Responding to sexual abuse survivors who hear voices: a challenge for mental health services

© 2017 Dr. Kathryn SellickA growing body of research indicates that a substantial proportion of individuals who hear voices (otherwise known as auditory hallucinations) have also had experiences of sexual abuse. In addition to this, research indicates that experiences of sexual abuse lead to an increased severity and complexity of presenting psychiatric distress. Consequently, need exists for mental health services to effectively respond to consumers who hear voices and have experienced sexual abuse. This is consistent with a growing interest in trauma-informed approaches to care. There is limited research, particularly in Australia, examining how the service system responds to sexual abuse survivors who hear voices. This research project aimed to address this gap by investigating how the Australian mental health system responds to individuals who experience voice hearing and have past experiences of sexual abuse. This project implemented a multi-strand, mixed method design. Consumers who hear voices and had experienced sexual abuse (n=7) were interviewed about their use of mental health services. Mental health professionals (n=213) were surveyed about their work practices when working with voice hearers who have experienced sexual abuse. The results of this study indicate that while a proportion of mental health professionals surveyed were routinely screening voice hearers for sexual abuse, almost half were not. Several factors were found to influence screening behaviour including the presentation of consumers, beliefs about the causes of voice hearing, concerns about upsetting consumers, the gender of the professional, and organisational requirements for screening. The consumers who were interviewed detailed rarely being screened for sexual abuse when using mental health services and identified numerous barriers to voluntary disclosure. Further, they identified various negative impacts of not being screened. This highlights the need for mental health professionals to effectively screen for sexual abuse. Mental health professionals surveyed largely included disclosures of sexual abuse in professional formulations and treatment plans, but found that a lack of appropriate, accessible trauma counselling services impacted on their ability to respond effectively to voice hearers who had experienced sexual abuse. The consumers interviewed reflected this finding and described struggling to find effective support in a divided service system. Several themes were evident in the interviews and surveys that reflect supportive practice for voice hearers who have experienced sexual abuse. The value of helping consumers develop an understanding of their distress was highlighted. In addition, the need to avoid re-traumatisation was noted along with the importance of quality, power-sensitive relationships between consumers and professionals. The results from this study indicate that there are several approaches that practitioners and organisations can take to meet the needs of voice hearers who have experienced sexual abuse. There are, however, a number of systemic barriers that can be seen to inhibit effective service responses. This reveals limitations in the current positioning of trauma-informed care in Australian mental health services and the highlights the need for integrated approaches to care for voice hearers who have experienced sexual abuse