ACC Changes – implications for survivors of sexual crime

A speech by Eric Medcalf delivered at Crossroads Community Centre, Wellington

Sexual abuse in New Zealand is a scandal. ACC pulling back on services for survivors is a scandal.
They say it’s because of the law – that’s a SHAM. They say it’s because of scientific evidence – that’s a SHAM.
It’s about cutting costs and bullying the vulnerable.
Dr Smith has said publicly that the government has no plans to change ACC services to victims of sex crimes - yet the corporation for which he has overall responsibility has stated publicly that it is its policy to reduce the number of sensitive claims.
It would be wonderful if this were through a concerted campaign of prevention, which is ACC’s statutory obligation.
“There is an urgent need for the implementation of programmes for the primary prevention of child sexual abuse, and the provision of support and treatment for women who have experienced child sexual abuse,” says Dr Janet Fanslow of the Auckland University Faculty of Medical Sciences.
But the facts are that ACC is doing this through policies in which it has made it much more difficult for victims of sex crimes to gain the support they need. This will have repercussions for the health of New Zealand.
The effects of sexual abuse are well known in relation to individuals, but individuals are also members of families, workplaces, social and community groups. Untreated psychological trauma has its consequences. It’s not surprising then that sexual abuse histories are over-represented in prison and mental hospital populations, that we get bullying in workplaces, family breakdowns, community violence and vandalism.

Some facts about sexual abuse in New Zealand
A study by the University of Auckland indicates that about one in four New Zealand women have been victims of child sexual abuse before the age of 15. In the majority of cases one perpetrator was involved, usually a male family member, and around half of the women had experienced the abuse on more than one occasion. The average age of the victim at the start of the abuse was nine years old, with the average age of the abuser being 30. 488,792 New Zealand women have been subject to childhood sexual abuse.

• Researchers think that 1 in every 4 girls will be molested before her sixteenth birthday. One out of every 9 boys will be molested. (The Sexual Abuse of Children: Facts You Should Know – Mental Health Foundation of New Zealand pamphlet)
• 4-10% of children physically abused and 11-20% of children sexually abused (New Zealand Children’s Social Health Monitor 2009)

Some information about the ways that ACC works
ACC is built upon the Woodhouse Committee of 1967. It is a “no fault” system based on five basic principles:

• community responsibility
• comprehensive entitlement
• complete rehabilitation
• real compensation
• administrative efficiency

(A lot of good came out of 1967, not just Sergeant Pepper, Jim Hendrix and the Cream.) To make a claim there has to be an accident and an injury – if you have an accident and no injury then ACC will not be interested. If you have an injury, but no accident then likewise.
In the case of sexual abuse and assault Parliament has made it possible for victims of sex crimes to able to gain treatment and rehabilitation on the basis that the crime constitutes the “accident”, as long as there is also a mental injury. Since this has been the case victims of sex crimes have been able to make claims on the basis that they have described what happened to them and have been assessed by a professional counsellor, psychologist or psychotherapist as having a “a clinically significant behavioural, cognitive or psychological dysfunction”. This would have been an assessment of impairment, not illness; observable ways in which a person’s ordinary functioning is significantly impaired by the psychological consequences of abuse.
ACC services for survivors of sexual crimes have been the jewel in the crown of ACC. Since the inclusion of sexual abuse crimes in the early 1980s many thousands of survivors of sexual abuse have received ACC-funded treatment and rehabilitation. This service epitomises the Woodhouse principle that the ACC scheme is not just about insurance, it is also a arm of social welfare policy, with the good of New Zealanders at its heart.
We are now in a climate of cost cutting in the public sector and of turning ACC from an arm of health and welfare policy to an American-style managed care insurance company.  This will have implications across the board for New Zealanders. In the US kids no longer play American football because the health insurers demand so much in premiums. What will that mean for New Zealand kids' sporting activities?
To repeat myself: Dr Nick Smith has repeated stated that the National Government has no cost cutting agenda for ACC’s cover for mental injuries arising from sexual abuse. Yet ACC has publicly stated that it is their policy to reduce the number of sensitive claims. They are doing this by making it more difficult for survivors of sexual crimes to make a claim to ACC. ACC are:

1. Insisting on a full psychiatric diagnosis – citing a legal judgement which, they say, obliges them to do this.A diagnosis is a clinical tool to be used carefully and safely. It is not a legal test. This must be questioned by the lawyers and the law makers. Very few people will be available to make this diagnosis. To do this properly requires not only training in diagnostic procedures but also significant experience in sexual abuse treatment. This shortage will make it very difficult for survivors to gain access to these assessments, if they are not put off in advance by the coercion to comply – a direct parallel of the reality of sexual abuse.
2. Reducing the treatment hours, citing research from Massey University in support. But the research does not support this – ACC are misusing and misquoting scientific evidence to suit their cost cutting purposes. Massey University have distanced themselves from ACC’s claims and it is noticeable that ACC are no longer making reference to this $800,000 research study – it no longer suits their agenda.
3. Promoting and/or allowing administrative delays and inconsistencies. Claimants and treatment providers get confused messages about what they are supposed to do.
4. Declining claims on spurious grounds - some examples:
   

• Claimant came from a “dysfunctional family” (you don’t say?)
• Claimant was a psychiatric patient and was raped by another patient, therefore was "already mentally ill"
• Claimant didn’t have a GP therefore no GP notes available
• One client, recently applied for ACC, has completed initial sessions but is now likely to pull out – she is extremely afraid of being given a diagnosis and what this will mean for her future employment, mortgage, insurance, etc, prospects. She is also angry that she may need to tell her story again to someone else within a few months.
• “My client received several pages of questions from an ACC psychologist that were to be posted back before meeting him. She felt most anxious and daunted by the questions and needed support  as to how to answer. She also felt nauseous at being forced to meet a male and felt she was being 'punished'. My client reports it's for an assessment. She had 2-3 pages of questions - 1 page covering 150 questions. She laid it aside for 2/52 and then tackled it. She reports it was like an exam and was degrading. 'Äll my trauma was laid out in front of me and I could see visions of all the perpetrators. I felt yuck and exhausted afterwards.' Now, she feels 'labelled' and is 'angry'."
• A mental health social worker said that one of their clients was referred to ACC for child sexual abuse therapy by a mental health service psychiatrist after an assessment. ACC insisted the person see a second psychiatrist to distinguish mental illness due to chid sexual abuse rather than some other condition. Client objected and consequently self-harmed.
• From a counsellor in a small New Zealand town: "Last week I saw a client who had previous counselling with a local clinical psychologist. She chose to return to counselling with a psychotherapist because she felt the previous counselling did not go deep enough and she required more in depth work. I sent the return to counselling report in (I was told by the call centre that they were still accepting these) and the response she got had this to say: 'In order to determine further treatment for you, your claim will be reviewed by a Clinical Psychologist employed by us… following this review, we may be able to make a decision on your claim or we may need you to have an assessment with an independent psychologist or psychiatrist.' They then go on to say, 'We will write to you to let you know: what our decision is, or who you will be assessed by (the emphasis is mine) and what the assessment will involve.' There aren't many clinical psychs in this little town so it is likely that  she will need to return to the person she didn't want to return to. Will she have a say in this? And why can't they accept my own assessment of the situation?"

Skilled and experienced counsellors, psychologists and psychotherapists are considering whether they can continue to support a system which is causing harm to victims of crime. I believe that it is bullying that we are observing here. It has been well reported that ACC as a place of employment has a “bullying culture” (see Dominion Post 2/10/08).
This is now being extended to the bullying of some of our most vulnerable members of society. When ACC insist that all new claimants must have a full psychiatric assessment and a diagnosis of mental illness they are raising the bar to help for many thousands of people, women, children and men, who have suffered sexual abuse as children, or been sexually assaulted as adults. They are saying “prove to us you are mentally ill before we will give you any help”. This is insulting to victims of sex crimes. This also plays into the hands of abusers whose mantra is that “it doesn’t do any harm".
Dr Nick Smith is the Minister for ACC and Climate Change. He needs to watch out for the climate of public opinion - it’s changing rapidly and this government is digging a hole for itself in the minds of ordinary New Zealanders.

http://www.grantrobertson.co.nz/2009/12/01/eric-medcalf-speech-on-acc/