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Radical approaches to prevention, protection and support
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In this outspoken and challenging book, Sarah Nelson argues that progress in addressing childhood sexual abuse has been in fearful or complacent retreat and that change is urgently needed in order to prevent abuse occurring, and to better support survivors.

From this starting point, she puts forward radical suggestions for new models of practice. These are designed to provide perpetrator-focussed child protection, to encourage community approaches to prevention, and to better support those who have survived abuse.

As revelations of widespread child abuse continue to emerge at an unprecedented rate, this book campaigns for change, offering policy makers and practitioners solutions for new ways in tackling sexual abuse, working alongside survivors to reduce its prevalence and impact.

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Surely in the UK we are now tackling child sexual abuse (CSA) more successfully, giving us all confidence for continuing progress? Consider the vast array of child protection procedures and guidelines now in place, and the almost weekly media publicity about CSA, which suggests this hidden crime is now being addressed more openly and more effectively. Consider the powerful impetus which shocking revelations of large scale, unrecognised or previously unaddressed sexual abuse against children has given to efforts against its repetition. That includes widespread revelations of sexual abuse by clergy, particularly by Catholic and Anglican priests; and growing acknowledgement of the silencing power which was held over victims and prospective whistleblowers by these religious figures, by showbusiness celebrities and by politicians.

A succession of inquiries in 2013 and 2014 followed the televised exposé in October 2012 into many hundreds of assaults over five decades by the late disc jockey and presenter Jimmy Savile, whose targets included disabled and mentally distressed young hospital patients. Few attacks had been reported, and none prosecuted (Gray and Watt, 2013). Convictions of the artist and international entertainer Rolf Harris and the broadcaster Stuart Hall for sexual offences against girls followed (BBC News, 2014a; Spillett, 2014). Longstanding abuse of boys by the late Cyril Smith MP had apparently been concealed for decades by the authorities, while investigations were also launched into suspected child sexual abuse by several prominent former members of the British Parliament (Glennie, 2013; MacKean, 2013; BBC News, 2015c; Grierson, 2015).

Then police inquiries were belatedly reopened into in-care abuse rings where perpetrators allegedly included influential figures from politics, business and social care, for instance in North Wales and London (Dobson, 2013).

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In order to escape accountability for his crimes, the perpetrator does everything in his power to promote forgetting. If secrecy fails, the perpetrator attacks the credibility of his victim. If he cannot silence her absolutely, he tries to make sure no one listens. (Herman, 1992)

The opening chapter discussed some ways in which the modern backlash against the exposure of child sexual abuse (CSA) has undermined protection of children at risk. Supporters of accused adults have used media and academic discourse to shape public, legal and medical opinion; and at times to discredit, intimidate and silence child and adult survivors of CSA, the children’s mothers and professionals who have tried to protect or support them.

Theories promoted by proponents of the backlash against exposure of CSA have received widespread credibility and media publicity. Those who believed abused children and adults have often found themselves portrayed as gullible and naive. This chapter examines how credible some major examples of backlash theories have actually been: the ‘satanic panic’, ‘false memory syndrome’ (FMS) and ‘parental alienation syndrome’ (PAS). Some individuals particularly active against sexual abuse, and repeatedly targeted for discredit, are discussed. Continuing attempts at discredit are suggested through the example of the ‘Butner study’.

Careful academic and legal critiques already exist of FMS and PAS. As discussed later, the memory debates from the early 1990s onwards inspired valuable professional analyses of amnesia and memory issues following trauma. Rather than simply repeat these, I concentrate here on sometimes glaring weaknesses in backlash theories, which should have raised obvious doubts about their reliability and credibility, yet did not.

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This book is published in the 25th anniversary year of the Orkney child abuse case and inquiry

Why should highly publicised child sexual abuse cases from decades ago remain important? Why should informed accuracy about them matter?

Because the way in which facts, or more often myths, about such cases are perceived is influential for decades – with a disproportionate, negative influence on public attitudes, on professional behaviour, and, it can be argued, on subsequent child law. The myths have fuelled suspicion, even denigration, of the social work and paediatric professions; increased the stress involved in child protection work; tightened legislation and practice in ways which make it harder to protect children at risk; and eaten into professional courage and confidence. The legacy of such cases not only influences opinion, but becomes the narrative of is true and what is false in sexual abuse.

For example, I and others working in this field continue to meet teachers, youth workers, children’s panel members and social workers who still quote the Orkney child abuse case of 1991–92 as a reason not to ask a child if anyone has harmed them sexually, however disturbing the signs and behaviours may be. ‘The Orkney Report said we mustn’t – didn’t it?’ Actually: no, it did not.

Thus it remains important to analyse individual, highly publicised cases, to check the facts, and to ask if lessons drawn, influenced by media coverage, are soundly based or not.

Thus it remains important to analyse individual, highly publicised cases, to check the facts, and to ask if lessons drawn, influenced by media coverage, are soundly based or not.

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Asked by a House of Commons select committee in 2012 what lay behind repeated failures in Rochdale to protect young teenagers and pre-teens from sexual exploitation, Sara Rowbotham answered simply and powerfully. She was coordinator of the local NHS crisis intervention team, which had made more than 100 largely fruitless referrals to social services and police between 2004 and 2010.

It was about attitudes towards teenagers. It was absolute disrespect that vulnerable young people did not have a voice. They were overlooked. They were discriminated against. They were treated appallingly by protective services. (Williams, 2012a)

This chapter highlights stigmatised teenagers who have faced child sexual exploitation (CSE) or very young (especially pre-teen) pregnancy. It concentrates here on prejudiced, sexist attitudes to girls and young women and how these attitudes have contributed heavily to contemptuous perceptions of their suffering. This is not to deny that a significant minority of boys and young men have also faced sexual exploitation.1 Many of the changes called for in protection and provision will also be helpful to them, although certain perceptions which they face are different (see Chapter Nine).

This chapter describes sexist vilification, contempt and blame sexually exploited girls have faced from professionals, public and media alike. It challenges theories of so-called ‘political correctness’ as a reason for failing to bring to justice perpetrators from minority ethnic backgrounds. I argue that the most urgent need for professionals in ensuring genuine change is to examine very searchingly of themselves why, in CSE, their clear witness of distress and huge dereliction of care persisted decades after it was made clear through practice, legislation and legislative guidance that the young people were victims of exploitation, and must be treated as such.

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I believe that such changes, along with the rejection of prejudicial, gender-biased assumptions about CSA survivors in healthcare, will make more appropriate and effective the treatments and therapies available to them. It will not be sufficient in itself to carry through, in medical practice, excellent recommendations already available to healthcare professionals for sensitive approaches to abuse survivors: about ensuring that healthcare offers a safe welcoming environment, confidential services, the availability of chaperones, an awareness of ‘triggering’ examinations, and sensitivity in questioning about assault history (for example, Teram et al, 2006; Schachter et al, 2009; McGregor et al, 2009; Nelson, 2012b). Such thoughtful survivor-centredness in routine practice is very important, but it is only part of what is needed. In this chapter I challenge conventional theories of the links between child sexual abuse (CSA) trauma and physical ill health. The chapter explores the extent and possible causes of widespread physical ill health and chronic pain among adult survivors of CSA. This contributes to their suffering and disability throughout life, becoming an additional burden and stigma. Yet their physical health has received far less research attention than their mental health. Tenacious theories of ‘somatisation’ and ‘secondary gain’ explain away these often serious disorders, yet there are flaws in both theories. The greatest problem adult survivors of CSA have found in accessing respectful, appropriate healthcare and support is the assumption that their ill health must be psychosomatic, or even ‘hypochondriacal’, due to their actual or assumed mental health problems.

I argue the case for the little-considered, direct effects of sexual violence through injury, damage and sexually transmitted infections (STIs).

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Our psychiatric hospitals, secure hospitals and outpatient psychiatric clinics are packed with the victims of crime – especially with victims of child sexual abuse (CSA). This fact continues to be heavily obscured due to dominant medical model paradigms in mental health. As a result, such hospitals and clinics remain major parties to the concealment of the extent and impact of such crimes.

This chapter considers the persistence of biomedical models of mental ill health despite repeated and continuing evidence for trauma aetiologies, and discusses some reasons why this evidence has been consistently ignored. It argues that it is very important, but not sufficient, to challenge biomedical models of mental illness, to challenge current diagnostic labelling, and to oppose coercive techniques of restraint: as many committed critics within and beyond the mental health professions have already done. It is also very important, but not sufficient, to provide – for survivors of abuse and indeed survivors of other serious life adversities – adequate, humanistic, caring, appropriate therapeutic and support services, and genuinely to involve service users in shaping those services.

But the major implications for prevention of the crimes which continue to make so many people mentally ill must also, at last, be fully acknowledged and acted upon. Given the major roleaccorded to prevention in many other areas of public health, it is after all extraordinary and unusual that they have not been. Thus our mental health systems, with forceful prompting from governments and health authorities, need actively to contribute to multidisciplinary efforts to prevent and reduce CSA.

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“Nobody ever asked me what was wrong when I was in care or prison … nobody said, ‘why are you doing this?’ I was always in trouble – dishonesty, fire raising and property stuff. It’s all children in care, who’ve been abused, who end up in prison … it makes my heart bleed that there will be more children.” (Pete, ex-prisoner)

“There was nine of us in the ‘List D’ school who suffered that [sexual abuse] and later nine of us later got life sentences, because we didn’t know anything else but badness.” (Paddy, life prisoner)

What might the connections be between being sexually abused as a child, and becoming an offender? And why should understanding the connections be important? For many reasons: because earlier protection from abuse might make many of these survivors less likely to commit crimes, protecting future victims; because reactions to child sexual abuse (CSA) trauma might explain ‘meaningless’, even fatal, violence, increasing the urgency of earlier therapeutic support which might save lives; because all CSA survivors, whatever they have done, deserve help to reduce the effects of their trauma; because many young offenders might be enabled to change their lives; and because most offender services and penal institutions remain very poorly equipped to meet – or even to recognise – the needs of sexually abused prisoners.

Most male and female survivors of sexual abuse do not offend. It’s very important to stress that. However, very many convicted offenders have sexual abuse histories.

Research has shown that sexually abused young people have higher risks of offending than non-abused young people (Dembo et al, 1992; Jumper, 1995; Tyler, 2002; Levy, 2004; Johnson et al, 2006; Fergusson et al, 2008).

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How can convicted sexual predators be made less dangerous to children? Public and professional concern about that question has been heightened by the highly publicised convictions of ‘celebrity’ offenders such as Jimmy Savile, Rolf Harris and Stuart Hall, who appeared repetitively to abuse over decades; by the ever-increasing numbers of convicted sex offenders in the UK; by a series of national and international child sexual abuse scandals in institutions, including the Catholic Church; and by the huge, ever-growing international industry in abusive images of children, aided by a range of modern and ever-developing technologies.

The Bourke and Hernandez (2009) study of internet offenders viewing child abuse images (see Chapters One and Two), which found that 85% of the men in their sex offender treatment programme eventually revealed hands-on abuse with an average of 13 victims per offender, raised further serious questions about possible risks posed by online sex offenders to children in the offline world.

There is an urgent need for dialogue between feminist and other approaches towards sex offender work. In this chapter I discuss those male sex offenders who have been both perpetrators and victims. I believe that revising our thinking towards work with male survivor offenders will reduce future risks to children. These changes will challenge our assumptions, but need not betray our principles. I go on to discuss ways in which feminist approaches can truly inform general sex offender work: that will also, I believe, reduce future risks to children.

I write from a feminist tradition. We have not viewed work to change known sex offenders against children as a priority for reducing child sexual abuse (CSA).

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We can never eradicate child sexual abuse. But we can reduce it substantially, along with the numbers of women and men, girls and boys who suffer lifelong pain, distress and stigma as a result. There are already many past and current models of good practice, and this book demonstrates some of them. Harnessed to imaginative use of new technologies, which can meet the considerable and growing challenges in the online world, these can significantly reduce a serious crime which inflicts such costs on the whole of society.

A lack of promising models and initiatives, which can be adapted, are thus are not the problem. Rather it is lack of priority and political will, it is complacency, denial or mere embarrassment, a failure of courage, and continuing prejudice against the most vulnerable young people and those who try to support them. It is the size and power of lobbies which support and protect networks of abusers. Their threadbare theories minimising or denying CSA have been swallowed with relief, in preference to confronting realities which at the extremes excite horror, but which more often are mundane, squalid and distressingly widespread.

This is why those of us who have campaigned for decades against CSA have been pressing many of the same arguments for 20 or 30 years. And why there are so often two steps forward, then two back, in sexual abuse work. Time is overdue now to ask policymakers, managers and practitioners in particular why unsustainable things have continued to happen for many decades, and why obvious changes have not.

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