Trust betrayed

The word “professional” is bandied about a lot these days. Time
was when its use was reserved for lawyers, doctors, accountants and
teachers. Yet now, whether you are a tennis player or a social
worker, you are likely to be a professional. Yet it is ironic that
a word with such positive connotations can be linked to acts
carried out by perpetrators who are anything but
professional.

For in the health and social care sectors, professional abuse
refers to unacceptable acts against vulnerable people by those who
are paid to look after them .

Professional abuse generally falls within four
categories:emotional, sexual, physical or financial. Violence or
sexual behaviour are unmistakable acts of abuse, but other
unacceptable behaviours can be more difficult to detect. In mental
health services a therapist may disclose inappropriate information
about their personal life or insist a client stay in therapy when
they are no longer benefiting. In some cases the client may not
realise the abuse has occurred until years later.

Few people enjoy consulting health and social care services and
some are pretty desperate by the time they do. So to then be taken
advantage of can have devastating mental and physical effects.
Their self-esteem is likely to plummet and they may feel confused
or to blame for the abuse. They may feel angry, depressed or unable
to tell anyone about what has been going on. And while the effects
will vary, all victims are likely to feel that their trust has been
dented.

“Once a professional has violated that boundary, broken the trust
and exploited the patient or client it will be difficult for that
person to trust a health or social care professional again,” says
Jonathan Coe, chief executive of the Prevention of Professional
Abuse Network (Popan).

Popan provides an advocacy and support service for people who have
been abused by health and social care professionals and it receives
so many calls that there is a waiting list.

Support over the phone is available, as well as information to help
people decide how to move on. Ways of doing this will differ – some
will want to make a formal complaint to the NHS trust or to the
police, some will want to work through the issues with a therapist,
while others will just want to block out the whole
experience.

Most of the calls to Popan concern abuse in mental health services,
particularly from people involved in therapies involving one to one
talking. An exact perpetrator profile is not clear but Coe says
they are often male, advanced in their careers and in a position of
authority.

Others find it more difficult to believe that someone in this
position would so seriously exploit their patients and risk their
career, says Coe. And, on the other side, those most likely to be
targeted tend to be more vulnerable and less likely to be believed
by others.

But, in the health and social care sectors, where people generally
enter the professions because they want to help people, how
widespread is this malpractice?

It is difficult to quantify, says Coe. “As it stands today, nobody
has any real figure for the prevalence of professional abuse. We
think that the regulators could play a more central role by working
together and standardising the way they categorise reports and
allegations.”

He also urges the government to take a more active lead. “The
Department of Health records the level of abuse of health staff by
patients across the country and publishes it every year. If it’s
possible to do it that way round, then it must be possible to
publish the abuse of patients by staff,” he says.

One of the most vulnerable groups of people affected by
professional abuse are those with learning difficulties.

“This abuse is massively under-reported and there are many reasons
for that,” says Kathryn Stone, director of learning difficulties
charity Voice UK. “People with learning difficulties are less
likely to disclose it because they are frightened of the
consequences, think people won’t believe them or have been
threatened by the person abusing them.”

Stone cites the case of one young man who had been repeatedly raped
by a worker and was warned that if he told anyone about the abuse
he would not get macaroni cheese for his tea.

Another issue is that some people with learning difficulties have
additional physical difficulties and may need help with personal
care such as using the toilet and bathing.

Stone says: “If they aren’t aware of the boundaries between care
and sexual abuse they might not know that what’s happening to them
is an abusive act. It’s important for them to be educated about
their bodies so that they know the difference between someone
helping them go to the loo and someone abusing them.”

Similarly, older people are vulnerable to professional abuse,
particularly if they are physically frail or suffering from
dementia. Worryingly, Gary Fitzgerald, chief executive of Action on
Elder Abuse, says the situation is becoming worse rather than
better, and that he hears of about 35 cases each month.

“Practitioner abuse may be the deliberate wilful choice to inflict
cruelty, or there may be institutional structures that allow abuse
to take place,” he says.

But not everyone accepts that professional abuse takes place.
Health and social care workers have taken such a pounding in recent
years that many have become defensive about allegations of poor
practice.

“There is a siege mentality developing in health and social care
provision that’s not helping any of us,” says Fitzgerald.

There are also doubts as to whether whistle-blowing is working.
“We’re seeing that it is very unusual for someone to whistle-blow
and survive the process. In reality they are not likely to be
employed after two years with that employer,” says
Fitzgerald.

He believes that this needs to be altered by changing the focus of
whistle-blowing. Rather than reporting suspicions being the
employee’s decision, it should be an obligation under their
employment contract.

“If we don’t get whistle-blowing right then we’re not going to deal
with abuse taking place, because inspection can’t discover all
abuse and it’s unfair to expect it to do so,” he says.

“Professional abuse needs to be recognised and its existence
accepted. It’s everybody’s responsibility, not just the
regulators.”

Victims of professional abuse often want to seek redress for what
has happened to them. Obviously if a crime has been committed the
police must be involved. However, victims can also claim financial
compensation.

They may decide to pursue a civil case, where a claim is made
against those in charge, such as the people who employed an abusing
care worker. For some victims, seeking compensation in this way can
help them to move on.

“A lot of people want to pursue claims for compensation, as it can
help in the recovery process and gives them recognition that what
happened to them was wrong. It is their chance to have their case
looked at by the court,” says Nicola Harney, head of the abuse
litigation team at Stewarts solicitors, a London-based law firm
that specialises in abuse cases.

“It can also open up how it was allowed to happen and help them
rebuild their lives. It’s not always for financial gain.”

And even if it were, no sum of money could ever make up for the
trauma suffered. Professional abuse is wrong, unacceptable and
should never be tolerated – not by clients and certainly not by
other professionals.

– For more information go to www.popan.org.uk

‘I had never seen a cpn before so i didn’t know what to
expect’   

Lynn Edwards* won an out-of-court settlement of £10,000
from her local health trust after a male community psychiatric
nurse (CPN) abused her. 

She had been referred to a female CPN by her GP for treatment
for post-natal depression. However, the male team leader took over
her case, arguing that she needed his specialist support. 

From the outset Edwards saw the team leader three or four times
a week. Sessions were often two to three hours long and scheduled
at the end of the day.  

“I had never seen a CPN before so I didn’t know what to expect.
Often I was going into the centre when all the staff were leaving.
I even had appointments on Sundays when the building was empty,”
Edwards says. 

The CPN told Edwards that her husband was to blame for her
depression and that he, the nurse, was the only person she could
trust. He would lock her in the consulting room and force her to
talk about her childhood sexual abuse. He threatened to have her
sectioned if she did not agree to these sessions. 

On one occasion he took her to a remote wood for anger therapy.
He told her that he had fallen in love with her and initiated a
sexual relationship. 

Edwards’s husband and relatives became suspicious and reported
the CPN to the health centre. While he discharged Edwards from his
care, the relationship continued. 

Following a suicide attempt, Edwards told the whole story to her
husband who informed the authorities. Within days the CPN had
resigned from his post and the trust began an inquiry. With the
help of a solicitor Edwards began compiling her case. 

When her psychiatrist found out that Edwards was suing the
trust, he told her that it could no longer provide mental health
services. Another health professional referred to the relationship
not as abuse but as “an affair at the wrong time”.  

Since then Edwards has been diagnosed as suffering from
post-traumatic stress disorder and has received help. However, she
can no longer cope with seeing male practitioners.  

The CPN no longer works in the health professions and Edwards
has never received a letter of apology from the trust involved.  *
Source Popan. Name has been changed.

Tips for professionals  

l Tell the client what to expect from the client-professional
relationship and encourage them to ask questions.  l Accept it is
normal to have emotional or sexual feelings towards clients but
wrong to act on them.  l Take responsibility for setting and
maintaining boundaries with clients.

• Discuss ending the relationship well in advance.
• Take difficult issues to supervision.
• Remember the relationship is based on an imbalance of
  power. 
• Don’t disclose personal information unless you are sure it will
  help the client. 
• Refer a client to someone else if it is in their best
  interest.

What is professional abuse? 

There are four main types: 

• Emotional: the professional may undermine the client, criticise
  them, break confidentiality or suddenly end the relationship. 
• Sexual: sexual acts or comments, or inappropriate questions
  about the client’s sex life. 
• Physical: violent acts, such as slapping or shaking, but also
  threatening gestures or preventing a client from leaving the
  treatment room. 
• Financial: ranges from the professional stealing from the
  client or using their money for their own gain, to insisting a
  client remains in therapy when they are no longer benefiting.