"Off the Couch" The weblog of Kyle MacDonald.   A psychotherapist's view of events and happenings in Aotearoa and beyond...

Off the Couch Archives...

 

Question time, but no answers...
 
 
 

 
 
So what questions would you like answered by the Hon. Dr. Nick Smith?  Personally I'd like to know who these "expert clinicans" are, especially seeing he's relying on them so heavily .  So far as I can tell none of the people they're relying on are experts in the field, so I'd like that one cleared up.
 
I'd also like to know how ACC and the National Government keep claiming that this new pathway is based on the "Massey Guidelines" when the authors of this research are clear it isn't?  I'd love to hear a straight answer on that one too.
 
You can ask him questions as well (but don't expect a straight answer).  His contact details are here:
 
nick4nelson@parliament.govt.nz
 
 
Parliament Office
Private Bag 18888
Parliament Buildings
Wellington 6160
 
Nelson Electorate Office:
Phone 547 2314
Fax 547 2315
 
 
 

2nd April, 2010

 
 
The Poison Chalice

 
I’m pretty optimistic by nature, so forgive my spin on this one. Maybe it’s also just my need to feel like we are actually making a difference. But I honestly believe we are.
 
It seems ACC are unable to find a “reviewer” for the new clinical pathway. Rumours are two have been approached, and turned it down flat. So how is this a victory? First some background:
 
Over six months ago now, I started an online petition. Many of you signed it, and with the support of Lynne Pillay MP and the Labour party I took it to parliament and it was thrown at Nick Smith’s feet. (Not literally of course, but it makes a nice story.) His response was classic, throw ‘em off the scent politicking, namely promise a review, at some stage in the future. I say politicking because, hey presto, the news story went away almost overnight.
 
And so since then we have all had to battle on under this abusive new pathway and beleaguered but far from worn out, here we all are at the six month mark.
 
First problem: ACC are quick to qualify, the review was to take place after six months. OK, so when exactly?  Not sure.  And what’s the terms of reference? No one knows. And the reviewers? Sorry, can’t find any.
 
This part is a victory because thanks to all of you and your sustained political pressure on ACC and the National Government, this issue has not gone away. And from the point of view of a potential reviewer, it most certainly is a poison chalice. To take it as a political appointment would be career suicide, because to find anything other than this pathway has been an abject failure would be an absolute sham. But to publicly make those findings, well it would be unlikely you’d ever get hired again, at least until there is a change of government.
 
Just one small example. This table details the number of sensitive claims approved by ACC since January 1st, 2010. It makes for very sober reading.  This is not a pathway that is "working," unless you're funding it.
 
So it’s time to put the pressure back on Dr. Peter Jansen (Senior Clinical Director), Graham Bashford (“Director of Operations” and Peter Jansen’s boss) and the Hon. Nick Smith.
 
We were promised an independent review at the six month mark, and it is essential that this be an open and fair process, and more importantly that it actually happen.
 
So let’s get emailing, and letter writing. We haven’t collected all this data for nothing!
 
Peter.Jansen@acc.co.nz

Graham.Bashford@acc.co.nz

nick4nelson@parliament.govt.nz
 

24th March, 2010

 
The Swamp Creatures

 
 
Organizational culture is a hard thing to measure and describe. ACC has worked over the years to generate an image of them being helpful and compassionate over the years; their logo even says, “Prevention, Care Recovery.”

However as all who have dealt with ACC recently know, for sensitive claims or indeed any claim, the culture and their attitudes have changed. This disturbing document published via the Labour party is both shocking and revolting in what it reveals about the attitude and culture of those who are paid by compulsory levy to help the most vulnerable of New Zealander’s:
 
    
"The reports, prepared for the new ACC board last year, say ACC had ‘moved too far towards customer focus’ and needed to begin ‘tightening the gateway by reducing the level and costs of treatment provided – especially rationalising the range of services available’.

"Perhaps the most disturbing example of the callous new approach however is the phrase used in the Morrison Low report to the ACC board which talks about the need to ‘significantly cut back to essential and core (services) – effectively draining the swamp."
 
    
Draining the swamp. Prevention, Care, Recovery? I hope they find this guy when they try to drain the swamp:
 
 

 
 
 
So this is how those making changes at ACC view the long term, most vulnerable and most injured clients. And their stated plan is to remove clients from entitlements, in fact the documents also reveal plans to incentivise staff to reduce the number of accepted claims.  Yet despite this the Sensitive Claims Unit keep banging the same old drum, just this week from the Christchurch Press:
 
 
"ACC senior medical adviser Peter Jansen said the review was not about cost-cutting, but about improving services… …"We are not trying to withdraw things... ...The point of having this plan is to make the service better"
 
 
So let’s look at some facts.
 
A recent snap poll of providers, completed by yours truly shows that of the claims filed since the new pathway, only 6% are being accepted; 44% require “further information,” and 36% are declined outright, with 14% no response or delayed. (n=128).
 
I’d hate to imagine what would happen if they were actually trying to withdraw services.
 
Furthermore over 60% of the claims counted by this survey are adult presentations of child abuse. This reflects the anecdotal stories that we who oppose these changes are hearing, claims are no longer being accepted, and in particular adults claiming for childhood abuse. The growing trend is that ACC are able to justify this by stating variations on the theme that too much time had elapsed, so therefore it’s likely to have been other stressors. Ergo: child abuse is not the cause, and no funding required.
 
Anyone who has ever worked with these clients, or even read the literarature knows this is clinically absurd, and furthermore legally unreasonable.
 
So who’s making these decisions? I hoped you might ask that. Here’s a list of those on the Multi Disciplinary Assessment Panel: (drum roll)
 
 
Dr Kristine Fernando (Registered Clinical Psychologist).

Mr Christoph Huelsmann (Registered Clinical Psychologist).

Mr Thomas Neser (Registered Clinical Psychologist).

Dr Peter Jansen (Registered Medical Practitioner).
 
Dr Darryl Lee Prince (Registered Medical Practitioner).

Michael Watson, Stephanie Bennett, Rachael Stephenson and Shelley Mills in their roles as team managers.

James Du Plessis, Manager, Jeanie Robinson and Allanah Andrews, Technical Claims Managers.
 
 
The regional Traige Psychologists are: (tense silence)
 
 

Dr Frances Brinn (Registered Clinical Psychologist)

Dr Gillian Pow (Registered Clinical Psychologist)

Dr Barry Kirker (Registered Clinical Psychologist)
 
 
ACC refused to tell me if any of these clinicians had specific training or experience in sexual abuse and trauma. Apparently that’s private. But I figured those of you out there who are still reading my irregular outpourings might know. If you do, let me knowhere.
 
Also if you are aware of any psychologists or psychiatrists who may have lost their contracts’, or their referrals have dried up for DATA due to protesting or complaining about these changes, could you also let me know here? I’ve heard rumours…
 

18th February, 2010
 

 
 
 
ACC invents Time Machine: Uses it for Evil

 
 
Having been unhappy with only finding ways to deny current and new claims, ACC appeared to have used their considerable talents and resources to develop technology that even the most skilled and ingenious quantum physicists have been unable to achieve: the ability to travel through time and change the past!
 
Now anyone who has ever seen Back to the Future, perhaps the greatest scientific study ever of the dangers of time travel, knows that time travel is a tricky business, and often quite unpredictable. What confuses me the most though is how can ACC can afford the research and design costs of inventing time travel (which I can only assume must be considerable) and claim they can’t afford to pay for New Zealander’s treatment costs for, well just about anything really…
 
Sorry, what am I on about? Well check this out.
 
ACC have decided, with the help of some legal scullduggery (OK not really time travel, but sort of) that if you were unfortunate enough to have been sexually assaulted prior to 1974 your claim approval disappears in a puff of legal wizardy (kind of like Marty McFly nearly did when he was silly enough to mess around with time travel and get in the way of his parents meeting.)
 
How do they do this? Well ACC didn’t exist before 1974, so sorry previously we said yes, but now we’re changing how we interpret the law and saying no.
 
So if you were abused before 1974 and claimed between 1974 and 1992 (when the law was clarified to state that the date the claim was made was considered the “date of injury”) then your claim is now likely to be declined, retrospectively.
 
Why don’t you just go the full hog ACC and sue everyone for all the money you accidentally spent in the past and didn’t mean to?
 
ACC has also been messing around with the space-time continuum. In the same NZ Hearld article they were quoted as saying:
 
“The practice has been that counselling has been provided without any determination of cover. That is what happened in the past.”
 
Hang on a minute ACC, what? Which past? So now ACC was just handing out counseling willy-nilly, without people even making a claim? What were they doing, knocking on people’s doors and just awarding them counselling? I can tell you I have been filling out forms, quite lengthy ones too, describing injury effects and getting claims approved for some years now.  But perhaps ACC is talking about a parallel universe where “Things are different.” That’ll be it. I told you this time travel thing was tricky.
 
So just one request then, ACC if you do have a time machine, can you go back in time and change the result of the 1995 Rugby World Cup? I’d really appreciate that.  And I don’t care about tears in the space time continuum, I just don’t think I can stand history being re-written by Clint Eastwood “Invictus” style.  Didn't anyone tell Clint the All Blacks were poisoned?
 
Lastly, speaking of movies here's one by the Taranaki Daily News interviewing experienced sexual abuse counsellor Bob Stevens about the changes to the pathway and his objections.  Thanks to Paul Flanagan for the link.

 
28th January, 2010

 
 
 
New Years Resolution: Complain more

 

I have always been inclined to complain about injustice. It will surprise few that I have even been known to send the odd letter to the editor in the past and much to my partner’s annoyance even  yell at the evening news. Occasionally I even stop watching the news, just so I stop yelling at it. This behaviour is not good for my blood pressure. It may have even caused me a mental injury.
 
However nothing soothes my furrowed brow, and lowers my systolic pressure more than a well crafted, slightly patronising, sarcastic and verbose letter of complaint. Any good letter of complaint contains a few crucial elements, but in essence is a clever longwinded way of saying “F**K YOU, YOU'RE WRONG (and may very well be an idiot.)”
 
Fortunately for all this blog, the online petition and numerous complaints to ACC have led to much less yelling at the television. And we know that effective expression of aggression is actually good for us, to move from powerless “victims” to assertive actors is what much of good therapy is all about.
 
So despite the somewhat worn out, defeated tone of my last blog, I have resolved in 2010 to complain more, and I hope to provide you all with some guidance and motivation to do the same.
 
Members of the public:

Wait until you are in a bad mood. Don’t kick the cat, or yell at the television for that matter, write a letter:
 
“Dear Hon. N Smith, It astounds me that you seem able to ignore the very real impact your government’s decisions are having on the most vulnerable members of our society…”
 
Template letters from the National Council of Women are here and one I have posted in the past is here. Please feel free to edit to your hearts content.
 
The details of all minsters of the National Government are here. Postage to government is free, so send them to as many ministers as frequently as you like. More is, in this case, more. Don’t forget to mention how likely this all is to influence your voting…

 
Counsellors, therapists and other professionals.

Feel free to do the above. Also if you still see ACC clients, then in the interests of self care, and general wellbeing I suggest you complain vociferously and often to complaints@acc.co.nz  ACC are required under their statutory obligations to process all complaints received. If they offer you the option of either having it resolved at the “unit level” or escalating to the office of complaints, escalate. A simple count of the number of complaints received at the six month review is evidence of the new pathway not working. Any action or inaction by ACC is grounds for complaint. Rude case managers, not sticking to their own pathway, delays in processing claims, customer service people not knowing about their own processes etc.
 
However when it comes to clinical decisions there is a separate process of mediation, review and appeal. This process is managed externally by DRSL. Again, ACC are required to follow through on all requests for mediation and review received and increased number of reviews is also evidence of the new pathway not working.
 
An excellent detailed summary of the process here and another on DRSL’s site here.
 
It is important to note that you can do all of the above for one claim. So if your claim is declined, in ways that are clearly in violation of ACC’s statutory obligations, you can make a complaint about the nature of the declined claim, request mediation and request a review of the decision.  Also for each claim filed under the new pathway don't forget to fill out our survey for clinicians, linked to on this site or go here.
 
Clients:

So here’s the good news: despite how powerless you feel at the hands of ACC, you are more powerful than you think. All of the above is available to you as well. As a client of ACC you are able to make a formal complaint, and request a review of a claims decision. See here for ACC’s info page on how to do these things, as well as the above links.
 
It is inevitable that as this fight against such a faceless and cruel beauracracy wears on that this will become a war of attrition. The risk is that as we lose energy, faith and as the bruning fire of anger slowly dies the Sensitive Claims scheme dies with it, fading into antiquity and ACC wins. We must continue to find ways to voice our anger and target it in ways that are effective. The more valid complaints, mediation requests and reviews are conducted over this six month period prior to the review, the better.
 
And if you need to add some fuel to the fire, I suggest you read this excellent article from Saturday's Christchurch Press. In it Dr. Peter Jansen is quoted as saying:
 
"He [Jansen} believed counsellors were unhappy because the ACC was not allowing them to make a diagnosis.”   Press, 09/01/10.
 
So join me in my resolution to keep fighting. Don’t yell at the television, yell eloquently at ACC. And feel free to let me know your own experiences of mediation, review and the complaints procedure. I’d love to hear how you get on.
 

10th January, 2010
 
   

The Rapists Charter

 
One of the most well recognised tactics that abusers of all types use, and this is confirmed time and time again in the clinical literature, is to "blame the victim."  The classic example of this being when a woman is blamed for being attacked due to having dressed too provocatively.
 
That's why I was so shocked to read the report last week in the New Zealand Herald when ACC responded to accusations that the new pathway was blocking access for clients by blaming clinicians and professional organizations:
 
"Some might also suggest that the scaremongering being undertaken by certain lobby groups has also put off some clients from seeking ACC help. Today's description of the new process as a 'rapists' charter' is one such example."
 
So why refer to it as a "Rapists Charter?"  That’s a bit over the top isn't it?  Why do therapists, counsellors and social workers feel so vehemently about these changes?
 
Well first it requires an understanding of the dynamics of the types of families that sexually abused children come from.
 
Research and clinical experience tells us that families where abuse occurs tend to be chaotic, unpredictable, invalidating of the emotional world of others (particularly the children) secretive, socially isolated and poorly supported.
 
Okay, so what?  Well the main way that abusers tend to be able to continue to maintain to have sex with children (or adult men raping women for that matter) is to completely deny the impact of their actions, through denying the emotional response of the victim and blaming the victim for being provocative, enjoying it or having in some way been complicit in the abuse.
 
So when ACC tells a claimant that their sexual abuse, when they were 12, with an 18 year old abuser who was allowed to live with the family by dysfunctional parents (real example I'm afraid) is not abuse because the sex is judged to be "consensual" they are acting in exactly the same way as an abuser.
 
I mean it's not "a little bit like it," not therapists "reading too much into things" it's right there "your months of terror and rape when you were a child was not abuse, you're wrong to feel and believe the things you do."
 
Also ACC seems isolated, unsupported and able to behave any way it chooses, much like an abusive family, where everyone is too scared or too brainwashed to hold the abuser to account.  Our feedback is that the Health and Disability Commission has no ability hold them to account, nor do any other health body.  The only body that has any power to oversee ACC is the Government via the Minister for ACC, currently Hon. Nick Smith, and he explicitly supports this Rapists Charter see here.
 
So what about chaotic and unpredictable?  Where do I start...
 
The kindest thing one can say about this process from start to finish is that it has been incompetent (as opposed to malicious.)  Inconsistent answers, different answers to the same questions from different people, inconsistent application of the new pathway rules to different cases, last minute changes to the pathway; the list goes on...
 
And don't even get me started on the complete lack of transparency.
 
So is this a Rapists charter?  It most certainly is.  ACC could hardly have done a better job of designing a system that would be guaranteed to re-traumatize claimants if they'd tried.  It's an amazing accident; I'm not for one moment suggesting that it is deliberate because that would require reading the clinical literature, and it's clear they haven't done that.
 
So this is why I am no longer taking any ACC referrals.
 
I just can't knowingly put clients through this traumatizing invalidation of their trauma, I've tried and I now feel certain that to do so is unethical and irresponsible.  I have a small number of clients that I currently see, and will continue to see and a small number I am currently battling ACC about and will also continue to do so.
 
In this vein the results of my online poll are in and you can view them here.  To quickly summarize:
 
Only 10% surveyed intended to continue offering a service under the new pathway;
 
85% rate ACC's service and communication as worse or terrible over the last six months;
 
84% disagree or strongly disagree with the compulsory use of the DSM-IV in the new pathway.
 
My colleague Gudrun Frerichs has designed two excellent surveys, one for clinicians and one for clients to assist us in recording the injustices of this new pathway in anticipation of the review early next year.  The clinician’s version is here and the clients here.
 
Lastly this (click here) is from a client, which seems a much more efficient way of saying everything I've just said.
 

16th December, 2009