ACC TO RETHINK ABUSE LINK

A judge has ruled in favour of an ACC claimant in a case expected to have "enormous" ramifications for the way mental health patients are treated.

In the decision, released recently, Judge Grant Powell in the Wellington District Court agreed with a psychiatrist who said a man's schizophrenia had been caused by trauma from sexual abuse in childhood.

Two ACC-employed psychiatrists had earlier said there was no evidence schizophrenia was anything other than a biological condition passed down through families and so the man's abuse had nothing to do with his condition.

However, the judge agreed with a growing body of research that says traumatic events can cause psychosis.

The research includes the work of clinical psychologist John Read, who has been at the forefront of research to show a relationship between childhood sexual and physical abuse and psychotic symptoms, including schizophrenia.

Read said the ramifications of the decision were "enormous".

"It is gratifying that years of research on this issue is impacting the judicial system. These rulings will also make it harder for psychiatrists to ignore disclosures of sexual abuse by severely disturbed patients, or to dismiss them as either irrelevant or imagined.

"This is a significant victory for all those patients and researchers who have been saying for many years that the experiences which biological psychiatry believes are symptoms of a brain disease called schizophrenia are best understood as responses to adverse life events.

"Very often the voices abused people hear are the actual voices of the perpetrator of the abuse."

Read said it was "alarming" that the two ACC psychiatrists "either knew nothing about the many studies documenting the relationship between child abuse and psychosis or were trying to mislead the judge".

The man referred to in the finding had been covered by ACC for his history of sexual abuse but it was schizophrenia that had stopped him from working. He had sought to gain an independence allowance from ACC in December 2010. An independence allowance covers people who are permanently impaired as a result of an injury. The maximum weekly allowance is $84.97.

In 2011, ACC decided it would not cover the allowance because it said his schizophrenia was not linked to his covered injury - a significant history of sexual abuse between five and 13.

He was assessed by a psychiatrist who prepared three reports but concluded sexual abuse "is not likely to be the material cause of the current condition. There is no evidence of sexual abuse as an etiological factor [cause] in schizophrenia."

His claim was declined and despite an appeal and subsequent reviews it was again found his incapacity related to his schizophrenia, which ACC said was a health issue unrelated to the sexual abuse.

After another appeal, psychiatrist David Codyre provided a report that completely disagreed with the previous psychiatrists.

"With due respect to my colleagues who undertook the prior psychiatric reports . . . their opinion that sexual abuse is not causally related to schizophrenia is not evidence based."

Judge Powell said ultimately he found Codyre's analysis "a more compelling and inherently more credible cause of the appellant's schizophrenia".

Read said the finding would reduce the frequency with which psychiatrists dismissed abuse disclosures as irrelevant or imagined and increased the probability of people being offered trauma-based psychological therapy instead of anti-psychotic medication.

New Zealand Association of Psychotherapists public issues spokesman Kyle MacDonald said the judgement was encouraging and could mean entitlements for many other people.

"The reality is there a lot of people who would be in the mental health system who would have a diagnosis of a psychotic disorder who may now be entitled to access some treatment under the ACC.

"For a long time there has been a mindset of how schizophrenia and psychotic disorders are treated, which is that it is a biological disorder which needs to be medicated and managed.

"The reality is that actually these people are underserviced in terms of therapy and psychological intervention. This is a way to get people more therapy and more psychological help."

ACC said it would consider whether this decision "has any wider impact" but took the view it would have "limited" value as a precedent and it would "continue to carefully consider each person's unique situation and circumstances".

- Sunday Star Times  by Sarah Harvey  8/12/2013