The prevalence of child abuse in Canada is approximately 1%. This may seem not to be very high but the impact child abuse has on those affected has far reaching consequences. This is best illustrated by more statistics, so I am going to summarize these over the next few paragraphs. While you review them, I suspect that, like me, you will find yourself asking how any of these children ever recover and, when they do, you will wonder how they managed.

Thirty percent of children who are abused do not finish high school (Lansford, Miller-Johnson, Berlin, Dodge, Bates, & Petit – 2007). They are 26 times more likely to be homeless (Herman et al, 1997), 4 times more likely to be arrested as a young offender and twice as likely to be arrested as an adult (Lansford et al, ibid.). They are 3 times more likely to have an unplanned pregnancy (Irish, Kobayashi, & Delahunty, 2009). All these circumstances interfere tremendously with becoming a productive adult and so the gifts these children might have brought to the world may be lost forever.

The impact of the trauma they have suffered does result in serious mental illness in these children and youth. They are 4 times more likely to experience suicidal ideation and self-harm (Irish et al, ibid.) Not surprisingly, some studies show that as many as 100% of these children suffer from some symptoms of Posttraumatic Stress Disorder and 37-50% develop Posttraumatic Stress Disorder (Trask, Walsh, & Dilillo, 2011). They have 4 times as many contacts with mental health services as adults than the rest of the population (Spataro, Mullen, Burgess, Wells & Moss, 2004).

When I contemplate the histories of the young people that I see in the tertiary care psychiatric hospital where I work, these numbers – other than the 100% – seem low. I suspect, however, that this is because the youth we see have usually had significant mental health services even before they were seen in our programs and so those who are eventually seen in tertiary care likely have a higher prevalence of child abuse.
The young people who have been victims of child abuse also have more contact with the general medical system as 90% of them have worse health than the general population (Springer, Sheridan, Kuo & Karnes, 2007).

I am looking up these statistics for the purposes of determining to what degree mental health programs must consider their impact as they design programming for conditions beyond trauma. For example, to what degree must a program for youth with psychotic disorders allow for a history of childhood trauma? In fact, this is likely the wrong question.

The question that must be asked is: how do mental health programs ensure that the specific needs of those children and youth who are victims of child abuse get services that will also address their psychological trauma, as well as the other programs they require?

The traits that ensure that a young person can recover from the impact of child abuse, based on numerous studies examining longer term outcomes, focus on the development of resilience. You don’t have to do more than scrape the surface of the resilience literature to determine that remaining positive about one’s talents, about one’s ability to recover and about the future are the keys that unlock the development of resilience. As mental health care providers, it is our task to ensure that everyone can feel positive about themselves and their future., no matter which mental health condition they suffer from.

What I like best about this is that it is a simple lens through which to examine programming. You examine each facet of a mental health program asking: Does this foster the development of a positive attitude toward the patient, their recovery and their future? If the answer to the question in any circumstance is “no”, then changes are needed until the answers and the approach is positive.

I do find it personally helpful to be mindful of this when I see a young person who has been the victim of child abuse. If I can focus on helping them to be positive about the future, we can usually figure out what services they need to move forward.

“Note to self: Every time you were convinced you couldn’t go on, you did.” (Anon.)

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