Yes, Minister, the needs of victims are paramount

Curious things are afoot at ACC, still, despite their announced delay to their proposed changes in funding therapy for sexual abuse survivors. The delay was due to very public criticism that the new clinical pathway was not the best thing since sliced bread for survivors.

Firstly, as Labour’s David Parker pointed out in Parliament last week, despite the delay and Minister Nick Smith promising no final decisions have been made, ACC were advertising for the new position of Triage Clinical Psychologist – central to the new clinical pathway – on Seek.

The advertisement (once here) appears to have since been pulled, and doesn’t appear on the ACC careers page anymore either.

So you’ll have to take my word on the fact that the new position, assessing sexual abuse survivors to decide what kind and amount of therapy would be most effective, did not require any specialist knowledge of sexual abuse according to the job description online.

A long list of desired attributes – but nothing about the impacts of sexual violence, the differences between one-off victimisation and repeated-over-many-years victimisation, nothing requiring knowledge, training or research in the most effective treatment modalities, the typical clinical needs of survivors.

ACC have redesigned their pathway after the very public criticism.

Their new suggestion, which closes for consultation this week, offers counsellors 2 sessions (reduced from 4) with a survivor to establish the extent of abuse, and the extent of the impacts this abuse is having on the survivor.

To establish why someone needs counselling essentially.

So in two hours, survivors will be expected to “tell all” to a stranger. Some will be able to manage this, many will not – particularly if the abuse is multi-faceted; if they feel shame (which in our victim-blaming culture which often excuses the rapist and blames the raped, is sadly completely and utterly near-universal); if they are struggling to cope to the extent that unhealthy coping strategies have begun to seem almost routine, almost normal.

These forms – which are unlikely to be incomplete for the reasons above – will then be sent in to the ACC Clinical Psychologist. The one without the sexual violence knowledge. Who will decide whether the symptoms described are due to the event(s) of sexual violence, or something else.

At the same time, survivors will be asked to sign a consent form authorising ACC to ask for information from anyone they might think would be relevant. About sexual abuse. This doesn’t usually happen now, and is likely to be extremely off-putting for many survivors.

Haven’t told your doctor, your employer, your teacher at school you’ve been raped? If you make an ACC claim, someone might be in touch with them:

The purpose of collecting all of this information is to enable ACC to make a claims decision. It is likely that the more complex the individual clinical situation, the more information that needs to be collected.

If accepted for counselling, the new clinical pathway has increased accountability in the form of asking for four weekly reports. The initial acceptance for counselling will still only be short-term, and this is still based on the Massey Guidelines for sexual abuse counselling.

The assumption that short-term counselling will be effective – and will only be reviewed after it doesn’t work – is contrary to the spirit, and the actual recommendations, in the Massey Guidelines.

‘Short- to medium-term therapy was most effective for a single event of rape or sexual assault for an adult (7–16 sessions)’ (page 80)

‘Many adult survivors of CSA did well with medium-duration therapy (10–16 sessions). With a small group of clients with confirmed complex presentations,longer-term therapy may be appropriate in some situations. (page 80)

Following a single event of sexual abuse as an adult, short-term treatment, up to 20 sessions is recommended. (Pages 59 and 63)

‘Adults tend to benefit most from therapy that has some level of structure, is time-limited (fewer than 30 sessions), and incorporates some type of instruction or direction from the therapist. … Generally, the majority of clients with routine presentations of mental injuries arising from sexual abuse/assault benefit more from short-term, time-limited therapy. However, with confirmed complex presentations the duration of therapy will be determined by the level of complexity, reaction to therapy, etc. (Page 23)

The Massey Guidelines recommend early assessment of need, with an ongoing capacity to review, as events such as puberty, new sexual relationships, pregnancies etc can often re-traumatise. Many people who are sexually abused will never seek clinical assistance. But to quote the Massey Guidelines (p31) again:

‘Sexual abuse always affects the person abused in some way. The literature has suggested an increased prevalence of a wide array of effects for children, adolescents, and adults who report sexual abuse. The life course following CSA can encompass effects that can be continuous, solitary, and/or a combination of outcomes. Children and adults can also experience temporary, discontinuous, or “sleeper” effects that remain undetected but emerge at key times in their lives, or in new situations.’

What about the people whose mental harm is not deemed sufficient by ACC, despite them coming to ask for help?

If the claim is not approved ACC will inform the client of the claims decision, any alternatives for help or support in their region [new process] and the review process [existing process].

My emphasis.

So, we won’t fund your therapeutic recovery, but we will tell you how to find your nearest community organisation which works with survivors of sexual violence. And who will fund that? Or are community organisations endless pools of resources, able to cope with ever-increasing numbers of people asking for help?

Will other government departments – usually the Ministry of Social Development and Child, Youth and Family in the community sector – pick up this tab?

Someone is going to have to, because every indication is that these measures will place barriers in the way of timely treatment for sexual violence victims.

Meanwhile, ACC Minister Nick Smith has told parliament: