by frog
ACC’s cuts to sexual abuse counselling are scheduled to come into effect next week. They propose to both reduce the number of counselling sessions a sexual abuse survivor can get, and make it tougher to get cover for mental injury caused by sexual abuse.
ACC are arguing that their legislation requires a sexual abuse survivor to have a mental illness diagnosis under the American Diagnostic and Statistical Manual DSM-IV to get cover.
That’s not what the legislation says – it requires that that a claimant has a “clinically significant behavioural, cognitive, or psychological dysfunction”. I would interpret that more widely than just a DSM-IV mental illness diagnosis. For example, a condition such as codependency, which is a frequent consequence of childhood sexual abuse, would seem to meet the test in the legislation of “behavioural dysfunction” without necessarily manifesting itself as a DSM-IV mental illness diagnosis.
ACC have interpreted the legislation more widely for many years too. So why the change in interpretation now? My suspicions are that it is all about saving money.
Dr Kim McGregor of the National Network Ending Sexual Violence Together has slammed the proposal, saying:
If you have a DSM-IV diagnosis, for example for depression, and you go for a mortgage, and they say, ‘Have you ever had a mental illness?’ you have to declare that. If you go for a job interview and you’re asked, you have to disclose that.
So many sexual abuse survivors won’t seek cover and counselling, for fear of the stigma of being labelled mentally ill. Which, ironically, increases the likelihood of them developing severe mental illness or even committing suicide in the future.
Survivors of sexual violence and their therapists are fighting back against the cuts to ACC cover and therapy. There are protests organised for this Monday 19th October:
AUCKLAND: Meet at 12pm, Albert Park band rotunda, CBD.
WELLINGTON: Meet at 12.30pm, Cenotaph, Lambton Quay.
CHRISTCHURCH: Meet at 12.30pm, Speakers Corner, Cathedral Square (beside Chess Board)
DUNEDIN: Meet at 3pm, ACC offices, Corner Maclaggan & Clark Streets.
Please go along and offer your support to the protests if you can.
Because it’s just not fair!
Published in Economy, Work, & Welfare | Health & Wellbeing by frog on Sun, October 18th, 2009
Tags: ACC, Dr Kim McGregor, mental illness, mental injury, sexual abuse, sexual violence
on the trolls and those who are unable to keep on topic
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If it does not meet DSM-IV-TR criteria then it is, at most, either sub-clinial or unsupported. The ACC claim is valid; if it is ethical is another matter entirely.
Depression is incredibly common, esspecially at sub-clinical levels. Though by definition if it is at sub-clinical levels it is fleeting and thus requires no real counseling as the two major categories of depression are Major Depressive Disorder, the depression often thought of as clinical, and Dysthymia, depression bellow the diagnostic criteria for major depressive disorder but is chronic and thus non-fleeting. Employers are in the right to request such details and any effort to hide such details, even if through regulations, is blatent dishonesty. A education effort would far better benefit both those whom are undiagnosed and those whom are diagnosed.
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The main issues for me is the fact that we (myself being a clinican) are being underfunded so that we can only treat those of serious need. Those that fall below that threshold receive little support even though they display clear signs of dysfunction. Therefore, even with a disgnosis from the DSM-IV-TR this still does not guarentee treatment.
The other issue is that with the new rules by the ACC, clinicans will be spending more and more time getting through red tape and paper work to try and PROVE that the person before them is mentally unwell as a DIRECT result of sexual assualt rather than actually building a relationship with their client and treating them. I also wonder who makes that final decision; will they leave it to clinicans? or will the decision rest with someone in an office with a pen and calculator?
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Exactly. And those who fall below the threshold will be more likely to develop a serious mental illness because they do not receive treatment.
What’s more, ACC will be attempt to trawl people’s mental health history to try to get evidence that their mental injury is substantially caused by something other than the sexual assault. And then, as davec suggests on another thread in another context, there will be a “scrap between medical professionals at an ACC review hearing. Meanwhile, the claimant is left in limbo.
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It would be far better if ACC investigated what was an effective efficient treatment. There are studies that show some types of counselling produce the problem and/or worsen it.
Cognitive behaviour therapy can be effective but psychoanalysis is often counterproductive for depression. From my experience as an NLP Practitioner major elimination of symptoms can be achieved in under 6 sessions with most clients. The exceptions are those that have become dependent on having a trauma. I have had one client who had become dependent on their “problem” to get sympathy and stay on a benefit. However another one, who was a ritual abuse victim, recovered well enough after three sessions to be free of fears in situations that were reminders of the abuse.
ACC would not accept NLP practitioners where i was, but I heard Wellington ACC did.
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“The exceptions are those that have become dependent on having a trauma. ”
This is an absolutely massive problem in NZ. It is cruel to hold people in their abusive past in the name of “therapy” it is also a burden on everybody else around the person.
It is about time we dropped the PC approach to mental health and actually started helping people get better, NZ is becoming the moderate mental illness capital of the world.
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When we work with clients who have been sexually abused one thing we do not do is ‘hold people in their abusive past’. why would we? The aim of therapy is to help them work through there problems in the here and now not dwell on the past. The past cannot be changed for these people unfortunately but we can help them to re-frame the way that they look at it and also assist them in dealing with the problems that they face on a day to day basis. I am not too sure what you mean by a PC approach to mental health or why you think NZ is becoming the moderate mental illness capital of the world. I do totally agree that our aim is to get people to a level where they can get on with their lives.
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Then therapy in its current form is not working very well. I know many people in this position and most of them are a burden to their families and friends around them, they do not get better despite a huge amount of energy and resources directed their way. Why should these people receive ACC to prop up an excuse? Why should they be financially rewarded for a refusal to get better?. I have met people that have suffered a horrific amount of abuse and have recovered, then those with a relatively minor amount hell bent on making their own lives and everybody around them miserable.
ACC should not cover these people, they should be directed to a church group or some other community initiative.
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first you say that they are ‘a burden to their friends and family around them’. Imagine if someone knows this, do you think that this is going help them get better or make them feel worse? A person doesn’t get better in isolation, they need the support from their friends and family.
‘why should they get ACC to prop up an excuse?’ do you really see sexual abuse as an excuse?
‘Why should they be financially rewarded for a refusal to get better?.’ treatment of sexual abuse can range from short treatments to long haul. If somone has been abused it can take years before they even tell someone about it. Some when they do tell someone are accused of lying especially if the offender is known to the family. People’s lives are turned upside down by sexual abuse. My clients don’t refuse to get better, there is no switch that they can flick to forget all about it.
‘I have met people that have suffered a horrific amount of abuse and have recovered, then those with a relatively minor amount hell bent on making their own lives and everybody around them miserable’. People’s reactions to trauma differ. There are some that are simply born with a better ability to cope with life trauma and added to that an environment where they are supported. Others, unfortunately don’t have that biological or environmental advantage so what may seem to you to be a ‘minor’ trauma to them is something that is more than they can cope with in an already chaotic world. Have a look again at those people you describe as having minor problems, how are their lives different to the people you know who have got better so quickly?
‘ACC should not cover these people, they should be directed to a church group or some other community initiative’ – church groups and community iniatives do have a place in rehabilitation as they can talk about their trauma and realise that they are not on their own. But this approach does not work for everyone. my clients need more than just talking about their trauma, they need help and strategies to work through it. That is why ACC funding is so important for them.
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So nobody ever uses trauma as an excuse not to change? I have seen how abused people that refuse to get well ruin the lives of their children and other people that care about them, when does the abused person have to step up and take responsibility for their life?
You seem to think I am being heartless to abuse victims, I am not.
If you really are a professional in this area you know very well what I am talking about.
We often define mental illness from abuse in terms that encourage the victim to feel helpless and powerless to change.
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Shunda,
I am not a clinical psych, more because I have no tolerance for people b*tching and would snap at them than anything else. Though, the PC that penetrates the feild is probally about equal as a detirant. So perhaps you will accept this from me, even if my focus is dispropotionatly on the scientific side of psychology rather than the clinical (psychological engineering?) side.
Different individuals respond to experiances differently. As an example; in about half of cases of childhood sexual abuse no detectable adverse effects are formed but in the other half adverse effects can range from minor depression or low self esteem to severe suicidality, self-destructive behaviours, or an inability to function in society at all. This difference may potentially be accounted for by social networks and differences in an individuals cognitive make-up and and tendancies to attribute blame.
Trauma can be devistating for an individual and their associates and where this trauma is sustained can pose a significant burden to the state and vastly increase the incidence of illness. Treatment can decrease this burden and increase the individual’s productivity, and that of their family, such that avoiding treatment would cost more than granting it. Cognitive behvioural therapy is probally the most effective treatment for psychological disfunction which arises, as trauma does, from cognitive processes and is even more so when combined with social activation. It is my understanding that CBT is one of the most popular therapy methods in NZ and as such most will be getting the best treatment. Some people do use a potentially trauma-inducing event as an excuse to gain attention, money, sympathy, or any number of other things but eliminating treatment for these individuals, even if the judgement is made by a competant practicioner, would likely lead to social detriment both to other indivdiuals and, by extension, to society as a whole socially and economically.
Psychological treatment is an area where, unlike the dole, you just have to accept that some will try to scam the system.
As a side not; my previous post has three thumbs down. It would appear that this thread is brimming with ideolouges. As usual.
Not unlike clinical psychology, sociology, or anthropology: Its sad really.
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Shunda
Sorry but i still disagree with you. Indeed, the reason people do not move on is because they feel helpless and powerless, this is what maintains the negative cycle that they live in. We do not encourage helplessness or powerlessness instead quite the opposite. Think of all the beliefs that you hold about yourself and other people. Imagine that something happened to you that contradicted your view of the world and shattered all your beliefs. It is easy to tell people to get over it and take responsibility. It is a lot harder to try and figure out why they are acting the way they are and to help them change but this is the only way to gain enduring change.
BTW ‘you seem to think i am being heartless to abuse victims…’? I don’t recall saying anything like that. Indeed i appreciate your viewpoint even if i disagree.
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“Imagine that something happened to you that contradicted your view of the world and shattered all your beliefs. It is easy to tell people to get over it and take responsibility.”
Well actually!!…..
I have found that in my case forgiveness seems to be an essential component to recovering from trauma inflicted by others, also treating negative or insecure thinking like an intruder attempting to steal my peace seems to help. The problem with a victim mentality is that it removes the will to fight this stuff off, and it is a fight.
I guess from my perspective I can see a very large victim culture developing among those with mild to moderate mental illness, I wonder whether refusing ACC to some of these people would actually be better for them and society overall.
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“It would appear that this thread is brimming with ideolouges. As usual.
Not unlike clinical psychology, sociology, or anthropology: Its sad really.”
What is the future going to be like for these fields? Seems like another round of “science wars” is imminent.
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Shunda – nothing worse than having someone steal your peace!
Hey, I found two big kokopu in my creek yesterday, tucked under a rocky-overhangy thing. They were very calm and in nice condition. There were two mature inanga in the spring (I was clearing it if fallen twigs and leaves etc.) and 7 bullies (‘giants’ it think) and a sole crawdaddy!
Did you follow the ‘Off the Radar’ series with te Radar learnin’ t’live the greeny life, last year? If so, say so.
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Shunda,
I think the ideological view points are useful but they should never be considered the science they claim to be; they are an art and nothing more. Consider marxism; totally ideological, informed by the real world and with very valid criticisms, but totally ideotic in its proposed solutions and yet it is perhaps the single best tool to date for use in sociology, and to a limited extent in psychology.
These feilds have always been such. Infact the entire discipline of anthropology was founded in trying to find justification for exploiting natives. The ideological goal has mearly reversed.
While I strongly agree with you about how bad the encouragement of a victim culture is, this encouragement is simply not the case with modern psychological practice. Infact, cognitive behavioural therapy, as mentioned earlier, actually focuses on changing the persons perceptions through challanging the patients beliefs through their real world experiances and busting the cognitive bias’ they have developed that ultimatly reinforce or cause the disturbance.
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“Did you follow the ‘Off the Radar’ series with te Radar learnin’ t’live the greeny life, last year? If so, say so.”
No I didn’t, by the way I have some photo’s of the impending stream rehabilitation for you to look at, your words regarding killing them with kindness have been on my thoughts so I am keen NOT to make things worse for the little critters.
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you mean that series where each week he chose an animal to kill and eat..?
yeah..!..very ‘green’..!
or..very ‘green-party’..really..
eh..?
and you should see sue kedgley in full flight..
urging everyone to ‘eat nz pigs..!’..
(so so far away from even ’sitting on the fence’..eh..?
she is actually a meat-pimp..
green mp as meat-pimp..
eh..?
phil(whoar.co.nz)
[frog: You are getting very close to being put into moderation, Phil. This comment is is a blatant threadjack.
This thread is about ACC funding for sexual abuse counselling - not about animal welfare issues or veganism.
You asked for a general debate thread yesterday, and I duly provided it for you. That is where you should have posted this comment.]
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The main concern is, are these changes with ACC preparation for privatisation?
If privatisation comes in then Accident Compensation will become just like most Insurance companies that look for any way they can find to avoid paying out. I am recently back from the UK where accident compensation is done by insurance companies and it is very expensive. For example the UK has a lower vehicle accident rate than NZ but the premiums for a car vary from £200 to £1000/year depending on the rating of the vehicle. That is, generally you pay more for a 2 litre car than a 1.4 litre car. I also remember when NZ did have private injury insurance and it wasn’t a box of roses. ACC is not perfect but it is much better than other systems. Maybe the empire building within ACC needs curbing – I can’t see how paying office workers over $100,000 and up to $500,000 per year is necessary.
Eeeeee!
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