DSAC Concerns Over New Clinical Pathway

Doctors for Sexual Abuse Care (DSAC) support ACC’s overall intention to improve the quality of its funded services for individuals who have a mental injury arising from sexual assault/abuse. However, DSAC does not support the implementation of ACC’s new Clinical Pathway for Sensitive Claims as it currently stands.

This Pathway is a selective implementation of some parts of the Massey Guidelines. It was designed by ACC and introduced abruptly (design completed 19 October, effective from 28 October 2009) and without effective consultation and input from expert clinicians working in the area or with patient advocacy groups. It thus has some predictable flaws.

DSAC’s main concern is that the new Pathway has removed the ability of many individuals to access, in a timely manner, psychological support as a consequence of the crime committed against them/sexual assault.

DSAC does not support the new narrow definition of a DSM-IV diagnosed psychiatric illness as a requirement for cover. ACC has chosen this as its “preferred diagnostic tool.” Thus individuals have to see a New Zealand Registered Clinical Psychologist or Psychiatrist for a DSM-IV assessment prior to commencing counselling. ACC have indicated that “other registered health professionals” with “specific training and experience in mental health diagnostics” may be acceptable to ACC to provide a DSM-IV diagnosis. ACC also state that “competency in this and other domains of practice is a matter for registration authorities.” This leaves the professional bodies to solve a problem that ACC could have averted had they invested in a collaborative approach in the design of the Pathway.

Section 27 of the IPRC Act does not limit mental injury to a DSM-IV diagnosis. Instead it defines “mental injury” as “a clinically significant behavioural, cognitive or psychological dysfunction.” ACC have therefore recently indicated that they are open to using “alternative diagnostic tools.” Which alternative tools will be acceptable to ACC have not yet been defined. This means many mentally injured distressed patients who cannot access a DSM-IV diagnosis, or do not fit these limited criteria, are unable to receive ACC-funded psychological support in a timely manner.

As yet there are no guidelines in place indicating how children and adolescents who have been sexually abused, and who require intervention, will access psychological support. The DSM-IV classification system has severe limitations for children and adolescents.

DSAC also has significant concerns about the informed consent and the new procedures ACC is using to request disclosure of additional information by doctors immediately after a claim is lodged.

These concerns have been communicated to ACC on several occasions. Meanwhile DSAC is fielding enquiries from doctors seeking advice on what to advise patients alleging sexual assault as to how they are supposed to safely navigate the complex bureaucracy which is the “new pathway” in order to access psychological support. This advice is particularly needed for those doctors working in rural areas and small towns where local support agencies may not have the necessary “qualifications” which ACC require in order to make a DSM- IV diagnosis.

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