What an appropriate Victorian Government response to the public health emergency of survivors and communities impacted by child sexual abuse, looks like.
Key points
- 28% of Australians aged 16–65 and over have experienced child sexual abuse. Child maltreatment dramatically increases the odds of four serious mental disorders, and of having a mental disorder.
- Australians who experience child sexual abuse are, in the prior 12 months::
• 2.7 times more likely to have self-harmed
• 2.3 times more likely to have attempted suicide
• 1.2 times more likely to have had an overnight hospital admission - Multiple recommendations — Royal Commissions, Inquiries, Peak Bodies and governments, including the Victorian Government itself — have called for integrated systems of health and care to be implemented for various cohorts in Australia, including survivors of child sexual abuse, over the past decade.
- Although numerous examples of the benefits delivered by existing place-based integrated systems of health and care in the UK (since 2016) and New Zealand (since 2007), no Australian government has invested in learning from, and piloting them here.
- Given the prevalence and impact of child sexual abuse, we call on the Australian Government to acknowledge that the provision of an integrated model of health and care that benefits adult survivors and communities impacted by child sexual abuse, requires piloting a place-based model of integrated health and care for all citizens in a region.
- We call on the Australian Government to work with the Victorian Government, to pilot a place-based model of integrated care for all , by expanding the Regional Mental Health and Wellbeing Boards established in the Grampians and South East Metro, Melbourne, to be the first Australian pilots. As these regions include two Victorian communities devastated by historic, systemic institutional child sexual abuse, the Ballarat community, and the Bayside communities of Melbourne.
The Not So Good News
The Victorian Government Annual Report 2022 Royal Commission into Institutional Responses to Child Sexual Abuse tabled in Parliament on 30 May 2023, included the Government’s planned investment and response to, the following Royal Commission recommendation, which the Government accepted in principal only in 2017.
The Victorian Government has not in any of the five Annual Reports, ever provided any information that support their statements it is already delivering integrated services. The Government has never reported funding the foundations on which a trauma informed, integrated model of advocacy and support and counselling services operate:
- placed-based planning and funding, where funding is distributed to providers aligned with the assessed service needs of the population in that place/region, not provided via competitive funding processes,
- development of partnerships and delivery structures
- development of shared information, processes and technology systems, and
- development of education in trauma informed assessments to occur at primary care, community healthcare, social services, justice and other services, provide multiple entry points, whereby any disclosure of child sexual abuse results in “no wrong door” access to specialist services and supports.
The UK Health and Care Act Legislation 2022 put integrated care systems on a statutory footing. The following diagram depicts the foundations of their integrated care systems.
The following animation describes the benefits of integrated care systems, and why they matter.
In stark constrast to the UK model, the Victoria Government has repeatedly reported in every Annual Report as its response to Recommendation 9.1., the funding of primarily one organisation, Sexual Assault Services Victoria (SASVic), with the option of limited brokerage funding i.e. SASVic can use funding to pay for third party services, or may collaborate.Unfortunately the Government’s reporting has too often been a ‘copy and paste’ from previous reports, certainly not reporting on anything new, let alone signficant changes, progress and outcomes. Below are snapshots of the Government’s annual reporting on Recommendation 9.1 from 2018 to 2022.
SASVic’s response to increased funding states it is not enough to meet demands. Meaning it is not enough to fund innovations in integration of health and care services in Victoria.
The puzzling fact is that Recommendation 9.1 of the Royal Commission into Institutional Responses to Child Sexual Abuse of an integrated model of advocacy and support and counselling, has been historically supported and recommended by the Victorian Government, and recommended by many other inquiries, commissions and by Victoria’s peak body, Sexual Assault Services Victoria.
Mental Health, Productivity Commission Inquiry Report, 30 June 2020, “the National Mental Health Commission stated in its 2014 review that a successful mental health system would have a ‘no wrong door’ approach, and consumers would be referred onto the appropriate service for their needs, regardless of their initial point of entry into the mental health system. While parts of the system are working towards a ‘no wrong door’ approach, this remains far from the norm (box 15.3).
The Federal Department of Social Services Stakeholder consultation in 2020 with victims and survivors of child sexual abuse and their advocates, practitioners, non-government organisations, academics and government officials identified the following key gaps in Victoria:
Mental Health and Wellbeing Bill 2022, tabled in Victorian Parliament, June 2022, includes the establishment of Regional multiagency panels to deliver integrated. coordinated services.
Recommendation 9.9 of the Royal Commission into Institutional Responses to Child Sexual Abuse is
The Minimum Practice Standards — Consultation Summary. BASELINE ANALYSIS OF SPECIALIST AND COMMUNITY SUPPORT SERVICES RESPONDING TO CHILD SEXUAL ABUSE, August 2022, Australian Centre for Child Protection, University of South Australia is one outcome of Recommendation 9.9. I participated in this consultation, and the report included the following recommendations of minimum practice standards.
Fact. The prevalence and impact of child sexual abuse in Australia is a national health emergency. Why the most effective and least costly option — an integrated model of health and care — isn’t optional.
Recommendation 2.1 of the Royal Commission into Institutional Responses to Child Sexual Abuse is
One outcome of this recommendation is The prevalence and impact of child maltreatment in Australia: Findings from the Australian Child Maltreatment Study 2023, which highlights that child sexual abuse is a public health emergency, as 28.5% of Australians aged 16–65 and older have experienced it, and are living with the enduring impact this has through life, including significantly increased risks of mental health disorders and health risk behaviours. The following are some findings.
This infographic summarises the key ACMS findings related to child sexual abuse. It reports data across the whole Australian population of people aged 16–65 and older. The data show child sexual abuse is prevalent with 28.5% of Australians experiencing some type of sexual abuse.
The following “infographic highlights the significant association between childhood experiences of maltreatment and the development of mental disorder over life. It also shows that maltreatment dramatically increased the odds of four serious mental disorders and of having a mental disorder.
Child maltreatment, and especially sexual abuse and emotional abuse, is strongly associated with self-harm and suicide attempts. Australians who experience sexual abuse are:
• 2.7 times more likely to have self-harmed in the prior 12 months
• 2.3 times more likely to have attempted suicide in the prior 12 months
• 2.0 times more likely to be cannabis dependent”
“After adjusting for all other types of maltreatment, as well as for socio- demographic characteristics, financial hardship (childhood and current), and geographic remoteness, the odds of overnight hospital admission during the preceding twelve months were highest for participants who reported sexual abuse (aOR, 1.24; 95% CI, 1.03– 1.50) and then physical abuse (aOR, 1.21; 95% CI, 1.00– 1.46) (Box 1 ).”
Fact. There are mulitple entry points (doors) for adult survivors and communities impacted by child sexual abuse, where, with the right training and intake assessments, they could be connected with trauma informed health and care services and supports.
Imagine if behind any welfare, community, substance abuse, mental health, physical health, disability, education, police, prison, justice, homelessness, unemployment, relationship difficulties, child and family services door … there is a shift from asking “what’s wrong with you?” to asking “what’s happened to you?”
Entry point: Trauma-informed practice
When there is a shift from asking “what’s wrong with you?” as part of assessment and diagnosis of signs and symptoms, to asking “what’s happened to you?”, trauma can be identified.
Failure to diagnosis trauma as the root cause of what sits beneath signs and symptoms of mental health, substance use and other disorders, and self-harm and suicide attempts, and other behavioural and physical symptoms, is a significant barrier to healing and recovery. Below is the brilliant Carly Cards Poster, produced by NSW Health Education Center Against Violence.
“It explores the journey of Carly, a survivor of child sexual assault who enters the mental health system and the difference in trajectory depending on whether her abuse is identified or unidentified.”
A Victorian integrated model of health and care for any adult survivors and communities impacted by childhood Sexual Abuse, must ensure free education and training is available for trauma informed assessment / intake processes, for welfare, community, substance abuse, mental health, physical health, disability, education, police, prison, justice, homelessness, unemployment, relationship difficulties, child and family services providers.
Entry point: Substance abuse services and supports
When we consider people in addiction treatment, rates of PTSD are as high as 50–60%. When someone reduces or stops using, the symptoms of PTSD can re-emerge, leaving the individual without any means to cope. The two problems perpetuate and maintain each other in a vicious cycle that can be difficult to short-circuit. This is why it is so important to identify when trauma co-occurs with addiction, because treating the addiction alone won’t help the person recover.”
Failure to acknowledge substance abuse services and supports as a significant entry point to the healthcare system for many survivors of child sexual abuse, can cause harm, outlined by many submissions the Royal Commission heard.
“Inadequate service responses can re-traumatise survivors of child sexual abuse. Poor therapeutic treatment can leave a victim with chronic symptoms that follow them into adulthood. Ineffective treatment may cause victims to lose hope and disengage from treatment altogether.”
How inadequate substance use disorder service responses can harm adult survivors of child sexual abuse.
A Victorian integrated model of health and care for any adult survivors and communities impacted by childhood Sexual Abuse, must ensure government and community substance abuse services are included, and
- trained in trauma informed practices
- are regulated, including Alcoholics Anonymous and Narcotics Anonymous 12-step programs, and other community therapy groups.
Entry point: Community education and awareness
Family, friends and community members, play a key role in encouraging and connecting adult survivors of child sexual abuse, with professional services.
“Among survivors participating in private sessions for the Royal Commission into Institutional Responses to Child Sexual Abuse, 57% said they did not disclose about the abuse until they were an adult. Further, survivors took, on average, 23.9 years to disclose the abuse, with men taking longer to disclose than women (25.7 years for men and 20.6 years for women).
As with disclosure, access to support services following experiences of child sexual abuse is frequently delayed or does not occur at all. Research with adults in England and Wales who self-identified as victims and survivors of child sexual abuse found that most (73%) victims and survivors had not accessed support services. Support services for victims and survivors of child sexual abuse. Dr Anna Gekoski, Dr Tim McSweeney, Professor Steve Broome, Professor Joanna R. Adler, Dr Sam Jenkins and Demi Georgiou Commissioned and undertaken on behalf of the Independent Inquiry into Child Sexual Abuse August 2020
Easton and Parchment (2021) found in their study with 487 adult male survivors of CSA that for most men (59 %), their most helpful discussant was not a mental health professional but rather a family member, spouse or partner, friend, or fellow survivor. Overall, more than seven in ten men (71.7 %) mentioned that actions taken by discussants were beneficial, especially listening and believing the survivors’ CSA narrative, validating men’s feelings, demonstrating empathy, and encouraging help seeking, The whole wall fell apart, and I felt free for the first time”: Men’s perceptions of helpful responses during discussion of child sexual abuse. Scott D Easton 1, Tyrone M Parchment
A Victorian integrated model of health and care for any adult survivors and communities impacted by childhood Sexual Abuse, must include community education in safe, supportive conversations with survivors of child sexual abuse.
One existing example is, Mental Health First Aid Australia community courses do include guidelines for what to do and say if a child has disclosed they are being abused, and also what to do and say if an adult discloses past sexual abuse.
Fact. Integrated models of care for any adult survivors and communities impacted by childhood Sexual Abuse, Requires Investment in Services Not Dedicated to Sexual Abuse Services.
For all the reasons and evidence provided, an effective Victorian integrated model of health and care for adult survivors and communities impacted by institutional childhood sexual abuse, cannot be heavily reliant on the services of Sexual Assault Services Victoria (SAS Victoria).
The myriad of health and community system entry points for adult survivors and communities impacted by historic institutional child sexual abuse, is why NSW Health’s has adopted the principle, of ‘no wrong door’.
“A public health model emphasises collaboration and integration as core elements of effective interventions. No single service or service system has the capacity or expertise to respond to the needs of every client.
Principle 6: ‘No wrong door’ — NSW Health workers will collaborate to support people and their families to access the most appropriate service responses.
It means that collaborative practice within the NSW Health system and with partner agencies is a priority for NSW Health staff.”
The good news is the Victorian Government doesn’t need to invent models of integrated systems of care, as it can work with the Australian government and other States, to learn from those already in place
Working with the Australia Government
On October 27, 2021 the Federal Government released the National Strategy to Prevent and Respond to Child Sexual Abuse 2021–2030
The National Strategy’s response to Recommendation 9.1 is deeply concerning, as the scope is narrow, and only includes the development of a website and helpline.
We agree with Does the government’s new national plan to combat child sexual abuse go far enough?, that the plan doesn’t go far enough, specifically its failure to fund recovery and healing for survivors and communities.
Our BIG call for action.
We call on the Australian Government, through the National Office for Child Safety National Strategy Advisory Group, to work with the Victorian, and all State and Terriority Governments, to implement in full Recommendation 9.1. By acknowledging The prevalence and impact of child maltreatment in Australia: Findings from the Australian Child Maltreatment Study 2023 findings, included evidence that the prevalence and impact of child sexual abuse in Australia is a national public health emergency.
Given the prevalence and impact of child sexual abuse, we call on the Australian Government to acknowledge that provision of an integrated model of health and care for adult survivors and communities impacted by cvhild sexual abuse, requires piloting place-based model of integrated care for all citizens in a region.
We call on the Australian Government to work with the Victorian Government, to pilot place-based model of integrated care for all , by expanding
to be Australian pilots of integrated systems models of health and care. Based on lessons learnt in the UK and Canterbury, New Zealand.
This aligns with the Beaumaris And Surrounding Communities — CSA Survivors And Families Petition, Services and supports for survivors & communities impacted by systemic child sexual abuse. This petition is organised by a community group who act in loving memory of my brother Ian Walker and Trevor Foster, both deceased victims of child sexual abuse.
“This petition is seeking crucial acknowledgement by local, state, and federal governments of this systemic child sexual abuse, through their provision of appropriately funded and accessible mental health, recovery, and healing services, and other assistance and support, for impacted individuals, families, friends, and members of the local communities.
Our vision includes piloting frameworks of accessible and integrated service systems that are already working well elsewhere in Australia, and in the world, in a couple of Victorian communities devastated by historic, systemic institutional child sexual abuse. The Ballarat community, and the Bayside communities of Melbourne.
Our petition seeks to increase the opportunities for disclosure of child sexual abuse, that result in the diagnosis and treatment of complex post traumatic stress disorder (PTSD), needed for healing and recovery. Healing and recovery requires a diagnosis and treatment of complex PTSD AND services and treatment for the problems and symptoms caused by complex PTSD,
What this translates to is whatever service (health, social, welfare, employment, financial, justice and community) ‘door’ survivors and their families enter, is a safe place for disclosure of childhood sexual abuse, that enables access to all the services that meet their individual needs. And a case manager coordinates seamless care across multiple service providers (health, social, welfare, employment, financial, justice and community). Person-centred care also recognises that individuals are the experts of their own lived experiences and needs, and survivors and their families must be engaged in making informed decisions and choices about their care.
It also ensures each service an individual accesses delivers a trauma-informed approach that is nuanced and tailored to the their experiences. Vital to decrease the risks of individuals being re-traumatised by any service, whether it is related to substance abuse, depression, anxiety, physical ill-health, unemployment, homelessness, welfare, legal and financial services.”
Include learnings from the NSW Government initiatives
In the Royal Commission into Institutional Responses to Child Sexual Abuse, NSW Annual Report on Progress 2022, December 2022, the NSW Government reported the following actions it has taken in response to Recommendation 9.1.
As part of designing and pilotting an integrated model of health and care can the Victorian Government and members and Specialist Advisors for the National Strategy to Prevent and Respond to Child Sexual Abuse Advisory Group, meet and talk with the NSW Government, to learn from pilots in the Mid North Coast and South-Eastern Sydney local health districts, the rollout of a state-wide NSW Health Adult Survivors Program and NSW Health Education Centre Against Violence (ECAV) multi-part online training program on working with adult survivors of child sexual abuse.
Learning from the whole-system approach to integrated health and social services implemented in the Canterbury region, New Zeland.
“Whole-system approach adopted in Canterbury (Fig (Fig6)6) focuses on doing more in the community, making best use of specialised and scarce resources, and doing the right thing for the patient regardless of historical health system and funding silos. At its core lies identifying what is best for the patient, with what is best for the system as a balancing focus.
Development of primary healthcare and community services to support people in a community-based setting and provide a point of ongoing continuity. Freeing up secondary care-based specialist resources to be responsive to episodic events, more complex cases, and the provision of advice and support to primary and community care.”
Developing accountable care systems: lessons from Canterbury, New Zealand
As part of designing and piloting a Victorian integrated model of health and care, can the Australian Government, through the National Office for Child Safety National Strategy Advisory Group, and the Victorian Government meet and talk with their close New Zeland neighbours, Te Whatu Ora — Health New Zealand Waitaha Canterbury (formerly Canterbury District Health Board). To learn from their lessons learnt since 2007.
Learning from the whole-system approach to integrated health and social services being implemented across the UK
A year of integrated care systems: reviewing the journey so far.
As part of designing and piloting Victorian integrated model of health and care the the Australian Government, through the National Office for Child Safety National Strategy Advisory Group and Victorian Government meet and talk with Integrated Care Systems’ UK , to learn from:
- The Integrated Care Board and the Integrated Care Partnerships of Integrated Care Systems in the UK that are similar in population size to the South East Melbourne Public Health Network (SEMPHN) and Grampians Health, that align with the Regional Mental Health and Wellbeing Boards established in the Grampians and South East Metro, Melbourne.
