07 August 2005
	Help for Adult Victims Of Child Abuse. A non-profit making organisation based in the UK dedicated to provide help, support and information to any adult who is suffering from past childhood abuse.

Assessing the Cost of Trauma
By Mary Anne Reilly

Looking at the correlation between physical and mental
health problems and a history of sexual abuse will require us to reassess
how we analyze and diagnose physical and mental illness. This, of course,
will take time and cost money.

But the time taken may well save us money in the end. As
Judith Lewis Herman, M.D., author of Trauma and Recovery, has said, the
suffering of many seemingly different populations with seemingly different
needs may have a common source. The battered woman who remembers her
childhood abuse during her third visit to the emergency room, the combat
veteran who suffers from Post-Traumatic Stress Disorder (PTSD) that has its
roots in early terror, the homeless woman who cannot feel safe in any place
that resembles a home, and the teenage runaway with Human Immunodeficiency
Virus (HIV) all have different stories to tell.

In fact, stories like these have been recounted in the
offices of physicians and mental health professionals and in community
shelters throughout this nation: people with traumatic life histories use
such services and use them regularly (Bryer et al., 1987). The challenge to
all of us is to find the thread of common experience that many victims of
trauma share and weave it into a strong and supportive cloth, a new social
safety net, that gives as many people as possible a fighting chance today --
and tomorrow.

Physicians, mental health professionals, survivors, and
other service providers need to share the knowledge we have gained from our
individual and collective work to show whether paying attention to the
effects of victim costs less money than ignoring it. With health care costs
a constant concern and the threat of violence an everyday source of societal
stress, there is ample reason for conducting a deeper examination of the
causes and effects of the trauma we encounter each day.

There is also reason to think that the Clinton
administration would be interested in doing so. Earlier this year, Attorney
General Janet Reno indicated that she understood the necessity of providing
immediate care for victims of abuse and creating opportunities for long-term
protection from and prevention of abuse.

In fact, the former Dade County, FL, prosecutor has a
history of linking victims and perpetrators of family violence with relevant
mental health care programs. Reno appears aware that early and careful
intervention could result in long-term savings for judicial systems that are
currently over-burdened with cases involving family violence and other
criminal behavior that may be linked to a history of family violence.
During the Senate hearings that preceded her confirmation as Attorney
General, Reno said that "until we focus on violence in the family, we are
going to continue to have violence in the streets."

Some Numbers
But what exactly is the price we pay by sticking with the
status quo? One cost estimate is noted by author Murray Strauss (1987),
Director of the University of New Hampshire's Family Research Laboratory.
Strauss alludes to one statistic, based on his study of the incidence of
interfamily homicides in 1984 alone, that put the cost of such homicides at
$1.7 billion. Such data, he is quick to assert, are misleading because the
percentage of actual homicides is small in relation to the total number of
violent incidents involving families. Furthermore, that amount, in Strauss'
view, cannot begin to include the costs of the violence that preceded the
death of an adult or child in that comparatively small population.

"The true accounting of the cost of family violence,"
Strauss writes, "must also include the cost of providing mental health and
social services to victims and the cost of treating aggressors."
Some of these costs are beginning to be tabulated. While an
associate professor in the Department of Psychiatry at the University of
Manitoba, Canada, Colin A. Ross, M.D., calculated the lifetime psychiatric
health care costs of 15 women who had been diagnosed with multiple
personality disorder (MPD). The research, which assessed the cost of care
both before and after the women had been diagnosed, indicates that the
mental health care costs for women before being diagnosed with MPD are quite
high ($2,769,997.50 in Canadian dollars). Projections are that accurate
diagnosis and treatment of WD (which DSM III-R recognizes as a potential
effect of sexual child abuse) would produce a "net saving of $84,899.44 per
patient over 10 years" (Ross and Dua, 1993).

Such projections were made on the basis of data showing that
women in the study had spent an average of 98.77 months in the Canadian
mental health care system before being diagnosed with MPD. By contrast, the
average time they spent in the system after diagnosis came to 31.5 months.
Ross, now director of the Dissociative Disorders Unit at
Charter Hospital in Dallas, TX, and associate professor of psychiatry at
Southwestern Medical Center at Dallas, further contends that the savings per
person could increase to more than $250,000 if openness to and earlier
diagnosis of MPD were to occur in the mental health system. He states that
"If these women had been diagnosed before age 10, when, according to
retrospective history they all had alter personalities, and their abuse
stopped, the overall saving to the taxpayer for social services might have
been in the order of $10,000,000."

In the press of health policy-related lobbying, other
organizations have also produced estimates of the costs of mental illness.
According to USA Today (Healy, 1993) the Rockville, MD-based Institute for
Behavior and Health (IBH) estimates that anxiety disorders cost the nation
$46.6 billion in 1990. About three-fourths of those dollars, the study
says, are losses due to reduced productivity, worker absenteeism, and
disability -- not the cost of medical care itself.

Such research, though far from complete, has a variety of
implications. Some of the data show that abused children -- including those
who have been sexually abused -- have two to three times more difficulty in
making friends (Strauss, 1987). Many are much more likely to produce
failing grades, display "disciplinary" problems, have drug and alcohol
problems, and wind up in jail.

Ross also points to the possible long-term effects of
growing up in a violent home. While noting that his sample included no
males diagnosed with MPD, he indicated that additional studies suggest that
the "burden to the taxpayer of undiagnosed MPD in males is born largely
through the criminal justice system" (Ross and Dua, 1993).

As Strauss and Ross propose, mental health and non-medical
costs may far outweigh the cost of treating injuries themselves. These
kinds of costs are especially familiar to the millions of survivors who may
never have seen the inside of a county jail cell but who continually
struggle to finance their way out of the prison of their pain.

As the IBH study suggests, that price is paid in the form of
missed work time and troubled personal lives. Survivors also pay a price by
pouring what seems like more than their share of would-be disposable income
into services that societal ignorance of the effects of abuse largely
obliges them -- rather than individual and institutional
perpetrators -- to pay.

-Mary Anne Reilly

Mary Anne Reilly, a freelance writer and editor, has
published articles in a variety of publications including Newsday and The
Texas Observer. She served as a consultant to the American Medical
Association's taskforce that prepared the Diagnostic and Treatment
Guidelines on Child Physical and Child Sexual Abuse. A former social
services professional, she is an associate editor for Moving Forward.
Associate editor Stu Philipp, author Marge Elder, and the Clearinghouse on
Child Abuse and Neglect contributed research to this article.

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