Conference Report
Survivor Scotland Conference
Airth Castle
28 February 2007
Introduction
Scotland is the first country within the UK to have a national strategy for
adult survivors of childhood sexual abuse and this report summarises
SurvivorScotland, the first national conference on the subject.
The day had a dual purpose. It was an opportunity for people from all
over Scotland to hear at first hand about national initiatives that are
already under way. It also gave participants the opportunity to sign up to
becoming part of a national network that would roll out the strategy in
local areas. In particular, the conference placed a strong emphasis on
partnership working and on the importance of identifying and addressing
the wide range of support needs that survivors have.
The turnout was remarkable. The conference was intended for 150
participants but, due to demand, was extended to 330. Delegates came
from a diverse range of backgrounds, and presenters and facilitators,
many with vast experience in the field, put in considerable effort to make
the event a success. They were joined by many survivors who all talked
openly and honestly about their own experiences and about their
enthusiasm for the strategy as a gateway to the recovery process. Lewis
Macdonald, Deputy Minister for Health and Community Care and Marilyn
Livingstone, MSP, Chair of the Parliamentary Cross Party Group on
Survivors of Childhood Sexual Abuse also gave their support. Survivors
have since expressed how positive the media coverage has been in terms
of their recoveries. This shows that we are reaching out to people who
otherwise would not have chosen to be part of official support systems.
The SurvivorScotland website which was demonstrated at the conference
is in the final stages of development and will further help to take this
flagship policy forward. It will become the conduit for exchanging and
developing good practice. This conference report will be one of the first
items to be posted there.
The report itself is not extensively edited and replicates the key points
speakers made. It was heartening to see there are so many people who
are willing to work with us to make the strategy a reality. We now all
need to keep up the momentum and to ensure that everyone does
something locally to make a difference. As you read the report please
consider what difference you can make and how you might go about it.
Welcome
Jean MacLellan, Head of the Scottish Executive's Adult Care and
Support Change Team, and Marilyn Livingstone MSP, of the Scottish
Parliament Cross Party Group on Survivors of Childhood Sexual Abuse,
opened the conference and welcomed everyone. They detailed the
journey that had brought us to this important day, and thanked
participants for the overwhelming response which showed their
willingness to participate and make the difference.
Lewis MacDonald, the Deputy Minister for Health and Community
Care sent the following message:
"Due to Parliamentary commitments, I cannot be with you today for this
milestone event in the progress of the National Strategy for Adult
Survivors of Childhood Sexual Abuse, but I am delighted to know that the
SurvivorScotland conference has had such an overwhelming response.
This first conference on the National Strategy is a major opportunity to
build on networking, exchanging knowledge and raising awareness.
The strategy was developed to improve the quality of, and access to
services for adult survivors in Scotland. The measures that I outlined
when I launched it in September 2005, demonstrated the Scottish
Executive's commitment to ensuring that the needs of survivors of sexual
abuse are recognised and met. I am pleased that this continued
commitment on behalf of the National Reference Group has meant that
we have seen real progress in a number of key areas. In addition to
inviting organisations to apply to our Fund to develop services, we are
also working on an independent website which will help underpin the
strategy, develop networks and provide a help mechanism on personal
and professional levels. Public awareness raising has been a real priority -
and the very fact that there are so many of you here today will I'm sure
encourage survivors to feel that they are being listened to and will give
the general public an opportunity to understand what is for many people a
very difficult issue.
The Cross Party Group in the Scottish Parliament achieved real success in
breaking the silence that has existed so long on this issue. I am confident
that by working together adult survivors, professionals, voluntary
organisations, social work, health and other agencies can continue that
process, with continuing support from Scottish Ministers and MSPs.
I wish you every success in what promises to be an exciting and
interesting event today. I hope that we can take forward the benefit of
experience and what people can learn from each other, to help us forge
stronger networks which will make a real and lasting difference for adult
survivors in Scotland."
National Strategy for Survivors of Childhood
Sexual Abuse: Progress so far
Presentation: Anne Macdonald and Sarah Nelson , Lead Professionals,
National Strategy for Survivors of Childhood Sexual Abuse, Scottish
Executive Health Department
Parallel Session - Anne MacDonald and Jeannie Hunter
Anne and Sarah gave a brief history of the strategy and its origins within
the Cross Party Group and Short Life Working Group, of which they have
both been members. They set out the survivor-centred vision for the
future as one which recognised the wide range of abuse suffered, and
acknowledged the professional difficulties encountered by staff in
addressing survivors' needs and in attempting to 'mainstream' services
for survivors.
Jeannie and Anne's session went into further detail about the strategy
which is co-led by officials in the Scottish Executive Adult Care and
Support - Change Team, two Lead Professionals and a National Reference
Group.
The first year has focussed on five areas:
1. Development of a website and increased networking
The website will be a tool for communication, and will increase networking
between survivors and those working with survivors. It will be a space for
survivors to tell their stories and seek information on getting help, as well
as giving the latest news about survivor-related events. There will also be
a section on the latest research and policy.
2. Data collection
This refers to the way survivors needs are identified within a wide range
of service settings. For instance, only 1% of Child Sexual Abuse histories
are currently documented in health records. It is hoped that some pilot
projects which are in the process of being developed will add to the data
currently available.
3. Sexual Abuse Service Development Fund (SASDF)
The SASDF is an important strand of the overall strategy, which not only
seeks to pump prime new developments, but also to ascertain what gaps
in service provision exist across Scotland. The eligibility guidelines for the
SASDF are broad to encourage a wide range of innovative applications for
this fund, involving partnerships between the statutory and voluntary
sectors.
4. Prevention of sexual offending
The Strategy is committed to contributing towards preventing sexual
offending as stipulated by Recommendation 26 of the Cosgrove Report
(Reducing the Risk: Improving the Response to Sex Offending. Report of the
Expert Panel on Sex Offending, 2001). This will be through education
programmes targeted at changing the behaviour of perpetrators and
potential perpetrators as well as by looking into other behaviours that can
be linked to abuse. Work on this area will have an emphasis on young
offenders.
5. Public awareness raising and PR campaign
Its primary aim is to focus on reducing stigma and increase understanding
of the scale of the problem. The website will be a key element in
awareness raising, and will be aided by the distribution of a public
information leaflet. Media publicity also surrounded the conference, which
included pieces in The Scotsman and Scotland Today.
The presenters emphasised throughout the need for sustaining and
continuing progress on key priorities, widening the membership of people
wishing to be involved, and the importance of more seminars & events
across Scotland.
Discussion among those attending the parallel session stressed the need
to raise public awareness of the strategy through the media, and to
inform survivors of the services available and the need for improved
development and coordination of all services for survivors, especially
those abused in care.
Myths and Realities
Dr Alistair Wilson, Consultant Psychiatrist, Gartnavel Hospital, Glasgow
Alistair made clear that there are widely different prevalence rates noted
by researchers on childhood sexual abuse (CSA) as well as varying
prevalence between different populations. The effects of CSA vary from
person to person and he examined how trauma affects the brain's
interaction, especially that of the hippocampus, with the body, to produce
bodily sensations instead of explicit narrative memory.
The research evidence presented by Alistair indicated that if self-care and
preventative services were developed for this under-diagnosed group the
benefits to the individuals concerned would be considerable.
He took 13 robust studies of seriously ill men and women and found that
the rates of childhood sexual abuse were conservatively upwards of 30%.
Much of this abuse takes place in families and the subsequent trauma is
manifested in a range of behaviours from treatment resistant depression,
somatic symptoms such as chronic pain, alcohol and drug dependency (to
blot out the experience) through to full blown psychosis. Alistair's
presentation made clear the consequent extensive demands that are
placed on primary and psychiatric care services.
Finally, he stressed the need for education, training, research, improved
treatment techniques and support for survivors.
Parallel Session: Mindfulness-based approach to trauma
In his workshop Alistair detailed his work with the Mindfulness Based
Cognitive Therapy (MBCT)
This centres on:
• An individual's internal experiences (body sensations, thoughts and
moods);
• An individual's external experiences (interactions with others,
actions in the world); and
• The interplay between the two.
The aim of the programme is to allow participants to step out of the
mental reactions that create difficulties and to equip them to deal with
stress and factors that hurt them.
MBCT when geared towards depression, is an 8 week long programme. A
number who have attended his groups in the past have suffered abuse,
although the programme he runs has been developed for individuals
suffering from depression. The MBCT programme is a group work model,
and groups for those suffering from depression have approximately 8-12
members at a time.
Discussion following the presentation centred on how this course could be
adapted for survivors of trauma and whether this might have a different
effect on the participants than when the participants are suffering from
depression. Alistair suggested that a programme which addressed abuse
and trauma may have to run for perhaps 6 months rather than 8 weeks
and the group size would need to be reduced to about 6 members. It
would be important not to have less than 6 as this could make the group
work too intense. The length of each session would also need to be
extended for a trauma course from the 2 - 2 ½ hours that each session
centred on depression usually lasts.
Working with Homeless Young Women with
Complex Needs
Rosina McCrae, Director, SAY Women, Glasgow
"The core experiences of psychological trauma are disempowerment and
disconnection from others. Recovery is based upon the empowerment of
the survivors and the creation of new connections".*** (Herman, 1992)
Rosina opened by describing the work of SAY Women. The organisation
offers safe, supported accommodation and related services for single
young women, aged 16-25, who are homeless or threatened with
homelessness and who have disclosed childhood sexual abuse, rape or
sexual assault.
Young women can stay in the accommodation for up to 18 months. After
this time service users are offered a follow on service of housing and
resettlement support. This is crucial as the young women are particularly
vulnerable during resettlement and open to targeting by those who had
previously abused them. SAY Women also offers support to both young
men and young women living in other housing projects as well as
consultancy to staff, thus ensuring that those working alongside
individuals in housing projects are sufficiently trained and can offer
consistent support.
Rosina spoke of the many issues that the accommodation tenants and
resource service users are dealing with. These include high percentages
suffering from addiction problems, self injury and suicidal thoughts. It is
never just one issue that these women have to deal with, but many
layers. SAY Women base their work and understanding of the needs of
the young women around Dr Judith Herman's model of the 3 stages of
healing. These stages are
1. Establishing safety;
2. Remembering and mourning;
3. Reconnection
Rosina stressed the importance for the women they look after of feeling
safe before they can begin to deal with their past experiences. The
accommodation and support services that SAY Women provide offer such
safety.
Two service users, Lorna and Jenna, shared their stories. Their early lives
had both led to them staying in accommodation provided by SAY Women.
Both stressed the important role SAY Women's services provided, in
particular the manner in which the services were delivered and tailored
closely to each person's needs and ways of communicating.
Rosina concluded her presentation by emphasising that although sexual
abuse affected both men and women, that both nationally and
internationally, girls and women still suffered more heavily from many
forms of gender violence.
*** Herman, J. 1992 Trauma & Recovery
Emerging Issues for Male Survivors of Sexual
Abuse
Martin Henry, Executive Officer, Lothian & Borders Child Protection Office
Martin challenged the mythologies surrounding male survivors of
childhood sexual abuse. In particular, the following:
• The under representation in prevalence figures of male sexual
victimisation
• The idea that male victims become sexual abusers
• The belief that same sex abuse makes male victims become gay
• The notion that gay men present a risk to children
Problems with prevalence
Martin cautioned against blind acceptance of the differences suggested by
prevalence figures between the incidence of sex abuse among males as
opposed to females. The studies, he believes, are confounded by factors
which lead to under-reporting and the questions asked frequently do not
lead to disclosures from survivors, due to the nature of the question and
how/when/where it is asked.
Male victims become sexual abusers
There is no doubt that some abusers have been abused themselves.
However, this does not imply the reverse; that survivors of CSA will go on
to abuse others.
Same sex abuse makes male victims become gay
Martin discussed:
• Society confusing the abusive experience with gay sexuality
• Arousal and the myth of complicity
• Masculinity and homophobia
The arousal and complicity myth implies that if the victim is aroused
during abuse then this could not have constituted abuse. Instead, such
arousal indicates complicity in the abusive act and therefore indicates
homosexuality. This myth is exacerbated by perpetrators, who tell their
victims that their arousal indicates their willingness and consent to the
sexual act. This explanation lives on with the survivors into their adult
lives.
Gay men present a risk to children
If sexually abused boys become abusers and also become gay, then the
next myth proposed is that gay men present a risk to children.
Martin believes that these myths largely stem from society's conception of
masculinity. He analysed how masculinity has been constructed to ensure
conformity to a code of values and behaviours which not only suppresses
survivors' ability to disclose abuse, but also perpetuates society's attitude
towards survivors and increases the difficulties survivors have in dealing
with their abuse. He also looked at the particular issues presented for
those men who had been abused whilst in institutions.
Martin concluded by arguing that we all need to reclaim masculine values
and reconstruct the male identity and reinstate positive male values. Thus
endurance could be replaced by steadfastness, forbearance by fortitude,
aggression by courage, betrayal by honour, arrogance by determination,
secrecy by loyalty and insecurity by self-assuredness.
Parallel Sessions
Initiatives to prevent sex offending
Tink Palmer, Director, Stop it Now! UK
Tink opened her presentation by explaining the aims and work of Stop it
Now! It is an organisation that raises community awareness of childhood
sexual abuse, and offers a telephone helpline for those concerned about
their own or another's sexual behaviour. The organisation is currently
active in England, Wales, Northern Ireland and the Republic of Ireland,
and looking to set up in Scotland. It aims to target abuse and potential
abusers, either directly, or through concerned family and friends of
abused children and parents of young people with sexually worrying
behaviour.
Stop it Now! aims to prevent childhood sexual abuse, Tink adapted
Finkelhor's model of the motivation of an abuser (taken from D. Finkelhor
(1985) Child Sexual Abuse: New Theory and Research). Stop it Now! aims
to intervene before perpetrators shift from having the motivation to
abuse, to actually abusing a child.
From June 2002 to May 2005 the helpline received 4013 calls. 45% of
these have been from abusers and potential abusers concerned about
themselves, 30% have been from family, friends and other adults
concerned about another adult and 5% from parents, carers and adults
concerned about a young person. The remaining 20% were from callers
outside the organisation's target groups.
There are a substantial number of pilot projects running in England, Wales
and Northern Ireland. After 2.5 years of these projects, it is clear from
evaluations that that there is an increase in awareness of child sexual
abuse issues in the local populations. It was important that local groups
had close contact with local media in order to get their message out to
the public.
Attendees at the parallel session discussed working with perpetrators, the
introduction of Multi-Agency Public Protection Arrangements (MAPPAs) in
Scotland and the importance of partnership working in preventing sexual
abuse including safeguarding, public protection and criminal justice and
the difficulties of 'outing' someone close to you as an abuser.
Tink stressed in conclusion that we all need to consider what we ourselves
can do to make a difference.
Early trauma histories and mental health: survey
of in-patients
Dr Linda Treliving, Consultant Psychiatrist in Psychotherapy &
Alison Lowit, Researcher, Royal Cornhill Hospital, Aberdeen
Introduction
Research indicates that prevalence rates for Early Trauma among
psychiatric patients are significantly higher than in the general population.
There is a high association between early trauma and personality
disorders. The primary research aims of this study were to determine an
accurate estimate of the rate of childhood sexual, physical and emotional
abuse (early trauma) amongst clients in contact with mental health
services in Aberdeen, and to determine the range of psychological distress
likely to be associated with early trauma in this population. The secondary
research aims were to estimate the prevalence of personality disorder
amongst clients in Aberdeen, and correlate this with early trauma. Also
to determine the rate of recording by health care professionals in
Aberdeen of early trauma as a possible factor in adult mental illness.
Method
A consecutive recruitment/assessment cross-sectional study was carried
out on adults within the Aberdeen mental health services. Three validated
questionnaires were used:
The Childhood Trauma Questionnaire (CTQ); The Symptom Checklist
90 Revised (SCL-90-R); The Personality Disorder Questionnaire (PDQ-
4).
Due to the participants' preference, rather than filling out the
questionnaires themselves, they completed the forms via a structured
interview.
Results
• 90 of the 136 psychiatric inpatients had experienced
moderate/severe early trauma (66%), this included 48 out of 74
males (64%) and 42 out of 62 females (67%). 60 of the 90
participants who had experienced early trauma had this recorded in
their psychiatric medical records (66%).
• 95 of the 136 participants had significant personality disturbance
(70%), this included 58 out of 74 males (78%) and 37 out of 62
females (60%). 20 of the 95 participants who have significant
personality disturbance have a recorded diagnosis of it (21%).
• 70 of the 95 participants with significant personality disturbance
had experienced moderate/severe early trauma (74%), this
included 43 out of 58 males (74%) and 27 out of 37 females
(73%).
These results showed no significant differences between genders. They
cannot however be taken on face value, as epidemiologically men and
women in the overall population report different symptoms and severity
of symptoms. Such differences may distort interpretation of the results.
Therefore, the scores were adjusted to reflect that. They were then
compared and significant differences between the genders became
apparent.
Conclusions
There are very high rates of early trauma amongst mental health
inpatients in Aberdeen. A high percentage have significant personality
disturbance. Early trauma is associated with significant personality
disturbance. Male inpatients with early trauma report higher symptom
levels than similar female inpatients when gender differences in reporting
of symptoms are taken into account. Female inpatients regardless of
presence or absence of early trauma report similar symptom levels. Males
with early trauma reported significantly higher symptom levels for all
symptoms measured by the SCL-90-R than males without early trauma.
The clinical implications of this study
• A diagnosis of personality disorder is known to complicate treatment
regimes. However, this complication could have its origins in an
unrecognised history of early trauma.
• It is likely there is under-recognition of comorbid diagnoses
involving personality disorder.
• If a patient presents with symptoms of personality disorder it is
crucial to check for a history of early trauma - a treatment regime
may be more effective if it also tackles problems directly
attributable to early trauma.
Discussion with Dr Treliving and Alison after their presentation included :
• The methodology of the research;
• Explanations for the difference in results between males and
females;
• Patients'/clients' frustration at not being asked about early trauma;
• The need for more research on mental health, yet the difficulty of
getting mental health studies approved by ethics committees;
• Suggestions for further research included doing comparable work
with suicidality; looking at the effect on symptoms of the type of
abuse and age at which is abuse is experienced; and doing similar
work among the prison population.
Self-harm, abuse and the psychotic experience
Ron Coleman, Working to Recovery, Fife
Ron described the aims and background of the Hearing Voices Network
which was established in 1991.
Many people he works with who hear voices have been abused. To
illustrate the role of heard voices, Ron drew a voice diagram where the
voices are represented by concentric circles, with the voice of the abuser
at the centre. Through his work, Ron aims to make the voice of the
abuser less important, less central.
Ron pointed out that survivors can find it hard to believe that the abuse is
not their fault. This disbelief occurs because children are groomed by their
abusers to feel complicit.
It is important that people have a choice about going on the journey of
recovery and also to recognise that doing this may involve them in more
pain for a while. Many people believe psychosis is not suited to "talking
treatments". Ron however believes that these can help, especially where
pharmaceutical treatments are not working. This may be because the
psychosis is not rooted in issues to do with genes nor dopamine
receptors, but is a response to the abuse, and the person experiencing
psychosis is hearing the voice of the abuser.
Ron described simple coping strategies and the importance of thinking of
imaginative responses. For example, he talks to the voices that people
hear and gets the voices to talk to each other. These voices can be not
only that of the abuser but also of supportive people, or a "younger self"
of the client. One of the supporters may be able to speak to the voice of
the client's younger self, and help that self, where that voice cannot or
will not listen to Ron.
Attendees at the parallel session discussed treatment, services and the
current problems with both. One participant made the point that a client
may not wish to disclose to everyone, or a psychiatrist may choose not to
write down the history of CSA, because case notes are available to all
within the service, and thus not confidential. While Ron does keep notes,
he hands these over to the client at the end of their time with him. He
always sees himself as the facilitator, rather than the therapist, in order
that the client really owns the process.
Findings from the National Awareness Training
Project
Sue Hampson, Person Centred Counselling and Training Consultant
Sue began by noting that research carried out by Sarah Nelson in 2001
into the mental health care needs of adult survivors established that there
was a pattern of poor care responses and a fear by staff to openly discuss
patients' experiences with them. These concerns prompted the beginning
of a national awareness training project in which both front line staff and
managers were targeted.
The training programme was devised to address concerns through
building self confidence for front line staff, enabling staff to develop safe,
sensitive ways of exploring a sexual abuse history, encouraging safe and
helpful responses to disclosure and enabling managers to effectively
support staff working with adult disclosures. The training ran from 2005
to 2006 in 8 locations throughout Scotland. Overall, 300 people received
training.
The main feedback received from all of the training courses was that work
with survivors is a huge part of frontline workers' roles and this is not
acknowledged, or if it is, is underplayed by organisations throughout
Scotland. Staff felt that they were unsupported in dealing with CSA and
that it was important that the issues surrounding disclosures of abuse and
the issues surrounding CSA for frontline workers were acknowledged.
Time and support need to be given to front line staff so that they can
carry out their work.
Those who attended the training also expressed a need for access to
support and counselling for staff, feedback and understanding from
colleagues, organisational policy for CSA work, regular support and
supervision and training throughout their organisation starting from the
top.
Sue explained that staff disclosures were high from participants on the
course and it was therefore important for organisations to recognise the
prevalence of survivors within the workforce, establish a safe working
environment, actively promote work cultures where staff are able to
identify themselves without fear of discrimination and to put in place clear
and accessible support systems that become a meaningful part of the
work environment.
There were particular issues for men in training on CSA. Only 11% of
front line staff and 20% of managers that attended the course were men.
There were also men who left the course as they were having difficulty
with its content. There were a number of re-occurring themes from men
who attended the training. These were firstly that it was difficult for men
to talk to other men about being abused and secondly that it was very
difficult to show their vulnerability. Such issues are important to take into
account when considering how male survivors may present symptoms.
There is a need to consider male workers' fear of vulnerability and how
that may make them stop short of addressing male clients' vulnerability.
Following the training, staff were contacted 6 months later to evaluate
how the training had benefited them. The feedback was extremely
positive and paradoxically staff now stated they were more confident in
the knowledge that there is no magic solution to working with disclosures.
Discussion among attendees included concern that staff are sometimes
advised to immediately refer clients to experts when more spontaneous,
humane, responses could be of equal value. It was also noted that fewer
men than women disclose and that the establishment of male specific
counselling is important.
Medically Unexplained Symptoms in Childhood
Sexual Abuse(CSA) Survivors
Dr Sarah Nelson, Professor Julie Taylor and Professor Norma Baldwin,
University of Dundee
Sarah presented research conducted by herself and Professors Julie Taylor
and Norma Baldwin of Dundee University. They carried out a review of the
research literature on medically unexplained symptoms (MUS) in people
with sexual abuse histories and mental health symptoms:
The main types of Medically Unexplained Symptom (MUS) include:
• Irritable bowel syndrome & other gastro-intestinal complaints
• Chronic pelvic pain/severe premenstrual pain
• Fibromyalgia & other chronic pain
• Respiratory conditions, wheezing, throat problems
• Non-epileptic seizures
The study aimed to find out how "survivors with MUS and mental health
issues have been identified and sampled; the key findings of research
literature; theories used to explain inter-connections; any interventions
and treatments for the CSA group; gaps in knowledge or understanding
which require further research…and to make recommendations."
96 studies were analysed plus 27 reviews or discussion papers and was
largely a medical literature. CSA survivors were the main focus in only 9
studies. Instead, the symptoms that people were presenting with were
usually the focus. There were only three qualitative studies and three on
males. Most researchers were medical specialists rather than experts in
CSA, with few collaborations with CSA support agencies.
Most studies confirmed that people with CSA are at higher risk for MUS,
especially for GI and chronic pain. The more serious the abuse, the more
serious the impact on MUS, disability, sick days and healthcare use.
Childhood physical abuse and adult physical assaults were also significant
influences on MUS. Recommendations stressed general good practice
including detailed history-taking, respectful listening, referral for
psychological therapy.
Theories which try to explain the links between MUS and CSA include
• somatisation: where emotional stress translates into bodily
symptoms;
• severe trauma causes changes in the central nervous system
increasing vulnerability to pain and infections;
• depression and anxiety lead people to amplify their physical
symptoms;
• injury and infection through assaults directly influence symptoms,
especially chronic pain.
The main problem with existing research was found to be " An overriding
concern with testing which risk factors contribute to which outcomes
(this) has produced a repetitive (and competitive) body of case control
studies, which have failed to identify helpful interventions for sexually
abused people with MUS".
Studies often used variables which do not match survivors' experience,
there was little collaboration with specialists in CSA, the voices of
survivors were rarely heard and a lack of ethical safeguards or support for
the survivors involved. "Somatisation" concept was problematic,
prejudicial and ill defined.
The study made the following recommendations for future research
• CSA survivors must be the primary focus of research.
Research needs to be:
• Geared to exploring causes and relieving suffering;
• Open minded, free of value judgments re. "somatisation";
• Collaborative between medical specialists and CSA specialists for
design and interpretation of studies.
There is a need for:
• Qualitative research with adult survivors with MUS, to explore
health history, abuse history, experiences of health system, and
interconnections;
• Studies of male survivors with MUS;
• Case histories, exploring medical records and attitudes of clinicians;
• Research into direct physical effects of violence and injury, and into
"body memories", including collaboration with torture research
experts;
• Collaborative research with voluntary sector support agencies;
• Prospective studies with children & young people
These recommendations could result in the design of good-practice
interview schedules for MUS patients and an increase in respect and
dignity of CSA survivors. They could inform design of therapeutic
interventions which could be piloted and evaluated, increasing informed
knowledge, understanding of causes, and long-term research
collaboration.
Discussion among attendees at this parallel session centred on how
survivors carry the 'shame' of abuse in a variety of ways. They also
discussed the danger of medical professionals dismissing too readily
symptoms with which survivors present and the need for GPs to give
more time to addressing survivors' needs holistically. Advocacy and
support for survivors also needed to be improved.
Closing remarks
Jean MacLellan thanked all the speakers and presenters, the conference
organisers and indeed everyone who had attended in whatever capacity
for making the day so successful in taking forward a strategy that would
shed light in dark places.
The first sessions from Marilyn, Anne and Sarah had been interesting,
because of the clear evidence of progress in circumstances that all
acknowledged have not been easy. There was considerable goodwill to
keep going on the journey, but it was important to recognise that there is
a long road to travel.
The most challenging aspect of Alistair's presentation for her personally,
had been his question: why is major reseach not undertaken in this area?
Rosina's contribution and the personal testimonies from survivors made it
clear that intervention is a long-term necessity, but this can be based on
a few relatively simple principles like believing and listening, and sticking
with someone through 'thick and thin'.
Martin had said a very great deal on masculinity, 'identity theft' and
potential loss of spiritual values.
Jean said that everyone would take their own memories of the workshops,
but that for her, attending Tinks' workshop, Stop It Now, reminded her
that Scotland is the only country within the UK that has a Strategy. That
means it is incumbent on us to be generous to our colleagues in other
parts of the UK in sharing the challenges we have faced, and to building
up a joint agenda.
She closed the conference with contributions from her colleague, Jeannie,
and Carol, who is a survivor. What they hoped to do for everyone was to
help them to focus on what their own personal contribution to the
Strategy might be.
Jeannie Hunter works in the Scottish Executive as a Policy Officer on the
National Strategy and Carol is a service user representative on the Cross
Party Group and National Reference Group
Carol and Jeannie used the following image to illustrate the quote from a
survivor describing the effects of abuse:
Jeannie and Carol shared their personal experiences of becoming involved
in the strategy and the challenges involved. Jeannie said that above
everything else, what she had come to understand was that all of us,
whether we are aware of it or not, will know someone who has been
abused, therefore the need to address this issue and to raise awareness is
paramount.
Setting the remit for the Reference Group had been no easy task.
Although everyone had been aware of the need to improve services, it
had been difficult at times to recognise that other aspects were vitally
important, such as the need to consider prevention, and those who had
perpetrated the crimes. Members of the Reference Group come from a
variety of backgrounds and priorities. However despite these differences,
what has been apparent throughout is that they all have the same
overriding desire - to make things better for survivors and to address the
effects of abuse of all kinds.
Survivors are crucial in informing the strategy. For it to develop
effectively we must ensure that their experiences are taken into account.
Jeannie said that for her it had not been about sitting at a desk, but it had
been about speaking and listening to people - hearing the experiences of
others and making them count. This could be challenging, but we had a
real chance with this strategy to show we care. She never ceased to be
humbled by the experiences that survivors shared with her and despite
the fact that many of them have gone through a lifetime of pain, they
have the courage to help to make a better future for others.
Carol is one such person who has put her all into raising awareness and
making sure that others can learn from her experiences and is helping
shape the strategy. Jeannie passed the last words of the day to her.
Carol reflected on the years of abuse she had suffered within the family,
but thanks to support from many organisations her life was now for the
first time beginning to gain some stability. This did not however help the
hurt, pain and the memories. The everyday struggle she faced as she
tried to get on with her life was too much at times. She had been
frustrated not only with her situation, but because abuse of children
appeared to be continuing to happen and was ruining more and more
lives with nothing being done to stop it. Carol then found out about the
work being done by the Cross Party Group and became involved.
One of the biggest hindrances to the healing process and recovery is the
lack of acknowledgement that abuse of children is wrong. Carol stressed
the importance of the survivor's words in the poem. Children do not
always know that abuse is wrong, it isn't until they try to live their adult
life that it seriously affects them and this is the hardest struggle. She said
that although nothing could be done to change what had already
happened to survivors, with the support of everyone we can change it for
future children, by creating awareness, prevention and having the
appropriate justice. Just knowing that work on this area is now being
done, has played a major part in her recovery.
Frequently Asked Questions
We have put together some frequently asked questions about the
strategy. For any more specific questions, please could you contact
Jeannie Hunter on jeannie.hunter@scotland.gsi.gov.uk who will be happy
to direct as appropriate.
Q What do you hope to achieve with the National Strategy?
The aim of this work is to effect a culture change in service responses to
survivors of childhood sexual abuse across Scotland and to mainstream
health and support services, listen to survivors and provide them with
choices in how they access help and support when they need it. This will
not only lead to recovery from their early trauma, but make more efficient
use of existing public sector resources. We are also keen to increase
public awareness and society's response to childhood sexual abuse, with
the hope that girls and boys will feel more confident to disclose their
abuse at an earlier stage, and be protected from further abuse.
Q Long overdue - Why has it taken so long for any action to be
taken?
This is a long term project which will take time to fully deliver. Sexual
abuse is a complicated issue which requires careful consideration and a
reasoned approach for us to do it justice. But the initial steps and
progress to date are positive proof that we are determined that survivors
receive the most appropriate and sensitive care and support relevant to
their needs.
Q What's happening to the £2m which goes with the strategy?
In respect of the Development Fund, we have had an overwhelming
response from projects seeking funding to develop existing projects and
to create new and innovative services. An independent panel has been
working on this and we hope to be able to announce the results soon. We
appreciate that many will be disappointed, but we hope to use this
exercise to help inform policy development and to signpost applicants to
other areas where funding may be available if appropriate.
Q £2 million is not likely to go very far is it?
It is the commitment to policy change and development that is important,
for the long term. The funding is only one aspect of the whole strategic
approach to address all aspects of childhood sexual abuse and thereby
achieve lasting progress. £2m is a means to boost the areas the
Reference Group consider to be most in need. More than anything we
need to develop our Awareness Raising Campaign to raise the profile of
the issue, and to ensure current services are 'survivor aware'. The
forthcoming website will be vital in helping survivors, their families,
friends, as well as those who work in the field of CSA to be able to
communicate more effectively. The strategy is also geared towards
identifying areas for local authorities and health boards to consider taking
forward, by reprovisioning existing services and resources to better meet
the needs of survivors.
Q Will any of the funding be given to perpetrators ?
Some funding will be spent on education and prevention programmes
targeted at changing the behaviour of perpetrators and potential
perpetrators, as well as looking at behaviours that are linked to child
abuse.
Q Why?
We have a commitment to give consideration to identifying and securing
funding for risk assessment and personal change programmes for:
• individuals who have admitted sexually offending behaviour but
without providing sufficient information to secure a conviction; and
• individuals who admit concerns that they may be at risk of sexual
offending and convicted sex offenders who remain at risk but are not
subject to statutory supervision and who require ongoing
support/intervention to reduce the risk they present to the public.
Q How do you know this will be worth doing?
Evidence from child protection and domestic violence work suggests that
investment in such approaches leads to altered behaviours in the longer
term. Potential solutions lie not only with improved access to more proactive
and responsive psychiatric/counselling services, but changing
attitudes to children, strengthening vulnerable families capacity to parent
safely, and providing access to change programmes both within the
justice system and outside for potential abusers not yet convicted.
Q. What support are you currently giving survivors?
The Executive directly supports a range of survivor and victim support
services in Scotland under various funding routes. There are many good
and valued services available, and more are developing all the time e.g.
within Children's services, for those with mental health problems, and
from implementing our Domestic Abuse and Victims' Support strategies
across Scotland. At a strategic level, we continue to work with
stakeholders in the NHS, local authorities and the voluntary sector to be
more responsive to identified needs. The key emphasis for our
Community Health Partnerships is on improving access to services,
particularly to disadvantaged groups.
Q Why is this work so important?
The cost of sexual abuse for individuals, for families and for society is
difficult to determine because of its hidden and often unrecognised
nature. However, whilst many survivors lead full and productive lives,
there is strong evidence to suggest that people who have been sexually
abused have increased vulnerability to alcohol or substance misuse
problems; engage in unprotected sex or put themselves sexually at risk;
experience a range of physical and mental health problems including
depression, anxiety, post-traumatic stress disorder, and other mental
health problems. Looking at this wide range of consequences, it is
obvious that the cost of sexual abuse to our society in terms of lives lost
or damaged, the impact on survivor's ability to life free of distress and the
financial cost of treatments, is considerable.
Q. What about services for men ?
We know that services for men in Scotland are very patchy. There is
representation on our Reference Group from organisations working with
male survivors of abuse. We also work in partnership with care providers,
who have statutory duties for service delivery. The Scottish Executive
currently funds Thrive, an organisation which works primarily with males
who have been the victims of childhood sexual abuse. The service
welcomes referrals from all over Scotland and aims to engage this group
who are often reluctant to come forward for help, and are unlikely to seek
help through conventional NHS services.
Q How does the strategy link with other strategic work for
survivors?
There are already a number of important 'hooks' for this work to take
hold of in existing Scottish public policy. It falls naturally into the work of
the National Programme for Mental Health and Wellbeing - linking into
mental health promotion and prevention, tackling stigma, reducing suicide
and enabling recovery.
There is also very useful experience to draw on from the work on
domestic abuse, which is currently discussing ways to extend its remit to
cover rape and sexual abuse. Other important links are with Child
Protection and Substance Misuse. There is a crucial crossover on work
with survivors of In Care abuse. There is also work being done through
the recommendations of Respect and Responsibility, and the national
health strategy.
Q What training is available for prevention of abuse overall?
The Executive recognises the importance of ensuring that appropriate
training on identification and prevention of abuse is provided. Work is
due to be undertaken, as part of the implementation of the Adult Support
and Protection (Scotland) Act 2007, to map current training provision in
this area and to identify training needs. The Financial Memorandum, that
accompanied the Bill through Parliament, identified a number of training
costs associated with the Act including a specific adult protection training
post, based in an Adult Protection Unit, in each local authority area. It
also costed a regional development worker post to address inter-agency
training issues across a particular region.
Q What about other types of abuse - and abuse which has taken
place historically in institutional settings?
We are aware that the effects of all types of childhood abuse - physical,
sexual and emotional abuse and neglect - are immense and often interrelated,
and the boundaries between these very often merge. This is why
we intend to work on ways of helping survivors to cope with these effects.
We involve survivors of In care abuse in our Reference Group. We are
also setting up a sub group, which together with other groups focussing
on particular areas of the strategy, will gather information on any specific
requirements of this group of survivors.