Guys – an online support group that SAMSN are running, in case you are interested. I got info on it through an email from another Counsellor (BlueKnot)! Absolutely no pressure to join, It’s just in case it’s something you’re interested in… (6pm-8pm may be Daylight Savings time, which we’ll check on before then)
Mon 21st Feb is in just over 1 & 1/2 wks away. This should be a wonderful chance for you guys! You’re definitely not alone.
Professor Jill Astbury MAPS, College of Arts, Victoria University
All forms of child sexual abuse (CSA) are a profound violation of the human rights of children. CSA is a crime under Australian law and an extreme transgression of trust, duty of care and power by perpetrators. The rights violations that define CSA are critically connected to the deleterious behavioural and psychological health consequences that ensue. This article examines the long-term effects of CSA on mental health and the determinants of these outcomes, in order to identify opportunities to ameliorate the profound psychological impacts of CSA on the lives of many victims/survivors. The article is based on a literature review commissioned to inform the APS response to the Royal Commission into Institutional Responses to Child Sexual Abuse, which was established in 2013 by the Gillard Government.
Prevalence of child sexual abuse
Rates of CSA are difficult to gauge accurately given the clandestine, sensitive and criminal nature of the sexual abuse to which children are exposed. Perpetrators of CSA are often close to the victim, such as fathers, uncles, teachers, caregivers and other trusted members of the community (Finkelhor, Hammer & Sedlak, 2008). CSA often goes undisclosed and unreported to professionals or adults for many complex reasons, including fear of punishment and retaliation by the perpetrator, as well as the stigma and shame associated with this type of abuse (Priebe & Svedin, 2008).
A global meta-analysis of child sexual abuse prevalence figures found self-reported CSA ranged from 164-197 in every 1,000 girls and 66-88 per 1,000 boys (Stoltenborgh, van Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). In Australia, Fleming (1997) used a community sample of 710 women randomly selected from the Australian electoral roll and found that 20 per cent of the sample reported experiencing CSA involving contact. Another national survey involving both men and women (Najman, Dunne, Purdie, Boyle, & Coxeter, 2005) reported a higher prevalence of CSA, with more than one third of women and approximately one sixth of men reporting a history of CSA. A more recent study in Victoria (Moore et al., 2010) reported a prevalence rate of 17 per cent for any type of CSA for girls and seven per cent for boys when they took part in the study during adolescence. Both Australian studies involving community samples of women or girls and men or boys indicate that girls are two or more times more likely to experience CSA than boys.
Long-term mental health consequences
A significant body of research has demonstrated that the experience of CSA can exert long-lasting effects on brain development, psychological and social functioning, self-esteem, mental health, personality, sleep, health risk behaviours including substance use, self-harm and life expectancy. CSA often co-occurs with physical and emotional abuse and other negative and stressful childhood experiences that independently predict poor mental and physical health outcomes in adult life.
Nevertheless, the research literature indicates that when other predictors of poor adult mental health are statistically controlled, CSA remains a powerful determinant of psychological disorder in adult life (Kendler et al., 2000). Strong evidence from twin studies indicates that a causal relationship exists between CSA and subsequent mental disorders. Twin studies necessarily control for genetic and family environment factors and a number since 2000 have documented significant associations between CSA, depression, panic disorder, alcohol abuse/dependence, drug abuse/dependence, suicide attempts and completed suicides.
A systematic review and meta-analysis of studies published between 1980 and 2008 (Chen et al., 2010) found that a history of sexual abuse including child sexual abuse was related to significantly increased odds of a lifetime diagnosis of several different psychiatric disorders, including anxiety disorders, depression, eating disorders, posttraumatic stress disorder (PTSD), sleep disorders and suicide. A particularly strong link between CSA and subsequent PTSD has been found.
Although the diagnosis of PTSD may be appropriate for those who have been exposed to relatively circumscribed CSA, Herman (1992) argued more than two decades ago that this diagnosis does not adequately capture the psychological responses of people who are repeatedly traumatised over a long period of time, experience subsequent re-victimisation in adolescence or adult life and typically display multiple symptoms of psychological distress and high levels of psychiatric co-morbidity. For survivors of this kind of CSA, Herman (1992) proposed the expanded diagnostic concept of complex PTSD on the grounds that it was better able to accurately capture the complex psychological sequelae of prolonged, repeated trauma.
Risk of suicide: Australian research
Survivors of CSA face a significantly increased risk of suicide and a higher prevalence of suicide attempts and ideation. An Australian follow-up study (Plunkett et al., 2001) of young people who had experienced CSA compared with those who had not, reported that those with a CSA history had a suicide rate 10.7-13.0 times the national rate. Furthermore, 32 per cent of those sexually abused as children had attempted suicide and 43 per cent had thought about suicide. None of the non-abused participants had completed suicide.
A more recent Australian study confirms and extends this finding. Cutajar and colleagues (2010) conducted a cohort study of 2,759 victims of CSA by linking forensic records from the Victorian Institute of Forensic Medicine between 1964 and 1995 to coronial records up to 44 years later. They found that female sexual abuse victims had 40 times higher risk of suicide and 88 times higher risk of fatal overdose than the rates in the general population. Interestingly these rates were even higher than those for males, in contrast to the usual gender pattern for suicide. The respective rates for males were 14 times and 38 times higher than those in the general population.
Determinants of long-term mental health outcomes
While victims/survivors of CSA face greatly increased risks of poor mental health in adult life, a significant minority do not go on to develop psychological disorders (Saunders, Kilpatrick, Hanson, Resnick, & Walker, 1999). Broadly, two approaches to explaining this finding have informed research: differences in the nature of the abuse that has taken place; and post-abuse factors that positively mediate or intervene in the development of negative long-term mental health outcomes.
Nature of the sexual abuse
The likelihood of experiencing severe, negative mental health outcomes in adult life as the result of CSA is increased by several abuse-specific characteristics. Large scale epidemiological studies have consistently documented that forced penetrative sex, multiple perpetrators, abuse by a relative, and a long duration of CSA (e.g., more than a year) predict more severe psychiatric disturbance and a higher likelihood of being an in-patient in a psychiatric facility in adult life.
More than 20 years ago, Pribor and Dinwiddie (1992) investigated different types of CSA of increasing severity and found that incest victims had a significantly increased lifetime prevalence rate for seven psychological disorders including agoraphobia, alcohol abuse or dependence, depression, panic disorder, PTSD, simple phobia and social phobia. Bulik, Prescott and Kendler (2001) also confirmed that a higher risk for the development of psychiatric and substance use disorders was associated with certain characteristics of the abuse, including attempted or completed intercourse, the use of force or threats and abuse by a relative. More severe and chronic abuse which starts at an early age has also been reported to increase the risk of developing symptoms of dissociation.
Post-abuse mediating factors
Certain factors, both negative and positive, are likely to intervene after CSA has taken place and to mediate adult mental health outcomes.
Coping strategies Specific coping strategies used by survivors can positively or negatively predict long-term psychological outcomes. Overall, positive, constructive coping strategies such as expressing feelings and making efforts to improve the situation are associated with better adjustment (Runtz & Schallow, 1997; Tremblay, Hebert, & Piche, 1999), and negative coping strategies, including engaging in self-destructive or avoidant behaviours, with worse adjustment (Merrill, Thomsen, Sinclair, Gold, & Miller, 2001). However, the coping strategies used by survivors are contingent to some degree on the availability of social or material resources over which children have little or no control.
In addition, the number of negative or maladaptive coping strategies used is predictive of the likelihood of sexual re-victimisation in adulthood (Filipas & Ullman, 2006). This strongly indicates that the link between CSA, negative coping strategies and adverse adult psychological outcomes is strengthened by sexual re-victimisation. Several studies have confirmed this relationship.
Re-victimisation CSA is associated with an increased risk of subsequent violent victimisation including intimate partner violence and sexual violence in adolescence and adulthood (see, for example, Classen, Palesh, & Aggarwal, 2005). Sexual re-victimisation involving rape or other types of sexual abuse/assault poses a potent risk for worse psychological health in adult life. A number of studies have confirmed that women who are sexually re-victimised compared with their non-revictimised counterparts have more severe symptoms of psychological distress in adulthood.
Social support and reaction to disclosure Historically, the role of social support and other societal and cultural factors in determining survivors’ responses to CSA has been under-explored in comparison with the heavy focus on the survivor’s role in responding to sexual trauma. Increased interest in the contribution of social support and other sociocultural factors has prompted increased investigation into the social contextual factors that can mediate adult outcomes following childhood violence, many of which are associated with the reactions to disclosure.
Delay in the disclosure of CSA is linked inevitably with other delays, all of which are harmful to the child. These include delay in putting in place adequate means to protect the child from further victimisation, delay in the child receiving meaningful assistance including necessary psychological and physical health care, and delay in redress and justice for the victim. Without disclosure, negative health outcomes are more likely to proliferate and compound. Conversely, disclosure within one month of sexual assault occurring is associated with a significantly lower risk of subsequent psychosocial difficulties in adult life including lower rates of PTSD and major depressive episodes (Ruggiero et al., 2004).
Yet experiences of disclosure are not uniform and whether they are positive or negative depends on the reactions of the person to whom the CSA is disclosed. Unfortunately, negative reactions to disclosure are common, constitute secondary traumatisation and are associated with poorer adult psychological outcomes (Ullman, 2007). Such reactions include not being believed, being blamed and judged, or punished and not supported, all of which can compound the impact of the original abuse and further increase the risk of psychological distress including increased symptoms of PTSD, particularly when the perpetrator is a relative.
Specific characteristics of disclosure appear to be protective against the development of psychiatric disorders. This finding highlights the importance of social support in concert with effective action by the person in whom the child confides. The degree to which someone is affected is likely to reflect various indicators of the severity of the abuse as well as countervailing protective factors such as the strength of family relationships and the survivor’s self-esteem. One such factor is a warm and supportive relationship with a non-offending parent, which is strongly associated with resilience following CSA and lower levels of abuse-related stress.
Implications for psychological training and practice
The research outlined above shows conclusively that CSA is associated with multiple adverse psychological outcomes, although such outcomes are not inevitable. The identified mediating or intervening factors that increase or decrease the risk of developing psychological disorders as a result of CSA have important implications for psychological training and for the practising psychologists who work with survivors of CSA.
Training on CSA
It is a matter of grave concern that the issue of CSA has been neglected in psychology training. When psychologists lack appropriate knowledge and skills to work with survivors they put both their clients and themselves at risk and can cause unintended harm. Training on CSA is urgently needed in psychology programs to disseminate evidence to students on the protean psychological consequences of CSA as well as the skills necessary to carry out the demanding mental and emotional work of treating survivors. Survivors can have chronic, complex problems in many areas of functioning and psychological disorders can overlap with physical health problems, including pain syndromes and high risk health behaviours such as alcohol, tobacco and drug use. Careful long-term psychological care is often necessary. As survivors may seek help from a range of psychologists, it is important that all psychologists are educated about the magnitude and psychological consequences of CSA.
Apart from acquiring more in-depth knowledge of the emotional effects of CSA and experience in trauma-related interventions, postgraduate courses should prepare practitioners for how exposure to their clients’ traumatic material can traumatise them as well. To remain psychologically healthy while working with survivors of CSA, psychologists need to be able to recognise symptoms of secondary traumatic stress and develop self-care strategies and support systems that will help them to manage the stress related to working with CSA survivors.
Most practising psychologists today who work with survivors have acquired their knowledge and skills ‘on the job’ post-graduation or as a result of their own initiative by attending workshops delivered by specialists in the field. An unknown number of registered psychologists may have no training on CSA and a more systematic continuing education program should be available and accessible so that all psychologists are equipped, at the very least, to ‘do no harm’ to the clients who have experienced CSA.
Implications for psychological practice
Knowing how to facilitate disclosure and take a comprehensive trauma history is an essential first step in developing a treatment plan for survivors of CSA. How a psychologist responds to a client’s disclosure will have an enormous impact on whether a survivor continues or abruptly terminates treatment. Any hint of disbelief, blame or judgment is likely to fracture the client’s fragile hope that she or he will be believed and that it is safe to undertake the painful task of working through the original abuse and its aftermath. If the response to a disclosure is negative it may be years before a survivor is willing to try again, and in the meantime the psychological burden of the abuse and its effects can proliferate. The effort to remain silent and keep the abuse hidden is extremely isolating and cuts off access to potential avenues of psychosocial support.
It would be a mistake for psychologists to assume, for example, that knowing about prolonged exposure therapy for the treatment of PTSD, would, by itself, be sufficient to offer effective treatment to survivors. Beyond the symptoms of traumatic stress associated with CSA, survivors often struggle with many other pressing concerns. These often relate to the deep betrayal of trust by the adult/s with a duty of care towards them as children. This betrayal can prompt persistent negative self-perceptions, difficulties in trusting others and their own judgement, and abiding feelings of shame and intrinsic ‘unloveability’ that contribute to insecure, unsatisfying relationships in adult life. These same issues can impinge on the client-psychologist interaction, making it challenging to establish a robust therapeutic alliance or maintain appropriate boundaries.
CSA does not result in a single disorder such as depression, treatable within the 10 sessions supported under the Better Access to Mental Health Care initiative. The chronicity and complexity of the disorders stemming from CSA require much longer term mental health care. The current system under Medicare is very poorly suited to meeting the mental health care needs of perhaps the most numerous and psychologically vulnerable group in society – CSA survivors.
The Royal Commission has provided a timely opportunity to closely examine the enduring, deleterious and multi-faceted impacts of CSA on survivors, how institutions in which abuse took place failed to intervene and the kind of assistance survivors believe will be most helpful in healing from their traumatic experiences. Psychology has much to contribute to this process and to ensure that the best available psychological evidence is put forward to address the profoundly disturbing phenomenon of child sexual abuse.
Clergy-perpetrated child sexual abuseIn contrast with the large evidence base amassed since the 1980s on the prevalence and health consequences of CSA occurring in the general community, minimal research was published before 2000 on CSA perpetrated by clergy or others working for institutions or organisations, and evidence remains limited in scope.There is an additional theological and spiritual dimension to clergy-perpetrated abuse that sets it apart other forms of CSA, including a spiritual and religious crisis during and after the abuse (Farrell & Taylor, 2000). CSA perpetrated by priests and other members of the clergy has been described as “a unique betrayal” (Guido, 2008) and the “ultimate deception” (Cook, 2005), and the implications of such abuse for victims are eloquently described by McMackin, Keane and Kline (2008):The sexual exploitation of a child by one who has been privileged, even anointed, as a representative of God is a sinister assault on that person’s psychosocial and spiritual well-being. The impact of such a violent betrayal is amplified when the perpetrator is sheltered and supported by a larger religious community. (p.198)Psychological consequences of clergy-perpetrated child sexual abuseClergy-perpetrated sexual abuse of children can catastrophically alter the trajectory of victims’ psychosocial, sexual and spiritual development (Fogler et al., 2008). In the US, investigation into the Catholic Church by the John Jay Research Team repeatedly identified certain psychological effects of clergy CSA in the personal testimony of survivors and family members. These included major symptoms of PTSD with co-occurring substance abuse, affective lability, relational conflicts, and a profound alteration in individual spirituality and religious practices associated with a deep sense of betrayal by the individual perpetrator and the church more broadly (John Jay College, 2004, 2006; McMackin et al., 2008).Some of these negative psychological outcomes are shared with survivors of CSA in the general population but those related to spirituality, religious practices and a sense of betrayal by the church alter the nature of the harm caused by clergy-perpetrated CSA. While a diagnosis of PTSD may be useful as a starting point in understanding and treating survivors of clergy CSA, Farrell and Taylor (2000) contend that “there are qualitative differences in [clergy-perpetrated CSA] symptomatology, which the PTSD diagnosis cannot explain” (p. 28). Such symptoms include self-blame, guilt, psychosexual disturbances, self-destructive behaviours, substance abuse, and re-victimisation. These symptoms are argued to emanate from the theological, spiritual and existential features of clergy CSA. For these reasons, Farrell and Taylor (2000) suggest that a diagnosis of complex PTSD (Herman, 1992) offers a better fit for the symptoms reported by survivors of clergy-perpetrated CSA.Preventing clergy-perpetrated child sexual abuseThe history of denial, cover up and delays in response to disclosures of clergy CSA by churches has been well documented, with their responses to perpetrators evidencing a failure to implement any effective preventative measures. To stop institutional CSA from occurring, it is critical to understand the situational indicators of such abuse so that the opportunities they afford to perpetrators to commit the crime of CSA can be identified.Parkinson and colleagues (2009) identified that having immediate and convenient access to minors were the defining characteristics that facilitated abuse. The evidence also suggests the need for parents and their children to be made much more aware of the grooming tactics used by clergy who perpetrate CSA. The John Jay College study (2006) identified the strategies that allowed the perpetrators to become close to the child they subsequently abused including being friendly with the victims’ families, giving gifts or other enticements such as taking them to sporting events or letting them drive cars, and spending a lot of time with victims.A recurrent theme in Australian victims’ accounts is how their parents’ religious beliefs and trust and reverence for members of the clergy meant that they could not conceive of the possibility that priests could sexually abuse their children and betray their own vows. Yet there is ample evidence that this trust was sadly misplaced and the same caution that would be applied to other members of society needs to be applied to the clergy.Finally, in tandem with a message from churches that there is zero tolerance for CSA, there needs to be a clear and trustworthy process in place, independent of the churches, that encourages children to disclose CSA safely and confidentially. Educational programs in all schools beginning in primary school might be one way of achieving this.Victims of clergy-perpetrated CSA need to be heard with respect and compassion, given meaningful assistance to meet their psychosocial needs, and provided with justice through those who perpetrated the abuse and those who covered it up being held fully accountable. Only then will it be possible for recovery from the immense trauma of clergy CSA and the rebuilding of shattered lives to truly begin.
Parkinson, P., Oates, K. & Jayakody, A. (2009). Study of reported child sexual abuse in the Anglican Church. Submission to the Victorian Inquiry into the handling of child abuse by religious and other organisations.
Plunkett, A., O’Toole B., Swanston, H., Oates, R. K., Shrimpton, S. & Parkinson, P. (2001). Suicide risk following child sexual abuse. Ambulatory Paediatrics, 1 (5), 262-266.
Pribor, E. F. & Dinwiddie, S. H. (1992). Psychiatric correlates of incest in childhood. American Journal of Psychiatry, 149, 52-56.
Priebe, G. & Svedin, C. G. (2008). Child sexual abuse is largely hidden from the adult society: An epidemiological study of adolescents’ disclosures. Child Abuse and Neglect, 32(12), 1095-108.
Ruggiero, K. J., Smith, D. W., Hanson, A., Resnick, H. S., Saunders, B. E., Kilpatrick, D. G., Best, C. L. (2004). Is disclosure of childhood rape associated with mental health outcome? Results from the National Women’s Study. Child Maltreatment, 9, 62-77.
Runtz, M. G. & Schallow, J. R. (1997). Social support and coping strategies as mediators of adult adjustment following childhood maltreatment. Child Abuse and Neglect, 21(2), 211-226.
Saunders, B. E., Kilpatrick, D. G., Hanson, R. F., Resnick, H. S., & Walker, M. E. (1999). Prevalence, case characteristics, and long-term psychological correlates of child rape among women: A national survey. Child Maltreatment, 4,187-200.
Stoltenborgh, M., van Ijzendoorn, M.H., Euser, E. M. & Bakermans-Kranenburg, M. J. (2011). A Global Perspective on child sexual abuse: Meta-Analysis of prevalence around the world. Child Maltreatment, 16(2), 79-101.
Tremblay, C., Hebert, M. & Piche, C. (1999). Coping strategies and social support as mediators of consequences in child sexual abuse victims. Child Abuse and Neglect, 23, 929–945.
Ullman, S. E. (2007). Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors. Journal of Child Sexual Abuse, 16(1), 19-36.
Bulik, C. M., Prescott, C. A., & Kendler, K. S. (2001). Features of childhood sexual abuse and the development of psychiatric and substance use disorders. British Journal of Psychiatry, 179, 444-449.
Chen, L. P., Murad, M. H., Paras, M. L., Colberson, K. M., Sattler, A. L., et al. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clinic Proceedings, 85(7), 618-629.
Classen, C. C., Palesh, O. G. & Aggarwal, R. (2005). Sexual revictimization: A review of the empirical literature. Trauma, Violence & Abuse, 6(2), 102–129.
Cook, L. J. (2005). The ultimate deception: Childhood sexual abuse in the church. Journal of Psychosocial Nursing and Mental Health Services. 43(10), 18-24.
Cutajar, M. C., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D., Wells, D. L. & Spataro, J. (2010b). Suicide and fatal drug overdose in child sexual abuse victims: A historical cohort study. Medical Journal of Australia, 192(4), 184–187.
Farrell, D. P. & Taylor, M. (2000). Silenced by God: An examination of unique characteristics within sexual abuse by the clergy. Counselling Psychology Review, 15, 22-31.
Filipas, H. H. & Ullman, S. E. (2006). Child sexual abuse, coping responses, self-blame, PTSD, and adult sexual revictimization. Journal of Interpersonal Violence, 21, 652-672.
Finkelhor, D., Hammer, H. & Sedlak, A. J. (2008). Sexually Assaulted Children: National Estimates and Characteristics. National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART–2) Bulletin. US: Department of Justice.
Fleming, J. (1997). Prevalence of childhood sexual abuse in a community sample of Australian women. Medical Journal of Australia, 166, 65-68.
Fogler, J. M., Shipherd, J.C., Clarke, S., Jensen, J. & Rowe, E. (2008). The impact of clergy-perpetrated sexual abuse: the role of gender, development and posttraumatic stress. Journal of Child Sexual Abuse, 17(3-4), 329-358.
Guido, J. (2008). A unique betrayal: Clergy sexual abuse in the context of the Catholic religious tradition. Journal of Child Sexual abuse,17(3-4), 255-269.
Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5 (3), 377-391.
John Jay College. (2004). The nature and scope of sexual abuse of minors by Catholic priests and deacons in the United States, 1950-2000. Washington, DC: United States Conference of Catholic Bishops.
John Jay College. (2006). The nature and scope of sexual abuse of minors by Catholic priests and deacons in the United States- supplementary data analysis. Washington, DC: United States Conference of Catholic Bishops.
Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J. & Prescott, C.A. (2000) Childhood sexual abuse and adult psychiatric and substance use disorders: An epidemiological and co twin control analysis. Archives of General Psychiatry, 57, 953 -959.
McMackin, R.A., Keane, T. M. & Kline, P.M. (2008). Introduction to special issue on betrayal and recovery: Understanding the trauma of child sexual abuse. Journal of Child Sexual Abuse, 17(3-4), 197-200.
Merrill, L. L., Thomsen, C. J., Sinclair, B. B., Gold, S. R. & Milner, J. S. (2001). Predicting the impact of child sexual abuse on women: The role of abuse severity, parental support and coping strategies. Journal of Consulting Clinical Psychology, 69(6), 992-1006.
Moore, E. E., Romaniuk, H., Olsson, C. A., Jayasinghe, Y., Carlin, J. B. & Patton, G. C. (2010). The prevalence of childhood sexual abuse and adolescent unwanted sexual contact among boys and girls living in Victoria, Australia. Child Abuse and Neglect,34 (5), 379-385.
Najman, J. M., Dunne, M. P., Purdie, D. M., Boyle, F. M. & Coxeter, P. D. (2005). Sexual abuse in childhood and sexual dysfunction in adulthood: An Australian population based study. Archives of Sexual Behaviour, 34, 517-526.
Disclaimer: Published in InPsych on October 2013. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.OCTOBER 2013 | ISSUE INDEX
“If a community values its children, it must cherish their parents” – John Bowlby, 1951
At Beacon House, we are passionate about working with networks who are supporting families at risk of breakdown, where children are identified as being ‘In Need’ or meeting criteria for child protection procedures. We also sometimes work directly with families (or their professional networks) where care proceedings have been initiated, where the parties are open in principle to supporting therapeutic intervention prior to a final hearing. Please note that this sometimes requires an extension to standard timescales, as long as this is safe for the child.
The role that we take is somewhat different from that of an independent expert; we commence every piece of work with an overarching question of “What would need to be put in place for everyone in this family to be safe, and have their needs well met?”
Our work is inspired and shaped by the pioneering writing and research of Dr Patricia Crittenden. Crittenden’s key text, ‘Raising Parents’, shines a light on attachment throughout the lifespan, and the impact of parents’ own early years and developmental experiences on their capacity to safely parent their own children.
“Supporting – cherishing – parents is central to caring for their children. Doing so makes emotional sense, functional sense, and economic sense; parents are the only resource that is never cut back. Moreover, they are the architects of society; let’s value all parents and assist those that need help”
Patricia Crittenden, 2008.
We offer three different pathways for families at risk of breakdown – all with a primary focus of meeting the emotional and psychological needs of the caregiver, and facilitating them to do the same for their children:
Case Consultation to the Allocated Social Worker
Case Consultation to the Professional Network
Parental Therapeutic Needs Assessment
Consultation to the Allocated Social Worker
Why choose this?
This option is useful when:
There are parts of a family’s situation that are difficult to understand
There are multiple significant needs, and it is difficult to know which to prioritise
Things feel ‘stuck’, or expected change is not happening
It is difficult to accurately assess risk
Aspects of the case are having a powerful impact upon the allocated worker
What is involved?
Key background reading is undertaken by the consulting Psychologist (e.g. chronology, PAMS assessment, assessments by other mental health professionals).
The Allocated Social Worker meets with the consulting Psychologist (either at one of our clinics, or the Social Worker’s usual base), and is guided through the process of developing a trauma and attachment informed, psychological formulation of the case.
The Social Worker is supported to connect with the emotional and psychological impact of the case for them, and thus, understand the ‘helping’ attachment relationship more deeply. This understanding is incorporated in to the formulation.
What happens next?
Initial recommendations are shared during the consultation session. Recommendations are likely to include:
Attachment and trauma informed strategies for working with the family
Priority needs to be addressed (i.e. those most likely to result in timely change)
How to sequence interventions
How to optimise the attachment relationship between parents and professionals
A written case formulation will be provided by the consulting Psychologist within two weeks of the consultation.
Case Consultation to the Professional Network
Why choose this?
This is a useful option when:
A case is complex, with the potential for risk of harm to children or young people is significant, and a number of different agencies are involved
There are parts of a case that are difficult to understand, and there is a lack of consensus within the professional network
There are multiple significant needs that require the input of a large number of professionals, and it is difficult to know which to prioritise
The professional network is not working as effectively together as everyone would like
Professionals, and the family, feel stuck and frustrated
Aspects of the case are having a powerful impact upon the all of the professionals involved, which may be manifesting as difficulties in relationships between professionals
What is involved?
Key background reading is undertaken by the consulting Psychologist (e.g. chronology, PAMS assessment, assessments by other mental health professionals)
The entire professional network meets with the consulting Psychologist (either at one of our clinics, or a convenient location for the network), and is guided through the process of developing a trauma and attachment informed, psychological formulation of the case.
Considerable time is dedicated to supporting the entire professional network to connect with the emotional and psychological impact of the case for each individual, and the network as a whole. The patterns of survival, defence, attachment, resilience and compassion within the team will be ‘brought to life’ in the room, and the network will be supported to observe these patterns with acceptance, curiosity and respect. This understanding is incorporated into the formulation.
What happens next?
We ask professional networks to approach these consultations with openness, honesty and self-reflection. Therefore, we do not minute or record what is shared.
In the final part of the meeting, the consulting Psychologist will facilitate the network to bring their reflections together in to a clear and concise plan for future working.
Parental Therapeutic Needs Assessment
Why choose this?
Empirical evidence tells us that the most powerful way to meet the emotional and psychological needs of a child is to meet the emotional and psychological needs of their caregiver. Creating a safe and secure care environment in the home has more profound and long-lasting impact than any individual therapy provision or even a number of discrete therapies.
Working alongside West Sussex County Council, we have developed a specialism in meeting the therapeutic needs of vulnerable parents. Often, parents come to us with a history of significant adversity, disruption, loss and trauma. They may have been removed from their own birth family. They may have insecure and mistrustful attachments with professional caregivers. They may find it difficult to relate openly to ‘help’, as help may feel threatening, overwhelming, or confusing.
A Parental Therapeutic Needs Assessment may be appropriate when there is a recognition that a parent’s own psychological and emotional vulnerabilities are serving to inhibit their capacity to parent their own children in the way that they would want to. We are very happy to work alongside statutory services to proactively engage parents who are anxious, ambivalent or unsure.
What is involved?
We commence all of our assessments with a professional network meeting. It is really important for parents to know that all of the professionals around them are working together in a joined-up way, and that there is an overall commitment to supporting them therapeutically. This meeting happens with the knowledge of the parent, but they would not usually be in attendance. This is an opportunity for professionals to share both their concerns and their hopes.
Following this, we would typically undertake any background reading, and meet with the parent over two to three hours to complete a clinical interview and administer psychological measures. Our aim is to develop a psychological ‘formulation’ of the parent’s difficulties, both as an adult in their own right, and as a parent. This involves developing an understanding of:
The parent’s own early years environment, early experiences of care, and developmental experiences.
The story of the parent’s key transitional stages (e.g. childhood to adolescence, adolescence to adulthood).
Understanding any significant life events, including the experience of becoming a parent.
A detailed picture of how difficulty and distress impact upon daily life, including the challenges of parenting.
The factors that seem to make things worse, or stop them from getting better.
How the parent experiences ‘help’, in the context of their own attachment pattern, and how they relate to professional caregivers.
The parent’s strengths, resources, skills and qualities.
All of this information is then brought together, underpinned by psychological theory and research evidence. We draw upon this understanding to generate our therapeutic recommendations for the parent.
What happens next?
Our assessment letter will be ready within three weeks of the last assessment appointment. This letter will include our formulation, and detailed recommendations for the type of therapeutic intervention that we think would be most helpful. We will invite the parent and allocated Social Worker to come back to meet with us face-to-face, to share our formulation and therapeutic recommendations. We usually conduct this meeting in two parts, allowing the parent to be the first person that our feedback is shared with.
Where therapeutic intervention is recommended, a phased programme will be devised, allowing the commissioning service to regularly review progress before commissioning the next phase. Please see ‘How will progress be reviewed?’
The psychological interventions that we use with vulnerable parents include:
Cognitive Analytic Therapy
Comprehensive Resource Model
Eye Movement Desensitisation and Reprocessing
Internal Family Systems Therapy
Mentalization Based Treatment
If, as part of a Parental Therapeutic Needs Assessment, it becomes clear that the parent-child relationship could be further supported by a dyadic intervention, this will form part of our recommendations. Most often, individual intervention with parents will be sequenced to take place before their child is brought into a therapeutic space with them.
How will progress be reviewed?
Therapeutic progress is something which is continually reviewed throughout the intervention. During the feedback and treatment planning meeting with the parent and Social Worker, the intervals for review will be agreed. Review can take the form of a telephone call between therapist and Social Worker, a written report, or a professional’s review meeting.
Alongside this, we have three main ways that we evaluate therapeutic progress:
During the Therapeutic Needs Assessment, the parent will be asked to fill out a number of questionnaires, which will be re-administered at the end of each piece of work.
At the start of the therapeutic intervention, the parent will be asked to identify three therapeutic goals, and scale them to show how well they feel they are achieving those goals. We will review these goals and the scaling at the end of therapy.
At the end of therapy, both parent and referrer will be asked to tell us how satisfied you feel with your experience of coming to Beacon House, and whether you feel the difficulties you have been working on have improved.
How do I make a referral?
You can request a referral form by contacting the clinic on 01444 413939. Alternatively, you can email firstname.lastname@example.org. Please specify which service you are requesting: case consultation, professional network case consultation, or therapeutic needs assessment and your preference of whether the work should take place from our Cuckfield or Chichester clinic. If you are unsure of the right option, please feel free to request a free of charge initial telephone conversation with Dr Laura France, Adult Services Lead, to help you to select the most appropriate service.
Your referral form and supporting documentation will be reviewed by our Adult Services Lead, who will then provide an estimate within three working days. We are usually able to commence work immediately on the receipt of a Purchase Order number. We do not have a waiting list and can usually organise the first appointment within two weeks.
Our commitment to working therapeutically with parents is rooted in our commitment to the safety, protection and well-being of children. Please see our Safeguarding Policy here.
(Please do not send Post or attend for Therapy) Registered Name Beacon House Psychological Services Ltd Registered in England and Wales. Registered Address AD5 Littlehampton Marina, Ferry Road, Littlehampton BN17 5DS Registered No: 09205920Chichester 01243 219 900Cuckfield 01444 413 939Enquiry: Message Us
1.1The Joint Select Committee (Committee) was formed to inquire into the Australian Government policy, program and legal response to the redress related recommendations of the Royal Commission into Institutional Responses to Child Sexual Abuse, including the establishment and operation of the Commonwealth Redress Scheme and ongoing support of survivors. 1.2The Committee is required to table its final report in May 2022.1.3Section 192 of the National Redress Scheme for Institutional Child Sexual Abuse Act 2018 (the Act) provides that the relevant Minister must conduct a review of the National Redress Scheme (NRS) as soon as possible after the second anniversary of NRS operation. The Committee notes that the NRS commenced 1 July 2018, and as such, the review must commence prior to 30 June 2020. 1.4Early in its deliberations, the Committee resolved that its first priority should be to review the early experience of survivors with the NRS and use their evidence to identify priority issues that should be addressed by the second anniversary review. 1.5It is the Committee’s expectation that the Minister for Families and Social Services and the Department of Social Services (DSS) accept the findings in this interim report and ensure that the matters identified are incorporated into the terms of reference and design of the second anniversary review as a matter of priority.
Objectives and Scope1.6On 2 April 2020, the Committee announced that it would table an interim report into the implementation of the NRS to reflect the evidence received so far by the Committee.11.7It remains the Committee’s intention that this report will inform the work and priorities of the legislated second anniversary review of the NRS which is to commence after 30 June 2020.1.8The Committee has resolved to finalise a second interim report before tabling its final report in May 2022.
1.9On 13 February 2020, the Committee issued a media release announcing initial public hearing program. Due to matters associated with COVID-19 on 16 March 2020, a separate media release was published noting the hearing program would continue as advised via teleconference.1.10Since the establishment of the Committee, six public hearings have been held. Transcripts can be found on the Committee website and a list of witnesses that appeared is at Appendix A.1.11The Committee invited submissions to be received by 29 May 2020, noting that submissions could be received after that date. The Committee also informed people that confidential and name withheld submissions would also be received. To date the Committee has received 20 submissions, which are listed at Appendix B.
1.12Chapter 1 details the scope of the activities conducted to undertake the interim report and includes discussion of the Committees aims for the interim report. 1.13Chapter 2 provides a background to the development of the NRS, and discusses how the government has implemented the recommendations of the Royal Commission into Institutional Child Sexual Abuse. Consideration of previous parliamentary committee findings is also included in this section. 1.14Chapter 3 examines the NRS application process. The three components of an offer of redress including monetary payment, counselling services and direct personal responses are also examined.1.15Chapter 4 considers NRS participation and examines factors that may be influencing a survivor’s decision on whether to apply for redress through the NRS. The number and rate of institutions joining the NRS is also discussed. 1.16Chapter 5 discusses the appropriateness of funder of last resort provisions within the Act.1.17Chapter 6 outlines areas that the Committee believe need to be examined in order to maximise the opportunities of the second anniversary review to deliver improved survivor experiences and outcomes from the NRS.1.18Throughout the interim report the Committee has included quotes that refer to the NRS as the scheme or redress scheme. The Committee has not amended these references.1.19Two appendices accompany this report and provide details on submissions received and a list of witnesses who appeared before the Committee. 1.20A copy of this report, transcripts of hearings and submissions received are available on the Committee’s website at www.aph.gov.au/redress.
Following the recent 4corners Airing of ‘Boys Club’ On 17 Feb 2020, various Headlines have been released:
Elite school that backed sex pest teacher instead of his victim orders staff to escort students on public transport over fears for their safety after damning TV exposé (DailyMail)
St Kevin’s headmaster Stephen Russell resigns over character reference for paedophile (The Guardian)
St Kevin’s College headmaster resigns, dean of sport stood down following grooming scandal (ABC News)
Grooming has also appeared amongst numerous Journalist Publications, continuing the traditional reluctance to acceptance of genuine alterations required following the Final Report of the 13-17 #CARC. This Final Report is available for viewing at the URL: https://www.childabuseroyalcommission.gov.au/final-report
To those who’ve kept up-to-date with some of the BBC situations (Buchanan, Golding, Bradley and Lloyd) may recognise some similarities (parallels); Those past Students / ‘Old Boys’ (sorry if offended) reminded of other Elite Schools mentioned during ‘Boys Club’; Parents of current and past BBC enrolments; most importantly surviving families of Deceased / Suicided / Drug-effected / Care-facilitated BBC Graduates / Past-enrolled : Your losses are shared by many others! You’re definitely not alone, with facilities of Compensation/Redress, Public Apologies and Counselling available to ALL.
By Debbie Cuthbertson, Simone Fox Koob, Farrah Tomazin and Chris Vedelago
February 16, 2020 — 12.00am
“Jesus is coming to get you.”
That was the warning Lionel (not his real name) alleges Christian Brother Rex Francis Elmer gave in an attempt to silence him after he sexually assaulted him at a Melbourne orphanage in the 1970s.
The words rang in the boy’s ears long after.
Elmer “kissed me on the forehead and said well done” after molesting him, Lionel said.
“He then told me not to tell anyone. He said to me, if you tell anyone, Jesus would come down from heaven and take me away and you will not see your family or friends ever again,” he told police.
“I was scared and really believed what he had said, that Jesus would take me away if I said anything. I was an altar boy and I believed this.
“The word ‘Jesus’ was ringing in my ears.”
The assaults continued, as did the warnings, for more than a year, Lionel said. It was a vicious circle.
“This sort of incident happened at least two to three times a week,” Lionel said in his witness statement to police. “The same sort of thing. I would piss the bed scared at night that [Elmer] would come to me. I was petrified of him. I couldn’t tell anyone because I was scared of getting a flogging and being taken away by Jesus.”
Another boy who had complained about being abused by Elmer was flogged with a cane by another brother then removed from the St Vincent de Paul Boys’ Home, Lionel said.
“He dobbed Elmer in for doing something sexual to him. It was two days later that this guy who got hit and dobbed got taken from the home.”
He said he told another boy at the home about the abuse. That boy replied that Elmer had also sexually assaulted him. “We were both scared that Jesus would come to take us,” Lionel said. “This is what we thought happened to [the boy who left].”
Lionel said he also confided in a nun from a nearby convent. “I told her what Elmer had been doing to me. She said ‘Darling, please do not say a word to anyone, I will fix this for you’.”
Soon after he confessed to her, Lionel alleges, Elmer and two other brothers brutally beat him, including with a cane, in an assault that left him bleeding from his behind and bedridden for more than a week.
While he was still recovering, Lionel said, Elmer abused him again. He punched the boy repeatedly, giving him a black eye and bloody nose after the boy vomited on the brother during the assault.
When I spewed, he punched me in the face with a clenched fist … three or four times. I couldn’t see out of my left eye for a few days until the swelling went down. He said to me ‘Jesus is coming to get you’. This is the last time that I ever saw Elmer.”
In mid-1976, Elmer suddenly left St Vincent’s. “I don’t know what happened to Elmer, but he was gone from the home,” Lionel told police.
Lionel, now aged 59, said of the ongoing effect of his abuse: “I get teary talking about this but I have learnt to deal with it. It is always in my mind and it always hurts me.”
On Monday, Elmer pleaded guilty in the County Court to the indecent assault of two other complainants, also from St Vincent’s, in the 1970s, after which prosecutors did not proceed with charges related to Lionel’s accusations. That meant that Lionel’s witness statement was never tendered and Elmer never faced his allegations.
Court documents show the 75-year-old was charged in 2018 with 19 counts of indecent assault and one of false imprisonment in relation to three victims during the 1970s.
The first complainant, who had been in state care since infancy, told police Elmer repeatedly abused him between the ages of 11 and 13, usually while he was sleeping in a dormitory.
He said the first assault occurred when Elmer threw off his bed covers, demanded he do as he was told, and put his hand down the boy’s pyjama pants. The assault, however, was interrupted. “Someone has approached the bed as he was being assaulted by the accused, who then fled,” according to the police brief of evidence.
“The complainant was summoned to the office of the now deceased Brother in charge, Brother Carey … Shortly thereafter the complainant recalls being sexually abused by the accused on many occasions.”
The second complainant, who came to the orphanage aged seven after his parents died, was sexually abused by Elmer repeatedly between the ages of nine and 11.
On one occasion Elmer led the boy, who had been playing in the grounds of the home after school, upstairs into his private bedroom at the end of a dormitory.
Elmer produced a large book with pictures of human anatomy and made the boy sit on his knee while the brother asked him to name various body parts, including male genitalia, and masturbated against the boy’s back during the 20-minute assault.
As dormitory master at St Vincent’s, Elmer was responsible for up to 40 children at a time, aged between seven and 14.
The most senior Christian Brothers officials in Victoria knew in mid-1976, when they removed Elmer from the orphanage, that he had abused boys there.
Later that year they made Elmer principal of St Joseph’s, a Catholic boys primary school in Warrnambool.
Elmer was in charge of the school from 1976-81. He worked in the town alongside several other notorious paedophile clerics including priests Paul David Ryan and Robert Claffey, and fellow Christian Brother Edward Dowlan (all since jailed for child sexual assault).
Elmer left Warrnambool after more complaints about his behaviour at St Vincent’s reached his superiors. In 1988 he reappeared, in an article from a small Tasmanian newspaper called Western Tiers, published in his home town of Deloraine.
“Brother Rex Elmer will be spending Christmas at home with his mother … and family before leaving to go to Africa to set up a Mission School at Arushia [sic] in Tanzania with two other Christian Brothers,” the newspaper reported proudly on page 3.
“Rex was a pupil at Our Lady of Mercy College and St Patrick’s [College] and has been teaching at various schools, including Warrnambool in Victoria. He is hoping to see old school friends while at home and we all wish him well in the future.”
The school Elmer helped found in northern Tanzania is now run by the Congregation of Christian Brothers East Africa District and has more than 1300 students.
Elmer left the school in 1993 after more complaints surfaced, and was sent by his order to the United States for counselling at the St Luke Institute for paedophile Catholic clergy in Maryland.
He was charged In 1997 with 69 counts. He was convicted the next year of 12 counts: one charge of indecent assault against each of the 12 boys. The judge sentenced him to five years in prison with a minimum of three years and four months.
At his sentencing, Judge Thomas Neesham described Elmer, then 53, as a man of God who had indulged in “depraved self-gratification”, The Age reported at the time.
“Each of your victims was a small boy in your care. Each was an inmate,” he said. The boys, many of them orphans or wards of the state, were aged between eight and 12.
“They were helpless,” Judge Neesham said. “Who could they tell, who would believe them?
“All your victims wear deep emotional scars to this day as is brought out by their victim impact statements,” he said. “As a teacher and a man of God, how could you not have had an inkling of the devastation to your victims’ faith … by your act of misbehaviour.
“Your victims will have to live in the misery that you inflicted upon them … You will have to live with the disgrace that you brought on yourself and your family.”
Elmer had been living in a Christian Brothers home in Brunswick at the time of his first conviction and was still working for the order in an administrative role. In 2002, after his release from prison, he was placed him on “restricted ministry”.
He now resides in a property owned by the order in the same suburb. His bail was extended following his guilty plea this week until his sentencing in July.
“The accused is currently retired and resides within the Christian Brothers Community,” a police brief from his current case states.
The order has received 22 claims for redress from people who allege Elmer sexually abused them as children, according to documents it provided to Austalia’s Royal Commission into Institutional Responses to Child Sex Abuse, which reported its findings in 2017.
Those claims all related to accusations of multiple assaults alleged to have occurred between 1969 and 1985 – from when Elmer was a novitiate (a Christian Brother in training) to the years when he worked in South Melbourne and Warrnambool, mainly during his time at St Vincent’s.
The documents also show the order knew that a number of victims had alleged that other clergy had participated in the abuse by Elmer.
Catholic Church Insurance (CCI) refused to cover the Christian Brothers in relation to any claims of abuse by Elmer after 1976, ruling the order – including its most senior cleric, then provincial Brother Patrick Naughtin – had “prior knowledge” of his crimes.
“Whilst the Visitation was in progress [13/06/1976], a Child Welfare Office reported to Brother [redacted] Acting Superior that Rex had been interfering with little boys; this was true and it had been attended to by the Provincial,” said a CCI document submitted to the royal commission.
In a letter dated June 20, 1976, Naughtin wrote to the acting superior of the orphanage: “Thank you very much for the report on the situation which developed … in connection with Br Elmer. It is indeed a serious and most unfortunate state of affairs and I am grateful for your bringing it to my attention so promptly.”
In his letter, Naughtin (who died in 2010) expressed concern for Elmer’s reputation, not for the welfare of the children he had abused. He also referenced the illegality of Elmer’s actions but did not report him to authorities.
“I have interviewed Br Elmer and discussed this position with him. He is clearly aware of the serious nature of his actions and I took pains to point out his legal and moral obligations in the matter.
“It seems to me extremely unlikely that there will be any recurrence of what had happened … It would seem to me best at this stage not to transfer Brother … immediately, though I would propose to announce his change next August – the usual time for releasing details of staffing for the following year.
“In coming to this decision I have been guided by the Brother’s assurance for the future, by his excellent record to date and by consideration for his reputation which would undoubtedly be harmed by a sudden transfer at this time.”
When Elmer left St Vincent’s he was replaced by Edward ‘Ted’ Dowlan, now one of the most notorious paedophile clerics in Victoria. They later worked together at St Joseph’s in Warrnambool.
A 1996 letter from an unnamed Christian Brother was submitted to the Victorian parliamentary inquiry in 2013 into the handling of child abuse by institutions, including religious orders. It sheds light on how widespread the abuse was at St Vincent’s, and how determined the church was to dismiss it.
“I accepted with good faith the sudden departure of Brother Elmer from the school and the appointment of Brother Dowlan to fill his position,” the letter reads. “Indeed, I spent many extra hours, which I could ill afford, assisting Brother Dowlan to understand the nature and behaviours of the boys and the teachers.
“As you are probably aware, many of St Vincent’s residents had been sexually abused, and often displayed overt and outrageous sexualised behaviour. Furthermore, they expected or requested that this behaviour be reciprocated by the adults in their lives. A major part of our endeavours at St Vincent’s was getting these boys to a point where they would expect not to be abused. Now I find that all of this work could have been compromised by the presence of a man like Brother Dowlan …
“I take note of your congregation’s position that the brothers were unaware of Brother Dowlan’s tendencies and activities. I cannot accept this as a reasonable position. I cannot believe that the number of allegations against this man could have been kept from his various communities’ and the congregation’s superiors. I find that expecting the public to believe this is preposterous. I do not believe this plea of ignorance.”
St Vincent’s orphanage closed in 1997. It was home to more than 6000 boys over 140 years.
Information provided by the Catholic Church to the royal commission showed it had received 114 claims of sexual abuse at the home, the highest number of any Catholic institution in Victoria.
The Christian Brothers declined to answer The Age’s questions about Elmer, citing “ongoing legal proceedings”.
Whether an entry is made ‘Unknown’ (Anonymous), ‘made-up’ (Pseudonym) or actual name (relations): everyone is invited to read over other comments, add their own or even send us your message – which we’ll repost (Anonymously). Particularly over this weekend, is a great chance to read of others who’ve gone through similar horrors that you know of!
Sometimes people come to our website because they are looking for personal help.
If someone asked you right now if you are having thoughts of suicide, what would your honest answer be?
If your answer is ‘yes’, this is undoubtedly a very difficult time for you. You don’t need to go through this alone. Help is available.
It is not uncommon for men who have experienced child sexual abuse or sexual assault to have to deal with suicidal thoughts. An experience of child sexual abuse or sexual assault can have men feeling distressed and overwhelmed both at the time and at stressful times in the future. If suicidal thoughts are unchallenged they can convince a man that because he is doing it tough now it will always be like this. If there is time to talk about suicidal thoughts they can provide a clue to what a man holds dear, about certain connections he values and the dreams and aspirations he has for life. In order for such conversation to occur it is first important to make sure you are safe now.
If you think you might harm yourself call for help immediately
Reach out to someone you trust and ask for help. Tell them honestly how you feel, including your thoughts of suicide.
Call 000 (police, ambulance, fire) or
Call Lifeline 13 11 14 or
Go, or have someone take you to your local hospital emergency department.
It is important to understand suicidal thoughts
I felt like shit, like there was no way out. It wasn’t like my first thought but it was there in the background.
Remember that thoughts about suicide are just that – thoughts. You don’t need to act on them. They won’t last for ever, and often they pass very quickly. Many people who have had serious thoughts of suicide have said that they felt completely different only hours later. It is common to feel overwhelmed and distressed during difficult times or when it seems that things will never improve.
Things you can do to keep yourself safe
Seek help early. Talk to a family member or friend, see your local doctor, or ring a telephone counselling service.
Postpone any decision to end your life. Many people find that if they postpone big decisions for just 24 hours, things improve, they feel better able to cope and they find the support they need.
Talk to someone. Find someone you can trust to talk to: family, friends, a colleague, teacher or minister. 24-hour telephone counselling lines allow you to talk anonymously to a trained counsellor any time of the day or night.
Avoid being alone (especially at night). Stay with a family member or friend or have someone stay with you until your thoughts of suicide decrease.
Develop a safety plan. Come up with a plan that you can put into action at any time, for example have a friend or family member agree that you will call them when you are feeling overwhelmed or upset.
Avoid drugs and alcohol when you are feeling down. Many drugs are depressants and can make you feel worse, they don’t help to solve problems and can make you do things you wouldn’t normally do.
Set yourself small goals to help you move forward and feel in control. Set goals even on an hour-by-hour or day-by-day basis – write them down and cross them off as you achieve them.
Write down your feelings. You might keep a journal, write poetry or simply jot down your feelings. This can help you to understand yourself better and help you to think about alternative solutions to problems.
Stay healthy. try to get enough exercise and eat well – Exercising can help you to feel better by releasing hormones (endorphins) into your brain. Eating well will help you to feel energetic and better able to manage difficult life events.
See your local doctor or a specialist to discuss support or treatment. Discuss your suicidal thoughts and feelings with your doctor, talk about ways to keep yourself safe, and make sure you receive the best treatment and care.
See a mental health professional. Psychologists, psychiatrists, counsellors and other health professionals are trained to deal with issues relating to suicide, mental illness and well being. You can find them in the Yellow Pages or visit your GP or contact a crisis line for information.
Thoughts of suicide occur to many people and for a range of reasons. The most important thing to remember is that help is available. Talking to someone is a good place to start, even though it may seem difficult. Tell someone today!
Find help in your local area
If you’re feeling suicidal, getting help early can help you cope with the situation and avoid things getting worse. After you get over a crisis, you need to do all you can to make sure it doesn’t happen again. There are a number of sources of support in your local area. If the first place or person you contact can’t help, or doesn’t meet your needs, try another.
Where to get help
Lifeline has centres all around Australia. Check their website for the centre closest to you, and for resources and information related to suicide prevention: www.lifeline.org.au or www.justlook.org.au.
General practitioner A GP can refer you for a Mental Health Care Plan. Look for one in the Yellow Pages, or contact your local community health centre.
Community Health CentresThese are listed in the White Pages.
PsychiatristLook in the Yellow Pages, or ask a referring organisation such as Lifeline’s Just Ask. To claim the Medicare rebate, you need a letter of referral from a GP.
PsychologistYou can find these through your GP, community health centre, the Yellow Pages or the Australian Psychological Society (APS). The APS provides a referral service on 1800 333 497 or visit their website at www.psychology.org.au.
Counsellors and psychotherapistsYou can find these through your GP, community health centre, or the Psychotherapy and Counselling Federation of Australia Inc (PACFA). PACFA have a national register of individual counsellors and psychotherapists available to the public at www.pacfa.org.au.
Gay and Lesbian Counselling and Community Services of Australia provides information and links to counselling services for gay and lesbian people. Telephone: 1800 18 45 27 or see the website for numbers in your state/territory, www.glccs.org.au
Who to call
For immediate support, when your life may be in danger, ring 000 or go to your local hospital emergency department.
National 24 Hour crisis telephone counselling services
Note: Many of these services also offer interpreter services for those people who speak English as a second language (ESL).
Acknowledgement: This page was created with reference to the “Living is for everyone” publication Promoting good practice in suicide prevention: Activities targeting men produced by the Australian Government Department of Health and Ageing: 2008.