NHS apologizes for decades of failures in treating adult survivors of childhood sexual abuse

The Royal College of Psychiatrists has issued a formal apology for what it describes as decades of systematic failure in how the NHS treats adults who survived childhood sexual abuse and later seek mental health support. The college, speaking through its immediate past president Dr. Lade Smith, acknowledged that too many survivors have endured what amounts to preventable harm when turning to the health service for help—harm that sometimes compounded their original trauma rather than relieving it.

The problem, according to the college's damning internal report, runs deeper than individual clinical errors. Mental health staff have been trained to treat symptoms in isolation, the report found, rather than understanding how past abuse continues to shape a person's present suffering. Patients have been misdiagnosed, re-traumatized by repeated assessments and histories they've had to recount, and sometimes simply disbelieved. The system itself is fractured: services are designed to deliver short, discrete episodes of care—often just eight therapy sessions—when survivors of childhood abuse may need eight sessions simply to disclose what happened to them. Many never get that far. With services stretched thin, countless survivors never access mental health care at all.

The scale of the problem is substantial. Nearly one in ten adults in England and Wales experienced childhood sexual abuse. Around two-thirds of those abused as children have not disclosed it to any service by adulthood. One in five never disclose at all. Those who do often wait decades. The trauma itself—psychological and sexual—significantly increases the risk of depression, anxiety, complex PTSD, eating disorders, self-harm, and substance misuse. Yet the system designed to help them has, in many cases, made things worse.

Caroline Thompson's experience illustrates the gap between what survivors need and what they receive. A specialist ear, nose, and throat doctor with a successful career and family, Thompson didn't seek help until age 55, when terrifying nightmares began leaving her unable to sleep or function. When she was referred to mental health services, the psychiatrist she saw dismissed the possibility that her symptoms stemmed from childhood abuse. The reasoning: the delay in presentation, combined with her professional success and family life, made abuse an unlikely cause. She was diagnosed with anxiety, prescribed anti-psychotic drugs, given about a year of therapy, and then discharged—still unable to understand what was happening to her, still plagued by nightmares and medication side effects, forced to abandon the career she loved. Only when she later sought private therapy from a specialist in childhood trauma did she begin to recover. As she reflected afterward, it seemed astonishing that mental health professionals didn't understand something fundamental: traumatic memories are buried as a survival mechanism, and they can surface years or decades later. Delay in disclosure is not unusual. It is normal.

Dr. Smith told the BBC that the failures extend across the entire mental health system, not just psychiatry. The fragmentation of services means psychiatrists rarely have time to build genuine relationships with patients. Eight sessions of therapy—when a patient is lucky enough to receive it—is insufficient for the work required. The structural problem is compounded by insufficient training. Mental health staff have not been equipped with trauma-informed approaches specific to survivors of childhood sexual abuse.

The college's apology, included in a formal report given to the BBC, comes after the college established a working group of experts, doctors, and abuse survivors—including Thompson—to review how NHS care has failed. The group was convened partly in response to a rise in disclosures over the past decade, following high-profile abuse scandals in schools, children's homes, and religious institutions, as well as the crimes of Jimmy Savile.

The college is now calling for concrete changes. It promises to develop specialist training materials for psychiatrists and is demanding mandatory trauma-informed training for all mental health staff. It has recommended that national guidance be published on recognizing and responding to disclosures of historic child sexual abuse. Most fundamentally, it is calling for an overhaul of services so that survivors can access long-term support rather than brief, disconnected episodes of care.

Gabrielle Shaw, chief executive of the National Association for People Abused in Childhood, called the apology significant and welcome but emphasized that it must translate into action. For too many survivors, she said, mental health services have not felt like a route to safety or recovery but rather another place where trauma was missed, where treatment was inappropriate, or where survivors met disbelief—a response that can be particularly damaging. Some are told they are too complex, unsuitable, or outside the scope of available services. NHS England responded by pointing to existing 24-hour support through sexual assault referral centres and counselling services, and said additional training is being provided to mental health support teams in schools and colleges. But the college's report suggests these measures, while welcome, do not yet address the systemic failures that have left survivors without adequate, trauma-informed care.