A beacon for hope and recovery

The Royal Commission into Institutional Responses to Child Sexual Abuse has shone a light on the millions of Australians living with the long-term impacts of childhood trauma and abuse. With a bill currently before parliament to remove the time limit on instituting civil claims, Victoria has made a significant move in supporting victims of child abuse. The tide is turning but there is still much more to be done.

As a result of the Royal Commission’s work to date we have seen some positive investment in services that enable survivors to find pathways to recovery, however we need more services to fill the substantial gaps. To keep up with the growing number of survivors reaching out to ASCA and other organisations, now more than ever, more government support is needed.

At the start of this year ASCA presented a detailed report in response to the Prime Minister’s call for policy suggestions to inform the Health Budget. The report titled, The cost of unresolved childhood trauma and abuse in adults in Australia, outlines the significant potential cost savings that could be made across governments by actively and comprehensively responding to the impacts of childhood trauma in adults. In other words, greater government support would not simply advance ASCA’s mission to improve the lives of more Australian adults affected by childhood trauma but would be a mutually beneficial investment.

The report considered the weighted costs of four of the numerous trauma-related repercussions Australian adult survivors of childhood trauma face – including alcohol abuse, anxiety/depression, obesity, suicide and attempted suicide. By conservative* measures, the cost to the budget of not addressing the impacts of childhood trauma overall was estimated to be a minimum of $9.1 billion annually; or for child abuse (in all its forms) alone, the minimum cost was $6.8 billion annually.

To break this down, the report found that each of these four major effects on childhood abuse and trauma survivors had large per person costs. Conservatively estimated, the report showed:
•Alcohol abuse costs $4,983 per person, annually
•Mental illness costs $7,686 per person, annually
•Obesity costs $6,042 per person, annually
•Suicide and attempted suicide costs $5,281 per person, annually

To the wider community these figures may appear astounding, however as experts in the field of trauma-informed practice, they merely validate what we have long observed.
(*ASCA’s 1300 Professional Support Line Data Report, released in October 2014, established that of those reporting the impacts of their abuse, 72% had experienced multiple impacts. Therefore, the assumption of survivors imposing just one cost is highly conservative.)

Evidence-based, long-term solutions are needed for the government’s budget challenges. This includes the provision of accessible affordable specialist services including helplines, online support and resources, a primary care workforce, alert and responsive to trauma, accredited skilled health practitioners and trauma-informed organisations and institutions.

We want to collaborate with government, both Federal and State, to help address the structural budget deficit, to reduce health and welfare expenditure and improve tax revenue and health outcomes – exactly what the Abbott government is looking for.

Active, timely and comprehensive intervention in adults revolutionises outcomes for individuals, families and whole communities impacted by childhood trauma and abuse.

I was proud to present ASCA’s ground-breaking report, at the Lighthouse Institute’s Journey to Recovery: The International Conference of Attachment and Trauma Informed Practice, held at The Melbourne Cricket Ground (MCG) on the 5-6 March, where I and the wider service community came together to share our experiences and reflect on practice and research into trauma-informed recovery-orientated approaches.

Addressing-unresolved-childhood-trauma-abuse-in-adults-would-save-Australian-governments-billions-each-year

A new report commissioned by Adults Surviving Child Abuse (ASCA) and prepared by Pegasus Economics, released in early February 2015, showed that as a nation, Australia could save a minimum of $9.1 billion annually by addressing the impacts of unresolved childhood trauma and abuse in adults[1]. ASCA has already made a significant contribution to helping address the public health challenge childhood trauma and abuse in Australia through broad-based dissemination of ASCA’s Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery. Their national and international uptake has already made a significant impact on public health outcomes.

With Prime Minister Tony Abbott actively seeking alternatives to the Federal Government’s proposals for the Health Budget, ASCA presented these cost savings to the government as part of its pre-budget submission, in the report – The cost of unresolved childhood trauma and abuse in adults in Australia.

The report presented evidence-based solutions for the structural budget deficit for the 2015-16 Budget, scheduled for release mid-May 2015. It highlighted the main steps to reduce these costs, including investment in specialist and trauma-informed services, training of primary care and allied health practitioners and accreditation.

The report considered the weighted costs of four of the many trauma-related issues Australian adult survivors of childhood trauma face – alcohol abuse, anxiety/depression, obesity and suicide/attempted suicide. By conservative measures, the cost to the budget of not addressing these impacts totaled a minimum of $9.1 billion annually for childhood trauma overall; or for child abuse alone, the minimum cost came to $6.8 billion annually.

The report presented the conservative[2] estimated per affected person cost, for each of the four key areas as:
•Alcohol abuse: $4,983 per person, annually
•Mental illness: $7,686 per person, annually
•Obesity: $6,042 per person, annually
•Suicide/attempted suicide: $5,281 per person, annually

The Commonwealth Government’s latest inter-generational report showed the major future stress on government expenditures to be in health outlays[3]. ASCA wishes to work with government in response to the call for policy proposals to reduce health expenditure and improve health outcomes. Our report with Pegasus Economics identifies an area in which substantive real cost savings can be made. The long-term solutions will deliver genuine health outcomes through active, early and comprehensive intervention.

In the report ASCA outlined the main steps to help address childhood trauma and abuse in adults, which included:
•Active investment in specialist services including specialist helplines and online services, which provide support, counseling and resources to promote recovery.
•More, better trained and accredited treating practitioners who identify and address the underlying childhood trauma and abuse, rather than solely focusing on the immediate health issues, such as depression and alcoholism.
•Investing in the training of primary care practitioners. In strengthening primary health responses survivors can receive the right support, either directly or through targeted referrals, including specialist referral, ideally from an accredited practitioner. This would provide a convenient fail-safe pathway to treatment i.e. No wrong door
•System, service and institutional improvements. Raising awareness around the possibility of unresolved childhood trauma and abuse. Financing broad-based implementation of trauma-informed practice responses across health and human services to help minimise the impact of trauma and the risk of re-traumatisation.

[1]Childhood trauma includes abuse in all its forms, neglect, growing up with domestic violence and the traumatic impact on children in experiencing a parental divorce or other relationship breakdown, death of a parent, an alcoholic or drug addicted parent, or a parent affected by mental illness or other significant mental health problem.
[2]ASCA’s 1300 Professional Support Line Data Report, released in October 2014, established that of those reporting the impacts of their abuse, 72% had experienced multiple impacts. Therefore, the assumption of survivors imposing just one cost is highly conservative.
[3]Swan, W. (2012). 2010 Intergenerational Report: Australia to 2050: future challenges. Canberra: Commonwealth Government

Tardy redress would hurt victims more

The testimony given to the royal commission sitting in Ballarat provides further insight into the unconscionable human cost of child sexual abuse. The inquiry has revealed that 12 boys have died, allegedly by suicide from a single class of 33 at St Alipius school and 40 suicides related to child sexual assault have occurred within the Ballarat community. This community has been crushed to its core.

Silenced survivors have shown courage coming forward. … To not promptly address their needs would not only be soul-destroying but also life-threatening.

One after another, victims are continuing to come forward courageously breaking their silence. It has been asserted that there were schools in which no child was safe, with periods during which every teacher was an alleged sex offender.

With no safe place or person to tell, these children lived in constant fear of the next assault, powerless and helpless, as those charged with their care abused their power and betrayed them time and again. The possibility of “fight or flight”, a normal physiological response to danger was not available. Where was their community of nurture, care and compassion? And why did no one intervene to protect them?

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These survivors, now men, have related heartbreaking stories of lives ruined by disability, welfare dependency, mental illness, substance abuse and relationship breakdown. Many of those who have not paid the ultimate price are living a life sentence imposed by the predatory behaviour of paedophile priests and sealed by a system which protected its own at all costs.

The leadership of the Catholic Church in particular, is now under intense scrutiny. The Royal Commission into Institutional Responses to Child Sexual Abuse is prising open a previously secretive and closed network. The silence is being shattered.

Throughout the royal commission we have seen a series of entrenched systems previously accountable only to their own internal intransigence publicly examined and we as a community have been shocked. That so many once revered systems could so conspire to betray their charges, not once but repeatedly, over decades and across leadership structures, is not acceptable.

The royal commission will release its interim recommendations around redress and civil litigation at the end of June. The recommendations will lay the foundations for a fair and just response for victims, including those now providing testimony in Ballarat. Adults Surviving Child Abuse (ASCA) calls on state and federal governments in Australia to respond proactively. They must immediately move to put in place frameworks and structures to implement the recommendations.

Silenced survivors have shown courage coming forward. They have trusted the commission and its processes as well as the governments that have supported it. To not promptly address their needs would not only be soul-destroying but also life-threatening.

When the recommendations are released, the immediate response should provide optimal possibilities for survivors to access much-needed support and redress. For many it will be too little; let’s not make it too late for all.

It is time for institutions to be brought to justice and held accountable. It is also time for true leadership, the sort of leadership seen within the commission, and it needs to come not just from all of the institutions paraded before the commission, but also from governments across Australia.

Dr Cathy Kezelman is the president of Adults Surviving Child Abuse (ASCA)

Help and support for adult survivors of childhood trauma and abuse is available from the ASCA professional support line on 1300 657 380, 9am- 5pm Monday-Sunday.

Read more: http://www.smh.com.au/comment/tardy-redress-would-hurt-sex-abuse-victims-further-20150521-gh6hex.html#ixzz3vdhh4mUz
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Trauma-informed Practice

Trauma can arise from single or repeated adverse events that threaten to overwhelm a person’s ability to cope. When it is repeated and extreme, occurs over a long time, or is perpetrated in childhood by care-givers it is called complex trauma.

Two thirds of people presenting to mental health services, inpatient and outpatient, have a lived experience of child physical or sexual abuse. Other causes of complex trauma include emotional abuse, neglect, family violence, living with a parent with a mental illness or who abuses substances, war and refugee trauma, separation and loss. In Australia 5 million adults have been affected by childhood trauma.

Many trauma survivors show remarkable resilience. However many are left struggling day to day with their health, wellbeing, emotions, relationships, and sense of self and identity. Complex trauma affects not only its victims but those with whom they are in contact as well as the children they go on to have.

Research has established that trauma is a major public health problem. Yet within current systems it is frequently unrecognised, unacknowledged, and unaddressed. Many of those affected have been inadvertently re-traumatised in systems of care lacking the requisite knowledge and training around the particular sensitivities, vulnerabilities and triggers of trauma survivors.

Trauma Informed Practice is a strengths-based framework which is founded on five core principles – safety, trustworthiness, choice, collaboration and empowerment as well as respect for diversity. Trauma informed services do no harm i.e. they do not re-traumatise or blame victims for their efforts to manage their traumatic reactions, and they embrace a message of hope and optimism that recovery is possible. In trauma informed services trauma survivors are seen as unique individuals who have experienced extremely abnormal situations and have managed as best they could.

Becoming trauma informed necessitates a cultural and philosophical shift across every part of a service and is applicable to all human and health service systems. Trauma informed systems understand the dynamics of traumatic stress, survivors in the context of their lives and the role of coping strategies. They feature safety from harm and re-traumatisation, emphasise strength building and skill acquisition rather than symptom management, and foster true collaboration and power sharing between workers and those seeking help at all service levels.

Studies have shown that programs that utilize a trauma-informed practice model report a decrease in symptoms, an improvement in consumers’ daily functioning, and decreases in the use of hospitalization and crisis intervention.

Trauma-informed services do not cost more than standard services and report more successful collaboration with all stakeholders, enhanced skills, and a greater sense of self-efficacy among consumers, improved staff morale, fewer negative events, and more effective services and positive outcomes.

We need to embed trauma informed practice within all health and human service systems to provide appropriate trauma-informed services to those needing them. The provision of trauma informed services must also be supported by trauma specific services, which provide specific interventions to address the consequences of trauma.

For more information see ASCA Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery www.asca.org.au/guidelines and www.asca.org.au/workshops

Abuse on the radar

CHILD abuse and other forms of child maltreatment are common and destructive.

The ongoing proceedings of the Royal Commission into Institutional Responses to Child Sexual Abuse along with the national family violence agenda, are spearheading change in our awareness and attitudes to this trauma.

Trauma is an experience of real or perceived threat arising from single or repeated adverse event/s. Such trauma generally involves abuse of power, betrayal of trust, fear and a sense of helplessness and confusion.

When trauma is interpersonal it is especially damaging. When it is repeated and extreme, occurs over a long time, and is perpetrated in childhood by the very people charged with a child’s care, it is called complex trauma.

It is important to differentiate complex trauma from “single incident” trauma, where the latter describes one-off events in adulthood such as a physical or sexual assault, or a natural disaster such as flood or fire.

Complex trauma requires different treatment responses.

Many survivors of complex trauma show remarkable resilience and manage well. However, many are left struggling day to day with their emotions, relationships and sense of who they are and where they fit in the world.

According to the ACE study in the US (the largest longitudinal study of adverse childhood experiences ever undertaken), such events are “vastly more common than recognized or acknowledged”. They powerfully impact the mental and physical health and wellbeing of individuals “a half-century later” and, without intervention, they cause “long-term disease, disability, chronic social problems and early death”.

This is because strategies adopted to cope with overwhelming childhood experiences, such as smoking, substance abuse, overeating and physical inactivity, become risk factors for physical health problems later on.

In February of this year, the national organisation, Adults Surviving Child Abuse (ASCA), released an economic report — The cost of unresolved childhood trauma and abuse in adults in Australia — which outlined the urgent need for informed responses to unresolved childhood trauma that is highly prevalent in the general population.

The groundbreaking report builds on ASCA’s 2012 “Practice guidelines for treatment of complex trauma and trauma informed care and service delivery”, which set the standards for clinical and service practice.

Research findings from both reports confirm that people who have experienced even extreme early life trauma can recover.

So what is the role of doctors in helping to improve the lives of Australians directly affected by childhood trauma? What can practitioners do to identify those impacted and provide them with the tools, resources and referral pathways they need to find a path to health and wellbeing?

The prevalence of complex trauma, particularly from childhood, is such that, every day, doctors are seeing a high number of patients who have diverse and sometimes medically unexplained symptoms or comorbid diagnoses.

Many of our most challenging health problems are the result of compensatory behaviours such as smoking, overeating, and alcohol and drug abuse. While damaging to health in the longer term, such behaviours often provide immediate partial relief from emotional problems caused by traumatic childhood experiences.

It is important for all practitioners to be aware that past and/or present trauma may underlie some diverse presentations of their patients and be alert to its effects, in the knowledge that trauma becomes compounded over time and its impacts become cumulative.

Primary care practitioners are in a unique position to help patients feel safe and build the trusting environment that can enable disclosure. The response to any disclosure of overwhelming experiences — both in childhood and in adulthood — is critical.

This means that when engaging with all patients, it is important to keep the issue of trauma on the radar. It is also important to practise from a trauma-informed perspective that incorporates the core principles of safety, trustworthiness, choice, collaboration and empowerment.

While direct screening for trauma requires specialist training, all patients benefit from trauma-informed physicians who are aware of the impacts of trauma, and of the resources, tools and referral pathways, which optimise safety and the possibilities for recovery.

Help and support is available from the ASCA professional support line on 1300 657 380, 9 am – 5 pm Monday-Sunday. Additional resources and information regarding education and training are available at www.asca.org.au

Dr Cathy Kezelman AM is the president of Adults Surviving Child Abuse and practised as a GP for 20 years.

The Knox Grammar Controversy is a Heartbreaking Story

We now know about the horrors of Knox Grammar. But how many other schools were hiding the same secrets?

As the Royal Commission into Institutional Responses to Child Sexual Abuse shines the spotlight on Knox Grammar we sit aghast at how this school, and, so many others could fail our children so badly.

As parents we all want our children to be safe always…

But what are we talking about? How many schools? How many children?

Then? Now? How have things changed and what can we expect in years to come?

The Royal Commission has shown that there is no one school type implicated – religious, secular, single-sex or co-ed.

More pertinent than features of difference are those of cultural similarity. Failure to notice, failure to believe, failure to report, failure to act.

In some cases there was more than one perpetrator. In others, principals and other teachers were complicit in protecting perpetrators. Those guilty were moved from school to school, exposing more children to harm.

What was it like for the children trapped in a culture in which they were scared to disclose, threatened into silence, punished for speaking out? To be told they were special and plied with treats to prove it – victims of insidious grooming behaviour which went unrecognised. Only to learn that being special brought repeated pain, angst and shame.

As we watch victims come forward to speak out about their horror and entrapment, the incredible betrayal they felt, the power imbalance which kept them disempowered, we are moved by their courage and shocked by their angst. The horrors of living for years with inappropriate shame, guilt and self-blame, imposed on them by their perpetrators and a culture which ostracised and punished victims.

Their daily struggles to feel okay, to make it to work, to hold a relationship, to feel and be healthy, to not drink or smoke to excess in an attempt to try and feel distress. Depression, self-harm, suicide attempts and for some, the ultimate cost – losing their life.

While many of the instances are historical, sadly some are all too recent. It is important to say that many schools are in fact safe. For others the prior culture of secrecy, cover-up, fear and intimidation is starting to change.

The Royal Commission has been a catalyst for greater openness and transparency. And the time in which children were seen and not heard, in which child sexual abuse was named or spoken about has truly passed.

Read more: Carrie has a message for child abuse survivors in Australia.

We now know that children rarely ‘make up stories’ of being sexually abused and we are beginning to understand what it means for a person to be sexually abused as a child – in childhood, as an adolescent and into adulthood. The culture is changing.

Working with children checks, mandatory reporting, child-safe practices, age-appropriate child programs, education and training of all staff. But most important is a fundamental cultural shift which demands strong leadership to produce cultures which are open, transparent and accountable.

The Royal Commission will complete its work in December 2017 and provide recommendations to government. In the meantime and always, we have every right to seek evidence from our schools that they are putting the safety of our children first in everything they do.

If you or another adult you know was sexually abused as a child call ASCA on 1300 657 380.

Read more at http://www.mamamia.com.au/knox-grammar-controversy/#9O6BjYEjjx7e421O.99

Cardinal George Pell – his personal appearance – a real opportunity

Cardinal George Pell withdrew from his much-awaited personal appearance by at the public hearing into the Melbourne archdiocese and Ballarat diocese this week, due to a sudden exacerbation of long-standing heart condition. The move frustrated not only victims and advocates, but also the very process of the Royal Commission into Institutional Responses to Child Sexual Abuse.

Call me naïve, but I am struggling to retain a fundamental belief in the moral rectitude of our institutions, and the compassion of those in a position of power and responsibility within them. The wealth of contentious evidence and damning allegations uncovered makes this a primal challenge, and one in which I believe I am far from alone.

Failure to respond to systemic child sexual abuse is not restricted to religious institutions; nor to the Catholic Church alone. However, allegations have been mounting about the role of the then Archbishop Pell, the integrity of the Catholic Church process, in particularly The Melbourne Response, further challenged in the recent 60 Minutes segment. Searing testimony during the last week’s public hearing into the Ballarat diocese, makes consideration of the Church’s actions, in general, and Cardinal Pell’s role, in particular, pertinent and topical.

As the President of Australia’s national organisation, Adults Surviving Child Abuse (ASCA), and, as a child abuse survivor myself, I am struck by the contrast between the tenacity of victims seeking to be heard and acknowledged, and the apparent ongoing disregard, for their welfare by some of the powers that be.

The decision by Cardinal Pell, prior to his ill-health intervening, to cross-examine victims runs the very real risk of re-traumatising survivors.

The Melbourne Response, established by the then Archbishop Pell, was established as an independent body to efficiently respond to victims, lessen their suffering and provide support, compensation and justice. According to Cardinal Pell, the three main components – the Commissioners, the counselling arm and the Compensation Panel – of The Melbourne Response, were independent from the Archdiocese.

Under the scrutiny of the Royal Commission, its processes, goals and outcomes are being brought into question.

Firstly, it has been alleged that the ‘Independent’ Commissioner, Peter O’Callaghan QC, appointed in 1996, shared his instructing solicitor with the Archdiocese. Secondly, the Royal Commission’s public hearing in May heard that Peter O’Callaghan never, in his role as Commissioner, reported abuse to the police. Furthermore, in stark contrast to the Commission’s sensitivity to the need to optimise survivor psychological and physical safety, Peter O’Callaghan interviewed victims in his chambers, a daunting physical space for anyone, but especially for victims of abuse.

The role of Professor Richard Ball, the psychiatrist appointed for clinical services to victims of Church abuse, also highlights the question of independence and trust. Recent allegations about two letters allegedly written by Professor Ball on the same day, one to the paedophile priest, Father O’Donnell’s lawyer, and the second to a sentencing judge, providing conflicting information is clearly a matter of the utmost gravity.

The personal appearance of Cardinal Pell before the Commission would provide a long-awaited opportunity for him to prove that the needs of victims for justice, compassion and support are his primary concern.

One only hopes that Cardinal Pell’s ill-health will improve and he will have the opportunity to respond to all allegations made to the Royal Commission, and so right the record. If he fails to do so, one could be forgiven for believing that minimising financial and legal risk and accountability were, and still remain, key drivers for the Church, and for him, as Vatican treasurer.

If my faith, and that of so many others, in this institution and in institutions more broadly, is to be restored, the needs of victims as well as genuine compassion must dominate the words and actions of all leaders.

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Help and support for adult survivors of childhood trauma and abuse is available from the ASCA professional support line on 1300 657 380, 9am- 5pm Monday-Sunday

Children of domestic violence – the silent lasting effects

The need to respond proactively to trauma and violence in our society, as well as globally, has never been more urgent. From threats of terrorism, civil wars, genocide to those of domestic violence and child abuse we need to understand the impacts of trauma and address them. Repeated traumas reap havoc on individuals, families and societies, even after the overt threats have abated. Repercussions are cumulative, compounded and insidious.

Last week we saw communities unite against the ever-too present reality of violence against women. White Ribbon Day is a public expression of solidarity and collective action championing the need for respectful relationships and attitudinal change. Such movements help mobilise the collective support of the nation, which is often needed to garner the political will to mobilise a government response.

However the challenge is far more complex. Many women affected by domestic and family violence have children who, rather than simply being an addendum to the violence or passively witnessing it, experience violence directly or live in fear in their home, robbed of a sense of safety or protection. The longer the violence continues, the more likely it is to impact children’s attitudes and their sense of relationships and the world.

An estimated 30-60 per cent of families affected by domestic and family violence experience harm from other forms of child abuse. More than half (55 per cent) of Australian children who have experienced physical abuse are also exposed to domestic violence, while an estimated 40 per cent who have experienced sexual abuse are also exposed to domestic violence.

Family violence has potentially profound effects across the lifecycle of an individual – from infancy, through childhood and adolescence, and even through to adulthood. Such trauma has long-term implications on self-esteem, relationships, physical and mental health, daily functioning. When those affected become parents, and have not had the right support to work through their issues, it often impacts the next generation.

The focus on domestic and family violence is much needed and, in addition, at a time dominated by the Royal Commission into Institutional Responses to Child Sexual Abuse we need to extend the focus on the trauma children experience in abusive and violent families, neighbourhoods, institutions and communities.

In a recent report commissioned by ASCA, an individual who has been abused or otherwise traumatised in childhood is at significantly higher risk of impaired social, emotional and cognitive wellbeing as an adult. They are also at a higher risk of adopting coping behaviours, such as alcohol and substance abuse, overeating and smoking, the harmful repercussions of which compound the propensity to mental illness, attempted suicide and suicide. Therefore we must offer the right support to the people across the life cycle who have experienced abuse or trauma in childhood so they get the opportunity to be safe, healthy and connected with their communities.

These scourges thrive on secrecy, silence and the complicit hands-off bystander response, which has characterised our society until now. Compounding these factors is the appalling lack of accessible affordable specialist services. Lack of such services means that victims are not provided with the opportunities they need to rebuild their lives. Trauma is a public health issue of significant proportions and we need to respond in a coordinated informed and integrated way.

Our growing understanding of brain plasticity has established that possibilities for recovery are real. Critical to recovery are the positive relational experiences, which are central to wellbeing and a better future. Victims of all ages need to be and feel safe, and have opportunities to discuss, process and make sense of their experiences. Such support needs to come from the community, including from family and friends but also professionally.

The recent response by Minister Ley to the recommendations of the national mental health commission acknowledged the need for systems’ reform to address the severe and complex needs of many Australians who have previously not had their needs met – many of whom experienced child abuse or other forms of trauma. The recommendations of the Redress report from the Royal Commission into Institutional Responses to Child Sexual Abuse are for ongoing counselling and psychological care as and when and for as long as required for survivors of institutional child sexual abuse.

By addressing childhood trauma and abuse in adults, Australia can save an estimated $9.1 billion annually. It is time for a coordinated government response to the scourge of violence and abuse impacted on our children, which without the right interventions continues to play out, often for a lifetime.

Help and support is available from the ASCA professional support line on 1300 657 380, 9am- 5pm Monday-Sunday.

The lasting impact of childhood family violence

The crimes of family violence and child abuse first hit the headlines in the 1970s and 1980s when political feminist waves exposed the issues within Australian society. For the first time, sexual and other forms of abuse and violence were publicly named, personal stories were told and power imbalance and control were identified as key factors in the perpetration of such violence.

Australia’s first royal commission into family violence will wrap up public hearings after four weeks of evidence from victims, advocates and support services. We’ve learnt that the impacts of early experiences of family violence and child abuse are often both significant and long-term.

However, until recently, society has continued to ignore and stigmatise the daily challenges often experienced by the five million Australian adults living with the effects of childhood trauma and abuse.

Childhood trauma results from various forms of abuse, including but not limited to, sexual, physical or emotional abuse. Different forms of violence and trauma regularly co-occur. For example, 55% of Australian children who have experienced physical abuse are also exposed to domestic violence, while an estimated 40% who have experienced sexual abuse are also exposed to domestic violence.

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Further to this, from more than 4000 calls to the Adults Surviving Child Abuse (ASCA) Professional Support Line in 2014, a staggering 65% of callers reported that their childhood trauma, including abuse, had occurred within the home. Such statistics demonstrate that this is a national emergency and more so because the effects last long after the violence stops.

Both childhood abuse and family violence are an exploitation and imbalance of power, predicated on an inherent lack of respect and a betrayal of trust within an intimate and primary relationship of care. Such trauma violates the victim’s right to safety and wellbeing through fear, threat, dominance, control and repeated physical and psychological harm.

These scourges thrive on secrecy, silence and the complicit hands-off bystander response, which has characterised our society until now. Compounding these factors is the appalling lack of accessible affordable specialist services. Lack of such services means that victims are not provided with the opportunities they need to rebuild their lives.

Violence, trauma and abuse – especially within the home – are rarely isolated events; they are often repeated, prolonged and extreme. In a recent report commissioned by ASCA, an individual who has been abused or otherwise traumatised in childhood is at significantly higher risk of impaired social, emotional and cognitive wellbeing as an adult. They are also at a higher risk of adopting coping behaviours, such as alcohol and substance abuse, overeating and smoking, the harmful repercussions of which compound the propensity to mental illness, attempted suicide and suicide.

However, our growing understanding of brain plasticity has established that possibilities for recovery are real. Critical to recovery are the positive relational experiences, which are central to a person’s wellbeing and vital in building on people’s inherent strengths towards a better future. Survivors seeking to recover from childhood trauma need to be and feel safe, with opportunities to discuss, process and make sense of their experiences so they can find a path to recovery. Such support needs to come from the community, including from family and friends but also professionally.

With the Royal Commission into family violence coming to a close, we can only commend the support from the Victorian Government and in particular Premier Daniel Andrews who made it his election promise to review what he called as the states most urgent law and order emergency. However now, we must ensure there is a continued response to family violence and childhood trauma and abuse in Australia.

By addressing childhood trauma and abuse in adults, Australia can save an estimated $9.1 billion annually. It is therefore critical that governments of all persuasions build on their good work in establishing and supporting such Commissions. They need to demonstrate the way they value their citizens by providing much-needed resources and specialist services to enable our fellow Australians to recover.

The Role Medical Practitioners play

Interview Life Matters Feb 27th Dr Cathy Kezelman ABC Radio National discussing the role medical practitioners play in helping adults who have been victims of childhood sexual abuse

http://www.abc.net.au/radionational/programs/lifematters/surviving-child-abuse/5282264