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Is The Blood On ACC's Hands?

Contributor:
Fuseworks Media
Fuseworks Media

A few weeks ago a male survivor, a professional young man who said he had been "violently raped" at the age of 7 years by member of his extended family warned the heads of the ACC Sensitive Claims Unit (SCU) that the "blood will be on your hands" if the new Clinical Pathway to access therapy for survivors of sexual abuse was implemented. In his view if he had to face the Clinical Pathway that the ACC SCU was proposing to implement on 27th October he would probably not have got the counselling help he needed as a student in his 20s. In a letter he told the heads of ACC and the Minister of ACC:

"I am absolutely certain that without the help of a counsellor, the pain and disability that I experienced due to the abuse I suffered as a child would have driven me to suicide. I would not be here today. At the time when I went to see my counsellor, I barely had the confidence or strength to tell him about the existence of the abuse. If my counsellor had told me I needed to see ACC's shrink three times and be diagnosed with a mental condition before I could go to counselling, I would never have gone back. The bottom line is that many young New Zealanders will not let themselves be diagnosed as crazy, and nor should they have to, to receive sex abuse counselling. Other than ACC counselling, many of those youngsters will never have an opportunity to receive counselling to deal with the consequences of child sexual abuse. Some of those individuals will commit suicide. When people start committing suicide as a result of the ACC's new policy, the blood will be on your hands. If this new policy is implemented, I hope that you like awake every night thinking about the talented, innocent young New Zealanders who have died because of the changes you have made".

Could the following case be the first example of the "blood on their hands" even before the Clinical Pathway is implemented?

A woman took years in the mental health system before she finally felt able to disclose that she had experienced many years of extreme sexually abuse by a member of her family as a child.

While in the mental health system she had been labelled with a particularly stigmatising psychiatric diagnosis because of her self-harming behaviours and suicide attempts. She reported feeling "judged", not taken seriously but instead felt "dismissed" by those in the mental health system.

Once she disclosed the sexual abuse she was referred for ACC subsidised counselling.

She completed ACC counselling several years ago and had stablised her life sufficiently to hold down a steady job and develop a secure ongoing relationship.

Recently she was extremely distressed at work when she came across a child who had been sexually abused at the same age as when the sexual abuse began for her. Distress about this child's case meant that the woman could not return to her job.

At her own costs she went to see a private psychiatrist to assess her for medication - she did not want to see a psychiatrist in the mental health system because of her previous experiences.

To help her deal with symptom of flashbacks, nightmares, sleeping difficulties, and difficulties concentrating at her work, she sought further ACC subsidised counselling support.

ACC accepted her claim to return to counselling and allocated her a number of sessions. Over a few weeks she became more stable. She was contacted by ACC and told that in order to be allocated further counselling sessions she needed to be assessed by an ACC psychiatrist. She was told that the ACC psychiatrist would assess her self-harming behaviours and also which of her issues should be covered by ACC and which issues she should be referred back to the mental health system for. The client was concerned that ACC would insist on her returning back to the mental health system.

When the client then read in the media about the new ACC SCU Clinical Pathway she asked her counsellor how the implementation of this pathway could affect her. She clearly had the impression from ACC that they were assessing how much of her issues were to do with the sexual abuse. Her counsellor helped her consider what options she had if ACC would no longer fund her therapy. The client was concerned that she would not be able to afford to pay for counselling if ACC stopped subsidising her sessions. She had had to leave her job as a result of being triggered to remember her child sexual abuse experiences, had costs associated with paying to see a psychiatrist privately to avoid going back into the mental health system and therefore had built up some debt.

The woman's counsellor said when she next saw the client and the woman was worried about how her partner was being affected by her trauma-related depression and worried that the relationship may not last. She reported feeling "weighted down" by how difficult her life was becoming - financial difficulties, being off work, worrying about her relationship, worrying about how she would be able to pay for therapy if ACC stopped funding her counselling and insisted that she return for help back to the mental health system. She reported "nothing feels stable".

She committed suicide two days later.

Her counsellor was understandably distraught and reviewed the last few sessions several times in supervision.

The counsellor has been left with uncertainty and states that although her client was suicidal she "might have been able to have been more supported if she had been confident that ongoing therapy would continue" and "also if she had not dreaded yet another psychiatric assessment where she was scared of some negative assessment that would impact on her". "I recognise that even if either of those two things had been changed she still may have decided to suicide but ....... "

Many people do not realise that for some survivors of severe interpersonal trauma such as child sexual abuse, their counsellor may be their lifeline. If their connection to their counsellor is threatened (in this case by having to see a psychiatrist for an assessment in order to decide whether ACC will continue to cover further counselling sessions)- for some their very life feels under threat.

Therapists who work with survivors of sexual abuse as well as survivors themselves have advised ACC of this fact. They have told the Minister of ACC Nick Smith, the Associate Minister of ACC Pansy Wong and the ACC Sensitive Claims Unit hierarchy continuously that their new processes are not safe and clients' lives are at stake.

ACC does not appear to be listening to survivors of sexual violence or to the experts who work with them.

ACC will not be moved on insisting that to have a claim for therapy accepted in the first one or two sessions: 1) a psychiatric diagnosis is required and 2) 'a clear causal link' between the abuse and the current effects is proven.

This means that in the first one or two sessions a survivor of sexual violence would not only have to disclose the abuse (that they may have taken 20 years to find the courage to see a counsellor about) but they would ALSO need to provide sufficient information to enable the psychologist to give a psychiatric diagnosis from the American Diagnostic and Statistical Manual of Mental Disorders (DSMIV) AND provide a 'clear causal link' between the sexual violence and the effects now.

In the first one or two sessions the survivor will also be required to sign release forms so that all of her or his medical records and employment records could be collected.

A cynic may conclude that ACC could review these records and find alternative explanations for the current effects (eg if the survivor of abuse is suffering depression that the survivor said was related to a rape or child sexual abuse years earlier - it would be easy for ACC to point to other issues in the survivor's life such as current relationship difficulties or job stress that could be the cause of the current depression).

A recent example may be found in an article reported by the Taranaki Daily News last week about a letter from ACC to a grandmother whose grandsons had been sexually abused, declining cover. The letter stated ACC "found no clinically significant mental injury arising from the events described". The newspaper went on to state: "An ACC psychologist believes one of the boy's mood swings, tearfulness and sitting alone sucking his thumb could be due to settling into school and a new environment rather than the sexual abuse events". According to the newspaper the letter from ACC stated: "The best practice may be not to treat this child for sexual abuse unless further problems which were clearly related to the abuse later became evident".

The requirement of 1) a person's symptoms fitting the criteria of a psychiatric diagnosis and 2) being able to 'prove' a clear causal link between the abuse and the current effects on a person's life, will mean that it will be almost impossible for survivors of sexual violence to have any ACC subsidized therapy allocated.

In the Auckland area alone in the last 9 months over 470 survivors of sexual violence have had their claims for counselling declined. There are more than a 100 waiting for approval.

There are endless cases of survivors of sexual violence around the country waiting 2-4 months for psychiatric assessments so that ACC can decide whether it believes they are entitled to counselling support.

As I was about to send this Press Release out I received an email from a colleague stating:

"I have just seen a client who told me that her friend has decided not to proceed with filing a claim for counselling, as she received a letter from ACC Sensitive Claims telling her that she'd get 4 sessions with the counsellor to write the report and then she'd have to see someone else to determine whether that counsellor is the best person for her to have counselling with. She'd already completed 3 sessions with the counsellor and just can't face the idea of having to see anyone else. It has taken her YEARS to work up the courage to talk to anyone about her history of abuse.

It seems that the new pathways are already being implemented, despite the start date being deferred".

To keep some survivors of sexual abuse alive it is vital that they are able to access specialist counselling support when they need it and to know that this support it is available to them for as long as they need.

The government needs to take all necessary steps to make sure that survivors of sexual violence get this support.

In recent months since the shock announcement by ACC to counsellors who work with survivors of sexual violence there has been a huge amount of professional outrage, letters to Ministers and a petition with over 3000 signatures calling for ACC to stop its Clinical Pathway.

I have been a therapist registered with ACC since 1986. I wrote the first set of ACC therapy guidelines for therapists working with survivors of child sexual abuse published in 2001.

If this Pathway is implemented I and many other therapists particularly Maori therapists have said they will resign as ACC registered therapists. We will not put our clients through this cruel assessment process.

All we ask is that ACC stop the implementation of this pathway and work with the professionals who work with survivors of sexual violence to sort out what ever it is that ACC is trying to fix.

We want to work 'with' ACC to find a solution but we do not know why ACC is changing the current system with such haste and without the experts' help to ensure that any changes to the current clinical pathway is safe.

I and many of my colleagues believe that the proposed ACC Clinical Pathway is unethical and many professionals and survivors believe that lives will be lost because of it.

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