Introduction

Our psychiatric hospitals, secure hospitals and outpatient psychiatric clinics are packed with the victims of crime – especially with victims of child sexual abuse (CSA). This fact continues to be heavily obscured due to dominant medical model paradigms in mental health. As a result, such hospitals and clinics remain major parties to the concealment of the extent and impact of such crimes.

This chapter considers the persistence of biomedical models of mental ill health despite repeated and continuing evidence for trauma aetiologies, and discusses some reasons why this evidence has been consistently ignored. It argues that it is very important, but not sufficient, to challenge biomedical models of mental illness, to challenge current diagnostic labelling, and to oppose coercive techniques of restraint: as many committed critics within and beyond the mental health professions have already done. It is also very important, but not sufficient, to provide – for survivors of abuse and indeed survivors of other serious life adversities – adequate, humanistic, caring, appropriate therapeutic and support services, and genuinely to involve service users in shaping those services.

But the major implications for prevention of the crimes which continue to make so many people mentally ill must also, at last, be fully acknowledged and acted upon. Given the major role accorded to prevention in many other areas of public health, it is after all extraordinary and unusual that they have not been. Thus our mental health systems, with forceful prompting from governments and health authorities, need actively to contribute to multidisciplinary efforts to prevent and reduce CSA.

This chapter suggests some directions for such work. They include new working alliances with those working against other forms of violence and abuse, nationally and internationally; the redirection of some significant resources; a regular means for survivors of CSA in all mental health settings to pass on vital information about perpetrators; and funding for new forms and topics of research.

This chapter argues that governments, senior policymakers and commissioners in mental health – working with those professionals and service user groups who urgently seek change – must do all they can to enact and enforce change, rather than continuing to defer to powerful professional lobbies, particularly that of biological psychiatry.