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Sunday, December 30, 2012

Rape Victim in India is an inter personal violence issue worldwide

As the world media focuses on the death of the woman in India who was gang raped, they may focus on two themes - the outrage in India which is leading to large scale public demonstrations and on the charges against the alleged assailants which may lead to the death penalty.

One hopes that the many protests will, however, cause a larger discussion about the role of sexual abuse in India. I have done some volunteer work there around the issues of child protection and sexual abuse. The official statistics in India are that 53% of children will be sexually abused. This may be the biggest story that should now become the focus of attention. It is a discussion of what has become too normal. Challenging the status quo such that sexual abuse of any person in India should be seen as wrong. This is an opportunity to bring to the national stage this very large discussion.

It is also a discussion of the remarkably few resources that exist in India to heal. I am impressed with the organizations that do exist such as the Tulir Centre for Prevention and Healing of Sexual Abuse located in Chennai. But they do not have the supports they need. Indeed, I am advised that there is a real shortage of skilled therapists to help with those who have been abused and those that abuse. Creative approaches are needed (An example is the wonderful ideas of Vikram Patel which can be hear in his TedTalk.

But there should be no nation that sits in judgment of India. For interpersonal violence is an international concern. We need only look at Sandy Hook in the United States where a shooter in a rampage killed children and adults. Then there is Amanda Todd who committed suicide after taunting bullying. Or how about Phoenix Sinclair, the Aboriginal child in Canada who died at parental hands? The point is, that this sexual assault in India should be seen as an incident of world wide inter personal violence that needs to be addressed by all of us.

Sunday, December 23, 2012

Holding mental health and child protection professionals criminally liable

An interesting case in France should send a chill to many mental health professionals.  It is the case of Daniele Canarelli, a French psychiatrist. Dr. Canarelli has been held criminally liable for the actions of a patient who killed his grandmother. As BioEdge reports:

Daniele Canarelli, 58, was guilty of a "grave error" in her treatment of Joel Gaillard, her patient of four years. She should  have had him committed or referred him to another medical team. Instead, he escaped from a consultation with her and went on to hack to death the 80-year-old partner of his grandmother.

French Psychiatrist Daniele Caranelli

The implications for mental health professionals, if this became commonplace, are astounding. At the heart of the notion is the idea that it is possible to accurately predict the behavior of clients. The reality is that is not possible. This court decision could create an over response. We have seen that with child protection workers when governments and the media lambast them for failing to protect a child.

This is different from those situations where a social workers might be held liable for a failure to protect in that this involves criminal convictions. That is very different than malpractice.  The latter is becoming more of a concern for child protection workers. For example, earlier in 2012, we saw a case in which civil liability was deemed appropriate in a Colorado case. The Juvenile Justice Information Exchange reported:

Earlier this month, the Colorado Court of Appeals ruled that social workers in Adams County may be held legally responsible for failures to protect children in foster care from abuse....The ruling allows the siblings to proceed with their lawsuit against the Adams County Department of Social Services, on the grounds that their rights to safety were violated by county social workers...The appellate court determined that the state’s division director of Child Welfare Angela Lytle, who supervised social workers Joan Forsmark and Cathy O’Donnell, acted “recklessly in conscious disregard” of the plaintiffs’ safety.

There can be a strong argument that a failure to act when the risk is known is quite different from holding a professional criminally accountable for something that may or may not occur within an unspecified level of risk. It will be fascinating to see if this French case leads to other such actions in other jurisdictions. However, we continue to await the results of charges against 2 American social workers in the Marchella Pierce case. As the New York Times reported in March 2011:

A former New York City child welfare worker and his supervisor were indicted on charges of criminally negligent homicide, the Brooklyn district attorney announced on Wednesday, saying that their failures had contributed to the death of a 4-year-old, Marchella Pierce, who had been repeatedly beaten and tied to a bed and weighed 18 pounds at the end of her life in September.

Damon Adams and Cheerece Bell - Social workers accused in the Marchella Pierce case

 Such cases will make child protection workers fearful of the implications of their decisions. This trend can make them more cautious, less willing to risk family preservation and more intrusive. This is a trend that needs to be watched.

We might reflect on the now famous Tarasoff case in the US and the ways that it led to changes in intervention - some good but often very concerning. As The Guardian noted in their coverage of the Caranelli case:

In the 1970s, a psychologist who had been treating Prosenjit Poddar, a student at the University of California at Berkeley, was held liable by the California supreme court for failing to warn Poddar's girlfriend, Tatiana Tarasoff, that he intended to kill her, as Podder had told the psychologist in therapy he intended to do.
"Psychiatrists rushed about rounding up their patients," said Turner. They looked for reasons to put them in institutions. "It set up a lot of concerns as to risk management and risk assessment."

Saturday, December 15, 2012

Recovering from Sandy Hook Elementary Shooting

To have not heard about the tragic shooting at Sandy Hook Elementary School would have required that you have been cloistered. The details have been plastered on news outlets around the world. It has been sensational - many killed, out of control gun access, theories trying to unravel what happened, traumatized families and first responders. These are the elements that have been repeated over and over again.

Some images, like the one below of police officers leading children away, have been seen by millions. Viewers have been glued to televisions as the minute details trickle out surrounded by multiple repetitions of what is possibly known.

There are at multiple sets of traumas here. The first is obviously the children and staff who were in the school. They witnessed or heard what went on. The second is the family members of both the deceased and the survivors. Then there is the community that must grieve the loss of the children but also the rewriting of what they had come to understand their town was all about. There are the first responders who faced head on the victims. There is a larger series of traumas though that occur vicariously. It is comprised of those millions who are over consuming this story. It is becoming too much their personal reaction to the tragedy.

Fortunately, most people recover from trauma as long as they take steps to connect with what really matters in their life. In other words, tragic as this is, they come to see that the tragedy is an isolated event in what is otherwise a life that they can manage. It is much more difficult for those who have other traumas upon which this adds further baggage. But that is not the case for most.

So what can we do? One of the most important things we can do for children is ensure that they are surrounded by people, things and places that make them feel safe. This often means family. The message needs to be that they are safe and they are and will be ok.

The child may need to talk about what happened. This is important while not causing the child to tell the story multiple times. Allow them to grieve and let them know that such feelings are normal. Let them participate in healing activities such as commiserating with friends. It is important to ensure that they feel resilient - they will get over this.

Why would I write these things - I am not at Sandy Hook nor will I be. It is because children have been widely exposed to these stories in the media.

Real child protection occurs in families who make their children feel safe and secure. This is a chance for that to happen. For the children who have been exposed to these stories, they need to know how rare these events really are. They also need to know that it won't happen to them. This is a chance for parents to talk to their children about how their lives are ok.

For some few children who have other traumas or losses, however, this may be more complicated. But be assured, making them now feel safe will help. For a small few, professional help may be required. But they are the few.

Another vital step adults can take, is to model that things will be safe, secure and manageable. Kids take their leads from adults on this. Something very constructive that the adults can do is limit the amount of exposure that the child has to this and similar stories. In other words, turn the news off - it is not helping the child and really not helping most adults.

I have worked in emergency cases such as through the ER of a major hospital and on a child abuse team. Taking these tragedies into your home life does not help you or your family.

Instead, turn the family focus on to things that are normal, fun and engaging. This reinforces the child's sense of security. That is real help.

Wednesday, December 5, 2012

Harassment as domestic violence

The Ontario Court of Appeal in its decision regarding R v. Doherty has emphasized a powerful legal principal which affirms that abuse can include harassment. This means that physical violence is not a necessary element of a criminal charge and conviction. 

Mr. Doherty is a man with a lengthy criminal record that includes prior convictions for regarding three other women. He also had a record for failing to honour the direction of police, probation and the courts. However, what matters in this case is the inclusion of non physical injury as the basis for a conviction.

The court states at para. 7 of its decision:
Ms. Mikulska suffered greatly as a result of the harassment. She was terrified of the appellant.
The decision further notes at para. 13:

Ms. Mikulska suffered mentally and physically as a result of the appellant’s harassment. She lost weight, lost sleep and was anxious and worried about what he may do to her. The impact on her was magnified each time he ignored her pleas to stop, the police warnings and the court orders    
In other words, his harassment caused her injury but not through physical force. 

The court also makes reference to a comment from the trail judge that is worth considering. The giving of evidence against your abuser also has an impact on the victim:

In my view, she fell within that category of witness who was re-victimized by having to come to court and give evidence.

In para. 15, the appeal court affirms that physical force is not necessary:

I agree with the respondent that the appellant is not entitled to mitigation on the basis that there were no physical assaults. As the trial judge noted, submissions suggesting that the lack of physical violence makes this offence less serious, “reflect a failure to appreciate that the primary impact of harassment is very often psychological … there is no requirement that there be physical harm to make out a very serious case of criminal harassment.

This decision will not solve domestic violence including harassment. It does give the police and the judiciary good guidance on the role that harassment plays as part of the world of abuse.