Guidance Nineteen - Support for individuals who have been abused
Introduction
An act of abuse may be experienced by a vulnerable adult as a traumatic event. Staff should be aware that they need to offer support to the individual. They also need to know that the type of support they offer could have an impact on both the individual concerned and any subsequent investigation.
What help should be given immediately after an incident?
There is a temptation to try to intervene as soon as possible to help the person adjust to what has just happened. However, the best practice in dealing with trauma is NOT to have an immediate intensive “debriefing” session focussed on the incident. (NICE Guideline CG26, 2005). Also this sort of intervention may compromise a criminal investigation. The focus of help given to a person immediately after an abusive incident should be physical and emotional care to provide them with feelings of safety.
What about longer term?
Carers and staff can help in three ways:
a) Providing a nurturing and safe environment. This may mean ensuring a person is not alone if they are anxious. It may mean providing extra support in situations which are similar to the abuse. Staff should continue to reassure the person they were right to talk about the abuse, and emphasise that it is being taken seriously. From time to time, they should ask such things as: “How are you? Are you worried about anything?”
b) “Watchful Waiting.” Staff should be aware of possible symptoms of post traumatic stress disorder and past abuse. These may include symptoms of anxiety, difficulty concentrating, difficulties in sleeping, fears related to people or objects, avoidance of situations or people, feelings of guilt and low self worth, withdrawal from activities. The person may re-experience the event, having recurrent thoughts, recurrent nightmares, and acting as if it is happening again. Vulnerable adults may show distress in other ways too; anger outbursts, challenging behaviour, self injury, and loss of skills. Such symptoms may occur in anyone who has experienced a trauma, and should not be considered “abnormal”. However, if they persist or seriously distress a person, then referral on for specialist therapeutic help should be considered. Staff should also be aware that the effects of a trauma may be worse/ more extreme where this triggers memories of a previous trauma.
c) Seek specialist help. If the person is extremely distressed or if symptoms and changes in behaviour are persistent, a referral to specialist therapeutic services should be considered. Such therapeutic help should be sought from qualified local practitioners. These may be Clinical Psychologists, Psychotherapists, Psychiatrists or members of other professions who have undergone further specialist training. Such therapy may need to be long term, and will aim to help the person to understand what has happened to them, to improve their feelings of self worth, to feel less distressed and to have the resources to face the rest of their life. There are a number of different therapeutic techniques which may be helpful, drawn from Psychodynamic Psychotherapy, Cognitive Behaviour Therapy and other theoretical backgrounds. Part of the therapy may involve giving the person skills and confidence to deal with future situations of risk e.g. by assertiveness skills, or sex education which may involve other staff in programmes. It is important that therapists are told if there is a pending Court Case as there are guidelines about what therapy may be undertaken without jeopardising the legal process. (Home Office Communication Directorate, 2001)
To access specialist support, you should support individuals to visit their GP.
Harmony Counselling Service
The Harmony Counselling Service aims to provide free, person-centred counselling to people over the age of 60 in the Nottingham City and Nottinghamshire County area. The service is dependant on volunteers and provides counselling for a variety of needs from bereavement to family issues, but has a specific aim to provide counselling to victims of abuse. The Counselling Coordinator will visit a person in their home to assess their needs and then will match a volunteer to provide confidential counselling. Counselling is preferably carried out in a neutral venue such as our counselling room in the City, GP’s surgeries or if necessary a person’s home. For more details on this service, contact:
Harmony Counselling Service
Age Concern Nottingham and Nottinghamshire
Sybil Levin Centre
578 Nuthall Road
Cinderhill
Nottingham
NG8 6AD
Email: harmonycounselling@ageconcernnotts.org.uk
Tel: 0115 919 4876