The National Council of Psychotherapists
ABUSE OF PATIENTS AND CLIENTS - THE WORK OF POPAN
Frances Blunden (Director) and Jo Nash (Research and Development Worker)
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
(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.
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.
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.
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.
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.
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.
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
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.
is professional abuse?
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.
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
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.
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.
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
contacts POPAN for help:
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.
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:
of our regular users reported experiencing abuse as a child
were abused within mental health services
were women, mainly abused by men.
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.
of alleged 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.
a sample of 240 cases between 1 April to 31 December 1998, we found:
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.
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.
effects of 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
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.
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.
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.
working with our clients there is also a crucial need to rebuild trusts, and to
maintain clear boundaries to the relationship.
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.
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.
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
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.
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.
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.
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.
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.
this underlines the responsibility we all share to take action on this serious
problem and play our part in its prevention.
can be contacted at: 1 Wyvil Court, Wyvil Road, London SW8 2TG
Tel: 0207 622 6334 - Web site: www.popan.org.uk