Open letter to ministers: Stop the use of clinical notes in rape cases
Ciara Mangan, flanked by Ruth Coppinger TD and Sarah Grace, speaking in February at a press conference where survivors called for reform of Ireland's 'barbaric' legal system. See link at foot of this article. Picture: Stephen Collins
- An open letter to
- Minister for Children, Disability and Equality, Norma Foley;
- Minister of State with responsibility for disability, Hildegarde Naughton;
- Minister for Health, Jennifer Carroll MacNeill;
- Minster for Justice, Jim O’Callaghan;
- Minister for Mental Health, Mary Butler.
This letter is written in response to the current discussions around the practice of accessing therapy notes in legal cases for rape and sexual assault cases in Ireland.
We, the undersigned, are all clinicians, therapists, researchers, and academics in various specialisms in healthcare including adult mental health; child and adolescent mental health; trauma, and intellectual disability.
We are compelled to write to you all to preserve the safety of our clients, empower their recovery, and safeguard clinical practice. We contend that this is an issue of health, mental health, and equality primarily, and justice secondarily, where applicable.
This is why we are writing to all ministers with responsibility in these areas.
An incredibly small percentage of victims and survivors of sexual violence report to the gardaí.
Of those who do, a smaller percentage again will secure a prosecution. However, the practice of clinical notes being used in criminal cases acts as a deterrent to many seeking therapeutic supports. This is a practice that cannot continue.
Sexual violence is one of the most heinous crimes that can be perpetrated on another human being. The statistics are stark and tell us that lifetime prevalence of sexual violence across genders in Ireland is 40%, with females disproportionately affected.
Other vulnerable cohorts include members of the LGBTQ+ community, disabled people, those with intellectual disabilities, and older people.
Working in mental health, we see directly the impact of such violence, with links between exposure to violence and a variety of mental health presentations including, but not limited to, post-traumatic stress disorder; personality disorders; schizophrenia/psychosis; eating disorders; and substance misuse.
It is striking therefore to reflect that, when surveyed, the strategy least likely to be used in Ireland to improve mental health is talking to a mental health professional, thus indicating that we most likely only meet with a small percentage of those who might benefit from therapeutic input.
Recent public discourse, led by victims’ and survivors’ testimony revealed starkly that they did not access vital therapeutic supports for fear their notes would be used indiscriminately in court.
Indeed, we are now seeing the impact of this testimony in our services where clients are too afraid to attend for this very reason. This is harrowing and will continue to result in others not seeking the support they need.
This wholly undermines the work we do in trying to create a space that is safe and free from judgment to help our clients work through their trauma. Moreover, we know that trauma when unprocessed and unintegrated can continue to impact functioning in disproportionate ways, with more long-lasting impacts.
Our aim in writing to you is simple: We want to protect the crucial therapeutic work we do with our clients.
We want anyone in the State to be able to talk freely and without fear that their notes might be used against them in a court of law.
Our therapy notes are not evidence — they are exploratory, and our clients often tell us experiences and thoughts that they would never share with anyone else. They deserve to do this unencumbered.
We owe it to our clients to carry out therapeutic work in a way that leads to better outcomes and to support them find a life post trauma.
In working through traumatic experiences with clients, we invite them to be curious, to explore their understanding of what has happened to them: In this manner, therapy is not a static process.
How a client might assess a traumatic experience might change from session to session and can take a long time, and indeed safety to explore the impact of trauma on their functioning. As therapists, we know how dynamic and delicate this process is.
Trauma significantly disrupts the brain, mind, and body. Memory, of which there are many types (procedural, emotional, and semantic amongst others) becomes disrupted after trauma. What is recalled can take time; it might come in fragments.
One must also bear in mind how difficult it is for a person who is highly traumatised to communicate what has happened to them. All of this requires time, safety, and connection.
While the act of sexual violence breaches an individual’s integrity, bodily and psychologically, the impact is in what follows next — the whole disintegration of self, sense of safety in the world, and connection with those they once trusted.
Therapeutic work is successful when we gain the trust of our clients and when we can model for them that they are safe, they are believed, and that they are worthy of healing. We simply cannot do this adequately as the current practice stands.
At present, any note can be used in a manner that might fit with the narrative or argument proposed by counsel for the defence, and thus it is unlikely to be an accurate representation of the impact. As clinicians and therapists, many of us will write reports based on our work with a client if requested to do so by the court. This therapeutic work will be represented accurately and fairly, and we are duty bound by codes of ethics to represent our work in this manner.
This current practice, and the proposal to not review and change it, as promised less than a year ago by then justice minister Helen McEntee, is an accessibility issue for those impacted by trauma. We have a duty to support our clients to make sense of their experiences, heal, and recover.
This cannot be done if there is fear their notes will be taken and read out of context.
We urge you to listen to the testimony and words of victims and survivors who have brought the harm of this practice to light.
We lend our voices and clinical expertise to support their calls to end this practice.
We welcome the opportunity to meet with you further discuss the content of this letter and bring clinical expertise, skills, and experience to decision-making.
We will continue to advocate for change to this practice and for systems that are humane, health- and recovery-focused, and evidence-based.
- Signatories from the Psychological Society of Ireland’s trauma and adversity special interest group include:
- Chartered senior clinical psychologist Niamh Ni Dhomhnaill;
- Treehouse Practice CEO and principal clinical psychologist Sara O’Byrne;
- Assistant professor in psychotherapy at DCU, chartered psychologist, and accredited psychotherapist Alice McEleney.
- Overall, signatories include more than 60 professionals in the disciplines of psychology, psychiatry, social work, nursing, speech and language therapy, psychotherapy, and counselling, as well as the CEO of St Patrick’s Mental Health Services.
• If you are affected by any of the issues raised in this article, please click here for a list of support services.
