Comments 'embarrassing' for ACC

An article from the Otago Daily Times by John Gibb

Recent comments by an ACC senior manager about sharply reducing long-term claimant numbers have been "very embarrassing" for the commission, a Dunedin lawyer says.
Peter Sara said the ACC had clearly not expected comments by ACC general manager Denise Cosgrove at an Institute of Actuaries of Australia conference in Brisbane would later be made widely available via internet and podcast.
Ms Cosgrove said ACC had faced major financial and other challenges but had since cut claims costs by $3.2 billion. ACC managers had "taken the low-hanging fruit", but now faced more complex claims which made rehabilitation and return to work "a bit harder", the conference transcript said. There had been targets for "actuarial release" and "stellar results", but there had also been adverse media coverage of issues such as "sensitive claims", involving sexual abuse, and elective surgery, she said. ACC administrators had done the right things but had "moved too fast and didn't take the sectors with us", the transcript said.
Mr Sara said he was a "very strong supporter" of ACC but was "appalled" by Ms Cosgrove's comment about "low-hanging fruit", made at the conference last November.
Dunedin ACC campaigners say the comments initially "flew under the radar" but have sparked parliamentary debate and media coverage since Green Party ACC spokesman Kevin Hague tabled in Parliament last month a transcript.
Mr Sara said many vulnerable, injured people had been viewed as "ripe for the picking" and had been removed from ACC scheme coverage in recent years, but in many cases rehabilitation had not been achieved. ACC's practices needed an "extreme makeover" if it was to recapture the public trust which had been lost, he said.
Darryl Frank, a Pricewaterhouse Coopers actuary, who has worked closely with ACC, told the conference there was "constant tension between the two sides of politics" in New Zealand and "differences in political ideologies". Labour governments were "typically increasing access to benefits" but this had been "to some degree reversed" by the National-led Government since 2009, given concerns about ACC finances, he said.
Dr Denise Powell, the president of Acclaim Otago, an ACC claimant support group, said a mask had slipped and the "incredibly blatant" truth had been revealed about the removal of large numbers of long-term claimants from ACC coverage in order to meet political objectives. She had listened to the conference on a podcast, and recalled "being quite shocked, sitting there with my mouth open".
Approached for comment, ACC lead media adviser Stephanie Melville said the term "low-hanging fruit" had been "used to describe the first raft of improvements"- that is "initiatives to yield rapid positive results to systems and process".
"It does not refer to individual clients or any attempt to stop people making claims."
No client was denied ACC help "before they're ready for vocational independence", she said.

© Allied Press Limited 2012

http://www.odt.co.nz/news/dunedin/215256/comments-embarrassing-acc

Survivor summit speech

A speech by Lynne Pillay delivered at the SOSA Summit, Auckland

Kia ora, good afternoon.
I stand before you today as Labour Spokesperson for Victims’ Rights and like so many people here a staunch campaigner and advocate for a return to a fair and just support system for survivors of sexual abuse.
Thanks to Gudrun, and the team of organisers, for bringing us here for the very first sexual abuse survivors' summit/hui. Congratulations on taking the initiative to make this happen and to give us an opportunity to share experiences and strengthen our collective voice. I am proud to be part of it.
I want to acknowledge the survivors who are here and also those who are not. The last several months have been a gruelling time for so many – counsellors, psychotherapists, professionals working in organisations who support survivors, advocates and even members of parliament. But it has been the hardest for survivors of sexual abuse who have been re-victimised by a cruel experiment which has had terrible consequences and has deprived them of the support they need and deserve. Thank you for your courage in being prepared to tell your stories – it has been effective and it has reinforced why the government MUST be challenged and held to account.
Can I make a special mention of the ACC Sensitive Claims panel who I understand have made the time to be here today. Former Mental Health Commissioner Dr Barbara Disley, Clinical psychologist Clive Banks, tireless community worker Ruth Herbert, and Professor Graham Mellsop. Thank you for being here. Thank you for listening. I am hearing positive things and I am cautiously optimistic. 
I do want to clarify issues with respect to the Review that relates to my Labour colleagues and me. Minister Nick Smith wrote to us earlier this year and asked us if we would like to view the terms of reference in confidence. We declined. We wrote back to the Minister asking for an urgent return to the status quo as we had enough real evidence and statistical information to know the new ACC-created pathway was not working, and that a restoration of something that did work was the first priority. We maintained that a review could be done in parallel while sexual abuse survivors could access help through the old process. Furthermore, we objected to being involved in any Terms of Reference which would be ‘in secret or in confidence’ – especially when connected to an issue that many people have fought for transparency and truth on.
Labour’s objections have been around the evidence, or the evident truths that survivors and sexual abuse experts alerted us to late last year. Their stories of frustration, desperation, and rage have continued and escalated since. We didn’t pluck this out of a hat and we have always been aware that we are dealing with a very sensitive issue and with people who must be treated with respect and dignity.
Last year there was the consultation with the sector on ACC’s ‘new pathway’ for sensitive claims. We assumed that consultation and the pathway was around the Massey Guidelines of 2008. Soon after, experts in the sector started contacting me with concerns. Many were very worried. There was a two week delay in the introduction of the new ACC-created pathway and finally, in October last year, a petition to delay implementation. 
The New Zealand Association of Psychotherapists (NZAP), the New Zealand Association of Counsellors (NZAC), the New Zealand Association of Christian Counsellors (NZACC), the New Zealand Association of Social Workers (NZASW) and almost 4000 people signed that petition. They stated:

All professionals involved in the treatment of these clients in New Zealand agree: that these proposed changes are clinically unsound, and contrary to ACC’s statutory requirement to provide treatment that conforms "to best clinical practice".
Under the changes ACC want to make it harder to get funding by making a diagnosis of mental illness a requirement. Furthermore they propose limiting funding to only sixteen sessions.
They also expect clients to disclose the assault(s) and then wait, with no counselling to happen until ACC has approved the claim. This process of approval currently takes weeks, sometimes months.
ACC claim to follow a recent research report titled “Massey Guidelines, 2008” yet have mis-interpreted the research report and used it to justify reduced funding for treatment.

At that time David Parker, Labour Spokesperson for ACC, and I met with Nick Smith, Dr Peter Jansen and ACC Officials to discuss our concerns about the ACC imposed pathway. We pushed to delay the implementation on the basis that the pathway was at completely at odds with the Massey Guidelines of which the first principle was about client safety. In fact the pathway had been described by many as unsafe, dangerous and would only serve to re-traumatise survivors. It became obvious that there was never going to be a meeting of minds and that the purpose of the meeting was to persuade us that the ACC pathway was in the best interest of all. I thought it would be helpful to point out to Dr Jansen that like me, a former nurse, as a GP he had no real understanding of this highly specialist work. It wasn’t helpful – Dr Jansen told me he was getting very angry. I was very tempted to advise him to see a counsellor!
Sadly, our combined efforts were unable to stop the introduction and the worries and concerns about what would happen after 27 October 2009, depressingly, came true.
Here we are seven days short of eight months later and the ACC-created pathway is still with us, with all the fallout – hundreds of counsellors and psychotherapists who are unable to do this work as they believe it is unsafe and unethical, the harsh system which discourages people from seeking help, for those in the system the moving of the goal posts so that virtually no one is eligible for treatment.
Examples include declining counselling for children who have been raped, rape victims still waiting after months for confirmation of counselling, people having to be deemed to have a mental illness to receive any assistance, the ludicrous situation where a survivor states that she is coping and is diagnosed as “in remission from depression” and is therefore ineligible for counselling – that same woman ending up in critical care with an overdose days later.  And the list goes on and on.
All of this was entirely preventable because people had predicted and warned of what would happen.
There has been a campaign to confuse and undermine around the new ACC-created pathway. The Minister is the biggest culprit. He has answered questions saying the ACC-created pathway was the Massey Guidelines, or based on the Massey guidelines. He has claimed all sorts of endorsements of the ACC-created pathway. First from the Royal NZ College of GPs – who said later it was the Massey Guidelines evidence they were welcoming. He claimed the RANZ College of Psychiatrists endorsed the ACC-created pathway when they had not. He backed away somewhat when Massey University wrote this letter:

Sir,
You reported on October 28 that ACC Minister Nick Smith says the changes to rules for sex abuse claims were developed by Massey University. This is not correct.
The new ACC guidelines for sensitive claims, which ACC calls "clinical pathways" were developed by ACC itself. Staff of Massey University did develop sexual abuse and mental injury practice guidelines, which were launched last year and have been used successfully and without controversy by sensitive claims counsellors throughout New Zealand since then.
James Gardiner
Communications Director, Massey University, Auckland
October 29 2009

I often regret resorting to statistics because I know there is a person behind every statistic. I know there are families and their supporters and they are not counted in any statistic. What these statistics measure is the most personal declaration from a person who finds the courage to say the words "I was abused". Often they have marshalled support to take charge of their lives after others have taken control over their bodies. Statistics don’t mention the people who have not yet had the courage to make the first step. In statistics they do not yet exist.
So I apologise that I must quote from statistics but I am trying to hold the Minister and ACC accountable and gain documentation from a Government on behalf of the people. I submit Parliamentary questions to the Minister on a regular basis but I am appalled that official statistics have become increasingly more difficult to obtain under this Minister for ACC.
Around 200-250 people used to be approved for ACC-funded counselling each month in New Zealand prior to the introduction of the ACC-created pathway. 
Let me tell you what happened when I asked the Minister in April this year. I asked how many people had been approved for ACC-funded counselling in February 2010 and here is the answer from Nick Smith (Written question 01771 2010): Six people. When Phil Goff took this up with him in Question Time in Parliament he huffed and said that those figures were provisional, "it is double that now". Well, we did the maths ... 12 people. Twelve people can start their journey to heal. But now he will not update these figures. We suspect the new system is creating its own internal embarrassment especially as it has introduced two additional data categories entitled "Awaiting necessary external information" and "Under assessment for claims decision by ACC". Whatever happened to "Approved", "Pending" and "Declined"? Most people seem to be languishing in these new categories and the Minister has yet to provide the updated figures.
Just this week (2 June) Nick Smith responded to a repeated written question from me asking for updated figures from November 2009:

Question: What are the numbers of sensitive claims, lodged, accepted, declined, awaiting external information, under assessment by ACC for claims decision and duplicate, by region for November 2009?
Answer: I am unable to provide the Member with a full and accurate response within the required timeframe.  The information will be supplied to the Member as soon as it is available.

I would have thought figures from November 2009 would be available. Why on earth would they not be? 
But here we are in a room where there is transparency and truth. If any of you wish to look I have brought along with me all the oral questions Labour MPs have asked Nick Smith. If nothing else the answers are consistent although not true – the pathway is supported by professionals and it is based on the Massey Guidelines.
Whenever we feel thwarted or outraged by these sorts of answers or lack of answers Phil Goff, Annette King, David Parker and I continue to come back to the evidence of people’s experiences. We must honour people’s experiences and keep demanding that their voices be heard. That is why we raise this injustice time and time again in Parliament, in the media and in communities. It’s neither fair nor just and it certainly has not been transparent or truthful.
Truth and transparency are vital aspects of all of our professional and personal lives. It is what we strive for; we may miss the mark sometimes, but we come back to the first principles that the ‘truth must come out’ and ‘sunlight is the best disinfectant’. Breaches of trust range from minor, through to offences from which many find it almost impossible to find their way back from. But the human journey has been characterised by many stories of redemption and triumph over adversity. The people in this room know what I am talking about. I commend you and I along with my colleagues will continue to fight alongside you to restore a system where survivors of sexual abuse are able to access the support the need and deserve.
Thank you.

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/

Speech at the release of Ministry of Women's Affairs' sexual violence research project

A speech by Pansy Wong from the National Party

Good evening everyone, it is a pleasure to be here as we gather to acknowledge the release of this significant research project.
First of all, I would like to thank the Ministry of Women's Affairs who led the two-year project, ‘Strong and Safe Communities - Effective Interventions for Adult Victim/Survivors of Sexual Violence', and to your project partners, the Ministry of Justice and the New Zealand Police.
Thank you also to the researchers from the Crime and Justice Research Centre at Victoria University for your skill, dedication, and absolute professionalism.
Above all, we must express our deep gratitude to the survivors who participated in the research. Without their strength and courage we would not be here tonight.
Thank you to all of you who had involvement in this research. The result is an outstanding example of a collaborative effort across many sectors.
This research is the result of a lot of hard work on the part of community agencies, researchers, service providers, and government agencies.
It is the first comprehensive piece of research to be conducted on adult sexual violation in New Zealand in the past three decades and it reaffirms our nation's international reputation of being a fair, caring and innovative country.
Through face-to-face interviews with survivors and surveys completed by them, we have gained a real insight into how the system caters to people who have been through the harrowing ordeal of a violent sexual attack.
Professionals like yourselves and decision makers like myself have long understood that many of the thoughts and perceptions surrounding sexual violence are myths.
For example, there is a common misconception that most attacks are committed by strangers.
Now, for the first time, this comprehensive two-year research project is able to dispel such myths with authority and provide us with a platform to change attitudes.
In fact, the research revealed that sexual violence cases involving a stranger have the highest success rate for prosecution, and that the victims of such incidents are more likely to report them to police.
The majority of sexual attacks involve someone the victim knows. The first hurdle is to convince these victims to report the crime and then comes the hurdle for them to jump over the justice bar.
The Minister of Justice has introduced a raft of legislative changes to lower the hurdles in the justice system for the victims of sexual violence, such as the removal of provocation as defence and launching a Law Commission review to consider alternative justice procedures for the victims of sexual violence.
This review includes looking at changing our approach from being an adversarial system to an inquisitorial system, which would see the judge becoming involved in collecting and determining the facts of the case.
Sexual violation is the most costly crime in New Zealand, with the social cost estimated to be at about $1.2 billion per year, but it is also the most significantly under-reported crimes.
The research has highlighted many reasons for this under-reporting, including shame, self-blame and the fear of not being believed.
This shows that one of the most useful tools we can have as a nation is to have the people around victims understand the importance of giving support and showing trust.
Unfortunately the research tells us this is not always the case, with some survivors saying their disclosures were met with disbelief, blame, and ostracism for bringing shame on the family.
Hence, it is important for us to work towards providing an environment that nurtures and caters for victims to come forward to report these dreadful crimes.
Often, a victim's first cry for help is through medical, mental health and social services - with them often seeking help for related issues such as drink or drug addiction, gambling or other problems that have arisen from their ordeal.
This is expected since specialist services for the victims of sexual violence are still in their development stages. Therefore it is important these frontline services are equipped to detect signs of sexual violence and refer the victims to other agencies to receive the specialised help they need.
Tomorrow, Hon Power will be releasing the Sexual Violence Taskforce report. The Government's responses to this report will be forthcoming.
Your good work has helped us to debunk the myths surrounding sexual violence and has armed us with facts and evidence to change society's attitude towards sexual violence.
This research has provided a good base from which we can look at the services available and determine how we can help victims and how the justice system can better cater to their needs.
This Government is committed to utilising this significant piece of research to reduce the impact sexual violence has on the victims - with one interviewee describing the feeling as having her soul stolen.
As Minister of Women's Affairs, I will do my best to restore the many souls that have been stolen through sexual violence.

http://beehive.govt.nz/speech/speech+release+ministry+women039s+affairs039+sexual+violence+research+project