Nick Smith, Minister for ACC, has promised an independent review after 6 months from implementation of the new clinical pathway ACC has pushed through inspite of wideranging protest from survivors and clinicians working with survivors alike. Sofar nothing seems to have been organised and the action group (therapists, counsellors, psychologists, doctors, psychiatrists, social workers and more) is still waiting for information about how the review will be conducted, who will conduct it, and what will be the reference points.
Those who have followed my reports about ACC will have cottoned on that I am mighty frustrated with the whole thing. I certainly don't think that we have been told the ugly truth yet about the scheming and hidden agenda that drove the government and ACC to act as they have. One thing is certain, it has nothing to do with improving services for survivors.
The summer- and holiday-time has seen a quitening of the protest against the shokking cuts. Understandably, because those who have been active need a rest and re-charge in order not to burn out. It's time now to start getting focused on what can be done not only to stop ACC from following through with their cynical plan for survivors. Check here what has been done sofar: WARNING: ITS LONG
1. In May, 2009 ACC sends out forms to all counsellors for a “desk” audit of information regarding qualification, recent training, and use of treatment modalities. In the past, such forms were discussed with SCAG re wording, content, generally best practice. This was not done- thus basic areas such as proof of counsellor's membership of professional body, thorough details of supervision, proof of cultural supervision, number of ACC clients were not requested. Thus an opportunity to monitor safe practice was not utilised.
2. In August, ACC goes on “Road show” to counsellors in main centres, to inform them of new “Clinical Pathways” which radically changes the way sexual abuse services are delivered to clients. These new ways of working are to begin on 14 September 2009 without consultation with SCAG or any other parties affected by the changes.
3. Staff from Sensitive Claims does not attend this “Road show”- it is presented by Dr Peter Jansen, Senior Medical Advisor to ACC and a researcher who has been employed by ACC attached to Sensitive Claims Unit who has been working on this project for the past year. Dr Jansen is a member of the Clinical Directorate who is responsible for formulating the Clinical Pathways.
4. This research project has been taking place in secret as neither SCAG nor TOAH NNEST have been informed. Sensitive Claims Advisory Group is made up of representatives of all professional bodies who provide sexual abuse counselling and medical services (pertaining to sexual abuse ) to ACC.
5. (The previous Labour Government has established a Taskforce on Sexual Violence, made up of ten Government Departments, and supported by Te Ohaakii A Hine-National Network Ending Sexual Violence Together (known as ‘TOAH NNEST’) which is the official body that provides community organisational representation on the Taskforce. ) Why were these groups not consulted?
6. When SCAG met with ACC on 27th March of this year- the last meeting before announcement of the Clinical Pathways- at that meeting there was no mention of the proposed changes. What is the reason for this omission? This group was meeting four times per year- at the March meeting the group was informed that meetings would be in future held twice a year as a “cost cutting measure” with the next meeting to be held on October 2. We can't help but wonder if this was deliberately done as another way of withholding of information regarding the proposed changes during the year.
7. As a result of general dissatisfaction at the national “Road shows”, counsellors were sent e mail by Dr Peter Jansen to say that the new Clinical Pathways have been modified and implementation to be delayed for a month, and counsellors have had two weeks to make submissions. This shows prior consultation would have been useful rather than an ill conceived, ill planned presentation of a plan that did not involve consultation with the professionals who actually do the work with the clients.
8. Under the new system, counsellors will be given two sessions to gain sufficient information and set goals for ACC to make a decision on whether the claim is accepted or not. (This is some improvement on the original plan to automatically send client to a clinical psychologist who was to carry out the assessment.)
9. We believe that it is impossible to carry out such an assessment in a safe and respectful manner in the time frame of 2 sessions; as well as to set goals for therapy during this time is simply not possible with clients who may be re traumatised by this pressure cooker assessment process.
10. ACC will then decide if the client needs to be seen by a clinical psychologist for another assessment on acceptability of claim if they feel insufficient information has been provided. ACC will then decide if the client begins the therapy with the counsellor who carried out the assessment or referred to a different counsellor, removing the client's choice of counsellor. Once a claim is accepted, clients will be allocated a maximum of 16 sessions to complete the work excepting “exceptional circumstances” when the client will be referred for an (expensive) specialist assessment with either a clinical psychologist or a psychiatrist. Generally if further sessions are required after this assessment, the client will be referred to a community agency such as Mental Health Services. These services are over burdened already and do not have the skilled therapists who are able to carry out this highly specialised work. The 16 or even less sessions may suffice for some clients but for many clients it will be an abusive process to have to see possibly their 4th professional in as many months to tell their story.
11. Counsellors will under the new system be required to label clients including children with a DSM IV psychiatric diagnosis which counsellors believe is disrespectful and unnecessary. Current regulation states that a mental injury (as defined in Section 27 of the IPRC Act,) means a clinically significant behavioural, cognitive or psychological dysfunction. It appears that ACC has decided, without legislative authority, to convert a significant dysfunction into a DSM IV psychiatric diagnosis to the detriment of the client.
12. ACC quotes the Massey Guidelines 2008 as the basis of these changes. Apart from the fact that ACC funded this research, counsellors believe that this research has been used selectively by ACC- and we understand that those who did the research at Massey are unhappy at the way their research has been used. In fact, in recent weeks the Massey researchers have publicly distanced themselves from the way ACC is interpreting their results. While they stated that short term therapy would work for some clients, nowhere in the Guidelines does it state that it will be effective for the majority of clients. There is a big difference in counselling requirements of a client who may have had a single incident of abuse with a good support system as opposed to a client who has been subjected to years of sexual abuse by multiple perpetrators both in childhood and adulthood. ACC seems to have overlooked the fact that we are dealing with some of the most vulnerable, damaged and marginalised members of our society.
13. We are thus waiting for ACC to publicly back down from their repeated claims that their Clinical Pathways are based on sound “best practice guidelines as supported by the Massey Guidelines”
14. Dr Jansen has not been able to ensure how this process would be made safe for Maori or Pacifica clients in his presentation. This needs to be addresses ASAP. As at end of November, we are still waiting for such guidelines.
15. ACC is showing a preference for clinical psychologists to do the work- while they may be well trained to assess for PTSD, they are not necessarily better trained than counsellors, psychotherapists or social workers who currently work in this area. ACC seems to have overlooked the importance of forming a trusting relationship between counsellor and client as part of the healing process.
16. The Clinical Framework ACC proposes is thus based on selective use of research that does not take into account of the reality of the diverse effects of sexual abuse and the reality that recovery is based on complex factors including personal capacities and a match of clients preference to treatment modalities. Under the new system, ACC will remove client choice of not only who is to provide the therapy but also what treatment modality will be provided. As the relationship between client and therapist is an important part of the therapy, we believe that this again will be detrimental to our clients.
17. An open letter to Nick Smith has been written and members of SCAG have requested a meeting with him- he has declined to meet with us. We would like ACC to instruct him to review this decision.
18. ACC have concerns about some of the over 700 counsellors nationwide who work in a way that their clients have hundreds of counselling hours. It is respectfully suggested that ACC contacts these counsellors and discuss these issues with those counsellors, rather than changing a whole system that on the whole has worked well for both counsellors and clients.
19. In an ACC media release on 20 August 2009, Dr Kevin Morris, ACC's Director of Clinical Services, and part of the Clinical Directorate, refers to the Massey Guidelines (2008) stating that sexual abuse should be viewed as a complex life experience not a disorder or life sentence. Yet somehow ACC has medicalised this complex life experience by requiring counsellors to give clients including children a DSM IV psychiatric diagnostic label. We believe that this is again disrespectful and damaging to our clients. We would like ACC to remove the requirement of giving clients a psychiatric label by use of the DSM IV criteria-there are alternative, more respectful ways of defining and describing a clinically significant mental injury.
20. In August, a request was made to ACC to gain access to statistics under the Official Information Act for the following information on a yearly basis for the past 5 years:
Total expenditure for Sensitive Claims Unit operations per annum
Total counselling costs per annum
Total expenditure for Diagnostic and Treatment Assessments (DATA) per annum
Total expenditure for Peer Reviews per annum
Total expenditure for Psychiatric Assessments per annum
Total expenditure for Independence Assessments per annum.
This information was due to be received 4th September, on which date an e mail was received from ACC to say that while they have now collected the data, they require an extra 10 working days to check accuracy and quality of the information. On 28th September, further e mail received from ACC to say that a further 10 working days is now required before they release this information which will be on the October 12, the day the new Clinical Pathways is due to commence.
WE BELIEVE ACC HAVE USED DELIBERATE DELAYING TACTICS IN NOT RELEASING THIS INFORMATION BEFORE COMMENCEMENT OF THEIR CLINICAL PATHWAYS. A complaint to the Ombudsman has now been lodged regarding this matter.
21. At NZ Association of Counsellors Conference in Hamilton, on 18 September, Dr Jansen reiterates amidst much opposition that this new scheme will benefit clients. He talks of the complements ACC has received on their proposed changes. As we have not heard of a single comment that is not negative, we are wondering where his information is coming from- certainly unlikely to be from counsellors or their clients.
22. At the above meeting, despite many pleas, Dr Jansen refuses to consider halting the process until wider consultation takes place. Many counsellors walk out of the meeting in protest. However, he does concede that that because of the universal concern of counsellors, the 4 sessions presently available for assessment may be retained under the new scheme. This again shows the lack of wisdom in no prior consultation with counsellors.
23. Also at this meeting, Dr Jansen reiterates that they are following Massey Guidelines. Counsellors present refute this and ask him to show where this New Pathway was proposed as being helpful in the Guidelines, which he was unable to do.
24. September 28: Peter Jansen tells NZ Herald reporter that people declined ACC funding have plenty of agencies they can approach who can provide sexual abuse counselling. This is simply speculation as agencies are already over worked and underfunded and simply do not have the trained and qualified staff who can do this extremely sensitive work. It will be to the detriment of clients and will increase the trauma in the lives of already traumatised clients. Inappropriate counselling in this very sensitive client group is likely to re traumatise already vulnerable people resulting in increased rates of stress, anxiety, depression and self harm. We would like Dr Jansen to name these agencies they must have already consulted about this.
25. We would like to know on what basis ACC has moved to the Clinical Pathways in the face of strong opposition from the Professional bodies, individual counsellors and allied health professionals as well as survivor groups.
26. TOAH-NNEST meets with ACC on 30th September. The group informs ACC that the pushing ahead with their Clinical Pathways will cripple the agencies they represent as many counsellors, particularly Maori counsellors, intend to resign, and the process will be dangerous and potentially lethal for survivors of sexual violence.
27. Tauiwi caucus of TOAH-NNEST at this meeting presents ACC with their Principles for the Development of a Clinical Pathway based on safety for survivors, effective therapy and research which addresses provider and funder needs. We would like the opportunity to discuss these Principles further with ACC and we would like to see ACC give these principles due consideration as it is a much more respective way of moving forward.
28. ACC acknowledges to this meeting that the Pathway needs to be more flexible and individually tailored. However ACC does not shift from their insistence on use of DSM IV, even though there are other methods of showing clear links between the abuse and its effects.
29. Also at this meeting, ACC state that they will consider their time frame of implementation and announce on Friday 2 October their decision.
30. SCAG meets with Dr. Jansen on 2 October, in presence of Sue Walker who is in charge of Sensitive Claims Unit. Peter Jansen announces that the implementation of the new Clinical Pathways is DELAYED YET AGAIN for another 2 weeks so that the Clinical Directorate is able to have more time to address the many concerns that have been expressed by counsellors and survivors. As stated previously, this is a clear indication of inadequate groundwork and lack of consultation by the Clinical Directorate resulting in this ill conceived, ill thought out scheme.
31. SCAG members were extremely disappointed that the delay is for such a short period of time which will not allow for thorough consultation and revision of the Clinical Pathway to take place. Even with the short time frame, an urgent workshop involving SCAG and TOAH NNEST was requested to find a more respectful way forward as the Clinical Directorate is firm in its resolve to implement the new Framework. Dr Jansen does not appear to be hopeful of such a workshop though he states he will take it away for consideration and make a decision during the next few days.
32. SCAG members informed on 6 October that ACC do not see benefit of the above request for an urgent workshop prior to implementation of new process. However, they do agree to hold two workshops prior to Christmas. It would have been much preferable to have some clinician input into the new process prior to implementation, especially in view of the fact that it has been delayed twice already because of its obvious deficiencies.
33. Lynne Pillay, Labour spokesperson for Victims rights, makes media release on 8 October stating that “the shameful debacle with ACC continues. Despite a common sense and measured approach from counsellors and psychotherapists throughout NZ, ACC continues to ignore their voices. All they are asking for is meaningful consultation to take place so that the guidelines can deliver support and care to victims and survivors of sexual abuse- this is clearly not the case under the new proposals. This is an appalling approach by ACC. “ She also voices concerns that ACC have not consulted with Ministry of Health or Rape Crisis Services about extra capacity or funding to support clients who would have previously been funded by ACC. She makes another media release asking ACC to go back to the drawing board on sexual abuse counselling changes and refers to the sham consultation process.
34. After complaints to the Ombudsman about unacceptable delays, ACC responds on 8 October to requests for statistics made on 16 August. The information requested is NOT provided- counselling costs and psychiatric assessment costs are combined together with psychological costs to produce between 12-13 million for each of the past 4 years. Thus it has been cleverly fudged- we know that a psychiatric assessment cost approximately $2500 and a session of counselling costs $69.70 (plus GST). ACC immediately notified this is unacceptable- informed unlikely they can break it down any further. However, they obviously had the individual costs to be able to combine them- so again appears to be deliberate avoidance of transparency. Another complaint has now been lodged with Ombudsman.
35. Complaints have now been lodged by professional bodies with Ombudsman, Disability Commissioner, and Commissioner for Children, Human Rights Commissioner, and Privacy Commissioner.
36. After 6 weeks, on October 9, response finally received from the Minister of ACC, Dr Nick Smith, responding to the open letter sent to him. He states that “not all victims of sexual abuse will be entitled to ACC assistance” reiterates the tightened DSM IV diagnostic requirement. Also states there was no requirement for ACC to consult with SCAG and TOAH-NNEST and other groups. HE ALSO STATES THAT THE NEW PROCESS IS NOT FUNDING DRIVEN. Then he contradicts himself by referring to the need to ensure the sustainability of the ACC scheme! Strangely, he also states that the new process has been designed “to ensure clients get the best treatment, when they need it, and as long as they need it” and refers to options other than direct counselling. He also refers to counselling costs being in excess of $15 million for each of the last 3 years- yet the data sent by ACC under OIA gives figures of between $12 and $13 million for each of the past 3 years- we would like Dr Smith to explain where this discrepancy comes from.
37. ACC continues to refer to the “thorough consultation that has taken place.” This implies a two way process- consulting and listening to feedback. In spite of a strong collective voice of protest, we have not been listened to and this unethical process is going ahead. It has been a dictatorial process with pre conceived strategies that have been planned in secret for the past year.
38. DSAC writes letter on 9 October to Peter Jansen re concerns around issues around privacy under the new system whereby ACC is able to request personal information from agencies which were not collected for the purpose of supplying to ACC – a clear breach of the Privacy Act. No reply has been received to date.
39. Chairman of ACC, John Judge, announces that “future of ACC is at risk.” He states that ACC is making changes to reduce external cost pressure and improve rehabilitation performance. He refers to measures including negotiating better deals with health professionals, better management of claims, tighter periods for support, limiting support to what was legally required, and reducing administrative costs. While not referring specifically to sensitive claims, it obviously has implications for our concerns.
40. October 10: ACC is calling in private case managers to handle up to 1500 claimants as it moves to cut $2 billion from its long-term claims bill. ACC confirms details in leaked e mails showing management faces a “challenging target” of cutting growth in the cost of existing claims. This will affect survivors who are receiving income related compensation as well as other claimants.
41. Teriyaki Daily news on 10 October runs article on ACC declining cover for children with clear PTSD symptoms on basis that “there were no clinically significant mental injuries arising from the events described.” The article refers to the huge numbers of clients waiting for decisions by ACC re eligibility and the increasing numbers turned down for cover in recent months.
42. Also in the Teriyaki Daily News on 10 October, Nick Smith's spokesperson states that “the origins of the new guidelines go back to 2004, when concerns were raised about the effectiveness of sexual abuse counselling.” We would like to know how and where these concerns were raised and why counsellors themselves and their representative SCAG were not informed of this concern at the time.
43. John Judge, on 11 October, in Sunday Star Times, states that ACC would not slash entitlements “but we are going to make sure that you only get the entitlements that you are due and that you need.” Thus it is becoming clear, that in spite of repeated denial, cost cutting is a significant factor in the proposed changes.
44. John Judge, on 12 October refers to “projected “$4.8 billion loss for ACC as reason for ACC cuts which now involve more than cut back on support of sexual abuse services- motor cyclists join the protest in the media. ACC in fact has not made a loss this year. Commercial doubts about the credibility of including projected future liability as a current 'loss'.
45. Increased media interest in sexual abuse concerns- several counsellors have been on National Radio for lengthy interviews, (as well as a survivor.) Articles and letters written by therapists published in National newspapers. Editorials in Auckland, Nelson and Taranaki newspapers supporting our concerns published.
46. Counsellors are receiving anecdotal evidence that the new process, set to begin on 27 October, is being already implemented as clients being informed that in spite of cover report being received, they are now required to consult another clinician who will decide who will become their therapist. Clients are choosing not to proceed. Also, numbers of clients declined cover continues to increase.
47. Contacted by Mental Health Case Manager concerned at “rumours” that they are included in with the “other agencies” who will be expected to accept clients declined by ACC. They state that they do not offer specific sexual abuse counselling and in fact they have clear instructions to refer such clients to other services such as ACC counsellors.
48. ACC is accused of “unethical practice” (14 October, Taranaki Daily Times). ACC acknowledges practice of counsellor's initial diagnosis being changed by one of their own (presumably newly employed) clinical psychologists in Wellington.
49. Lynne Pillay (Labour Spokesperson for Victims) releases several media statements voicing Labour's concern with the new process.
50. No response received from ACC to several e mails sent this week, asking for the correct information requested under the Official Information Act. This lack of even acknowledgement of weekly e mails requesting the information is to carry on for the next 6 weeks.
51. An ACC General Manager, Doreen Cosgrove, contacts Auckland Rape Crisis (16 October) in what appears to be damage control, discussing our concerns with the new Clinical Pathways.
52. Letter of support received on 16 October from Tartiana Turia.
53. Outrage at ACC statement in media (16 October) that sexual abuse victims will be entitled to a one off payment of $250 as compensation for damaged clothes. Again, if ACC had consulted with their advisory groups or had any understanding of the dynamics of sexual abuse, they would know that only when there is violence involved does clothing get damaged. Very few of our clients fall into this category, especially those abused as children, as it is easy for perpetrators to trick a child into compliance without the use of violence.
54. Professor Grant Gillet, Professor of Medical Ethics at Otago University, on October 16 agrees to support a submission for “ethics approval” for the new Clinical Pathways.
55. Eric Medcalf, Psychotherapist and previously Clinical Advisor for 5 years to ACC Sensitive Claims Unit, writes comprehensive letter to ACC critiquing the new Clinical Pathways, especially in areas of DSM IV labelling requirement, triaging, multiple and inadequate assessments and evaluations. He suggests ACC training and monitoring of counsellors if it is the quality of counsellors that ACC has issues with. (ACC is likely to suggest that it is not their role or at their expense to do this- however, it can be on user pays basis and a requirement for ACC counsellors to attend such training so counsellors are clear about reporting requirements)
56. Eric Medcalf also notes that the Massey Research supports the “16 sessions” argument ONLY IN RELATION TO SEXUAL ASSAULTS, which in their definition are one off single sexual assaults on adults. The Massey Technical Paper (available on line from Massey University) makes it clear that you can only use this argument in these scenarios. The Massey Research clearly differentiates between this group and survivors of Childhood Sexual Abuse. Interestingly, the paper also supports twice a weekly sessions for Childhood Sexual Abuse Survivors- this has not been mentioned by ACC.
57. Concerns about $250 clothing grant and its implications as well as general concerns about the new process sent to media on 17 October by concerned therapists.
58. Denise Cosgrove, an ACC General Manager on TV1 on 17 October, describing new Clinical Pathways as being designed to give certainty to clients, inform them if they are covered, to give them access to the support they need. She also stated that counselling may only be one of a range of support that people may need in their situation. We believe that the public should beware of this kind of nonsensical “business speak “ that ACC is fronting to the media.
59. ACC has taken a large ad in the main newspapers on Saturday 17 October attempting to justify the new process. Further damage control? Basically they are saying “don’t come to us for help if you have been sexually abused unless you can prove a DSM IV diagnosis – we can't help you unless you do. “ This of course means that survivors of sexual abuse who have been robbed of their self esteem, their ability to be clear about their boundaries, their ability to maintain relationships and jobs, robbed of their confidence and self respect will be excluded, as will those who have taken refuge in addictions such as drugs, sex, food, alcohol, work, exercise as their coping mechanism.
60. NZ Herald runs supportive editorial on Saturday 17 October “Don’t give Up on Victims of Sex Abuse”
61. Nelson group of concerned therapists, including Eric Medcalf who is visiting, meet with Nick Smith. Nick Smith is invited to immediately halt the process and call for an independent review. He is invited to work with SCAG and TOAH-NNEST to formulate a system that would improve the old system and take out the best of the new system. Nick Smith states that no savings are expected from the new process. (This is probably a likely outcome of the changes, as any savings in counselling costs will be quickly taken up by expensive clinical psychology assessments and even more expensive psychiatric assessments ($2500). Nick Smith goes away to think about what he has done and promises further dialogue with the Nelson group.
62. Sunday Star Times on Sunday October 18th publishes article regarding ACC's future plans to charge $100 excess on all claims- we presume that this includes sexual abuse claims. An example of yet another barrier to stop already disadvantaged clients access the help they need.
63. Members of SCAG, together with TOAH-NNEST and others, requested that the proposed implementation of the revised Clinical Pathways not begin on October 27 as planned but placed on hold until ACC carries out a detailed and proper consultation process with groups such as SCAG, TOAH-NNEST and the therapists who do the work with clients. Clients themselves should also be consulted about these changes and their views taken into account. These requests were ignored.
64. Well attended marches take place in Auckland, Wellington and Christchurch for National Day of Protest against ACC changes. TV and radio coverage.
65. TOAH-NNEST recently engaged a public lawyer to review the new SCU pathway for legality. We now have expert legal advice to the effect that the Pathway may be unlawful in two ways.
1) That the Act requires reasonableness in relation to the circumstances of every claimant and that the Pathway does not meet this statutory requirement.
2) That the changes import meaning into the law that is not justified by the statute – that is that s27 requires a clinically significant behavioural, cognitive or psychological dysfunction, not a DSM IV diagnosis.
68. Using our lawyer and this advice we have been able to get a meeting with the ACC Director of Operations to see if we can come to some agreement on the pathway.
69. On 19october it is announced that under the New Pathway, only psychologists, psychiatrists, and some psychotherapists and GP's with DSM IV qualifications are the only professionals deemed to be competent by ACC to use the DSM IV as a diagnostic tool. Counsellors and Social Workers are totally excluded, even if they have postgraduate qualifications in this area. Effectively, ACC determines who the client gets to see. It appears that clients will be given a list of counsellors by ACC if their claim is approved. It is unclear just who is likely to be on this list or how this process is likely to work.
70. According to report in Christchurch Press, 19 October, ACC is inundated with review requests. It appears that ACC has spent nearly $3.5 million on legal services during the past year, including $1.4 million paid to lawyers to defend reviewed decisions. (Any decisions ACC makes about a claim can be reviewed under the Claimant's Rights as long as it is carried out within 3 months of the decision made.) Mediation is also an option and is also funded by ACC.
71. During October, ACC continues public facade of “consultation” in the media- TV, newspapers.
72. By 20 October, ACC has ceased responding to e mails requesting information under Official Information Act. Ombudsman notified.
73. Dr Jansen, on 20 October, reiterates that clinical psychologists and psychiatrists are the preferred health professionals to provide DSM IV diagnosis. Others have to prove their experience. Social Workers and counsellors still excluded, even those with training and experience.
74. Mental Health Commissioner, Peter George, informed of concerns.
75. Many extremely experienced and well respected ACC counsellors publicly announce their refusal to work under the new system as they feel that it is unsafe and unethical.
76. Simon Collins, NZ Herald reporter, reports collective concerns of the professional bodies in his paper. Media reporting of concerns increases NZ wide.
77. TOAH-NNEST, on 21 October, engages public lawyer to challenge the legality of the New Pathways. Legal opinion points toward an injunction.
78. Nationwide drop in ACC referrals is reported.
79. Lynne Pillay continues to support protest against changes and asks questions in Parliament.
80. October 22: TOAH-NNEST proposes an alternative Framework and Principles for development of a Clinical Pathway based on a more respectful process of survivor’s needs, provider needs, funder needs, informed by relevant research. Offer to discuss this further not taken up by ACC.
81. Peter Jansen reiterates that minimum experience for DSM IV is post graduate paper where it is directly taught as part of clinical practice, such as psychologists and psychiatrists. However, other registered health professionals who have such training and experience, may also be considered. He is requesting other counsellors to advise prospective clients that they can only lodge the claim, and clients need to be informed that they are required to be referred on for diagnosis and provision of “guidance on therapy and support.” Counsellors are also asked to discuss with the client a range of support options until the assessment phase is completed.” Both counsellor and client groups are outraged at the lack of ethics of these requirements.
82. TOAH-NNEST makes final submissions on 25th October to ACC before the New Pathways commence on the 27th.
83. As a result of this, ACC backtracks on absolute DSM IV requirement and now permits use of other clinical tools if a reason is given. However, this still means that a mental health diagnosis is required rather than clinically significant symptoms. Again, this shows if proper consultation had taken place, these issues could have been worked through prior to announcement of the Pathways.
84. Peter Jansen notified in writing of our concerns on 25 October regarding sudden tertiary requirement for DSM IV diagnosis as a method of excluding experienced providers and stating that it would have been a more respectful process if time had been given for those wishing to use DSM IV to obtain such qualifications.
85. Letter written to Medical Council on 25 October to request their position on this issue as it is likely to adversely affect their client population also.
86. NZAC Press release on 26 October “ACC Shuts Door on Counsellors”- questioning why counsellors are left out of DSM IV diagnosing; questioning ACC's belief that someone can be abused and not have a level of psychological harm; questioning the need to put barriers to defer people from seeking help and again questioning the legality of ACC changing the requirement of a significant mental injury into a requirement of a diagnosable mental illness.
87. It is now clear that that the requirement for tertiary qualification in DSM IV with no warning/time to get these qualifications prevents the majority of providers from doing assessments now. An even greater issue is the ethics of having to give such a diagnosis- this is being questioned by most professional bodies at present.
88. Last minute negotiations with ACC on 26 October fail to stop implementation of the Pathways.
89. Nick Smith announces on 27 October an “Independent” Clinical Review of the Sensitive Claims Unit and the new approach to managing sensitive claims in 6 months time after repeatedly stating that he does not wish to intervene in the debate.
90. Lynne Pillay continues to support the protest against the changes both in Parliament and in the media.
91. On October 27 implementation goes ahead in spite of wide spread protest. Widespread anecdotal evidence reported that in fact the new process is being applied to claimants for some weeks prior to implementation date.
92. An on line petition to Nick Smith, Minister of ACC was set up to request him to take urgent action to delay implementation of changes to the Sensitive Claims Process until further consultation has taken place with representatives of the professional bodies, TOAH NNEST and survivors. In a very short space of time, this petition has gained just under 4000 signatures from professionals and survivors and supporters including clinical psychologists and psychiatrists. This petition was presented to Parliament by a group of therapists- Dr Smith chose not to be there to receive it.
93. Gail Kettle, from ACC Board and latterly head of SCU, continues to make media statements showing she is not listening to feedback from the Professional Associations and is determined to push through these changes, irrespective of effects on vulnerable sector of NZ population. We would expect that someone with her level of understanding of sensitive claims would have a more sympathetic understanding of the issues concerned.
94. One day after implementation date, adjustments to the new Pathways announced by ACC. Again, we need to state that a proper consultation would have avoided this need to publicly announce that they don't have a proper process in place.
95. Widespread media coverage of concerns about ethics of new Pathways.
96. By 28th October, reports pour in about Sensitive Claims Unit not being able to respond adequately and appropriately to questions around new pathways to counsellors needing information. There is ongoing confusion to all parties- SCU, counsellors, clients.
97. On 28 October, College of Clinical Psychologists, together with NZ Psychological Society, ( these 2 professional bodies represent all registered psychologists in NZ) produces media release expressing concerns that ACC is not being responsive to concerns of various professional bodies; concern about clients requirement to disclose to more than one clinician being unsafe; concern about survivors not meeting strict requirement for DSM diagnosis who may still be severely affected by trauma no longer being able access ACC funding; and the 16 sessions being applied across the board regardless of the severity of the trauma.
98. Again, lack of consultation is clearly showing.
99. Increasing numbers of ACC counsellors announce refusal to accept new clients under the new system.
100. It is clear that those with no DSM IV qualifications will not be paid for completing a cover report.
101. Media coverage intensifies: NZ Herald, 29 October: “ACC Scraps mentally ill Tag for Sex Abuse Help” ACC amends its own rules one day after implementation. However, a diagnosis of a psychiatric condition using alternative methods is still required.” Counsellors still object to this as it still requires us to label our clients as having a mental health diagnosis.
102. To date, pressure from Professional Body representatives has had some measure of success. From the original Pathway proposed in August, ACC have backed down on the compulsory requirement for all clients to be “externally assessed “ at the beginning of treatment; also backed down on ACC allocating an “appropriate clinician.” There is to be an independent review as requested. There have been partial concessions on psychotherapists, counsellors and social workers being excluded from the “inner sanctum.” Some psychotherapists are now able to diagnose and externally assess clients; counsellors and social workers can assess “alternative diagnostic systems.” Other than DSM IV can now be used. However, there is anecdotal evidence that ACC is over riding DATA assessments and limiting treatment in clear contradiction of DATA assessor's treatment plan. On a more positive note, our group has made strong links with radio, TV, newspapers and have the commitment and ongoing support of Lynne Pillay.
103. On 29 October, Lynne Pillay and David Parker meet with Nick Smith and Peter Jansen to represent our concerns which were not well received as they were challenging the idea of “best practice” and “evidence based” claims of the new process.
104. Also on 29 October, NZAC makes another press release asking for the new Pathways to be stopped until a review is carried out- this falls on deaf ears once again. NZAC also requests ACC to show what parts of the Massey Guidelines research supports their claims and points to a “deliberate distortion of scientific research for commercial gain, at the expense of victims of crime.” It goes on to say that the new process risks deterring survivors from seeking help, retraumatisation and denial of proper and effective treatment. NZAC are requesting ACC to stop the implementation of its new Pathway whilst a review is under way and also to enter into meaningful dialogue with the professional associations on a fair, humane and scientifically justifiable service for the victims of sexual crimes.
105. Don Rennie, Convenor of NZ Law Society committee on ACC (Morning Report, 28 October) believes that ACC has abolished rights under “Criminal Compensation Act and that victims of a crime, the survivors of sexual violence, should be entitled to compensation and not have to prove mental injury.
106. October 29- protest in form of hunger strike in Auckland carries on for some days. Kim McGregor and Louise Nicholas invited to speak on behalf of all survivors now denied treatment.
107. Wellington Rape Crisis announces on 31st October that it will not be working with the new Pathways
108. 2 November: Professional Body Representatives begin to collate and document reasons why clients are now being declined. It quickly becomes obvious that the focus of ACC is now on finding reasons to decline rather than to accept a claim.
109. Counsellors nationwide report absence of new/return to counselling clients as survivors do not wish to subject themselves to further abuse by the new system.
110. 3 November: Having been told in writing that 1 January 2001 was date existing claimants are to be moved on to the new system, David Chapman, in response to a question from Wellington Rape Crisis, states that at present, there are no plans for existing clients to be moved to the new system.
111. Some weeks later Peter Jansen informs us that in fact the January 1 date stands. This is yet another example of the confusion that reigns within ACC.
112. Long delays in DATA continue to be reported in spite of ACC's staged transition plan for 1 January.
113. Letter written to David Chapman requesting clarification and outcome of Counsellor Review Applications as we have not had any feedback about this. To date no response has been received. Counsellors continue to remain confused about whether they have been re approved or not. General confusion around new Pathways continues.
114. College of General Practitioners is the only Professional Body to publicly support the Clinical Pathways. We wonder if they understand the true implications of what they are supporting.
115. Statistics obtained show that in 2008, 5878 claims was lodged in the SCU; of those 3500 were accepted. It will be interesting to see how these statistics compare to those of 2009.
116. November 3: retraction in all major newspapers from Massey Guidelines authors refuting Peter Jansen's continued claim that the Massey Guidelines underpins the basis of the new Clinical Pathways. This is reassuring and validating to us as we have said this all along that the Guidelines have been misinterpreted and misrepresented.
117. November 3: Psychologists meet with Peter Jansen and ACC internal psychologists. They identify extreme chaos and lack of clarity. The psychologists suggest that ACC re engage with members of SCAG (who are there to consult and advise) when undertaking the 6 month formal review of the changes and providers experiences.
118. Counsellors continue to question Peter Jansen's ability to implement and manage the changes. The new Pathways are obviously unworkable. Web sites have been set up to document the concerns.
119. Positive response has been received from the Human Rights Commission who is now to make submissions to Parliament regarding proposed changes to IPRC Act.
120. The chaos within ACC is illustrated by the following: their response to a request for a list of DSM IV qualified counsellors: “unfortunately I am not able to provide you with a list of assessors in your area, please see your professional body for advice on who is qualified to give a DSM IV diagnosis.” As NZAC and ANZASW apparently have no members acceptable to ACC who can do the diagnostic assessments, obviously the professional bodies do not have access to this information.
121. After many e mails, some of us receive invitation to attend the promised meeting regarding how the new scheme will work with children and adolescents. Later this invitation is rescinded as Peter Jansen has decided to consult with the “experts” instead- such as CYPs, Ministry of Health, Ministry of Education and MSD. We wonder about the knowledge and understanding of the dynamics of sexual abuse that these “experts” will take to the meeting.
122. November 6: ACC in responding to our questions, states that it will take less than 6 weeks for clients to obtain a DSM IV diagnosis from the time a claim is lodged; that it will pay for 1 hour for lodging ACC 45 which requires a read code, narrative description describing the injury plus our case notes and “any other information”. This is ethically questionable in a 1 hour session with no time for a respectful engagement process to take place- and we wonder about the ethics of having to provide copies of our case notes. Also, it is stated that ACC can legally take 9 months to reach a claims decision. We wonder if ACC has thought of the implications of this for our clients. Further, ACC states that it will “identify” a suitable provider for the client. We wonder how this will actually work in practice and what choice the client will have. Also, we are told that list of accredited counsellors is currently being updated on their web site.
123. Lynne Pillay and Labour MPs continue to ask questions on our behalf in the House re ACC's refusal to listen to experienced health professionals concerns.
124. Donations towards legal costs already incurred in the challenge of the legality of the changes (and future costs) are able to be deposited in the Wellington Sexual
Abuse Help account set up for the purpose:
Westpac 03 0566 0120474 00
for receipts e mail firstname.lastname@example.org
who will send a receipt.
125. November 6: Lynne Pillay makes another Press release: Sexual Abuse Victims Continue to be Failed by ACC: she refers to Nick Smith “continuing with the shambolic approach to counselling cutbacks for sexual abuse victims”
126. November 6: Peter Jansen provides the following statistics on “active” claims: September, 7249. October 7660 clients are receiving counselling in the past 90 days. Of these,
50% have had 30 sessions or less
16% have had 30-50 sessions
18% have had 50-100 sessions
15% have had over 100 sessions
127. Call centre repeatedly unable to respond to simple questions about new Pathways.
128. Web site has been set up for ACC related articles and activities: and for a quick 1 minute satisfaction survey: http://www.psychotherapy.org.nz/index.php?page=acc-news. On line survey also available on the above web site. Thanks Kyle.
129. November 9: Letter written to Peter Jansen re ACC chaos and his continued claims that the changeover has gone smoothly. We are wondering if he has read any of our e mails and letters from Professional Bodies stating the opposite.
130. NZAC writes letter to Nick Smith requesting change to wording of Section 27 definition of Mental Injury so that it is clear that it does not have to rely on a psychiatric diagnosis in order to accept a claim for Mental Injury resulting from a criminal act as he told the counsellors who met with him that he has the ability to expedite legislative changes and this is currently before Parliament.
131. November 9: ACC announces who can administer DSM IV: registered clinical psychologists, psychiatrists, other registered health professionals such as psychotherapists, medical practitioners, psychologists with relevant training and experience if their registered body approves them. This effectively cuts out the majority of providers of counselling to ACC such as counsellors, social workers and some psychotherapists.
132. NZ College of Clinical Psychologists write letter to Peter Jansen expressing their concern at the new Pathways.
133. SCAG members have been feeling dismissed and discounted and have been wondering if it was the end of SCAG- however, meeting is announced for 12 March, which
Will be close to the 6 months time frame when the “independent” review commences. They hope they can have some input into how this review takes place. However, in reality this meeting should be well ahead of the 6 month deadline.
134. November 10: Summary of Findings of 2008 Ministry of Women's Affairs (who commissioned the Criminal Justice Centre to undertake research on the effective interventions for adult survivors of sexual violence) is released. Research findings indicated that it is critical that services are specialised to work with survivors of sexual violence, that they are immediately accessible, affordable or free, and widely advertised. Also seen as important was providing for the needs of specific groups of victim/survivors and moving towards a better understanding of how the needs of different groups may vary. Effective counselling was considered one of the more helpful ways to assist in the recovery and well-being of victim/survivors. Consequently, delays in gaining approval for access to ACC funded counselling, the lack of specialised counsellors and the often long waiting lists for those who are available are a real concern. The lack of specialised Māori counsellors is of particular concern since Māori are over-represented as victim/survivors of sexual violence. Over 86% of women interviewed said that counselling was the thing that helped them the most. WE HOPE THAT ACC, PARTICULARLY PETER JANSEN, WILL READ THIS REPORT IN ITS ENTIRITY.
135. Huge drop in new and returning claimants continues to be reported nationwide.
136. November 11: National Council of Women, Round Table of Violence Against Women pledge support to the protest against the Clinical Pathways. They see survivors as needing more support rather than increased obstacles.
137. November 12: Grant Robertson, Labour MP for Wellington Central, meets with groups of counsellors in Wellington and Whanganui and gives us his support.
138. We hear that all communication to Nick Smith is now going to Patsy Wong- we must have overwhelmed him with our letters and e mails!
139. November 12: clients whose counselling has been significantly disrupted by Pathways speak out to media.
140. November 13: peter Jansen states that ACC not accepting assessments with diagnostic formulations from non registered (under HPCA) health professionals – again this cuts out all NZAC members as well as ANZASW members as ANZASW is registered in its own right though it is linked to HPCA which Peter Jansen appears to be unaware of.
141. November 14: Counsellors report increase in declined claims:
1 A woman raped in a psychiatric hospital, while a patient. Claim declined because mental injury was clearly present before the rape.
2 A woman abused in childhood in the setting of a dysfunctional family. Claim declined because it was the dysfunctional family that caused the injury, not the sexual abuse specifically.
142. It is becoming increasingly apparent that there is no coherent policy or process, resulting in much confusion and dissatisfaction and anger by both clients and counsellors.
143. November 16: Peter Jansen obviously does not hear the stories we hear, when he states : “ WE ARE PLEASED TO REPORT THAT THE TRANSITION HAS GONE SMOOTHLY” We are wondering if he reads any of our e mails or talks to the call centre staff who are unable to answer our questions or give incorrect information when requested for clarification on the new process. We believe that their staff is just as confused as clients and counsellors and the general public as it seems to be an ad hoc process with frequent changes which has already stated, would not have happened if proper consultation had taken place.
144. November 16: ACC finally produces OIA statistics requested on 16 August and 9 October when they did not provide what was asked for, complete with profuse apologies. Of interest is the following: In 2008 the cost of group counselling was $60,000 which is approximately 15 groups nationwide. (Massey Guidelines were strong proponents of groups – however, ACC has made it increasingly difficult to facilitate groups with stringent time frames and other administrative requirements.) Counselling costs have been consistent (Between $11-12 million ) between 2005-2008 so much for a budget blow out we have been hearing about for counselling costs. However, psychiatric costs have almost doubled for the same period- have gone from $20 million to $39 million. We would like an explanation for this enormous increase. Interestingly, psychologists costs for same period have decreased from $1.3 million in 2005 to less than half million dollars. We still have not been provided with cost of psychiatric assessments as requested as the costs we have been given are for psychiatric counselling which we assume to be different from assessments.
145. November 17: two of our members give good account of problems we are facing on Morning Report. Media interest remains high.
146. Lynne Pillay obtains statistics by asking questions in the House showing approved claims in October of this year have dropped to almost half of that in August. ACC attempts to explain this by saying that they are using more robust cover determination processes than prior to the Clinical Pathways.
147. Kim McGregor's well respected Guidelines are removed from the ACC web site- we are wondering about the timing of this. However, it is still accessible on the following web site: http://www.nzfvc.org.nz/goodpracticedocument.aspx?doc=19
148. November 17: Points from letter to Peter Jansen refuting his claim “that the transition has gone smoothly” by one of our professional body representatives: “Both yourself, and the minister for ACC Hon. Dr. Nick Smith have repeatedly stated publicly that ACC covers the injury, not the event. It seems that the Sensitive Claims Unit do not understand this distinction as they clearly are considering the event as being relevant to a claims decision. “Our understanding is under law ACC are required to only test whether the event meets the criteria of the crimes act, which some of the events clearly do.
Clinically can you (i.e. Dr Jansen) confirm the view that if a child sexually assaults another child then this is not considered sexual abuse?
Also clinically, can you confirm that if a child victim of sexual abuse does not “say anything” at the time of the abuse then that is indicative of the abuse not having a traumatic effect?
Also clinically can you confirm that if present events trigger memories and recollections of abuse (as in this case) and those memories cause significant impairment, that this means the distress is actually about current life stressors and not the trauma?
Lastly, at what point did it become best practice to call and tell clients, without warning, that their claim has been declined, without informing the clinician until many days later.
Thank you for your time Peter and I hope that you find this information useful in determining the actual reality of current functioning within the Sensitive Claims Unit.
As far as we are aware, these questions have not been satisfactorily answered to date.
149. http://www.surveymonkey.com/s.aspx?sm=zR8MHLbrbwGu5nhpLjwtnQ_3d_3d This is the link to an on line survey that has been constructed by one of our group- thanks Gudrun for counsellors to fill in.
150. November 18: DSAC clarifies that their doctors are contracted by ACC to provide medical not psychological support. Thus DSAC doctors will no longer be able to completer cover reports. We are hearing concerns from DSAC doctors in the community who have filled in ACC 45s that their patients are still waiting to be contacted by ACC many weeks later. DSAC have expressed further concerns:
It is misleading to imply that the medical services, as funded by way of SAATS or the ACC Contract with DSAC-accredited doctors, is an alternative to timely crisis or psychological support services required by patients alleging sexual assault/abuse. DSAC remain extremely concerned about the gap that has been created by the new Clinical Pathway between patients presenting/disclosing and being entitled to receive ACC-funded psychological support. In many parts of the country there is currently no acute crisis support thus leaving patients extremely vulnerable.
151. Some results of the on line survey: 84% of counsellors who responded rate the service as being worse; 55% no longer accept ACC referrals; 84% disagree with the use of DSM IV. These figures speak for themselves.
152. http://www.scoop.co.nz/stories/PO0911/S00160.htm Description of chaotic nature of new process and refers to Massey retraction- makes interesting reading!!!!
153. November 20: Reports of SCU refusing to extend time frame even though not all sessions used up. However, other counsellors report being able to do this- so guess it depends on claims managers’ co operation.
154. ACC Southern Manager, Karen Walsh, speaking at the Fairlie Lions Club recently, revealed that it is ACC policy to reduce the number of Sensitive Claims. This is despite Nick Smith, Peter Jansen repeatedly and publicly saying that it is not about costs.
155. NZAC Press release on 22 November on “Real Reasons for Change in Abuse Claims Policy”
156. November 23: NZAP makes submission, with supporting submissions from ANZASW, NZAC, in relation to IPRC Amendment Bill, expressing our collective concerns. Thanks Eric. This is presented on 4th of December by Eric Medcalf together with a survivor who wished to be heard.
157. Our group and members of our various professions are surprised to hear that Peter Jansen receives cultural prize for his work with Maori when the Clinical Pathways were introduced with no cultural basis underpinning the work with Maori or other cultures.
158. November 24: Meeting with Peter Jansen to discuss who is able to administer DSM IV. NZAC not invited; ANZASW invited at last minute. However nurses have been invited. ACC does not fund travel or pay meeting fees. Outcome of meeting was unanimous concern about 2 sessions to do full diagnostic interview; debate about who can/cannot administer it; level of training acceptable to ACC; it became obvious that nationwide, there will be a huge shortage of professionals who have the required training in DSM IV as well as the knowledge base and experience of sexual abuse work. Dr Jansen refused to debate the ethics of the use of the DSM IV- the meeting was told that the time for that has passed! Concern expressed at use of this medicalised model even by psychologists. Peter Jansen undertakes to send participants copy of his PowerPoint and also minutes- as of 13 December, still waiting to receive these.
159. The meeting is provided with the following judicial decision which Peter Jansen repeatedly refers to:
Assessing Mental Injury:
Section 27 of the IPRC Act 2001 defines mental injury as ‘a clinically significant behavioural, cognitive, or psychological dysfunction’. In more detail, mental injury is a psychological dysfunction consisting of affective, behavioural, cognitive difficulties that make up more than the immediate and expected reaction to trauma, and result in impairment in everyday functioning.
The dysfunction must both:
a. Be assessed as clinically significant by a suitably qualified and experienced health professional, and
b. Require treatment typically provided for such injuries, over and above certification.
In terms of confirmation from the courts, I note the decision of Judge Cadenhead in ACC v Geerders (decision number 188/2004)
The Judge noted that mental injury is defined in the Act as a “clinically significantly behavioural, psychological, or cognitive dysfunction”. He accepted ACC’s argument that this definition accords with the way mental injury is classified in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM IV), and that DSM IV provided a universally accepted means of diagnosing and classifying mental injury.
In terms of the facts of the case, Judge Cadenhead found that while there was reference in the medical reports to the claimant being “depressed”, the evidence fell short of establishing that the claimant suffered met the criteria for “major depression” in DSM IV. Judge Cadenhead found that “mental injury” meant more than just “mental consequences” and that “indirect causation, such as brooding or worry, is not sufficient”.
We are wondering what training and understanding Judge Cadenhead has of the dynamics of sexual abuse; and more importantly, whether there are judicial decisions that give a less favourable outcome for ACC that has not been produced?
161. SCAG Members working with children and young people were promised a meeting prior the end of the year to discuss how the Pathways could be applied to children as even Peter Jansen admitted it wasn't workable for this group. Some of us had been invited to this meeting on 9 December- on 25 November I received an e mail from Peter Jansen to say that I am now un- invited as they have decided to consult with the “experts” instead. I understand these experts were from various Government agencies- with sexual abuse work experience? Probably not… Thank you once again Dr Jansen for a respectful process!! Those who attended report that it was a useful meeting. It was not attended by Dr Jansen. It was requested by some of the attendees that Professional Body representatives be invited to the next meeting- they were told there were other meeting for them already in place… we presume this must be the now only twice yearly meeting of SCAG where there is no opportunity to discuss this in detail because of the time factor.
162. Reports continue to pour in of unsafe decisions made by ACC- 2 young brothers referred to in the media some time ago who were anally raped and assessed back in June still waiting to start counselling…..
163. December 1: Nelson group of providers have follow up meeting with Nick Smith in Nelson. To their amazement, Nick Smith is accompanied by none other than Peter Jansen and Graham Bashford. The meeting is not productive as even though providers present refused Dr Jansen's wish to make yet another presentation, he continued to repeat information which the providers were already familiar with and he must have been aware that those present had strongly held beliefs quite different from his. However, Dr Jansen continued to promote his views as if he had never heard the strong opposition to his point of view. Nick Smith is again saying it is not about cost cutting and admits not everyone agrees its best clinical practice. Nick Smith has said that he would consult our organisations about terms of reference for the review. This appears to have been the most useful thing to come out of the review. We are left wondering whose budget the 3 airfares to Nelson came out of. We believe that ACC is getting away with poor process that stands to injure victims of crime further.