The Frog continues his series on ACC changes, complaining this time about the changes to the management of sexual abuse counseling. Interestingly, Frog is moaning about counsellors having to provide a DSM IV mental health diagnosis, which is odd, because they have always been expected to provide a diagnosis from DSM IV. These diagnoses are mainly taken from the Axis II section of DSM IV which not considered to be true mental illnesses. Frog himself quotes the issue of co-dependency (very common in sexual abuse cases), but this is simply called dependent personality disorder which has a DSM IV code of 3016. Some may argue that co-dependency and dependent personality disorder are not quite the same thing, but, for the purposes of ACC classification, this is perfectly adequate.
The actual changes proposed are that the diagnosis now has to be established independently by a second psychologist and the number of sessions has now been shortened to 16. The number of sessions are not capped but application will have to be made for more sessions.
I can understand how most victims of sexual abuse will not appreciate having to tell their story to a second psychologist. I can also see ACC’s point of view that they wish to ensure that they are only funding people who have come to mental harm from this. There are currently abuse victims in the system who have had more than a hundred sessions and ACC might be justifiably concerned that these counsellors are taking advantage of the system at the victim’s and ACC’s expense.
ACC spin the restriction on sessions as “best practice” – a phrase which rings all sorts of alarm bells when used by bureaucrats instead of clinicians. Louise Nicholas reckons this is simply a cost-saving measure and I suspect she is probably right. In reality, once a diagnosis is established, fixing it takes as long as it takes. There is no magic number of sessions that is the perfect number because people are individuals with their own unique responses to such trauma. ACC will simply be quoting some nice piece of research with some sort of statistical average. I would not consider this “best practice” so much as “bureaucratic practice”. Another fine example of one-size-fits-no-one management.
As I have argued in a previous post, the underlying issue here is that you are trying to get an accident insurance company to cover mental health illnesses. Because of this, you will always have ACC looking to curtail the claim (as insurance companies do) and insist that the cause (the sexual abuse) and the injury (mental trauma) are linked (hence the second psychologist). The treatment of sexual abuse victims would be much better dealt with under DHB mental health aegis rather than ACC. There would then be no pressure to prove causality. Specific funding would have to be available for this, as the previous history of DHB and the treatment of sexual abuse is not good (which is why Labour gave it to ACC in the first place). DHBs would have to demonstrate a proper system for dealing with sexual abuse victims before funding would be available.