What medical care is provided for child victims and perpetrators of sexual violence in France?

“I have images that come back to me in flashes, it was in kindergarten. I don’t know if I’m 3, 4 or 5 years old. Children from several classes force me to lie down on a bench, take off my underwear, look at me, laugh, put dirt and leaves in me. I felt like I was on a dissection table. Later, I had several episodes of sexual assault where I did not know how to defend myself. I have the impression that there is a form of passivity that has registered in me, that I have difficulty saying no, to exist. I had eating disorders (anorexia and bulimia) which are not unrelated to what happened in kindergarten, I have also been in relationships where there was domestic violence.” Dina, 40, tried, when she was little, to talk to adults about what she had suffered. But she was never listened to. And because of this, he never had any psychological follow-up.

Sexual abuse suffered during childhood can have very significant repercussions on the person who suffered it. “The destructive potential of psychotrauma increases over time, due to lack of appropriate treatment, and can lead the victim, sometimes years later, to pathologies of the bond (submission, control) or to the reproduction of violence as a “author or as a victim” estimates Richard Ziadé, educational director of the Jean Cotxet association, dedicated to child protection, in the book Sexual violence between minors (Artège, 2023). Muriel Salmona, founding psychiatrist of the association Traumatic memory and victimology and specialist in sexual violence, speaks of a “medical emergency”: “We must treat the disorders which otherwise may be at the origin of violence, addictive and delinquent behavior. »

The attackers, former victims who were not treated

The care of minors who commit sexual violence is just as urgent, and just as lacking. A survey carried out in 2002 by Léonore Le Caisne and Bénédicte Kail showed that 40% of minors committing sexual offenses are not subject to any specific monitoring, and even when there was an obligation of care, in 40 % of these cases, there was no specific follow-up with a health professional. Not to mention the vast majority of minor perpetrators who are not identified, or for whom there is a classification without further action which does not result in any treatment.

However, there is an urgent need to treat victims and perpetrators, who could otherwise be led to reproduce the traumas they have experienced, on themselves or on others. Because very often, the attackers are former victims who have not been treated. According to the report on The care of minors committing sexual offenses in the judicial protection of youth, by Marie Romero, minors who commit sexual offenses are on average, before committing an offense, five times more victims of these same offenses than other minors. According to Muriel Salmona, who relies on a study of Lancetwhen a woman has suffered physical and sexual violence as a child, this increases the risk of experiencing it again as an adult by 16, and for a boy, this increases the risk of committing it by 14.

“I felt like I was dispossessed of my body. At 10-11 years old for example I remember being alone in a jacuzzi, and a guy put his hand on my penis and I couldn’t move. From the age of 15-16 until I was 25, I was attacked several times a year without defending myself,” explains Dina.

“No psychological help, no reparations”

But is France giving itself the means to truly take care of these children? All the experts we interviewed are unanimous: this is not the case. “Currently there is nothing in France, no psychological help, no reparations, the victims are only entitled to medical-psychological centers” which we know are overloaded, criticizes Muriel Salmona. Walter Albardier, psychiatrist responsible for the Resource Center for Workers with Perpetrators of Sexual Violence (Criavs) in Île-de-France, estimates that waiting times for public treatment can reach three, four or even five years. “Try to make an appointment tomorrow in the public hospital for child psychiatry, you will have at least a year of waiting. So to tell you that the victims or perpetrators are sufficiently supported, certainly not. »

Failing to find an appointment in the public sector, parents of child victims turn to the private sector, where the cost of the session can reach around a hundred euros. “Our association does not have the budget to help all families, and there are many parents who do not have the means,” laments Homayra Sellier, founder of Innocence in Danger. This citizen, active for more than twenty years in child protection, believes that there should be a specific aid fund for these victims, particularly when the violence took place at school. “It is the responsibility of the State to come to the aid of minors when this has happened in schools. »

“We come to punish the child even though he is a victim”

Concerning minor perpetrators of violence, this support can be complicated by the fact that they may be viewed with a certain disgust. However, the child who engages in problematic sexual behavior or assaults another child has often been a victim himself. “The child who commits rape has almost certainly been exposed to rape as a victim or witness. It is a reproduction of acts committed by adults. It is colonized by intentionality, and becomes a vector of this intentionality,” explains Muriel Salmona. “Minors are sponges, the smaller they are, the more they repeat what they have seen or experienced, which can lead to problematic sexual behavior. We adults come to punish the child even though he is a victim,” adds Mathieu Lacambre, from the team at the resource center for those working with perpetrators of sexual violence (Criavs) in Montpellier.

The care of both victims and perpetrators of sexual offenses suffers from the lack of training of the various actors in the chain, from leisure center leaders to teachers, including those in charge of National Education, or even magistrates. and the police. Isabelle Debré, who with her association L’enfant bleu intervenes in classes, judges that teachers “don’t know how to do it”. “We need to train more people to act as soon as possible,” says Mathieu Lacambre, who developed A TOOLBOX for preventing sexual and gender-based violencewhich is aimed at all professionals working with children and adolescents.

Among the tools available to professionals and parents, there is a guideavailable on sexual-violence.info, which provides useful guidelines for knowing when to worry, and when to report. If a child in kindergarten “during games (doctor, mom, dad, etc.) explores and examines the bodies of other children, including their private parts”, this is “discovery behavior”. A child who plays “doctor” by examining the bodies of other children “very repeatedly, even compulsively”, has behavior considered “worrying”. If he “forces other children to play these games” you must then alert a professional as quickly as possible.

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