While the adverse impacts of child maltreatment have been recognised for many years, only recently have we begun to incorporate trauma-informed approaches into medical care.
Now for the first time, we have clear evidence of the endemic prevalence of child maltreatment in Australian society and powerful findings on the negative impacts that child maltreatment has on almost every aspect of victims’ lives.
The Australian Child Maltreatment Study (ACMS) surveyed 8,500 Australians to provide the first nationally representative evidence of the prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence they experienced before the age of 18 years, and their life trajectories into adulthood.
The results paint a picture of a previously hidden national crisis that requires urgent attention. More than 60% of Australians experienced at least one of the five types of child maltreatment. Half of those children who experienced maltreatment went on to have a mental disorder, including depression, anxiety, alcohol dependence or PTSD.
Similarly, rates of self-harm and suicide attempts were many times higher in Australians who experienced maltreatment as children. Starkly, there were almost no cases of self-harm or suicide attempts in adults aged 5 years and over who had not experienced child maltreatment.
These are startling findings that offers a new perspective on the implications of how we should be treating mental health issues in this country.
While one clear implication of the findings is the urgent need to improve child safety by reducing the incidence of child maltreatment, another critical issue is addressing the health and wellbeing needs of the many adults in our communities who have been impacted by their own experiences of child maltreatment and are still suffering the consequences.
Sadly, hurt people can go on to hurt other people. Breaking the intergenerational cycle of child abuse and neglect is a challenging and complex issue, but one key component is addressing the known consequences of past experiences of maltreatment in healthy ways so that victims can regain their sense of wellbeing and be able to lead productive, contributing lives that includes supporting those around them.
The developing area of trauma-informed care is starting to become more common. The underlying principle – that trauma is likely to be a common experience in people experiencing a range of mental health issues or health risk behaviours – is strongly supported by evidence from the ACMS.
Almost all adult cases of self-harming, suicidal behaviour, cannabis dependence and PTSD had a history of child maltreatment, and a considerable proportion of people with generalised anxiety, major depression or binge drinking had similar histories.
Based on these clear findings, asking about people’s experiences of abuse and neglect should be routine in supporting those presenting with these mental health issues or health risk behaviours. While these can be uncomfortable issues to discuss, victims can benefit from supportive, confidential environments to talk about past experiences.
Our understanding of the after-effects of trauma is growing, and we have a better understanding now of how many children will not disclose their experiences of abuse and neglect, and adults will often hold onto these experiences as secrets for years or decades.
The Royal Commission into Institutional Responses to Child Sexual Abuse brought the issue of child sexual abuse to national attention along with the work of several advocates and victim-survivors, yet the ACMS found that four times as many Australians experienced sexual abuse by a parent than by an institutional adult caregiver.
Moreover, the study found that emotional abuse is just as common as sexual abuse, and just as damaging.
We need to broaden the national conversation on child maltreatment to encompass all forms of maltreatment and there are a range of resources available to support GPs to have these conversations, such as the Adverse Childhood Experiences toolkit produced by Emerging Minds.
Asking about people’s experiences of maltreatment in general practice and supporting victims to receive trauma-informed care is a crucial step towards tackling the consequences of past experiences of child maltreatment – starting to break the cycle that perpetuates across generations.
ED Professor David Lawrence is a Professor of Mental Health at Curtin University whose research focuses on mental health and wellbeing.
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