The body remembers: ACC slow to provide somatic therapy to sexual abuse survivors
Thursday, 11 August 2022
CONTENT WARNING: Contains references to suicide.
Stuff series ACCountable takes a look at different people’s ACC experiences, considers how ACC can be improved and what an equitable system would look like for injured and disabled Kiwis.
It takes courage to lodge a sensitive claim for sexual abuse with ACC. Add to that a system that is difficult to navigate and the situation can quickly turn into desperation. Two survivors share their stories with EDA TANG in the final instalment of ACCountable.
“I’m pretty sure [ACC] knew that I had been having suicidal thoughts since October because it was written on all the clinician notes,” says Liv Redman, 22, who endures severe chronic pelvic pain as the result of sexual abuse when she was 16.
They are sharp, steady pains, sometimes coming in aches or jitters that shoot down her leg, she says.
“I've shattered my tibia to bits, and I've broken my back before and I don't think anything actually compares to how bad the chronic pain can get at times.'
Redman and 49-year-old Lana*, whose name has been changed to protect her privacy, are frustrated at how difficult it has been to get the physical injuries they have sustained from sexual abuse recognised by ACC.
They say it’s been a struggle to get help outside of talk-based therapies.
Even though ACC sensitive claims are for mental or physical injuries caused by criminal acts of sexual violence, none of the service providers under ACC’s registry of Integrated Services for Sensitive Claims (ISSC) are body-based therapists.
Of the 2230 providers under the ISSC, all are either clinical psychologists, counsellors, psychiatrists, registered psychologists, psychotherapists or social workers.
Redman (Ngāpuhi) was an up-and-coming freestyle snowboarder as a teenager and is a mental health journalist.
She has spent more than five years in pain, and waited seven months for a physiotherapy appointment to be covered by ACC.
“Even though the physiotherapists I saw knew that the injuries were from sexual abuse, somehow they needed a psychologist to check that … It’s no wonder so many women and so many men who have been abused just end up, you know, killing themselves.”
In 2018, she underwent investigative surgeries for endometriosis and polycystic ovary syndrome as a potential cause of pain, but nothing was found.
When asking a counsellor about tools to manage chronic pain and move on from the sexual abuse she endured at the age of 16, it was suggested that the pain and abuse could be linked.
She was later diagnosed with genitopelvic pain/penetration disorder (GPPPD), a combination of painful sex (dyspareunia) and involuntary vaginal muscle spasms (vaginismus). GPPPD is treated with a combination of psychological, and physical interventions such as pelvic physiotherapy.
“I kept it secret during the months that it had been happening and I struggled with it a lot.”
Around August 2021, Redman lodged a claim through a doctor for the physical injuries caused by the sexual abuse, but her claim was declined because “it wasn’t done right”, she says. “By that point, I think it was written down on my file that I was having suicidal thoughts and I had been self-harming.
“I definitely cried and yelled at her down the phone, like, I just don’t want to be here.”
ACC’s understanding of the situation was that Redman was “already seeing another psychologist and told us she was happy with the support being provided”, ACC chief reporting officer Gabrielle O’Connor said.
“On this basis, we agreed to close the claim for the time being, with the option to reopen it at any point if the situation changed. This resulted in a ‘decline decision’ being issued but did not impact future eligibility for support.
“We understand this process may have been unclear and we have apologised to Olivia for any confusion caused.”
But Redman says she never saw a psychologist and had lodged the claim because her university counselling sessions were coming to an end. By the end of the year, as she was finishing her university degree, Redman started again with the ACC and police process, which brought back her suicidal thoughts.
Redman wanted to see a psychologist so that her need for physiotherapy could be validated. But the wait lists were six months long and “it didn’t matter if you were suicidal or not”.
A doctor at Women’s Refuge wrote a formal letter to ACC, reminding the corporation of its obligations following such a claim. Within a week of that letter landing, an ACC case manager had found Redman a counsellor. The counsellor then got Redman seen by a psychologist.
As O’Connor explained, physical injuries have a different test applied to them in order to gain ACC cover.
“If a client sustains both physical injuries and mental injuries from a sexual assault, we have to apply different criteria to accept cover for each of the diagnoses, but once covered they are all managed under the one claim.”
Redman’s pain disorder was accepted as a mental injury, not a physical injury, she said, but if the client’s counsellor or GP can identify that there were physical and mental health issues, ACC would work with the client to help them through the process for the injuries to be considered.
Following Stuff inquiries to ACC on Redman’s case, her physiotherapy claim was accepted, and ACC said that GPPPD as a result of sexual abuse was covered under the sensitive claims scheme. It still took seven months to get Redman’s claim approved.
Redman’s case manager also apologised for not explaining the claims process in enough detail, but Redman said she was grateful for her case manager’s efforts – “I feel like she’s been told off and told to apologise to me when, actually, I don’t think it’s her that needs to apologise.”
Redman has now had eight to 10 sessions of mostly subsidised physiotherapy which she says has helped reconnect her with her body and better manage her pain.
Meanwhile, her physiotherapist, psychologist, counsellor and naturopath have suggested that Redman see a gynaecologist. Because of the bleeding that followed her sexual abuse, her periods, which can last up to 14 days, continue to be a trauma trigger. ACC has not yet accepted Redman’s request.
“I could just go and [see a gynaecologist] but it’s not a cheap amount of money.”
Redman has since had to quit her job as it became too difficult to manage with her conditions.
“I’m pretty vocal about this but for someone who isn’t, someone having to go through all this on top of dealing with the physical and mental injuries of your rape … like, they wouldn’t do this to someone who sprained their ankle.”
The long-term costs of childhood sexual abuse
Lana* (Ngāti Tūwharetoa) has suffered reduced immune function, inflammatory illnesses, chronic fatigue, slow wound healing and muscle pain since she was sexually abused between the ages of 5 and 7. Her uterus was removed when she was 22 due to a large cancerous mass caused by cervical cancer.
Lana says that her anxiety, depression and hypervigilance caused by the sexual abuse impaired her immune system's ability to fight HPV, leading to her diagnosis of cervical cancer. At the time, she did not link the two together but, '20-some years later, we know that there is a strong relationship between poor mental health and reduced immune function in the body and formation of a host of physical manifestations of distress'.
The original Adverse Childhood Experiences (ACE) study, which included more than 17,000 adults, found associations between adverse childhood exposures and adult diseases including ischaemic health disease, cancer, chronic lung disease, skeletal fractures, and liver disease.
Decades on, research has reasserted that the accumulation of chronic, excessive stress interferes with the development of healthy neural, immune and hormonal systems and can alter the expression of DNA.
Lana recently completed a Masters of Science in Health Psychology and is now working for an iwi health provider.
Thirty-eight years after the abuse, Lana approached ACC.
'Physically, I have not thrived in my life. I knew that all the shame and self-loathing that I felt within myself had gone to my most sacred and tapu of parts – my womb.
“I was living in a traumatised body … even though I’m 49 years old, sometimes I still feel resentful and ripped off.”
An ACC psychologist diagnosed Lana with PTSD, persistent depressive disorder and generalised anxiety with panic. An impairment assessment following that diagnosis assessed Lana as 20% impaired. “It was really hard … it means that they can attribute a dollar amount.”
With a 20% impairment rating, Lana was eligible for $358.41 every three months. “It’s pretty negligible … I don’t think 20% impairment accurately reflected the damage, but I didn’t want to go through another impairment assessment.”
Clients can arrange a reassessment if their treatment provider believes there to be a change in impairment since the initial assessment, but Lana said the assessments consume several days of her time and are emotionally intense and difficult.
“I do think sexual abuse survivors [are] kind of shocked after they get through that whole process to find out, actually, how little their injury is worth,” she said.
ACC said that the assessment “considers the impact of the injury on the client’s life in the following areas: activities of daily living; social functioning; concentration, persistence and pace; and adaptation/decompensation”.
With ACC, Lana felt an expectation to be improving within a certain timeframe – “I felt that pressure as a client.
“For me, PTSD is highly somatic,” she says. “The physiological symptoms of being in fight or flight mode are more distressing than the psychological symptoms, and they’ve had, in my opinion and in the health literature, a cumulative, negative impact on my health.
“From that wairua aspect, I felt spiritually dirty and shame … I just felt tarnished and violated on a soul level and I had a very strong intuition that I needed spiritual healing.
“I’ve been in this system for three years and I still don’t know all the helping modalities that I am entitled to, or are available to me.”
Lana forged her own pathway and asked ACC if it would cover spiritual healing within a te ao Māori framework. It took ACC five months to agree and fund 24 sessions.
“It was life-changing. Visual flashbacks that I had lived with for decades – gone.”
ACC said that at the time, rongoā Māori was not offered as a service by ACC, but that’s changed. O’Connor said that since the end of March 2020, ACC “had approved rongoā Māori for 1985 claims and funded more than 12,600 sessions”.
ACC’s definition of rongoa Māori covers mirimiri (bodywork), whitiwhiti kōrero (support and advice) and karakia (prayer) as some of the included Māori healing methodologies. It is described on their website as “culturally grounded care that weaves tikanga Māori, mātauranga Māori, te reo Māori, and te ao Māori”.
Before her healing, Lana says she was not in a “space to receive and be taught new ways to manage the debilitating PTSD symptoms, especially if my body is not acknowledged as being included”.
Lana says that in her ideal, dream system, ACC would better acknowledge the physical sequelae of PTSD.
“Breaking the PTSD sensitisation and kindling cycle in the body would bring the client to a better state of health … and help the client become more resilient in coping with future triggers.
“From a money perspective, body therapies tend to be of shorter duration … whereas therapy is long term, expensive and doesn’t work for all clients,” says Lana.
“My language privilege, my culture knowledge … and my academic knowledge meant that I was able to make ACC work much better for me than I think maybe some other people could.”
O’Connor said that “ACC [funds] services from qualified and experienced clinicians to deliver appropriate treatment and rehabilitation, including both talk-based and non-talk-based therapies.”
She said that common non-talk-based therapies used to treat sensitive claims clients include breath therapy, music or art therapy, equine therapy, trauma-based yoga, and group-based therapies.
“Additional supports that can be accessed once a claim is approved may include financial support, social rehabilitation, vocational rehabilitation, rongoā Māori services, and physiotherapy.
“ACC requires treatment of personal injuries to be evidence-based, necessary, and appropriate for the covered injury.”
*Name has been changed to protect Lana’s privacy.
Where to get help for sexual violence
Rape Crisis 0800 88 33 00, click link for local helplines.
Safe to talk: a 24/7 confidential helpline 0800 842 846, text 4334, webchat safetotalk.nz or email support@safetotalk.nz.
The Harbour Online support and information for people affected by sexual abuse.
Women’s Refuge 0800 733 843 (females only)
Male Survivors Aotearoa Helplines across NZ, click to find out more (males only)
If you or someone else is in immediate danger, call 111.
Need help? If you or someone you know is in a dangerous situation, click the Shielded icon at the bottom of this website to contact Women's Refuge in a safe and anonymous way without it being traced in your browser history. If you're in our app, visit the mobile website here to access Shielded.