The Royal College of Psychiatrists have issued an apology for survivors of non-recent child sexual abuse, what does this mean and why does this matter?
- dremilythepsycholo
- 12 hours ago
- 6 min read
The Royal College of Psychiatrists has published a new position statement on supporting adults who experienced non-recent child sexual abuse and, alongside it, they have issued an apology.
Dr Lade Smith, President of the Royal College of Psychiatrists, acknowledges that some survivors have experienced avoidable harm within mental health services, including retraumatisation, being unable to access the right support, and receiving treatment that did not adequately understand their experiences.
I read this statement through two lenses: as a clinical psychologist who works with complex trauma, and as someone with lived experience of childhood sexual abuse.
From both perspectives, there is something significant about seeing these words come from the Royal College of Psychiatrists. Recognising the impact of trauma is not new, nor are the questions psychologists, survivors and others have raised about how we conceptualise psychological distress. However, what does feel significant is the explicit acknowledgement that sometimes the systems designed to help survivors can become part of the harm.
When the system becomes part of the harm
One of the most important parts of the position statement, for me, is its discussion of iatrogenic harm. This is harm that is caused or compounded through healthcare itself.
The statement recognises that survivors can be retraumatised through interactions with mental health services, including through misdiagnosis, inappropriate treatment, repeated assessments, restrictive practices and poorly coordinated care.
Being trauma-informed cannot simply mean knowing that trauma exists, asking whether someone has experienced it, or sending staff on trauma-informed training. We also have to be willing to look at our systems.
For example:
What happens when someone finally tells their story and is passed from service to service?
What happens when they have to repeatedly disclose what happened to different professionals?
What happens when their response to threat is understood only as a symptom to be managed?
What happens when decisions are made about somebody rather than with them?
For someone whose experiences involved powerlessness, silencing, coercion or loss of control, healthcare systems can inadvertently recreate some of those same dynamics.
One of the principles running through the statement is that care for people who have experienced abuse and trauma should strive to be the opposite of abuse. That is a deceptively simple idea. We have to consider:
If trauma involved powerlessness, how do we promote agency?
If it involved coercion, how do we maximise choice?
If it involved unpredictability, how do we create consistency and safety?
If someone was silenced, how do we make sure their voice genuinely influences their care?
Trauma-informed care is not simply about what intervention we offer. It is also about how we relate to people and how our systems use power.
From diagnosis to understanding
Another part of the statement that particularly stood out to me was its emphasis on biopsychosocial formulation. For many clinical psychologists, this is familiar territory.
Psychological formulation asks us to understand someone's distress within the context of their experiences, relationships, environment, beliefs, resources and ways of coping.
A diagnosis and a formulation can both be useful, but they answer different questions. Diagnosis might help us describe the pattern of symptoms somebody is experiencing.
Formulation asks something more individual:
Why might this person, with this history, be experiencing these difficulties at this point in their life, and what might help?
This does not require us to reject diagnosis. Diagnoses can provide validation, access to treatment, a shared language and, for some people, an important way of understanding their experiences but diagnosis alone cannot tell us someone's story.
Psychologists, survivors and trauma-informed practitioners have been making this argument for a long time. Similar questions are central to approaches such as the Power Threat Meaning Framework, which asks us to consider how power has operated in someone's life, what threats they have faced, what meaning they have made of those experiences and what they have had to do to survive.
This is why I think the Royal College's explicit call for formulation-led care is significant.
Behaviours and experiences that appear disordered when separated from their context can sometimes become profoundly understandable when we know what happened.
What if the “symptom” helped someone survive?
There was another part of the statement that particularly stayed with me.
It recognises that the impact of childhood sexual abuse may sometimes be masked by hyper-functioning, perfectionism, appeasement and “pro-social” coping styles. I think this is incredibly important. We can become quite good at recognising trauma when somebody is visibly struggling. Perhaps we are less good, both within services and as a society, at recognising it when somebody has learned to hold everything together.
Survival does not always look like falling apart. Sometimes it looks like achieving. Being exceptionally competent. Taking care of everybody else. Reading a room before anybody has said a word. Avoiding conflict. Keeping people happy. Never asking for help. Being fiercely independent. Being the person everybody else relies upon. I know some of these ways of surviving only too well.
Of course, none of these things automatically mean somebody has experienced trauma. Context matters but formulation allows us to become curious about the function of someone's responses rather than immediately deciding whether they are healthy or pathological.
Instead of asking:
“Why are you like this?”
Perhaps we can ask:
“What happened to you?”
Many of the responses we later call “symptoms” may once have been extraordinarily effective ways of surviving. They may cause difficulties now. They may be exhausting. They may no longer be necessary but that doesn't mean they never made sense.
Disclosure is not a single event
The statement also recognises something that is vital for professionals to understand: disclosure is often a process.
A survivor may not sit down with a professional and tell their entire story in chronological order. They may disclose one thing and not another. They may tell different pieces to different people. They may minimise something before later finding words for it. They may disclose when they finally feel safe enough, sometimes many years after the abuse occurred. We therefore need to be careful about treating disclosure as information gathering. There is an enormous difference between somebody having told us something and somebody feeling safe enough to be known.
How professionals respond in those moments matters.
Trauma and the perinatal period
The statement specifically recognises that experiences such as pregnancy, childbirth and becoming a parent can bring previous trauma to the surface, and highlights areas including obstetrics, gynaecology and perinatal mental healthcare.
This really matters because trauma can be activated by experiences that make complete sense in context: examinations, exposure of the body, pain, loss of control, being touched, being observed, or feeling unable to say no.
A healthcare professional does not need to know the details of somebody's trauma to practise in a way that promotes dignity, choice, predictability and control. Trauma-informed healthcare therefore cannot belong exclusively to mental health services.
An apology is a good start. What happens next matters more.
I really do welcome this position statement. I welcome the acknowledgement of iatrogenic harm. I welcome the emphasis on survivor-centred and formulation-led care. I welcome the recognition that trauma may sit underneath presentations that don't necessarily look traumatised. And I welcome the recommendations for better training, reflective practice, specialist pathways and meaningful survivor involvement in research and service development.
But a position statement cannot, by itself, change somebody's experience of asking for help.
Implementation will matter. Will clinicians have enough time to develop meaningful formulations rather than repeatedly completing symptom and risk assessments? Will services become better at working with complexity rather than telling people they are “too complex” for one pathway but don't meet the criteria for another? Will survivors have greater continuity of care? Will professionals have access to meaningful supervision and reflective practice? Will lived experience genuinely shape how services are designed? And will we become willing to examine not only what has happened to the person sitting in front of us, but what might be happening to them within our services?
The ideas within this statement are not all new.
Survivors have been telling us many of these things for years. Psychologists and other trauma-informed professionals have long advocated for understanding people's distress within the context of their lives. But institutional acknowledgement still matters, particularly when it comes from an institution that has historically held considerable influence and power within mental health services.
An apology matters.
Recognition matters.
Perhaps the real test of this position statement will be whether, in the years that follow it, survivors experience something different when they ask us for help.
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