Citation

The Lancet. Lancet 2019; 394(10200): 710.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/S0140-6736(19)31999-3

PMID

31478487

Abstract

Institutional child abuse is particularly noxious in its betrayal of trust. On Aug 21, an Australian court dismissed an appeal against the conviction of child sexual abuse by Cardinal George Pell, once the third most senior Catholic cleric. However, the Catholic Church is not the only culpable institution. Australia's Royal Commission into Institutional Responses to Child Sexual Abuse (the final report was published in 2017) uncovered atrocities in residential, educational, religious, recreational, sports, and health-care institutions. Institutions had also dismissed allegations by children, families, and carers, and instead prioritised the reputations of perpetrators and institutions.

Many survivors of institutional abuse have learnt not to trust those in positions of responsibility and might not disclose abuse. They need trauma-informed care that recognises that risky behaviours or unhealthy lifestyles might be red flags for past trauma. Clinical queries should be proactive, respectful, and sensitive. Survivors must feel safe to disclose, knowing they will be believed, respected, and empowered to make decisions.

Treatments to aid recovery might include trauma-focused cognitive behavioural therapy for mental health symptoms. Treatment access requires clear referral pathways, flexibility, and community support. Siloes have no place here: health-care, social, legal, and justice services must collaborate more closely. The many evidence gaps are best filled when survivors and families are directly involved in research prioritisation and design...

Language: en