Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697634078061.pdf (Australia)
Child Abuse - a Mental Health Issue This submission underlines the substantial mental health needs of survivors of childhood abuse.

Despite comprising a large percentage of the Australian community, survivors form a severely disadvantaged and repeatedly marginalised sector whose complex needs have been largely ignored by governments.

ASCA is the only national organisation which offers a comprehensive set of services to this sector.

However ASCA receives no recurrent funding, either federal or state.
Many of the insidious social ills our community faces are a direct result of the unhealed trauma of childhood abuse.
Until we recognise the root causes of abuse, address them within the family, institutions and general community, assist individuals to address their abuse issues and make changes to break the cycle of abuse from one generation to the next, society will continue to flail under burgeoning rates of mental and physical ill health, addictive disorders, criminality, family breakdown, unemployment and homelessness.
Tackling child abuse not only requires early intervention and child protection programs but focussed and collaborative programs of support and mental health care for survivors.

Child abuse and neglect is Australia’s most serious social problem (NAPCAN).

The Senate Committee Report ‘Protecting Vulnerable Children- A National Challenge (Mar 2005) as its first recommendation the designation of a year as the National Year Against Child Abuse in Australia.
Although this recommendation has not been adopted ASCA is pleased to see that a summit is being called early in 2006.

In the last reporting year a child was substantiated to have been abused and/or neglected every 13 minutes – more than 40,000 children in total and given the secret nature of this crime true figures are undoubtedly much higher (AIHW).

These child victims become adult survivors.


As a society it is our responsibility to not only look after them but also to ensure that their legacy does not become that of future generations.

The impact of child abuse is long- lasting, both for individuals and society; services need to be sustainable and funding for service provision, recurrent.
A human rights issue… Everyone has the right to a standard of living adequate for the health and well-being of himself and of the family, including food, clothing, housing and medical care and necessary social services, and the right for security in the event of unemployment, sickness, disability, !
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 widowhood, or other lack of livelihood in circumstances beyond his control.
Universal Declaration of Human Rights, Article 25(1) Child victims not only endure repeated abuse, neglect and torture as children but adult victims are often repeatedly re-abused within a society which fails to acknowledge their fundamental rights and needs.

The State Parties to the present Covenant recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
(International Covenant on Economic Social and Cultural rights, Article 12) Abuse survivors experience a range of profoundly debilitating chronic physical and mental health issues and these are not being adequately addressed in our society.
A mental health issue… In the mental health arena, research has shown childhood sexual abuse (CSA) to be associated with depression,i anxiety disorders,ii poor self- esteem,iii aggressive behaviour,iv suicide attempts,v eating disorders,vi use of hard drugs,vii and alcohol abuse.viii These kinds of problems are not only related to sexual abuse; all forms of child abuse have long-term negative effects.ix Statistics vary.
However the prevalence of childhood sexual abuse is estimated to be 1 in 3 women, and 1 in 6 men.x Sexual abuse accounts for less than 25% of all reports of abuse and neglect to child protection authoritiesxi.

With the incidence of substantiated cases of abuse having doubled over the last 10 years, child abuse issues and their impact need to be actively addressed.
Survivors experience a wide range of emotional and mental health needs, related physical health issues and frequently utilise a variety of health and mental health services.xii Practitioners need to be trained to be sensitive and responsive to complex needs such as the compounding problems of mental illness and substance abuse exacerbated by socio-economic factors.
Until clients are able to access appropriate services, are provided with relevant information, and have an opportunity to discuss their health concerns with a practitioner or participate in counselling or therapy they cannot begin the recovery process.xiii The Burdekin Report 1993 called for counselling for women who have experienced all forms of sexual assault and violence.
ASCA asserts that all survivors of all forms of abuse, female and male, deserve access to counselling (one-to-one), intensive specifically-developed therapeutic programs or group therapy (either self-help or counselor- facilitated)… Survivors frequently find a therapeutic setting in which group members are able to share traumatic material within the safety, cohesion, and empathy provided by other victim / survivors invaluable.
“As group members achieve greater understanding and resolution of their trauma, they often feel more confident and able to trust.

As they discuss and share how they cope 2 with trauma-related shame, guilt, rage, fear, doubt, and self-condemnation, they prepare themselves to focus on the present rather than the past.” xiv While ASCA has the expertise to offer these options, it does not have the funds.
Many of these services are inaccessible to those needing them for economic, social or service delivery reasons.

Child Abuse needs to be acknowledged as a prominent mental illness issue.

Shrouded in secrecy, battling stigma and shame survivors are doubly disadvantaged and often face discrimination which compounds their existing problems.

Only by addressing survivors’ mental health issues will society maximise returns to full social and economic participation.
However diagnostic labelling of mental ills can also limit treatment – ideal is an appreciation of the range of issues with which survivors battle.

Mental Health Issues for Child Abuse Survivors - The Facts • CSA is linked with higher rates in adults of depressive symptoms, anxiety symptoms, substance abuse disorders, eating disorders and post-traumatic stress disorders (Briere & Runtz: 1988; Winfield et al.

: 1990; Bushnell et al., 1992; Mullen et al., 1993; Romans et al., 1995:1997; Fergusson et al.
: 1996; Silverman et al.

: 1996; Fleming et al.

in press).
A more controversial study links multiple personality disorder with CSA (Bucky & Dallenberg: 1992; Spanos: 1996).xv • “Abusive acts thereby serve as an etiologic reservoir for the development of later psychological disorder,” (Briere: 2002).xvi Survivors often experience conflictual relationships, chaotic lifestyles and frequently report difficulties forming adult intimate attachments.xvii • Studies have documented the close connection between the severity of CSA and the degree to which survivors experience dissociative states.xviii • Suicidality In one community study, 16% of survivors had attempted suicide compared to 6% of their non-abused cohorts.xix • Self-mutilation has is frequently described among former victim / survivors.xx • Several studies connect CSA with alcohol and substance abuse in adolescents and adults.
Briere and Runz (1990)xxi found that, !
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 compared to non-abused female clients, sexually abused females in a crisis centres were four times more likely to have a history of substance abuse and twice as likely to be alcoholic.xxii • In a study of pathways between drugs and crime, drug abuse consistently pointed to histories of sexual, physical and / or emotional abuse.
Research showed that, “eighty-seven per cent of incarcerated women were victims of sexual, physical or emotional abuse in either childhood (63 %) or adulthood (78 %).
The majority were victims of multiple forms of abuse; childhood and adult abuse were correlated with drug dependency and involvement in the sex trade...” (Johnson, 2004: xiv)xxiii • A large-scale study in the USA suggests that CSA and sexual assault may be more likely to lead to PTSD (Post Traumatic Stress Disorder) than other types of traumatic events.
This percentage was significantly higher than the 38.8% rate of PTSD percentage of men who had experienced combat.xxiv • There is frequent co-occurrence of CSA, neglect, physical abuse, emotional abuse, and exposure to domestic chaos in families of clients with BPD.xxv (Borderline Personality Disorder) • A sample of neglected, physically abused, and sexually abused 8-12 year old children were found to have very high levels of depressive symptomotology.xxvi • Eating disorders - Individual risk factors for eating disorders include dysfunctional family and social systems, obsessive-compulsive disorder, preceding depressive disorders, BPD and a previous history of sexual abuse.
xxvii xxviii • Abusive behaviours and assault, whether physical, sexual or psychological can create long-term interpersonal difficulties, distorted thinking patterns and emotional distress.

• Abused children indiscriminately seek the affections of someone to depend on, often from the very parents who are their abusers.

This fragmentation becomes central to personality organisation, preventing integration of knowledge, memory, emotional states and bodily experience.
Survivors often maintain this pattern into adulthood relationships with abusive partners.

In an environment of childhood abuse the child-like propensity towards self-blame and lack of worth are reinforced.
• • • Frequently feelings of rage and aggressive behaviour, normal reactions to abuse, manifest during childhood and are expressed in adulthood by an inability to resolve conflict and an inability to modulate anger It is now well acknowledged that the predictive factors of emotional and social well-being are diverse indeed…….In fact, many risk factors are complex, and obtain from the circumstances of our everyday lives – material well-being, education, community inclusion and acceptance, employment opportunities, social cohesion and , perhaps most importantly, housing and accommodation.
xxix 4 Survivors are often isolated, financially disadvantaged and ostracised.
Australian society is already experiencing… an increasingly numerous underclass with entrenched inter- generational deprivation and lack of social progress; an increasingly marginalised, disempowered subset of the community… this group is increasingly able to interact only with each other.. the greatest cost to us as a broad community, is the untapped potential of these children and adults who are trapped in an environment where their talents, skills and abilities will not see the light of day except through exceptional effort and struggle.
xxx Complex needs – adult and youth homelessness Youth homelessness in Australia has doubled since 1991.

The National Homelessness Strategy (2000)xxxi highlighted CSA, sexual and physical abuse, mental illness and substance abuse as risk factors for homelessness.

xxxii Abuse is the primary factor causing young people to seek safety by leaving home.xxxiii It is well documented that having become homeless, young people are at risk of becoming victims of further abuse.
The “Living Rough Report” (1999) identified that during a 12 month period 52% of homeless youth had been sexually assaulted.xxxiv Salvation Army estimates that at least 50% of the homeless young people currently being assisted by them have suffered physical or sexual abuse.
In “No Place That's Home, 45% of homeless young people cited sexual or physical abuse of themselves as critical reasons why they had become homeless.” xxxv Likewise, a survey conducted by Macquarie University amongst Sydney homeless children (1991) revealed very high levels of physical and sexual abuse, particularly for young females.
Of the girls interviewed, 73% reported physical abuse, 82% had been sexually abused, the abuse mostly having occurred under the age of 11 (67%), with 26% experiencing their first sexual abuse between the ages of 12 and 15 years.xxxvi Isolated, dealing with the effects of childhood trauma, these young people experience a complexity of problems exacerbated by homelessness.
Frequently seen in youth accommodation services, are excessive use of alcohol and other drugs, self-harm, anger, depression, suicidal ideation and ‘challenging behaviours’.
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 Service Provision - recommendations 1.

Access and Equity -Those within the mental health system experience barriers to access and equity – child abuse survivors experience an additional set of barriers.
• The National Standards of Practice Manual (1998) state that: “Access implies recognising cultural diversity, and identifying and addressing barriers and structural disadvantages experienced by members of the community.” xxxvii Access also requires that no barriers exist to psychological access, such as associated stigma or inappropriate values or philosophy of management.
xxxviii • The National Standards of Practice Manual (1998) state as a principle that: “Equity implies the fair treatment of all service users, a just allocation of resources and positive discrimination towards those facing additional barriers to services.” xxxix 2.

Availability - Child abuse survivors frequently either do not have access to/or cannot afford the services they need and this is exacerbated in rural, regional and remote areas.

3.
3.

Mental health services traditionally provide preferentially for crisis intervention whereas child abuse survivors usually require long-term multi-faceted support 4.

Most survivors cannot afford long-term therapy/counselling as their disability often means ongoing financial hardship.

5.

Subsidised counselling is rare; services with limited resources cannot meet the demand and prioritise services to assist those in crisis xl 6.
Subsidised services under health funds rarely offer more that 6 or 8 sessions with a psychologist.

This can lead to re-traumatisation, if once material is exposed, treatment ceases due to lack of resources.

It is inappropriate to engage with a client and then be unable to offer them the long-term support they need as this could be perceived as another rejection or result in feelings of abandonment.xli 7.
Survivors benefit from support groups in which they can develop trusting relationships with others survivors, break their feelings of isolation and find validation for their experiences 8.
Survivors consistently pinpoint a number of inadequacies in current service provision: difficulties in finding expert, long-term, affordable counselling; a lack of support groups and workshops; being referred to a service that only was able to offer a few sessions or telephone counselling; insensitivity or ignorance within generalist health services and inadequate training and responses from a wide spectrum of specialist services, such as drug and alcohol and mental health services.xlii 9.
Survivors have complex needs, many of which need the attention of experts trained in the field of trauma and programs specifically designed to address those needs 6 10.

Consumer Participation - Survivors provide unique understanding due to their lived experience and acknowledging this is paramount to empowering them to contribute to service delivery planning, education and training, evaluation and involvement in improving quality outcomes.

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11.

Partnerships - The considerable evidence that exists associating child abuse with mental health issues, problems surrounding access and equity, and the negative experiences of survivors in their interactions with mental health services provides compelling justification for the formation of stronger links between mental health services and the NGO sector offering a wide diversity of community based services.
• The area of domestic violence and sexual assault presents an opportunity to hypothesise - Warshaw and Moroney (2002) suggest that treatment models need to find ways of integrating service responses that reflect social and advocacy requirements as well as the psychological needs, and that issues surrounding current as well as past abuse are addressed.xliii 12.

Research has also identified evidence-based best practice for adult survivors offers a range of flexible services from a holistic perspective.
Provision of these services must be delivered with dignity, care, respect, compassion and empathy.

NGO community based services play a crucial role in responding to the needs of survivors experiencing difficulties in accessing the myriad of government welfare services.

“Responses should be guided by coordination of effort, common sense and compassion.” xliv 13.
Properly resourced community based services which provide social and emotional supports, peer support and advocacy such as ASCA can help return survivors the humanity, dignity and self-respect which was stolen from them as children.

This needs to be offered hand-in-hand with professional services – ongoing counselling/therapy, purpose-developed programs in which individuals can pursue a personal journey within the safety of a survivors group.

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14.

Coordination of health, welfare and related community services (including provision of relevant education and workplace training)is imperative to address the complexity of issues that arise as a result of childhood abuse.

Survivors can potentially benefit from a broad spectrum of support/services including government and NGOs - DoCS or equivalent; family/community support; legal centres; drug and alcohol agencies as well as from Health Care professionals but they need to work cooperatively.
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 ASCA has the infrastructure and expertise to meet many of the above recommendations.

As a survivor-based organization, we have the insight ahd skills to provide the support and validation our marginalized group needs.
In addition we are aware of the need to utilise the expertise within our organization and outside so that we can better meet the complex needs of our members.

Currently these are primarily health professionals but stronger partnerships are needed within the professional community and with goverments and other NGO’s as well.

Only then will we be able to provide the holistic care needed.

Child abuse is a severe form of trauma and as such causes profound mental health repercussions.
Only now are governments beginning to address the inequities in mental health provisioning; acknowledging the long-term needs of those affected.

Survivors of the trauma of child abuse have been ignored and forgotten for too long already.

Without recurrent funding from federal and state governments ASCA cannot begin to provide the level of services required or reach even a small percentage of our target population.
It is time for governments to acknowledge the scale, the social, mental and economic repercussions of child abuse.

The focus has been on the need for early intervention and child protection.

Funding is in place in these areas and quite rightly so.

However it should not be to the exclusion of survivors; without appropriately addressing survivors’ needs, the cycle of abuse and neglect will continue unabated.
Prepared and submitted on behalf of ASCA by Dr. Cathy Kezelman, chairperson ckezelman@asca.org.au 0425 812 197 Endnotes.

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