and connecting patients with support services may decrease the impact of such experiences on patients' mission readiness.
Health care providers can assist service members who have experienced sexual harassment in the following ways:
- Consult with your local MEO program or SHARP program (Army only) personnel to understand the reporting and assistance options available to service members.
- Consult with your medical legal consultant about your responsibilities when someone reports sexual harassment to you in a treatment setting. While it is unlikely that you would have to break confidentiality and report the harassment allegation outside of a safety concern, getting advice from the consultant in these circumstances is a best practice.
- Consider and take steps to address how sexually harassing behavior may impact both your patient's treatment progress and their ability to function in their military unit.
- Remind the service member that sexual harassment is not their fault and they do not have to tolerate the behavior. They also do not have to tolerate retaliation for making a complaint. However, keep in mind that most service members may feel extremely uncomfortable addressing a harasser by themselves; in fact survey data indicates many will not say anything out of concern for making the situation worse.
- After consulting with the appropriate parties described above, it may be therapeutically beneficial to review with the patient the ways that their service receives allegations of sexual harassment, if they are interested. Reviewing reporting options in treatment, while observing your ethical boundaries, may help members better understand their options and the risks and benefits of each.
- Listen closely to the behaviors your patient alleges. Understanding when sexual harassment crosses over into sexual assault is a key warning sign.
- Military patients that allege sexual assault are eligible to make a Restricted or Unrestricted Report of sexual assault. They are also entitled to a variety of victim assistance and legal services. See SAPRO’s Victim Reporting Options Guide for more information.
- In accordance with DOD Instruction 6495.02, all allegations of sexual assault must be provided to the local Sexual Assault Response Coordinator (SARC); however providers do not have to provide identifying information about their patient when a patient declines to meet with the SARC. Document this consultation with the SARC in the patient record.
- An important caveat: If the patient discloses information that indicates a threat to his/her safety or to others' safety, both the SARC and criminal investigators must be notified to ensure the patient's safety is appropriately addressed. These important facts about sexual assault disclosure should be addressed in your facility's informed consent document and discussed with the patient at the outset of care.
- If your patient is experiencing distress as a result of sexual harassment, discuss how you might assist them in the treatment setting. If the distress requires psychological treatment, recommend interventions that are appropriate to the patient's presenting symptoms and are consistent with VA/DOD clinical practice guidelines.
Additional resources:
Dr. Mowle was a clinical psychologist and contracted sexual assault subject matter expert at the Psychological Health Center of Excellence. Her specialties include sexual assault prevention and treatment and the consequences of traumatic exposure.