The Missing Links Mental Health and Sexual Assault Trauma

1. The Missing LinksMental Health and Sexual Assault Trauma

2. Education Centre Against Violence NSW Health statewide specialist organisation auspiced by Sydney West Area Health Service. Delivering learning & development opportunities and resources for NSW Health & interagency professionals working with children & adults who have experienced: sexual assault, domestic/family violence & physical & emotional abuse & neglect. An understanding of Aboriginal, cultural & community diversity is promoted.

3. What the research says… • Incidence & prevalence rates of childhood sexual assault is higher for mental health consumers than for the general population • Mental Health consumers are at greater risk of further sexual assaults in adulthood • Strong correlation between experiences of severe childhood abuse & the development of mental health disorders • Low disclosure & low file documentation rates for inpatient mental health facilities • Mental Health consumers would rather have the opportunity to speak about their abuse than not.

4. Factors that influence impact • Early onset • Frequency • Penetration • Duration • Relatedness to perpetrator • Other socio/cultural factors • Other abuse • Response to attempts at disclosure

5. Links between Childhood Sexual Abuse and Mental Health Problems • Depression • Anxiety • Suicidal & self-damaging behaviours • Anti-social behaviours • Substance Abuse • Eating disorders • Somatoform disorders • Borderline Personality Disorder • PTSD and Complex PTSD • Dissociative Identity Disorder • Adjustment Disorder Ferguson & Mullen 1993 &1999, Read & Agar 2003Briere 2005

6. Links between recent victimization & severe mental illness. WomenSMIGen Pop sex/a 20.3% 0.3% phys/a 25.6% 1.9% Men sex/a 7.6% 0.1% phys/a 34.1% 3.4% (Goodman L, et al 2001)

7. Sexual Safety • Sexual Safety is the state in which physical & psychological boundaries of individuals are maintained and respected. • Individuals can promote their own sexual safety by engaging in protective behaviours, assertive communication & respectful relationships • Systems can promote sexual safety by developing & operationalising policies & procedures which:

8. Sexual Safety policies • Support the rights of physical & psychological safety • Encourage the monitoring of professional boundaries • Encourage and provide professional development • Respond appropriately to breaches in boundaries.

9. NSW Health Guidelines for the Promotions of Sexual Safety in Mental Health Services 2nd Ed (2004) • Assessment for vulnerability to sexual assault • Assessment for potential to harm others • Areas to develop clear & relevent policies for the effective management of clients exhibiting sexually disinhibited behaviours • All new units must have single bedroom accommodation & gender specific safe areas • Workers are to respond to all client’s disclosures of sexual assault.

10. Pandora’s Box Read the statement which gives a ‘reason’ why we are reluctant to ‘ask’ or ‘discuss’ or ‘respond’ to sexual assault. Think about and discuss pro’s and con’s around this statement. Is it a myth ?, a fear? A valid concern? What do you need to consider?

11. Best Practice Principles • Knowledge around trauma • Clear policies & procedures for safety and response • Practices that are respectful, empowering & consultative • Information regarding rights & referrals • Consultation with Sexual Assault Services • Respond with safety first for the victim • Sexual Safety audits • Culture of transparency

12. Education Centre Against Violence- Mental Health • 1 day ‘Implementing Sexual Safety in mental health inpatient units • 2 day ‘Child abuse & neglect for child & adolescent mental health workers • 2 day ‘Interpersonal trauma, suicidality & cultural diversity • 2 day ‘Working with survivors of interpersonal violence with a major mental illness. • 2 day ‘Shades of grey? ‘ Ethics & boundaries in trauma work • 2 or 3 day ‘Holding the frame’ Advanced therapeutic work with adult survivors of child sexual assault. • 3 day ‘Adult & child sexual assault for mental health workers.

13. Education Centre Against Violence- Diversity • People with a disability who experience sexual assault. • Abuse & the elderly • Lesbians & Gay men who experience DV • Men who have been sexually assaulted • Children under 10 who sexually abuse other children • Interpreting in sexual assault & domestic violence cases

14. What the research says.. Jacobsen & Herald 1990- 47% of 100 inpatients, 44% not disclosed Mullen, Martin, Anderson, Romans, Herbison 1993- 2500 csa survivors, significant correlation to MIEverett & Gallop 2002 Severity of abuse related to severity of BPD symptoms on all features Wurr & Partridge 1996- 46% of 120 inpatients 14% documented disclosure Garnefski & Arands 1998- comparison study of 1,490 adolescents 50% with csa, increased adjustment probs for csa group Everett & Gallop 2001- Severity of abuse related to severity of BPD symptoms on all features Read, Agar, Aderhold- 2003 200 com MH client files, 92 documented s/a, 108 no documention, more delusions & hallucinations in s/a clients particularly tactile and persecutory .