Forget the past -- at our peril
Jul 21, 2012
Today, I'd like to "re-publish" a post I submitted to the American blog "the Higher Education Chronicle" in response to encouragement from a colleague who responded to my post to the PsyLaw - Psychology and Law discussion list in response to his re-posting of somethi g comparing NZ and US responses to breaches in scientific ethics -- the original post to The Chronicle, by Dr Carl Elliott, of Otago University is available here -- [LINK]
"A colleague posted the contents of the post on a professional list serve of which I am a member. The list is largely American in membership, though I live in Dunedin, as apparently does Dr Elliott. However, the end result of our experiences has left very different impressions on us. With apologies I shall submit, largely, the contents of my post to the listserv (PsyLaw -- for those psychologists interested in both Psychology and the Law):
As someone who's spent most of the last 10 years working and living in New Zealand, as a psychologist working in adult clinical and forensic services, I can't help but wonder what the motivation was in making this comparison.
It seems to be comparing "how bad" things are in the United States with "how good" things are in "little ol' Downunder New Zealand". To me, who's been here for so long, after starting work as a psychologist in Australia, but also who's worked in England, and visited clinical and forensic services in the United States, Canada, and Scotland, it's clear it's been written by someone who's never worked, clinically, in this country, at least not in "sensitive areas" and who doesn't have knowledge of clinical psychological research in this country.
The story does note, and this shouldn't be forgotten, that the researchers were EVENTUALLY successful, after struggling for years, nearly decades, in getting responsible authorities to take steps to do something about the situation. I submit that a similar situation could, again, all too easily take place here today, that the "responsible authorities" still often act anything BUT responsibly. "Fortunately", the researchers he mentions could point to actual bodies, and post mortems, as solid evidence that "inadequate and inappropriate" treatment had been provided to those clearly in need of better, more "responsible" services.
A specialist interest of mine is the assessment and treatment of adults with childhood trauma-related psychological problems, especially those receiving adult Mental Health and Alcohol and Other Drugs counselling (MH & AOD) services. But isn't that all, or at least most, of those with "chronic problems" you might ask? (well, you would if you know your stuff). A new study -- by Dore, Mills, et al (published in the journal Drug and Alcohol Review -- from Australia (not New Zealand, not surprisingly, but more on that later), is relevant to this. The study, by Glenys Dore, Katherine Mills and colleagues at the National Drug an Alcohol Research Centre at the University of New South Wales (Australia) has found that upwards of 80 per cent of those hospitalised when suffering from depression, suicidal ideation, and with histories of substance abuse, have a history of childhood trauma, most experiencing multiple traumas, and nearly half suffering PTSD symptoms. Most importantly, prior to being asked by the researchers, very few had been asked about their experience of trauma, and even fewer had ever received any treatment for trauma (not discussed in the abstract, but information given by Mills in a radio interview on Australia's Radio National).
In New Zealand, I take part in the Alcohol and Drug discussion list (AandD Digest) and put questions to those on the list about a year ago -- "How many of you regularly ask about history of trauma?", "How many of you work in agencies with a standard practice of inquiring about trauma?" -- I got four responses, from people who "often" asked about trauma, as individual practitioners, but none who said they worked in an agency that made it a standard practice.
In New Zealand, as I guess in most countries in Western society, the prevailing practice is to discharge people from hospital care as soon as possible, with one exception, "Ashburn Clinic", here in Dunedin. I have had prior dealings with Ashburn clients and at the time of first inquiry, was "surprised" at how many had histories of childhood trauma (of one sort or another, perhaps a few with unresolved childhood grief after the loss of a caregiver -- but see Simon (2012, Depression and Anxiety "Is Complicated Grief a Post-loss Stress Disorder?"). Now, of course, after much more study and research, the Ashburn clientele (typically acute service "revolving door" clients, some with histories of sexual abuse) the high incidence of trauma in this group of patients is only to be expected. Unfortunately, that's not how Ashburn staff conduct their practice -- although duration of stay is much longer than at the acute services, the service is run as a "therapeutic community", "research-based" -- although the research base is thirty years old, and bears no relation to recent findings on treatment of psychological trauma, complex trauma, or male reactions to trauma. Ashburn says it gives equal time to addressing both male and female issues, but in practice it doesn't allow input from those with expertise in male survivor issues -- the Male Survivors of Sexual Abuse Trust (MSSAT) is explicitly prohibited from having contact with male clients while they are in Ashburn -- I am particularly offended, as apart from having a specialist interest and expertise in the area, I am a Trust board member of MSSAT. This helps Ashburn -- it saves it from public scrutiny, it allows Ashburn to minimise costs -- it employs Psychiatrists, Psychotherapists-in-training (in New Zealand, it's possible to become a Psychotherapist after only two years supervised "training"), a part-time occupational therapist, and nurses -- nurses who do not need to be psychiatrically trained or experienced, and who do not need training in counselling, but with NO Psychologists on staff, and NO Clinical Social Workers.
A complaint by a former patient of Ashburn to the NZ Health and Disability Commission (HDC) was dismissed quickly after a perfunctory "investigation" (or not - the complaint was never made "formal" by the HDC) by the Psychiatrist President-elect of the RANZCP (Royal Australian and New Zealand College of Psychiatry) with the assurance that the Ashburn Psychiatrist-administrator "vouched for" his staff's expertise, and the assurance that the service was "research-based" (like Harvey saying, in the 16th Century, that blood transfusions are "research-based" without any view to modern research on blood typing, say).
There are "professed" standards Psychologists in NZ should comply with, like maintaining patient confidentiality, and providing services under supervision if one is not experienced in providing certain therapies (like therapy to victims of childhood trauma) but in practice, in a further complaint, this time to the NZ Psychologists Board, about these very issues, the psychologist's word was accepted over the "misguided patient's" but, of course, in such cases there are no dead bodies, and no postmortems to point to.
The research conducted by Dore, Mills et al would simply NEVER be supported, academically or institutionally, in New Zealand. Have a look at the academic staff at one of NZ's "premier" Universities - Otago -- there are fewer than a handful of Psychology academics conducting research into the clinical problems of adults (the Psychiatry Department is impossible for Psychology graduates to enter as PhD students -- I've tried), and there is next to NO academic research being conducted into clinical remediation of adults' problems as a result of childhood trauma, ANYWHERE in New Zealand, despite the very high prevalence of such problems in MH and AOD areas. Male Survivors of sexual child abuse are one of the most stigmatised "clinical groups" in our NZ Society, dreadfully socially disconnected (Martin Dorahy, an "academic and not clinical" (HIS description) researcher at the University of Cantebury has done some good research on this). Yet, at places like Ashburn, relevant professional outsiders are treated as "persona non grata".
I am not saying that I know it all, and have always known it all. I am well into double figures in terms of knowing people who have committed suicide, people I should have asked about their possible history of abuse, people I maybe should have done a better job of "being there" for. But it's one thing to admit one's past ignorance and to try to do better, despite that past ignorance. It's another thing to say "they're the best there is" when describing the staff at Ashburn, as the local Head of Psychiatry at Otago does, to deny one's ignorance and blunder on none the less.
Bessel van der Kolk wrote of the need for a new diagnosis, to try to secure more "adequate and appropriate" treatment for those children and adolescents who had experienced trauma. We ARE moving towards having better standards for "adequate and appropriate" MH and AOD services for adult victims of childhood trauma, as I am trying to do for male victims of sexual child abuse, but I doubt that better standards will prevail, generally, in NZ services, at least in MY lifetime, in the Public Service, though some "servants of the public" will try to do so. The bodies of suicides just don't seem visible to those who don't want to see. The bodies of people who have committed suicide after failing to receive "adequate and appropriate treatment" at places like New Zealand's Ashburn Clinic.
As a colleague succinctly put it, after reading my post to the PsyLaw listserv: "It is very hard for those whose professional motivation contains a large dose of humanity to work in modern societies where human suffering is objectified, impersonalized, and ultimately commodified and monetized for personal and political gain." New Zealand is a small country, with a severely limited economic base, but should this allow the country to deny advances in clinical research, and sweep real problems in clinical services under the rug, pretending to be "the best there is" when the situation is in fact vastly different.
In New Zealand, we are a long, long, long way from where we could be, where we should be, where we NEED to be."
Dore,G, Mills, K, Murray, RM, Teesson, M & Farrugia, P, 2012, 'Post-traumatic stress disorder, depression and suicidality invinpatients with substance use disorders', Drug and Alcohol Review, vol. 31, no. 3, pp. 294 - 302
The message, to me, is clear: if we let our "responsible public bodies" repeat the errors of the past, as they have done by their NON-response to the issues mentioned, grievous harm will befall many more innocents.