Are mental health staff getting better at asking about abuse andneglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by
mental health services. A comprehensive audit of 250 randomly selected files from four
community mental health centres in Auckland, New Zealand was conducted, using similar
methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant
increases, compared to the 1997 audit, were found in the rates of child sexual and physical
abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files.
Identification of physical and emotional neglect, however, was poor. Male service users were
asked less often than females; and male staff enquired less often than female staff. People
with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less
often and had significantly lower rates of abuse/neglect identified. Despite the overall
improvement, mental health services are still missing significant amounts of childhood and
adulthood adversities, especially neglect. All services need clear policies that all service users
be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff
receive training that address the barriers to asking and to responding therapeutically to
disclosures.