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The National Council of Psychotherapists

Est. 1971

 

TACKLING ABUSE OF PATIENTS AND CLIENTS - THE WORK OF POPAN

 

by Frances Blunden (Director) and Jo Nash (Research and Development Worker)

 

The abuse of patients and clients by professionals working in the health and social care services is an issue that concerns us all. Despite the periodic scandals that catch the headlines, such abuse often remains unnoticed, unreported and unremedied.

 

POPAN (Prevention of Professional Abuse Network) is a national charity dedicated to tackling the issue by helping those who have suffered abuse and working to prevent future abuse.

 

POPAN developed as a response to the problem of abuse by psychotherapists - until then those who had experienced abuse had nowhere to go for appropriate help and advice. POPAN’s remit widened to include abuse by any health or social care professional, and it has done much to break the silence about this issue since it was established in 1990.

 

Important recognition of POPAN's work came in 1995 with the award of a grant from the Department of Health. Registration as a charity followed in 1996, and in 1997 POPAN secured the first substantive funding for its work with additional grants from the Department of Health and National Lottery Charities Board. This enabled POPAN to expand its services and develop an outreach programme to promote its work throughout the UK.

 

POPAN's services:

 

POPAN’s main priority is to help those who have suffered the devastating effects of professional abuse. We deal with telephone and written requests for help from throughout the UK.

 

Calls for help continue to increase. We currently receive about 12 new enquiries each week. We also deal with an average of another 50 case contacts each week, who approach us for a mixture of emotional support, information and complaints advice. However, we believe that POPAN only deals with the tip of the iceberg and many people continue to experience such abuse in secret and isolation.

 

Support is mainly provided by telephone, although we also facilitate regular support groups, providing clients with the opportunity to meet and share their experiences. Currently these are held in London and Leeds, but we hope to develop new groups in other areas soon.

 

Providing accessible information is vital not only for those who have been abused, but also for local groups and agencies who may deal with initial allegations of abuse. POPAN has produced a number of fact sheets covering professional abuse and its effects, making a complaint, what to expect when going into therapy and a list of helpful books. We also produce a quarterly newsletter, providing information for clients as well as an opportunity to express their feelings and experiences.

 

If clients wish to make a formal complaint about the professional and their behaviour, POPAN can provide advocacy help. We also support clients who are pursuing their own complaint or taking legal action. However, many POPAN clients do not want to complain formally, while for others it may not be possible to make a formal complaint. For example, the practitioner may be self-employed or may not be registered with any professional body. The time limits for making a complaint may have passed, or the complainant has no corroborative evidence to support their complaint. Others come to POPAN when they have already exhausted the complaints process or the organisation has rejected their complaint. In these circumstances, it is often difficult to find a way to channel the client’s hurt and distress.

 

What is professional abuse?

 

Fundamental to any relationship between a health or social care professional and their patient or client are trust, respect and a commitment to act always in the best interests of the patient. It is always the professional's responsibility to set and maintain boundaries to the relationship.

Abuse occurs when the professional breaks that trust and breaches the accepted boundaries to the patient/ professional relationship. The relationship is rarely one of equals, which makes it hard to challenge and question the professional’s behaviour.

 

Who abuses?

 

Abuse occurs across all professions and in all sectors - POPAN has dealt with complaints of abuse in the NHS and statutory services as well as private healthcare and the voluntary sector. It occurs in institutions, as well as more private settings, where it is less likely that there are witnesses.

 

POPAN receives allegations of abuse by a wide-range of professions. A significant proportion of these concern professionals who are not subject to statutory registration. Many callers are distressed that there is no legal requirement for psychotherapists, counsellors and psychologists to be trained or registered with a professional body before they can practice in this country.

 

 

Profession of alleged abuser: (1 April 1998 to 31 December 1998

Doctors

60

Psychotherapists

60

Counsellors

31

Nurses

23

Psychologists

16

Social Workers

16

 

 

We also receive allegations concerning complementary and alternative practitioners, including osteopaths, hypnotherapists, chiropodists, and unqualified staff, such as care workers, nursing auxiliaries, support workers, and support volunteers. These workers owe the same responsibilities to maintain boundaries and not misuse a client's or patient’s trust as any formally qualified "professionals".

 

 

 

 

Who contacts POPAN for help:

 

Most clients are very distressed when they first approach POPAN. For many it is the first time that anyone has listened to them and has understood their experiences. They are often relieved to know that they are not alone and are not responsible for their abuse.

 

Through our contact with survivors, POPAN collects detailed information that provides a valuable insight into the patterns and effects of abuse. For those clients contacting us in the year ending 31 March 1998, we found:

 

·       80% of our regular users reported experiencing abuse as a child

·       70% were abused within mental health services

·       85% were women, mainly abused by men.

 

This suggests that professionals who abuse target the most vulnerable patients and clients, who are least able to defend themselves and least likely to be believed. We do not claim that this is a comprehensive or representative picture of the problem.

 

Nature of alleged abuse:

 

Abuse can be emotional, sexual, physical and financial. Emotional abuse is the most common type of abuse, but is also often a precursor to other types of abuse, although our clients may not report this themselves.

 

In a sample of 240 cases between 1 April to 31 December 1998, we found:

 

Cases involving:

 

·       emotional abuse:       166       

 

·       sexual abuse:             100

 

·       physical abuse:           20

 

·       financial abuse:          10

 

·       racial abuse:               10

 

The abuse is not always intentional. It may be due to the professional's inexperience or lack of training to maintain boundaries or deal with the issues and behaviour the client brings into the relationship. Or it may that the professional’s personal difficulties affect their judgement.

 

However, it is important not to underestimate the role of the serial abuser. POPAN has encountered examples of professionals who consciously and intentionally target vulnerable clients and patients, using them to satisfy their own unmet (often sexual and emotional) needs. These abusers typically target very damaged clients who are least likely to be believed. They are often senior and well protected by their professional networks and alliances, which can make it very difficult to complain about their behaviour.

 

The effects of abuse:

 

Abuse within any caring or therapeutic relationship seriously affects the physical and psychological health of patients and clients, and those who are close to them. Many who contact POPAN suffer symptoms associated with post-traumatic-stress disorder such as anxiety, panic attacks, sleep disturbance, depression, mood swings, and low self esteem. Some have suicidal thoughts and may attempt suicide. Others exhibit self-harming behaviour, substance abuse, or have eating disorders.

 

Many also suffer from unresolved grief at the loss of the support they received from the professional who has abused them. They often feel responsible for the abuse and guilty that they let it happen. They frequently develop a deep mistrust and/or ambivalence towards caring professionals, which has serious long-term implications for future care.

 

The abuse also has a clear impact on the mental health of our clients, often exacerbating any existing mental distress. A fifth of new clients in the last year reported suffering from severe or enduring mental illness - i.e. psychiatric in-patient treatment of more than one month.

 

Helping with complaints:

 

Initially, POPAN clients feel isolated and confused, often needing to go over things repeatedly. Breaking that isolation, helping to reaffirm their value and restore self-esteem are vital in helping them to move on. 

 

However, working with our clients there is also a crucial need to rebuild trusts, and to maintain clear boundaries to the relationship.

 

It can be very empowering and healing for survivors to take action against their abuser to bring them to account for their actions. However, we have found it is important not to push clients into making complaints as the process is often confrontational, slow and distressing.

 

From helping clients complain to professional bodies and employers of health and social care professionals, POPAN has identified poor practice in all sectors. Complaints about abuse are often handled badly and it can be difficult even to get a complaint heard. Procedures are often inadequate or poorly administered. It can be difficult to get hold of necessary information, and professional bodies can be defensive and hostile to any enquiries.

 

The lack of transparency in many procedures and apparent collusion amongst the professionals can lead to complainants becoming suspicious and mistrustful of the entire process. Complaints processes need to be more efficient and straightforward if they are to be trusted and respected by complainants and the public.

 

Our clients report high levels of stress before, during, and after making the complaint often brought on by a combination of inadequate procedures and the trauma involved in reliving past events. Many feel undermined and bullied by the nature of the complaints process, and some self-harm and feel suicidal as a consequence of what they term "secondary abuse" by the organisation to which they are complaining.

 

Support and advocacy throughout this process are vital. Advocacy services can help with processing the complaint and supportive representation at meetings and hearings. Involvement of an advocate may also protect clients from further insensitivity and intrusion, and prevent attempts to delay the complaint or to discourage complainants from pursuing their case. POPAN clients with psychiatric histories often face additional problems in getting their complaint taken seriously because they are labelled as unreliable witnesses, and it is invaluable if there are independent witnesses to support any allegations of abuse.

 

Complaints about abuse can be difficult to prove, often relying on one person's word against another's. Some professional bodies require that complaints of professional misconduct are proved "beyond all reasonable doubt" (i.e., the same burden of proof used in a criminal court) while others adjudicate complaints on the "on the balance of probabilities". Understanding what standard of proof is required by the different procedures and what is involved is crucial to explaining the different options open to clients and enabling them to make informed choices.

 

Working towards prevention

 

Although our work with individual clients is important, POPAN also needs to work to change the overall context in which health and social care professionals practice to prevent the future abuse of patients and clients. We aim to increase public and professional awareness about the issue through the media, and contact with professional and training bodies, user groups and patients' councils. We have also developed a training programme for independent advocacy workers which we plan to take to local projects throughout the country.

 

POPAN not only makes representations to central government to strengthen the professional regulation to improve protection of the public, we also seek to influence the way that professional regulatory bodies respond to allegations of abuse. We aim to contribute to the training and development of good practice for professionals working in this field by developing a training module on abuse awareness, its detection and prevention. We also participate in a range of forums to advise on the prevention of abuse, including steering groups and ethical committees of professional bodies.

 

All this underlines the responsibility we all share to take action on this serious problem and play our part in its prevention.

 

POPAN can be contacted at: 1 Wyvil Court, Wyvil Road, London SW8 2TG

Tel: 0207 622 6334   - Web site: www.popan.org.uk

 

 

 

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