Rape counsellors out of ACC's fast-tracks

Critics of ACC's changes to sexual abuse treatment staged a public protest earlier this week . Photo / Martin Sykes

Most counsellors in rape crisis centres and other non-medical work have been shut out of fast-track claims for sexual abuse victims under the final version of new rules.

As indicated in earlier drafts by the Accident Compensation Corporation, it will pay for counselling for sexual abuse victims from next Monday only when they have a mental illness listed in the US Diagnostic and Statistical Manual Version 4 - abbreviated to DSM-IV.

Unexpectedly, the final version of the new "clinical pathway" sent to counsellors this week also says that the only people qualified to give a DSM-IV diagnosis are psychologists, psychiatrists, and psychotherapists and medical practitioners - suchas GPs - who have a a DSM-IV qualification".

This definition appears to exclude all 272 ACC-registered counsellors who belong to the Association of Counsellors and work in rape crisis centres, church and other community agencies and in private practice.

Susan Hawthorne of the Psychotherapists Association, said it was also likely that only a minority of New Zealand's 450 psychotherapists had a "DSM-IV qualification".

"We haven't heard of such a thing," she said.

She said ACC had told her it meant "a tertiary-level paper where DSM-IV is explicitly taught as part of the qualification, followed by continuing use in practice".

Associate Professor Stephen Appel of Auckland University of Technology, which teaches the country's only masters-level psychotherapy course, said use of DSM-IV had been part of that course since it started 20 years ago.

But Ms Hawthorne said many psychotherapists had trained before the AUT programme started, or trained overseas.

"If they [ACC] had said, 'We are going to organise training courses,' that would be more credible," she said.

"I feel quite devastated, to tell you the truth, quite stunned.

"It's incredibly disrespecting that they haven't taken on board many of the points that we've made, and that in this final version there are some things that they hadn't even forewarned us that they were thinking about."

The new pathway still allows any counsellor to lodge claims for sexual abuse counselling.

Bit it says only those with a diagnosis from someone with a "DSM-IV qualification" will be "fast-tracked" to a decision within a week.

All other claims will require a second assessment by someone with a DSM-IV qualification and will be decided within six weeks.

The pathway also provides that funding will start from the date a claim is approved, with no backdating for the waiting period.

Elayne Johnston of the Association of Counsellors said a six-week delay would harm many victims.

"What we can see happening is that they are going to be exposing their story and then left high and dry while someone else makes a decision on whether their claim is upheld or not.

"If that takes some weeks, we could well see an increase in suicides," she said.

But Dr Lyndy Matthews of the College of Psychiatrists said there was no evidence that long-term counselling was an effective treatment for post-traumatic stress disorder - the most common DSM-IV diagnosis given to sexual abuse victims.

"While more generic forms of counselling can be a very reparative form of therapy, and healing in terms of providing long-term relationships, that is not the same as effective evidence-based treatment."

* Sexual abuse claims

ACC receives 550 claims a month for sexual abuse counselling.

It spends $56 million a year on sexual abuse claims.

Tighter rules for counselling take effect on Monday.

ACC says the changes are not about cost-cutting but aim to give survivors treatment reflecting the latest evidence.

* acc.co.nz/news