Posts Tagged ‘medical ethics’

Sexual abuse recovery rationing by the ACC

datePosted on 10:04, August 24th, 2009 by Lew

This morning the New Zealand Association of Psychotherapists delivered an open letter to the Minister for ACC asking him to explain and justify the proposed changes to ACC’s sensitive claims policy. This issue was covered by Anjum last week and is now picking up steam.

Briefly, the proposals (which are due to come into effect in September) would change both the nature and amount of entitlement of treatment to which sexual abuse or assault victims are entitled. The changes represent a move from a therapeutic model mostly operated by psychotherapists and counsellors to a symptom-management model mostly run by the mental health system. Victims’ entitlement to treatment will generally be reduced to a maximum of sixteen hours, essentially meaning that many victims of the most severe abuse will not be fully treated. In addition, victims will need to explain themselves to as many as three different assessors in order to access this limited treatment, with each assessment a form of revictimisation. As if that wasn’t enough, knowing that many cases simply will not be treatable in the mandated 16-hour timeframe, some psychotherapists have indicated that they will refuse on ethical grounds to begin the work, knowing that they cannot finish it, on the basis of the ‘first, do no harm’ principle which underscores their practice as clinicians.

This means the already-high barriers to effective treatment of sexual abuse trauma are about to get higher. In effect, they are being rationed so as to exclude the ‘worst’ cases who require the most work (and therefore the most cost) to treat. However the revictimisation of repeated assessments and the uncertainty of treatment form a strong disincentive – not wanting to open a wound without being sure it can be closed, many people will simply not seek treatment, and many counsellors will simply not be able to provide it on ethical grounds. This chilling effect will lead to sexual abuse being pushed further underground and the problem fading from the public view to a greater extent than it already is, with potentially catastrophic long-term social consequences. At last count, sexual abuse cost NZ about $2.5 billion per year including the costs of crime, imprisonment, drug and alcohol, other health issues, unemployment and the cycle of abuse which an absence of treatment sustains. For the cost of a few million dollars in treatment, how much will that be allowed to increase?

The most absurd thing is that these are cuts to front-line services for victims of serious crime; the very thing the government said it would be increasing. ACC’s Sensitive Claims Unit costs $30m or so annually to deliver $20m of front-line services, and these cuts will shift that balance much further toward the back-office by relying more heavily on already-overworked case managers and the top echelons of the practice – psychiatrists and clinical psychologists who currently do 10% of the work – rather than the relatively cheap and numerous psychotherapists and counsellors who do the other 90%.

For the inevitable conspiracy theorists, this also isn’t a matter of psychotherapists feathering their nests – for most, ACC work is a small part of their practice, and not an especially lucrative part of their practice, since most can charge (much) more on the open market than what ACC will pay.

Expect this to be a fairly big deal in the coming weeks. It is an issue which is deeply embedded in many policy fields: justice, victim’s rights, human rights, child abuse, crime, drug and alcohol abuse and mental health are just a few. It’s not going away, because sexual abuse is not going away.

L

Disclosure: I was involved to a small extent in the process around this open letter. I have family members on both ends of this issue – both providing and receiving treatment. You probably do, too, even if you don’t know it.