The Royal College of Psychiatrists has apologised for what it describes as decades of mismanagement and misdiagnosis of adults who were sexually abused as children, after senior doctors told the BBC that many survivors have been failed by NHS mental health services.
In a report handed to the BBC, the college said mental health staff have too often focused on treating symptoms rather than exploring how traumatic experiences in childhood can continue to affect patients decades later. It said that, for some survivors, contact with services has worsened their trauma rather than eased it.
Dr Lade Smith, immediate past president of the Royal College of Psychiatrists, said she was "sorry" that victims have too often suffered "avoidable harm when seeking help". She told the BBC the problem was not confined to psychiatrists but reflected failings across the whole mental health system.
"Services are so fragmented. The system is set up to provide short, discrete episodes of care. Psychiatrists do not get the time to build up a relationship with patients so they can be properly supported," Dr Smith said. "They are lucky if they get eight sessions of therapy, when it could take eight sessions for a person just to disclose the abuse. And these are just the people who get support – many don't even get seen by mental health services because services are so stretched."
The college's report details cases in which treatment has been inappropriate, and where patients have been re-traumatised by repeated assessments and history-taking, or have simply not been believed.
Estimates suggest nearly one in ten adults in England and Wales experienced sexual abuse in childhood. Such trauma is linked to a heightened risk of mental health problems in later life, including alcohol and drug misuse, eating disorders, self-harm, complex post-traumatic stress disorder, anxiety and depression.
Many survivors struggle to disclose what happened to them. Around two-thirds of people abused as children have not told services about it by the time they reach adulthood, according to the report. One in five never disclose at all, and many who do come forward take decades to do so.
Caroline Thompson, 65, said she felt let down by the care she received. She was psychologically and sexually abused as a child, and went on to raise a family and build a career as a specialist ear, nose and throat doctor. It was only at the age of 55, after developing terrifying nightmares that left her mentally exhausted and unable to sleep, that she sought help and was referred to mental health services.
The psychiatrist she saw told her that her symptoms were unlikely to be linked to the earlier abuse, citing the delay in her coming forward and the fact she had been able to sustain a family and career. She was diagnosed with anxiety and prescribed anti-psychotic medication.
"I had therapy for about a year and was then discharged. At that point I still didn't understand what was happening to me and I still couldn't function due to the nightmares and side-effects of the drugs. I had to give up the job I loved," she said.
Ms Thompson later sought private therapy with a specialist in childhood trauma and gradually began to recover over the following years. "It was astonishing to me that it was not understood that traumatic memories are buried in order for you to survive, and that those memories can surface years later. So any delay in presenting is quite normal," she said.
The apology follows a review by a working group of experts, doctors and abuse survivors, including Ms Thompson, set up by the Royal College of Psychiatrists and chaired by consultant psychiatrists Jo Stubley and Maria Podlejska-Eyres. The group was established after mental health services saw a rise in people coming forward over the past decade or so, following high-profile abuse scandals involving schools, children's homes and religious institutions, as well as the crimes of Jimmy Savile.
The college is calling for a series of changes. It has pledged to develop specialist training materials for psychiatrists and wants mandatory training introduced for all mental health staff on trauma-informed care for survivors of child sexual abuse. It has also recommended that national guidance be published on how to recognise and respond to disclosures of historic abuse, alongside an overhaul of services so that those needing help can access long-term support.
Gabrielle Shaw, chief executive of the National Association for People Abused in Childhood, described the apology as "significant and welcome" but said it must lead to "meaningful change". "For too many adult survivors, mental health services have not felt like a route to safety or recovery," she said.
A spokesman for NHS England said specialist services were available, and that victims could access support 24 hours a day, seven days a week through sexual assault referral centres and counselling services, with details published on the NHS website. "People who have suffered historic child sexual abuse may not have spoken about it for years, so it's vital they know they can access specialist, trauma-informed support through the NHS," he said.
He added that steps were being taken to improve support for children and young people, including additional training for mental health support teams working in schools and colleges.
Anyone affected by the issues raised in this article can find information, advice and support through the BBC's Action Line. Anyone feeling emotionally distressed or suicidal can call Samaritans free on 116 123 or visit samaritans.org in the UK.
