Enemy Within

Military Sexual Assault Inflicts Physical, Psychological, Financial Pain

By Coreen Farris, Terry L. Schell, and Terri Tanielian

Coreen Farris and Terry Schell are behavioral scientists and Terri Tanielian is a social research analyst at the RAND Corporation.

Enemy Within

Photo illustration by Eileen La Russo; image adapted from iStockphoto

Awareness of sexual violence within the U.S. military has grown over the past decade. In the year following the 2005 implementation of a new reporting system within the U.S. Department of Defense, reports of military sexual assaults — which include rape, forcible sodomy, and other unwanted sexual contact that is aggravated or abusive — grew by 30 percent.

When a servicemember is assaulted from within the chain of command, he or she may have no route by which to escape the situation.

The new reporting system gives servicemembers the option of filing either unrestricted or restricted reports. When an unrestricted report is filed, it is provided to law enforcement for investigation, and the victim's commander is notified. This was the only option available to victims prior to 2005. Under the new system, reports may be filed as restricted, meaning that they are kept strictly confidential; they are not released to commanding officers, and no investigation is launched. Both types of reports allow victims to record a complaint and to receive medical and other supportive services.

However, many victims still choose not to disclose their experiences because they do not want anyone to know about them, are uncomfortable making a report, do not believe that their report will be kept confidential, or fear retaliation. In short, the reported incidents are likely to substantially underestimate the true number of sexual assaults in the military.

In fiscal year 2012, a total of 3,374 U.S. servicemembers formally reported that they had been victims of a sexual assault, representing about 0.2 percent of all servicemembers. But Pentagon officials believe that the total number of formal reports represents a mere fraction of all the assaults committed. In May 2013, the Pentagon released a study estimating, based on extrapolations from a survey of active-duty men and women, that 26,000 people in the military were sexually assaulted in fiscal year 2012.

Among the reports that were filed, only the unrestricted reports provide demographic details about the perpetrators and victims. The unrestricted reports from fiscal year 2012 indicate that 78 percent of incidents involved a servicemember victim and at least 84 percent involved a servicemember perpetrator (see the pie charts). One-quarter of the perpetrators were in the victim's chain of command.

In Reported Cases of Military Sexual Assault, Most Perpetrators and Most Victims Were U.S. Servicemembers

In Reported Cases of Military Sexual Assault, Most Perpetrators and Most Victims Were U.S. Servicemembers

SOURCE: Sexual Assault Prevention and Response Office, U.S. Department of Defense, 2012.

NOTE: Percentages are based on "unrestricted" reports, the only form of reporting that provides demographic details about the perpetrator and victim. "Restricted" reports are kept strictly confidential.

Sexual assault victims experience physical injuries and increased risk for sexually transmitted infections, human immunodeficiency virus, pregnancy, posttraumatic stress disorder, and other psychological health problems. U.S. Department of Defense guidelines for the care of these victims appear to be well matched to civilian recommendations for care. An important next step will be to evaluate the extent to which the care that victims actually receive — including medical care, forensic services, advocacy and support services, and mental health care — matches the departmental directives for the care they ought to receive.

Kori Cioca and Panayiota Bertzikis

AP IMAGES/CLIFF OWEN

Veterans Kori Cioca, of Wilmington, Ohio, and Panayiota Bertzikis, of Somerville, Massachusetts, who were assaulted and raped while serving in the U.S. Coast Guard, are plaintiffs among several women and at least one man who are suing Pentagon officials, seeking change in the military's handling of rape and sexual assault cases.

Brian Lewis

AP IMAGES/CAROLYN KASTER

Brian Lewis, former U.S. Navy Petty Officer Third Class, testifies at a U.S. Senate hearing on military sexual assault on March 13, 2013. Lewis said he was raped in 2000 by a superior officer and was ordered not to report the crime. The greater proportion of men in the military overall means that over half of military sexual assault victims will be male.

Everyone Pays

Sexual assaults result in costs for society as well as consequences for the individual victims. In the civilian sector, the average immediate medical cost for those who seek care is $2,084, with victims paying about 30 percent out of pocket. In addition to these immediate costs, medical care utilization grows by 56 percent annually after an assault, and this increased utilization persists for at least three years following the event. About one-third of rape victims also seek mental health services, and for those who do, the average total cost is $978, with the victim bearing 34 percent of that cost.

In addition, victims lose an average of 8.1 paid work days and 13.5 unpaid household labor days per assault. Lost productivity at work and in domestic tasks has been estimated at 1.1 million days annually. Assuming mean daily earnings of $95, the loss to the economy is $104.5 million annually.

Beyond the tangible financial costs, there are intangible ones that drive the total costs of sexual assault higher. After an inflation adjustment, the total cost of each assault has been calculated to be $138,204 in 2012. Multiplying this amount by the U.S. Department of Defense estimate of disclosed and undisclosed cases of military sexual assault in 2012 suggests that their total cost to U.S. society in that year alone was on the order of $3.6 billion.

Sexual assault during military service may differ from civilian assaults in a number of important ways. The nature of military service and its emphasis on loyalty and community may result in servicemembers experiencing a heightened sense of shock and betrayal when a colleague perpetrates the offense. Although male servicemembers are less likely to report an incident than are female servicemembers, the greater proportion of men in the military overall means that over half of military sexual assault victims will be male. Finally, when a servicemember is assaulted from within the chain of command, he or she may have no route by which to escape the situation and may remain vulnerable to repeated assaults and other abuses. There could be a harmful influence on career trajectories, and retention might decline.

Chuck Hagel listens to President Barack Obama

AP IMAGES/JACQUELYN MARTIN

U.S. Secretary of Defense Chuck Hagel, left, listens to President Barack Obama, alongside Joint Chiefs Chairman General Martin Dempsey and Vice Chief of Naval Operations Admiral Mike Ferguson, during a White House meeting on May 16, 2013, to discuss sexual assault in the military.

Shelli Hanks

AP IMAGES/ARIZONA DAILY STAR, MAMTA POPAT

Shelli Hanks, sister-in-law of Kimberly Hanks, speaks outside Davis-Monthan Air Force Base in Tucson, Arizona, on April 25, 2013. She and others denounced the decision by U.S. Air Force Lieutenant General Craig Franklin to overturn a jury's sexual assault conviction of U.S. Air Force Lieutenant Colonel James Wilkerson. Kimberly Hanks, a civilian employee, had accused Wilkerson of sexually assaulting her.

Multiple barriers stand between servicemembers who have been sexually assaulted and their access to psychological health care.

Inadequate Defenses

Multiple barriers stand between servicemembers who have been sexually assaulted and their access to psychological health care, as evidenced by long wait times for those seeking care, shortages of well-qualified mental health service providers, and a limited availability of care in rural regions. Active-duty personnel are often unable to take time off during standard work hours to seek care. Worries about confidentiality may prevent some from doing so. Servicemembers report concerns that they will appear weak to leadership and that seeking help will harm their careers. Concerns about the availability of mental health records to the chain of command may be particularly problematic for victims, given that the perpetrator is within the victim's chain of command in about a quarter of the cases.

Since 2005, the U.S. Department of Defense has worked to raise awareness of sexual assaults, to prevent future assaults, and to ensure that victims have access to an array of medical care, mental health, and legal services. The defense department should now consider several projects to help monitor the effectiveness of these efforts, to direct the provision of services, and to identify promising intervention or prevention strategies.

These projects could include a formal, anonymous survey of a representative sample of servicemembers to estimate the true extent of sexual assault across the services. The survey should be conducted by an outside entity to reduce fears that the responses may not be kept confidential. Other projects could include a needs assessment of disclosed and undisclosed victims, an evaluation of training programs for sexual assault prevention and response, and an evaluation to document the extent to which the directives requiring immediate, evidence-based care for victims are being implemented with fidelity.

Former Secretary of Defense Robert Gates has said: "The department has a no-tolerance policy toward sexual assault. This type of act not only does unconscionable harm to the victim; it destabilizes the workplace and threatens national security." Establishing an environment that does not tolerate sexual violence is likely to be an iterative process with multiple cycles of policy recommendations, directives, implementation, scientific research, and further recommendations. Such a process has the potential to reduce the incidents of military sexual assaults and to minimize the damage they cause. square

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