Mental Health Services and Sexual Abuse: The Need for Staff Training

Abstract

Identification of child abuse by mental health services is important for formulation of the causes of presenting problems and for development of comprehensive treatment plans. A small but growing number of studies suggest, however, that the majority of child sexual abuse cases are not identified by mental health services. A similarly small literature also suggests that abuse survivors are extremely reluctant to spontaneously tell anyone about the abuse, indicating that professionals have a responsibility to ask rather than wait for spontaneous disclosures. The purpose of this study, therefore, was to add to these two bodies of literature with a New Zealand sample. A postal questionnaire was completed by 191 women who had received counselling for childhood sexual abuse. The average amount of time taken to tell anyone about the abuse was 16 years. Only 22% of those who had been in contact with public mental health services had ever been asked about abuse by those services. It was concluded that New Zealand women are reluctant to disclose abuse and that mental health services are, as is the case elsewhere, failing to assist them with this process. The need for staff training is discussed, and an example described.

Why, when and how to ask about childhood abuse

“…A New Zealand study of 252 women who had been sexually abused during childhood found that 52% waited at least 10 years to tell someone, and 28% had told nobody . In another New Zealand study, of 191 women who had received counselling for childhood sexual abuse, the average time taken to tell anyone about it was 16 years (Read et al, 2006d).…”

“…A survey of New Zealand women who had been sexually abused during childhood and were later treated by mental health services found that 63% had never been asked about childhood sexual abuse by mental health staff (Read et al, 2006d). These studies focus on sexual and physical abuse, but neglect and emotional abuse may be similarly unrecognised by mental health services (Thompson & Kaplan, 1999).…”

Child abuse rating system for archival information in severe mental illness

“…have been systematically incorporated into archival records. However, such meticulous methods may not be standard in all inpatient or outpatient facilities (Read [16]). Thus, the reliability and other types of validity (e.g., concurrent and divergent validity) of the five subtypes of child abuse in SMI should be replicated in other clinical settings in order to examine whether under-investigation is an issue.…”

“…Assessing child abuse histories with accuracy is one of the most challenging tasks in psychiatric rehabilitation [16]. Even though there is evidence that self-reports of child sexual abuse or child physical abuse among individuals with first-episode psychosis had a fair level of agreement in the presence or absence of child abuse documented in case notes [17], it is still unclear whether psychiatric patients at various phase of illness accurately report or under-report child abuse during inpatient intake interviews [17][18][19], and the literature varies in regard to reported temporal stability of the reported abuse [17,20].…”

“…Furthermore, this type of archival data has the advantage of reduced bias in that it often includes comprehensive psychosocial evaluations, family interviews, and/or court documents. However, in many settings, intake interviews and psychiatric case notes do not thoroughly address abuse histories [16,23], and can be difficult resources from which to ascertain accurate abuse histories. There is often a dearth of intake technicians and professionals that are trained to thoroughly assess for and record histories of child abuse among adults hospitalized for psychiatric illness [19].…”