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.


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

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 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


Catholic Church must open way to transparency

Sydney Morning Herald | February 10 | Catholic Church must open way to transparency

The following opinion piece was published in the Sydney Morning Herald as well as online nationally.

It highlights the need for transparency by the Catholic Church, and all institutions in the context of the Royal Commission and recent UN findings
Australia’s Royal Commission into Institutional Responses to Child Sexual Abuse is a global first. Its private sessions and public hearings, including those into the Catholic Church’s Towards Healing Process, have given a voice to victims. The royal commission, Australia and the world are listening and bearing witness to a litany of abuses and failures within the church as well as other institutions. More is to come.

The commission is helping to bring the deep-seated, pervasive and devastating issues of child sexual abuse into the light. It is an open and transparent process to uncover the systemic failures of institutions to protect children and respond appropriately to these alleged and established crimes. It is leading the way in how these investigations should be handled. Hopefully, this will be reflected around the globe.

Another world first is the unprecedented and scathing report from the United Nations into the Vatican’s handling of child sexual abuse. The UN has deemed the Catholic Church to be in breach of the Convention on the Rights of the Child, a human rights treaty prioritising the rights of children, to which it is a signatory. This finding confirms what survivors and survivor groups have long known: tens of thousands of children have been betrayed, harmed and violated within and by the church, its clergy and workers.

The Vatican attests that the church has done more than any other institution to address these issues with repeated protestations implying distortion and exaggeration of survivor testimony.


Adults Surviving Child Abuse (ASCA) supports the UN’s call that as a bare minimum all clergy and church official workers suspected of or found guilty of child abuse or putting children in harm must be removed immediately; that known sex offenders are removed from the ranks and turned over to authorities. These actions would indeed be in the best interests of the child.

The UN committee was gravely concerned, not only that the Holy See had not acknowledged the extent of the crimes committed, but also had not taken the necessary measures to address cases of child sexual abuse and protect children. In fact it was found to have adopted policies and practices which have led to the continuation of abuse by clergy, while ensuring the impunity of the perpetrators, and those complicit in covering up their crimes.

The findings of the UN and the experiences of thousands of victims who assert that they have been re-traumatised in the process of seeking pastoral support, compensation and justice, need to drive real change. The time is long overdue for large and powerful institutions, such as the Catholic Church, to acknowledge their wrongdoings and take action. For decades victims, individually and collectively, have sought for church officials to respond with compassion and accountability.

Experience has taught us that any shift in hierarchical acknowledgement or processes requires pressure from outside of the church. Large numbers of victims have been party to internal church processes and few, it would seem, have left feeling that they have been heard, supported or justly treated.

The Vatican announced in December that Pope Francis would create a commission to study how to prevent abuse and help victims. The details of this initiative have not yet been released. The formation of another internal mechanism, without true independence and the scrutiny that brings, implies continuing efforts to keep this in-house. To date this has been at the expense of child safety and victim support. The church – and all institutions – must be held accountable to the laws of the land. Criminal acts or serious allegations should be referred to secular authorities.

Abuse flourishes in closed systems and within cultures of hierarchy and secrecy. The UN report demands immediate and decisive action, action which puts an end to the ”code of silence” which has seen the church prioritise its own needs over that of victims. The world needs this immediate action.

ASCA is calling for attitudinal change from the Catholic Church and, in fact, all institutions seeking to handle such matters internally – it’s time for open, independent transparency. We want to see every suspected case of child abuse investigated with the proper judicial processes within which the public is kept in the loop.

The church must demonstrate a real desire to uncover the truth in its ranks without obfuscation or cover-up. And we need global support with the full co-operation of all institutions.

We need to deal with this as a community, as we are doing in Australia with the royal commission. The testimony of survivors before the commission has led the way. Their experiences and their courage must count for something.

Child abuse – recovery

It is estimated that 4-5 million Australian adults have been victims of child abuse. We speak to Dr. Cathy Kezelman whose organization is advocating for the needs of these victims.
BY MINDFOOD | AUG 31, 2012

Podcast: http://www.mindfood.com/upload/media/audio/DR%20Cathy%20Kezelman%20-%20President%20ASCA.mp3

A Royal Commission is the only answer for Defence

A Royal Commission is the only answer for Defence

Cathy Kezelman

The review into the Australian Defence Force has revealed an endemic culture of physical and sexual assault, including that of children as young as thirteen, and other forms of abuse dating back six decades.

Just one of the anonymous victims. Pic: Network 10
Nothing less than a Royal Commission will deliver the systemic change needed to reverse the damage reaped by the existing culture.

The report, by law firm DLA Piper, is based on 847 independent reports of abuse, involving men and women including allegations of crimes which had been committed against children. The special needs of children, based on their inherent vulnerability and the necessity of incorporating additional protections for children in the ADF, have historically been ignored. Many, according to the reports, were not kept safe and the long-term impacts, as potentially for all child victims of abuse, who have not received the right support, have been substantial.

Over recent years we have witnessed widespread revelations of abuse, often of a systemic nature within an array of institutions and organisations. Many of these institutions and organisations have sought to protect themselves and those who work in them rather than to prioritise accountability, justice, and victim support.

The ADF is a closed hierarchical system which by necessity has a well defined chain of command. Its very structure and internal culture of fear wielded by many of those in authority have, it would appear, conspired to prevent far too many from abusing that authority and power and from reporting incidents of abuse. As the report indicates, it is anticipated that perpetrators of abuse, never held to account would still be holding middle and senior management positions.

Perpetrators use secrecy and silence to hide their crimes and if secrecy fails they attack the credibility of their victims. Secrecy, silence and discrediting occur organisationally and institutionally as well. Blaming, silencing, punishing and re-victimising victims are, it seems, endemic practices within the ADF. A ‘group herd mentality’ has reportedly predominated, discouraging victims to report.

Abuse victims often adopt an inappropriate sense of shame and self blame. The use of shaming and humiliation by the identifying group further fuels the shame inherent to being abused. Similarly a ‘dog-eat-dog’ mentality evidenced by generational practices of bastardisation, and cycles of abuse have reportedly continued unabated.

We have watched as institutions have doggedly clung to internal processes, attempted to stay closed to scrutiny, and abrogated hierarchical and bystander responsibility. Within the ADF there has been little to no culture which supports the victim and encourages them to report the abuse perpetrated against them. Or which provides them with the empathy, validation, and therapeutic support victims need to start to process and make sense of their trauma.

Similarly there has been a failure to make those accountable for substantiated cases or to pursue responsible investigation of alleged incidents.

Violence and sexual violence are primarily gendered crimes. Within the ADF, women in particular, appear to have been discriminated against by virtue of their gender, with female victims fearing further victimisation on disclosure, and a macho male mentality predominating in a fundamentally male environment.

Alcohol and other substances are known to fuel abuse and assault. The closed environment within the ADF, in which individuals are removed from family friends and other communities, further contributes to a culture in which fewer factors mitigate the perpetuation of abusive practices. Abuse is an established social practice in all communities. In the community of the ADF, in which personnel are subject to stresses and trauma which are often compounded and exceptional, it would appear that these practices are more entrenched still.

Like other institutions in which abuse has burgeoned, the ADF has insisted on utilising internal processes or, when subjected to reviews, has failed to enact systemic change. In so doing the ADF and successive Australian governments have effectively abrogated their hierarchical responsibility.

It is time to see systemic cultural change with zero tolerance to abuse, sexual abuse, violence and physical assault within the ADF. It is time to engender a culture that is based on mutual respect, acceptance of diversity of gender, race and religion, rather than fear, ignorance, bullying and abuse.

There needs to be an open and transparent culture of reporting in which all allegations are taken seriously and victims’ needs are prioritised. In which crimes are reported to the appropriate external authorities, legal processes are pursued and compensation claims are honoured. Perpetrators must be brought to account and justice, and unless rehabilitated be removed from positions in which they can abuse their power.

It is time for an extensive internal education process which highlights the courage and needs of victims along with the impacts of compounded trauma on the individuals’ development and their physical, mental health and behaviours. And we need to see the provision of informed and sustained therapeutic support for all victims regardless of the length of time since the crimes were committed.

Nothing less than a Royal Commission will institute the systemic changes needed for the ADF to model the respectful non-abusive behaviours which optimise the health and wellbeing of all the men and women of our defence forces.

Adults Surviving Child Abuse (ASCA) is the leading Australian charity promoting the needs of the more than two million adult Australian survivors of childhood trauma.Call ASCA 1300 professional support line 1300 657 380 or visit the website

Victorian abuse inquiry must be just the start

Victorian abuse inquiry must be just the start

published national times

Cathy Kezelman
April 20, 2012 – 11:15AM

Victoria’s inquiry may go some way to shattering the secrecy, tackling the stigma and addressing the denial that surrounds abuse. Photo: John Donegan

The Victorian parliamentary inquiry into sexual abuse within religious organisations is to be applauded. The long overdue announcement this week by the Baillieu government has come on the back of years of lobbying by victims, their families and victims’ groups.

The report into the appalling number of suicides by victims of clergy abuse in that state has delivered, it appears, the final momentum needed for the inquiry to be announced.

To those of us who work in the child abuse arena, such statistics, while always chilling, are not surprising. A 2008 Victorian study established that survivors of child sexual assault are up to 18 times more likely to commit suicide than people who haven’t been abused.

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Child abuse is destructive. When victims don’t receive the support and validation they need, as has been perpetrated by an array of religious institutions, the quality of their lives can be badly affected. In some cases, lives are lost.

In Australia more than 2 million adults are living with the impacts of their childhood abuse. Many have described it as an epidemic that is steeped in secrecy, stigma and collective denial. In Australia, Victoria is leading the way in shattering the secrecy, tackling the stigma and addressing the denial.

It’s a start, but it’s now time for full transparency and real accountability across the board.

This inquiry must be followed by similar processes in other states and territories, supported with a national broad-based inquiry.

As has been suggested, such a process may well be better served by a royal commission or judicial inquiry. It’s a matter of what will wield greater power.

Make no mistake, this is an issue of power; the power of a perpetrator over a victim, the power of an adult over a child, the power of a person in a position of trust betraying that trust, the power of a member of the clergy abrogating their responsibility, the power of the strong over the vulnerable.

It has also been an issue of the power of religious institutions to operate by their own rules, internal rules that have, at times, put them at odds with the very laws that hold other organisations, institutions and citizens accountable.

Religious institutions are predominantly closed patriarchal systems. The more closed the organisation or institution, often the greater the investment in maintaining silence and secrecy. Perpetrators use secrecy and silence to hide their crimes and if secrecy fails, they attack the credibility of victims to try to ensure that no one listens.

We have witnessed the blaming and discrediting of victims within religious institutions, with the shame that victims feel projected onto them all over again.

These systems have their own structures and hierarchies. In the case of the Catholic Church, these structures have prevented victims from pursuing claims against that institution, and internal canon law has taken precedence over civil law.

In many religious institutions the hierarchical systems have perpetuated secrecy and denial, led by an inherent belief that the religious institution knows best and will handle the issue internally, thereby seeking to contain the shame and controversy around such crimes.

So why has it taken so long for any government to come forward and tackle this issue? Collectively, as a society we recoil from stories of abuse. Often we would rather blame the victim for making us uncomfortable and, effectively, for their own victimisation.

As a society we continue to betray those who have been abused in childhood, silencing and shaming them, minimising and negating their experiences. As bystanders we are complicit in these practices, and the shame so inappropriately adopted by victims belongs with us all.

Generations of survivors of clergy abuse have now spoken out. The time has come for us as a society to overcome our disgust, push aside the stigma and taboo around abuse and take action.

It is within a conspiracy of silence and collective denial that the crime of child sexual assault thrives. It is enormously difficult for victims to speak out, both in childhood and as adults. Silenced by shame, threats and the fear of not being believed, many victims don’t ever tell their story. And some don’t ever get the chance.

Thank you, Premier Baillieu and your government, for listening.

Dr Cathy Kezelman is the president of Adults Surviving Child Abuse.

Read more: http://www.canberratimes.com.au/opinion/politics/victorian-abuse-inquiry-must-be-just-the-start-20120419-1x9of.html#ixzz1sZ9dbzeg

TED Global entry – The Trauma of Child Abuse

Below is the script for a video recorded for TED Global auditions, youtube link to the video as well as an article from Sydney Morning Herald related to the TED competition

“Do you know that the biggest public health issue of our times is the trauma of child abuse?

It affects one in five adults in our society and causes ‘long-term disease, disability, chronic social problems and early death’. And yet the issue is treated with a deafening silence.

Traumatic amnesia related to child abuse is not only experienced by survivors, but also collectively by communities.

I know because I’m a survivor, a medical practitioner and President of ASCA, where I help thousands of survivors.

New insights from neuropasticity research have brought hope and optimism. The brain can change and repair itself; people can recover. We need to translate this research into practice.

But first we need to shift attitudes. Just as child abuse survivors need to challenge their thinking and behaviours towards recovery so too do our policy makers and systems of care.

I want to create this change and bring health and wellbeing to people and communities affected by the trauma of child abuse.”