Advocacy, support and therapeutic treatment services

The trauma of institutional child sexual abuse can have profound, long-lasting and cumulative impacts on victims and survivors. Many survivors face a complex set of challenges throughout their lives. At various times, depending on the circumstances, victims and survivors seek support from a range of mainstream and specialist services to help manage the detrimental impacts of abuse on their mental health. They may also need support for legal, education, housing, health, employment and financial issues, and for assistance with reporting abuse. The services used by victims and survivors span several sectors and can be difficult to navigate. The need for support often extends to secondary victims, such as family members, carers and friends and others in the institution where the abuse occurred.

Advocacy and support and therapeutic treatment services are interdependent, assisting victims and survivors by addressing their practical, emotional and therapeutic needs. Advocacy and support can connect people to therapeutic treatment and can also be therapeutic. A strong advocacy sector can ensure responsive support services, effective and appropriate therapeutic treatments, and continuous improvement.

Survivors’ needs are interconnected and change over time. The type of advocacy and support and therapeutic treatment a child, young person, adult or older person who has experienced childhood sexual abuse may need and find helpful can vary, depending on the person’s life stage.

There is no single entry point to the service system for child and adult victims and survivors or secondary victims of institutional child sexual abuse. The types of services that victims and survivors access to address their advocacy and support and therapeutic treatment needs include:

• mainstream services, including mental health services, alcohol and other drugs services, community health services, general practitioners (GPs) and private practitioners such as psychologists
• community support services, including services for specific populations, such as Aboriginal Community Controlled Health Services, multicultural organisations or peer-based survivor support groups
• specialist services, such as child and adult sexual assault services.

Advocacy and support and therapeutic treatment are also provided through other system responses to reported cases of child sexual abuse – for example, redress schemes or criminal justice procedures. They are also provided in various institutions with which child and adult victims and survivors engage, for example, schools, out-of-home care and detention settings.

Currently, service systems across Australia do not have the capacity to meet victims’ and survivors’ needs. Inadequacies are most apparent when a victim or survivor is experiencing multiple and complex impacts from the trauma of child sexual abuse, particularly for those deemed as not fitting within the remit of a single service. In many cases, one individual will be in multiple systems, moving in and out of services over many years.

Throughout our inquiry, we heard a strong message about the barriers victims and survivors face when seeking assistance from services. Many survivors said they faced stigmatising community and professional attitudes about child sexual abuse. We were told that information was difficult to find and that services were often prohibitively expensive. We also heard about the range of systemic and structural barriers that created difficulties for survivors. This included the fragmentation of the various service systems they access, the limited capacity of services to collaborate with one another, the lack of relevant knowledge among mainstream service providers, the scarcity of resources in specialist sectors and a lack of cultural competence and disability awareness. We heard that the standard of service provision is inconsistent within and across jurisdictions. We were told about particular gaps in services, including for children and young people who have experienced sexual abuse, male survivors, survivors entering aged care settings, and survivors in and transitioning out of prisons or other detention settings. We heard survivors living in regional and remote communities face additional barriers to accessing services and have less choice of service providers.

Inadequate service responses can re-traumatise survivors of child sexual abuse. Poor therapeutic treatment can leave a victim with chronic symptoms that follow them into adulthood. Ineffective treatment may cause victims to lose hope and disengage from treatment altogether.

For services and professionals, failing to improve collaboration can mean knowledge and skills remain compartmentalised. A workforce without the right skills, knowledge and support mechanisms not only diminishes the quality of service provision, but also puts at risk the wellbeing of professionals working in a challenging field.

Low-quality services also diminish the effectiveness of government expenditure. The lifetime impacts of child sexual abuse on victims, their families and communities are broad-ranging and entail significant economic costs to individuals and governments in healthcare expenditure, lost earnings and tax revenue, increased costs associated with income support and child protection, and increased crime. Supporting victims and survivors to heal will interrupt cycles of trauma and enhance their quality of life and their ability to lead productive lives.

Demand for services is likely to continue from victims and survivors of child sexual abuse in institutions who engaged with the Royal Commission during our inquiry. They may need continued support immediately following the conclusion of our inquiry, or other support in the future. As knowledge increases on the extent of child sexual abuse and as social stigma surrounding sexual abuse diminishes, demand may also arise from victims and survivors who have not engaged with the Royal Commission, but want to reach out for assistance.

Our Redress and civil litigation report recommended that the Australian Government establish a national redress scheme for survivors. In relation to support and therapeutic treatment, the report recommended that a redress scheme should:

• fund support services and community legal centres to assist applicants to apply for redress (Recommendation 52)
• offer and fund counselling for applicants, and their family members if reasonably required, during the redress process (Recommendations 66–68)
• on an ongoing basis, provide support for counselling and psychological care as needed throughout a survivor’s life, for survivors assessed as eligible for redress (Recommendations 2, 9–14).

In response, the Australian Government has announced a national redress scheme that will include psychological counselling as an element of redress.^[1] The Australian Government has also announced that:^[2]

• there will be a dedicated telephone helpline and website to provide information to survivors and their families about the redress scheme
• survivors will be connected with legal and community support services that are currently provided through the Royal Commission and which will continue to be funded to support the redress scheme.

The extent to which governments other than the Australian Government and non-government institutions opt in to the national redress scheme is not yet clear. However, we are encouraged by the Australian Government’s leadership of the redress scheme and its commitment to provide ongoing counselling and psychological care as an element of redress and fund services to assist survivors to apply for redress.

This volume addresses the service system more broadly than we considered in relation to redress. Some survivors will not seek redress, and others may not be eligible. Further, the service system includes service responses beyond counselling and psychological care.

Our recommendations in this volume are intended to guide funders and providers of advocacy and support and therapeutic treatment so that services adequately meet the needs of victims and survivors outside of redress. We note that the material in this volume will also be valuable to those involved in designing and implementing relevant services in relation to redress.

Our recommendations in this volume aim to achieve service systems that:

• have the necessary components to respond adequately to victims’ and survivors’ support needs
• understand the ways child sexual abuse and institutional responses to it can affect an individual, their families and communities, and the way trauma can influence service needs
• provide a holistic response to victims and survivors as part of a cohesive systems approach
• support services and staff to sustainably work with victims and survivors safely, efficiently and effectively
• are underpinned by the principles of trauma-informed practice and an understanding of institutional child sexual abuse; and by the principles of collaboration, availability, accessibility, acceptability and high quality.

We consider that to meet the needs of children and adults who experienced childhood sexual abuse in institutions, the service system should include:

• a dedicated system of community-based support services for victims and survivors. This system should provide advocacy and support, including counselling, case management and brokerage assistance to coordinate and link to other services; it should facilitate peer-led support; and it should include Aboriginal and Torres Strait Islander healing approaches and disability-specific services
• a national service to assist victims and survivors to understand legal options and to navigate the legal system
• a national telephone helpline and website that are central, visible points through which victims, survivors, professionals and the broader community can get information and assistance to navigate the service system
• enhanced capacity of sexual assault services to provide specialist advocacy and support and therapeutic treatment for victims and survivors, and address service gaps
• mainstream services capable of responding effectively to survivors with complex trauma.

^{[1] Senator G Brandis, Attorney-General & C Porter MP, Minister for Social Services, Commonwealth redress scheme for survivors of institutional child sexual abuse, media release, Parliament House, Canberra, 4 November 2016.
[2] C Porter MP, Minister for Social Services & Senator G Brandis, Attorney General, Commonwealth redress scheme for survivors of institutional child sexual abuse, media release, Parliament House, Canberra, 9 May 2017.}

The impacts of child sexual abuse are compounded by secrecy and silence. Many survivors told us in private sessions the existence of the Royal Commission encouraged them to speak out and seek support. For some, the stigma associated with child sexual abuse was lifted by the work of the Royal Commission. Witnesses in our public hearings spoke of the increased awareness and positive progress made in response to our inquiry. The conclusion of the Royal Commission presents a potential risk that this positive momentum will stall. For this reason, we recommend governments task and fund an organisation to reduce stigma, maintain national attention on the impacts of child sexual abuse and build and translate evidence to inform the ongoing development of good practice for advocacy and support and therapeutic treatment services.

We know that to have the best opportunity to heal, survivors must feel safe to disclose and receive support that is non-stigmatising, appropriate to their needs, and effective. Practitioners should have access to the best available evidence and programs should be evaluated to continuously drive improvement. During the Royal Commission, we gathered knowledge and contributed new evidence to support best practice. However, gaps in research on the experiences and outcomes of survivors of institutional child sexual abuse still exist. Evidence on the effectiveness of therapeutic treatment is also limited. In particular, research to better understand therapeutic treatment approaches for a range of specific groups is needed. Currently, the coordination and translation of knowledge about trauma-informed approaches into practice is ad hoc, impacting workforce skills and exacerbating shortages in expertise.

While a number of organisations currently advocate for survivors and support awareness raising in related areas of trauma and child maltreatment, there is no national focus specifically on child sexual abuse. We are of the view that to sustain the current momentum for change, ongoing national leadership is necessary to reduce stigma, promote help-seeking and support good practice.

To this end, we recommend the creation of a national centre for children and adults who experienced sexual abuse in childhood to:

• undertake strategic awareness raising and stigma reduction activities to foster help-seeking behaviours
• provide national leadership in knowledge translation by promoting best practice in education and training and by promoting nationally consistent practice guidelines
• promote strategically important research and evaluation to address gaps in knowledge.