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Our Bodies Our Voice: A case study on utilization of governance streams to change the policy for prevention of sexual violence in universities and the role of grassroots organizations

Absrtact. Sexual violence (SV) is an issue of global importance, with significant prevalence in the EU generally and the Netherlands in particular. Stigma and taboo often result in underreporting and exacerbate the already substantial mental health consequences of SV. Universities are recognized as high-risk settings, but in general awareness, response and prevention in Dutch universities have been limited. This article analyzes a case study of key events over a number of years resulting in policy change and active response in one university in the Netherlands, focusing on the impact and role of the Our Bodies Our Voice foundation, which started as a grassroots student initiative, using the Kingdon model of policy change. The aim is to make explicit how governance streams need to be aligned to place the issue of SV on the agenda of higher educational institutions, and findings highlight the importance of media coverage, advocacy, awareness raising and perseverance on the part of initiatives like OBOV, while building towards a policy window.


Introduction
With the advent of the #MeToo era, it is not unreasonable to assume recognition of Sexual Violence (SV) as a global issue should be pervasive. However, in spite the high prevalence of Gender Based Violence in the EU generally, and the fact that over half of Dutch women having experienced SV, it has rarely been recognized as a problem in Dutch media or culture(Rutgers Institute, 2017; European Union Angency for Fundemental Human Rights, 2014; "Seksueel geweld tegen vrouwen 'doodnormaal,'" 2013). Less than a tenth of survivors report cases to the police, and only a fifth receive any sort of support in processing the trauma of SV, which coupled with the mental health consequences of PTSD, depression and anxiety among others, means the unacknowledged impact of this stigma and taboo is substantial (Bicanic, Engelhard, & Sijbrandij, 2014;Rutgers Institute, 2017;Ullman & Peter-Hagene, 2014). Furthermore, while universities are now generally recognized as high risk settings for SV, many Dutch universities continue to see their responsibility in prevention and the shaping of student culture as limited, with no need for further intervention than establishing complaints procedures (Brekelmans, 2015;Pinedo, 2016;van Schijndel, 2019). However, in one university in Amsterdam, at the time of writing numerous changes have occurred including: a pilot intervention of workshops running in multiple departments; the hiring of a specialized individual leading a social safety taskforce; joining of the UN Orange the World campaign; and the placing of social safety on the agenda for the academic year 2019-2020 in conjunction with a statement by the Association of Dutch Universities on the need for active efforts to improve social safety (Amsterdam, 2019; "Sociale veiligheid binnen de universiteiten," 2019).
The Our Bodies Our Voice foundation is an organization that started as a grassroots student initiative and has been campaigning and networking throughout the years in which the processes resulting in these changes occurred (Cherbit-Langer, 2019;"Our Bodies Our Voice," n.d.). With the insider perspective of the foundation's founders and board members, as well as documentation on key events, it is possible to analyze the trajectory through which these changes came about, and the role they may have played in it. With the continued global significance of the issue, and the similar issues with taboo and stigma other grassroots initiatives may be facing, understanding the interaction of governance streams that formed this trajectory could provide notes for practice in the future. For this reason, after a brief discussion of the context, an analysis of events and the insider perspective of OBOV will be conducted using Kingdon's model on policy change.
Background Sexual Violence (SV) and Gender Based Violence, while only recently being recognized as global issues, have seen promising growth in interventions, developing from local response to immediate needs in the aftermath of an occurrence, to national and international level interventions including policy and civil society initiatives focused on prevention (Michau, Horn, Bank, Dutt, & Zimmerman, 2015). This increase in awareness and willingness to act has been exacerbated by mass media movements such as #MeToo and coverage of other high-profile cases, as will be demonstrated in the analysis below. Considering the gendered nature of the problem, generalized statistics on the occurrence of sexual violence globally are often lacking, such that the extent of a problem in nations and institutions is usually measured by percentages of women affected. In line with the WHO's estimates for global prevalence, a Europe wide study has found that 33% of women have experienced physical or sexual violence since the age of 15 (European Union Angency for Fundemental Human Rights, 2014). Focusing on experiencing sexual harassment more generally, 55% of women were affected (ibid). Dutch national statistics, while not directly comparable as a result of differing definitions and a more direct focus on sexual violence, show equal or by some comparisons higher than average occurrences, where 22% of women and 6% of men have experienced manual, oral, vaginal or anal rape and/or were forced to conduct sexual acts against their will, and 53% of women and 19% of men have been sexually assaulted, using a broad definition ranging from kissing and sexual touching to rape (Rutgers Institute, 2017) Experiencing SV has numerous mental health consequences including generally decreased phycological, physical and sexual health, where survivors may experience depression, eating disorders and suicidal ideation or attempts (de Haas, 2012). Survivors of SV are disproportionately more likely to develop PTSD than those who experience other forms of trauma, where 49% of survivors of rape develop PTSD, in contrast to only 7.3% of people who witnessed death. (Bicanic et al., 2014) Beyond clinically measurable conditions, in a representative sample of the Dutch population, it was found that half of men and more than half of women are profoundly psychologically or behaviorally affected by experiences of sexual violence. ("Seksuele gezondheid in Nederland 2017," 2017).These consequences can be mitigated by timely and effective professional and/or social support, but studies have found that these are often lacking or subject to barriers making them inaccessible (Ullman & Peter-Hagene, 2014). For instance in the Netherlands only 1 in 5 male and 2 in 5 female survivors indicate that they received any support, and only 4% of male and 11% of female survivors reported their case to the police (Rutgers Institute, 2017).
Research in the UK and the US has found that there is a disproportionately higher incidence of SV in university settings than in the general population, and while no research has confirmed that this is the case in the Netherlands, similarities in structure and culture of such institutions make it likely to be similar. (Rutgers Institute, 2017; "Seksueel geweld tegen vrouwen 'doodnormaal,'" 2013;Fenton, Mott, McCartan, & Rumney, 2016;Newl & s, 2016;Pinedo, 2016). This is demonstrated most clearly by the concentration of a variety of high risk factors including age, attending higher education, regular alcohol consumption, and a growing campus culture and hookup culture (Rutgers Institute, 2017; "Seksueel geweld tegen vrouwen 'doodnormaal,'" 2013;Fenton et al., 2016;Newl & s, 2016;Pinedo, 2016). Thus far Dutch institutions have relied on existing complaints procedures and confidential advisors to deal with occurrences on a case by case basis, but over the last two years in particular, evidence has shown these measures to be ineffective (Logtenberg & van de Wiel, 2019). The national level pervasive stigmatization of the issue is shown most clearly in the preference of local media to cover occurrences of false reporting, rather than the recently published statistics demonstrating the troubling incidence of SV ("Seksueel geweld tegen vrouwen 'doodnormaal,'" 2013). SV is seen by the general population as a problem that occurs only in other, distant locations and survivors seeking to break the silence are seen as attention seekers (Brekelmans, 2015;"Seksueel geweld tegen vrouwen 'doodnormaal,'" 2013;van Schijndel, 2019).
Thus, a concerning threat to student health has gone unaddressed as a result of stigma taking the form of a culture of tolerance. In response to this, several student activists together with key actors at the university and experts from abroad collaborated to create the Our Bodies Our Voice (OBOV) foundation ("Our Bodies Our Voice," n.d.). The foundation aims to raise awareness about sexual violence and transform the culture within universities to create a safer environment for students and staff alike (ibid). Through workshops, they aim to provide participants with the necessary information and skills to support survivors and help dismantle the stigma around SV, and to create a safe, confidential space for discussions about participants' attitudes towards sex, boundaries and consent (ibid). OBOV also recognizes the substantial body of research indicating that sustainable change in SV prevention is only possible through multi-level, longterm intervention, for which institutional backing is a significant prerequisite (Mat, Altinyelken, Bos, & Volman, 2019;Michau et al., 2015). As a manifestation of such institutional support, policy changes that demonstrate the support of main decision-making bodies is of central importance to prevention. Therefore, in the following analysis, the conditions required to create a policy window in which SV can be placed on the agenda will be established through the case study of OBOV's successful intervention in the Netherlands.

Method
In order to understand agenda setting and policy change on an issue like SV in a sufficiently comprehensive manner, knowledge from the field of Governance for Global Health provides the most useful background, as it captures the roles of different actors and processes in policy making. A framework from this field that focuses on the prerequisites for policy change is the Kingdon model, an adapted version which was therefore used for a structured analysis of key events and insider accounts of OBOV board members and founders .Though the model is intended for the analysis of the actions of policy entrepreneurs at a national level, the model is being applied here to understand the impacts of student activism and collaboration to evoke institutional change, at a single university level. Kingdon's model consists of three different 'streams' representing processes and circumstances that are needed for policy change to occur (Buse, Mays, & Walt, 2012). The first is the problem stream, which relates to perceptions of problems and the responsibility of the body under consideration. Second is the policy stream which consists of actors analyzing the problem and solutions being considered. Lastly the politics stream refers to swings in general national (in this case institutional) mood, changes of key actors or campaigns by interest groups. For an issue to be taken seriously and put on the agenda, all three streams need to overlap creating a policy window. Each of the three streams will be analyzed relating to the specific context of a University in the Netherlands, using experiential knowledge of the founders as well as documentation and media coverage around the issue. Conclusions will then be drawn about the conditions that created the policy window and the role that OBOV played in its creation.

Results
In analyzing through streams rather than a linear account, key events can at times be difficult to present coherently. For that reason, a brief summary of the founding of OBOV is presented here to help maintain a central narrative. Towards the end of 2017, a number of concerned students from different departments of a university in Amsterdam established for themselves that the issue of SV was not being dealt with appropriately. They began collaborating, combining existing efforts that had failed to gain traction with input from external organizations, and the media impetus provided by the #MeToo movement to organize an event for the discussion of policy on SV prevention in the university. The event, titled Our Bodies Our Voice occurring in May 2018 attracted numerous students, staff members and key actors in influential positions within the university (Koeyvoets, 2018). The ensuing discussion and support encouraged the students to begin an organization by the same name in the summer of 2018, using experience from their respective backgrounds to set up a series of workshops. These began running around the end of 2018 and start of 2019, during which time the organization achieved the status of a foundation. Working through each of the streams, you will see the points at which this process of development overlaps with and underscores parallel processes.

Problem stream
Starting with the problem stream, the described culture of stigma, silence and lack of media coverage hampered if not actively prevented public recognition of the problem. The culture within the universities in Amsterdam specifically, and the Netherlands in general, were similar with action on the part of the university deemed unnecessary and the normalization of sexual violence such as groping in social situations ("Seksueel geweld wordt vaak niet eens herkend," 2017). Considering the general aversion to reporting among the student body, where less than 25% of students suffering from mental health issues seek support, the preference to be seen as normal likely extends and increases in stigmatized situations like surviving SV (Van der Heijde, Vonk, & Meijman, 2015;Verouden, Vonk, & Meijman, 2011). It took the massive media coverage of high profile cases in the USA for the first conversations on the topic to start (Brekelmans, 2015). Specifically the Stanford Letter, written by a survivor to the perpetrator of SV before the trial, and the #MeToo movement which started to open a conversation about SV in the film industry, and spread to a general movement raising awareness of SV (Newl & s, 2016;Seales, 2018).
In many ways this first media attention was a prerequisite for the very formation of the OBOV foundation, where running workshops and events on a problem that no one believes exists, proved somewhat challenging. After the pilot program was negotiated during the academic year 2018-2019, further media attention emphasized the issue's importance as in 2019 for the first time two local cases gained moderate media attention. The first concerned a professor and department head who sexually harassed women in his department for more than a decade without consequence, and the second concerned a student reporting sexual violence against another student in Rotterdam, and having the reporting procedures almost intentionally misdirected to discourage her taking action (Logtenberg & van de Wiel, 2019;van Schijndel, 2019). These cases provided a basis to support actors already campaigning the issue's significance, following the OBOV event of the previous year, making it impossible to continue to ignore the existence of the problem on a national level in universities.

Policy Stream
Resulting from but also parallel to the gradual recognition of SV as a problem in Dutch universities, it was possible for the first discussions on the extent of the issue and potential solutions to begin. The first OBOV event, aimed to open such a discussion with the student body on policy for SV prevention and response, highlighting the fact that the age group 18-24 is four times more likely to experience SV, and that 61% of students attending higher education have experienced SV as compared to 53% of the general population (Rutgers Institute, 2017; Koeyvoets, 2018). Building from the event, the academic year 2018-2019 saw roughly monthly meetings of key figures concerned with student welfare in the university to further discuss potential courses of action. One of the central topics of the early discussions concerned the extent and limitations of responsibility of a University, as their role has primarily been seen by the Dutch public as a purely academic one, where reporting is only necessary in extreme cases or cases concerning a staff member. However, recognizing at least in part the role a university plays in shaping student culture, as well as the academic impacts the mental health consequences of sexual violence have, suggestions of awareness campaigns, workshops and online help-seeking information began to take hold. These were informed by the local Sexual Assault Center (CSG Amsterdam), experiential knowledge from board members of OBOV, as well as the policy research conducted by the Student Life Officer at Amsterdam University College, Lydia Roberts, aiming to create policy and responsiveness similar to that found in universities like King's College London.
Simultaneously, the Chief Diversity Officer who had attended the original OBOV event and these exploratory meetings accepted a proposal for a pilot program of workshops to be run at three different departments. The structure of the program worked on the basis of evidence from numerous international sources, emphasizing the need to tackle culture and underlying drivers as well as sustained long-term investment in prevention (Michau et al., 2015). While the overarching program aims to raise awareness, create a culture of consent and strengthen institutional commitment, the individual workshops focus on bystander intervention and active listening training; the former being a method used in the united states and the UK in recent years, which has been shown in reviews to address primary prevention and engage men as well as women in positively ending violence; the latter focusing on appropriate response to first disclosures, as negative responses can have substantial impacts on overall recovery and the development of PTSD (Fenton et al., 2016;Ullman & Peter-Hagene, 2014). Workshops were tailored to specific departments and select groups, working with students in mixed groups, men only and staff members separately. Furthermore, in the process of tailoring workshops and understanding the individual context, OBOV conducted the first exploratory research on SV in a Dutch university, though the sample was not representative, and findings were not verified for statistical significance. They found that 55% of students in this group knew someone who had been pressured to engage in sexual activity against their will, but simultaneously 51% thought that sexual abuse was not a problem in the University, showing if nothing else the complex duality still at play and highlighting the need for active response.

Politics stream
In terms of the politics stream, two main drastic changes in overall mood or attitudes within the institution occurred during the academic year 2018-2019: the assumption that the university does address the areas it is considered responsible for; and that its responsibility is limited to the academic campus and actions of staff members. The former changed primarily as a result of the aforementioned case of the professor who was able to avoid any consequences for continuous inappropriate behavior, showing that the existing programs were already flawed. Likely as a result, a statement was made by the association of Dutch universities on the subject of social safety, in which undesirable sexual approaches are mentioned specifically, emphasizing that universities are responsible for creating a safe environment ("Sociale veiligheid binnen de universiteiten," 2019). In particular, they mention the need to strengthen the existing system with the addition of a note on the need for frequent research into social safety within the institution (ibid). Already this statement shows a substantial shift on the second front as well, that being the extending of university responsibility, but it is still limited and open to interpretation. Within the university of OBOV's intervention, the continued work between the CDO and OBOV, the placing of social safety on the agenda for the year by the board of directors and the creation of a social safety task force, capture the presence of both paradigm shifts. Though most statements concern the idea of social safety generally speaking, the process of joining UN women's Orange the World campaign on sexual violence prevention, as well as statements from the chair of the taskforce, demonstrate the underlying concern with this specific issue (Amsterdam, 2019). This results in part as a crisis response to the public case, but also from the work of visible actors like the Chief Diversity Officer, and hidden actors, like the exploratory panel of concerned parties and experts, who met over the course of the year and took a letter of advice to the higher levels of administration of the university requesting the creation of a position focused on social safety.

Discussion
A policy window occurs when all three streams intersect, and this is the point in time when agenda setting and policy change become possible. From recurring themes and events in the analysis, it is apparent that there is a significant amount of inter play and exchange between the various theoretical streams, with the metaphor of water appearing very appropriate. The events in the problem stream by which it became clear that SV is a public issue, created the conditions in which the development of OBOV, from event to foundation, was possible. Additionally, it was through this event and the ongoing collaboration of other individuals impacted by the defining events of the problem stream that created motion in the policy stream. In turn the exploratory panel, and the workshops proposed by the CDO and OBOV, in focusing on effective solutions help to raise awareness further, folding back into the problem stream. Finally, the exploratory panel from the policy stream, undeniably coupled with key events in the problem stream, increasing awareness of the problem at higher levels in the institution, resulted in shifts in the politics stream with the perceived responsibility of the university expanding. With just two of any of the three elements, change would not have been possible. For example, the creation of the taskforce resulted from key events making the board aware of the problem, key actors causing a shift in perceived responsibility and the exploratory panel suggesting a fixed position to allow for sufficient investment.
However, this analysis in its layered complexity does not lend itself well to the identification of best practices. Though discussion of each of the separate streams allows for an internally consistent narrative, the exact nature of the overlap is very fluid, making conclusions for future intervention complicated. In essence the use of the model in analysis emphasizes the weight of coincidence and timing in policy change, very little of which is easy to directly influence, quantify or identify direct causes of. The primary conclusion that can be drawn as a result of this analysis is that the three streams did align in the academic year of 2018-2019, with awareness of the problem, discussions of solutions, and interaction of key actors with the general mood, intersected and reinforced each-other, the occurrence of each rippling in to the other.
In order to identify specific elements of best practices for grass-roots initiatives like OBOV, a more linear model may have presented more concrete analysis. However, the overview given by the Kingdon approach does present the opportunity for observations on circumstances and situations outside the direct influence of such organizations that are significant. For instance, media coverage of issues related to SV has a substantial impact on all streams and provides opportunities to work towards a window. Another key element in creating such a window is networking with key actors and other concerned parties, as OBOV did with the CDO and the panel. Much like media events, the building of a social movement on an institutional level has ripple effects throughout the streams. In particular the original OBOV event, bringing together concerned parties and increasing awareness of the issue and the need to respond, played a substantial role in creating motion. It also provided the basis for the pilot program of workshops together with the CDO, and in bringing together diverse concerned individuals, and helped concentrate knowledge and expertise such that the evidence-based solutions incorporated in the workshops could be identified. Finally, building off of the role of context and coincidence highlighted by the model, the perseverance of concerned individuals awaiting a policy window is paramount. If there is no one to take advantage of the starting elements of a policy window, it is unlikely to take hold, whereas the ripple effect of persistent action may contribute to the aligning of the streams.

Broader implications
It is impossible to identify exactly what circumstances allowed the #MeToo movement to take hold when it did, where countless other attempts to gain attention were silenced. Regardless there is now a marked difference in the before and after, where claims that there is no problem are now less likely to be accepted at face value. Harvard originally claimed to be exempt from the national issue of SV, but it was soon discovered that cases were simply silenced (Brekelmans, 2015). Recognition of the problem of SV in the Netherlands generally and at universities in particular took a similar path, where it was easy to assume there was no problem so long as no one looked. The desire to put distance between ourselves, our institutions, and a stigmatized issue like SV is understandable, but in the face of the disastrous consequences, also unacceptable. What this analysis can contribute to the larger discussion around SV as a global issue is that this pattern of denial continues to occur and will likely persist at different levels in different countries. However, in the post #MeToo era, it has become easier to connect with other concerned parties and activists, if nothing else, and with each making ripple effects and reaching for policy windows, the promising changes we have seen will continue.

Implications for research
At the time of writing there has been limited research on policy change and agenda setting at the university level for comparison. Research conducted in the UK and USA where the majority of available articles are from primarily take a national perspective, investigating policy implementation comparatively. In instances where individual universities are considered the focus is on exploration of risk factors, culture and the efficacy of specific interventions (Cierniak, Heiman, & Plucker, 2012;Fenton et al., 2016;Newl & s, 2016). The assumption across these studies is an existing recognition of the problem of SV in university contexts, which requires no further discussion. There is little to no other literature on SV related policy making at any level in other EU countries, though this is likely related to the limitations of language in researching to English. Most research focusing on the early stages of SV prevention are focused on low and middle-income countries, establishing community-based interventions focusing on gender equality (Michau et al., 2015). The only comparable research was conducted by students in Brazil following the publication of troubling statistics on SV, prompting investigation for guideline development purposes, though the process of agenda setting is not investigated (Maito, Panúncio-Pinto, Severi, & Vieira, 2019). A more relevant case study of policy making at Yale traced similar elements such as the denial of problematic dynamics until contrary evidence becomes public, and the role of a student activist group in agenda setting, where their organizing of work groups played a central role in developing a network of experts, as also found in the current study (Bagley, Natarajan, Vayzman, Wexler, & McCarthy, 2012).
More generally speaking the role of civil society in placing violence against women on the agenda is well established, with a substantial body of literature investigating the role of feminist actors and organizations in policy making (Htun & Weldon, 2012). One set of case studies in the UK highlights the role of feminist activists in placing domestic abuse on local and national agendas, though contrary to radical theory the development of connections and networks with other allies was a significant factor in success (Abrar, 1996). The conclusion that local actions were inherently tied to events and trends on the national level to some degree mirror the role ascribed in this article to international events like the #MeToo movement. They also similarly highlight the role of key actors or organizations in seizing opportunities provided by the local and national changes. Finally, a case study of the Edinburgh Zero Tolerance policy, tracing local context and politics, the role of government research and concerned actors in key positions, similarly finds that effective networking at different institutional levels, and the perceived salience of the issue were determining factors (Mackay, 1996). It may be interesting to investigate the significance of emphasis on feminist movements in establishing the issue in the UK and USA and how that may differ or converge with the ongoing developments elsewhere at present.
One other case study on policy making and SV in Nepal made use of the Kingdon model, using it to analyze how changes in the framing of the issue from a health to a human rights perspective helped played a role in aligning streams to create a policy window (Colombini et al., 2016). In general, the Kingdon model is still frequently used to discuss health policy in Europe and abroad, as its flexibility allows it to be applied to many different contexts, much as we found here (Rawat & Morris, 2016). However, contrary to our experience some other researchers found it useful in establishing causation, though it has no predictive power (Rawat & Morris 2016). Others find that on a national level the generalist nature of the model does not allow for sufficiently detailed analysis, though the current study may indicate the potential of the model for smaller scale investigations at the institutional level.

Conclusion
Despite the alarmingly high prevalence of sexual violence (SV) internationally, in the Netherlands specifically, and in the university context in particular, previous years have seen limited response, on the part of the relevant institutions (Rutgers Institute, 2017; European Union Angency for Fundemental Human Rights, 2014; "Seksueel geweld wordt vaak niet eens herkend," 2017). The pervasive stigma and denial which has resulted in a culture of tolerance has led to significant underreporting and lack of support, in spite of the severe mental health consequences posed by SV related trauma (Bicanic et al., 2014;"Seksueel geweld tegen vrouwen 'doodnormaal,'" 2013;Ullman & Peter-Hagene, 2014). However, the current case study shows how a combination of factors and the effort of a number of key actors have resulted in policy change and agenda setting, with SV at the center of numerous efforts and changes in the academic year of 2019-2020 at one university in Amsterdam. The events leading up to these changes were analyzed using a governance framework called the Kingdon model.
The model itself proved as fluid as the metaphor of policy streams implies, and while this makes direct conclusions difficult, it does emphasize the weight of coincidence and timing in policy change, which cannot always be directly influenced. Other researchers have also found its flexibility useful, and in spite of the model's age it is still in frequent use, though the lack of detail or depth in its current form may lend itself better to other forms of analysis than its original national level configuration. It also helps to identify factors external and adjacent to the direct role of an organization like OBOV that are noteworthy, such as the role of media coverage in creating policy windows and the importance of networking with other key actors when coverage occurs. Events like the one organized by OBOV in the early stages play a vital role in creating social movement at an institutional level that ripple out into other streams, and also allow for a concentration of knowledge. Finally, because policy windows are time sensitive it is important for organizations or concerned actors working towards recognition of a certain issue to persevere, in order to take advantage when the opportunity arises. Thankfully for individuals working in SV prevention, in the post #MeToo era, it is easier to question denial and silence, bringing policy windows closer and continuing the global trend towards awareness and response.
Our research Presents a somewhat novel contribution to research as we were unable to identify other articles focusing on agenda setting pertaining to SV in universities, as most research focuses on national level analysis and comparison in locations where agenda setting has already occurred (Cierniak et al., 2012;Fenton et al., 2016;Newl & s, 2016). Research on early phases is primarily focused on low-and middle-income countries and focus on community interventions and gender equality (Michau et al., 2015). While some other articles do trace similar trends in universities where key events with media coverage allow student activist organizations to rally networks of experts and put the issue on the institutional agenda (Bagley et al., 2012;Maito et al., 2019). Finally, older studies in the UK and USA trace the role of civil society and feminist organizations in agenda setting in local and national settings, which similarly identify networking and salience as key (Abrar, 1996;Mackay, 1996). As such our research contributes to an existing if somewhat fragmented body of knowledge, which could do with further investigation to build information as more institutions and nations start to tackle SV and move towards prevention.