Psychiatric Assessment of The Effects of Historical Child Abuse

The recent public focus on historical child abuse has led to an increasing number of personal injury claims. This presents particular challenges for survivors and psychiatric experts.

Survivors will be asked to remember deeply painful experiences associated with powerful negative emotions such as shame, guilt and anger. Their instincts and psychological defences will have worked to suppress their memories of these events for many years. They will usually have been through police and solicitors’ interviews before they get to a psychiatric expert but they will still be raw and frightened and often overwhelmed with shame.

To get the most from the interview, the process needs to help the survivor to feel as safe as they can. They may associate psychiatry with social work and professionals who previously abused them. Some find it helpful to have a pre-interview telephone call to ask what will happen, and hearing the voice of the expert before the interview can offer reassurance. The interview has to be finely tuned to the survivor’s mental state at the time. If they are prone to using alcohol or drugs to manage their emotions then they should be encouraged not to drink or use before the interview. That should not be just assumed and some will find that very difficult to do. Clear explanation of the interview process can help to establish it as a safe place. It can be helpful to make a supportive statement, so that if there are any areas which they do not want to explore then that should be their choice, and they can stop a line of questioning or even the interview at any time if they wish. It may be best done over a number of sessions, which facilitates the building of trust.

For the expert, one of the most challenging questions is the ‘but for’ question. But for the index abuse where would the survivor have ended up? Some will have had traumatic family lives before the index events which led to them being placed in care or taken away from their families. Having objective information on their pre-incident functioning from school or social services’ reports can be helpful.

A positive assessment is one which not only fully addresses the issues raised in the letter of instruction, but is also cathartic for the survivor, increasing the chances of them being able to subsequently engage in psychiatric treatment for their injuries.

Dr Paul McLaren is a General Adult Psychiatrist and Medical Director of The Priory Hayes Grove and The Priory Ticehurst House. He is experienced in assessing parental mental health in the context of childcare proceedings and preparing medico-legal reports in the areas of post-traumatic stress disorder and psychological disorders complicating physical injury.
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