THE LAST FIRST by Matt Carey


A childhood sexual abuse survivor, author and advocate writes about a lack of services and support in the United Kingdom.

And so rock bottom became the solid foundation on which I rebuilt my life.(1) J.K. Rowling

Whilst society in the United Kingdom is starting to wake up and recognise a situation of what many would argue has been years of criminal negligence and denial from both church and government (both locally and nationally), we are now starting to acknowledge the shocking reality that epidemic levels of sexual abuse have been, and still are, taking place in the UK. There now needs to be a massive change in the provision of support for survivors.

The National Society for the Prevention of Cruelty to Children (NSPCC) is the leading children's charity fighting to end child abuse in the UK, Channel Islands and Isle of Man. The charity helps children who have been abused to rebuild their lives, protect those at risk, and find the best ways of preventing abuse from ever happening. There is a wealth of information on their website about the work they do, and the support they can offer.

 Abuse robs children of their childhood. Without help, the scars of abuse can last a lifetime.

And as devastating as it can be for the child, society pays a heavy price too.


I believe the word ‘epidemic’ is wholly appropriate when one consider these statistics:

  • There was a 60% increase in recorded cases of child sexual abuse (CSA) between 2011 – 2014 in the United Kingdom (Alan Travis, Reported child sexual abuse has risen 60% in last four years from The Guardian on Thursday 9 April 2015).

  • Over  54,000  sexual  offences  against  children  were  recorded  by  the  police  in 2015/16 in the United Kingdom

  • There was a 31% increase in reported cases of CSA during 2016/17 in the United Kingdom (Matthew Weaver, Cases of UK child sexual abuse up 31%, says NSPCC from The Guardian on Monday 18 December 2017).

  • Since 2014, there has been a 700% increase in the number of suspected incidents of online CSA referred to the London Metropolitan police. (2) (Owen Boycott, Online child sex abuse referred to Met increased by 700% since 2014 from The Guardian on Monday 22 January 2018)

  • There are 29,837 offenders on the Violent and Sex Offenders Register (ViSOR) Dangerous Persons Database with convictions against children (aged under 18)

  • in the United Kingdom (from House of Commons Hansard Written Answers for 13 December 2012)

A 2015 report from the Children’s Commissioner for England estimated that approximately 1.3 million children currently living in England will have been a victim of contact sexual abuse by the time they reach 18 (3), whilst a U.S research paper (4) reports that more than 80% of survivors of CSA are reported to experience some symptoms of PTSD (such as sudden, aggressive flashbacks to the sexual  abuse,  depression  and  anxiety,  or  addictions,  self-harming,  eating  disorders,  and  recurrent suicidal thoughts).

Alarmed by these statistics, I decided to do more research into the provision of counselling specifically for children and young people who might be survivors of CSA, and who have shown the enormous courage to come forward and ask for help at such a young age.

One of the shocking things I learned from the 2016 NSPCC report How Safe are our Children was the fact that there has been an 80% rise in reported sexual offences against under 18 year olds in England over the last 4 years. Despite this dramatic increase, research by YoungMinds (5) revealed that 64% of the 199 Clinical Commissioning Groups (CCG) diverted some or all of the new funding received for children's mental health to other priorities in 2015-16.

 The devastating knock-on effect for the children needing professional support is clear to be seen. More recently the office of the children’s commissioner estimated that as few as a quarter or a fifth of children with mental health problems received the help they needed last year, with, in some areas, children with severe mental health needs waiting as long as 18 months for an appointment. (6)

Tragically, the article also reported that some children are resorting to suicide attempts, in a desperate attempt to ensure that they are seen by Child and Adolescent Mental Health Services professionals. It beggars belief that half of all the CCGs are not planning on spending more on mental health services this financial year (2018), despite the continued huge increase in demand for these services. (7)

I then considered what the response of the professional community was to the standard of mental health provision for children and young people under the NHS.

The Royal College of Paediatrics and Child Health (RCPCH) said there had been “destructive” reductions in preventive services with England falling further behind the rest of the UK when it concerned policies aimed at improving child health. They continued, “Children deserve better. It is they who are disadvantaged most by inefficient health services, cuts to public health and the rising tide of poverty.” (8)

Perhaps the following quote from Peter Hindley (the former chair of the Royal College of psychiatrists faculty of child and adolescent psychiatry) sums up the role the government has played to worsen this mental health crisis, and indeed its lamentable record offering protection and care for vulnerable children.

 Cuts in recent years to early intervention services provided by the NHS and local councils meant children’s mental health problems worsened because they were not detected or treated quickly enough, often leaving schools to pick up the pieces. (9)

There is a wider context that also needs to be considered. Whilst I've been fortunate to have worked full time for almost all of the last twenty-four years, I've had periods when I've needed to have extended professional therapy (at least 12 weeks) to help me deal with flashbacks and the PTSD. I've always been in a position to pay for this therapy myself, but this is often not the case for many survivors.

More recently the consequences to my mental health of living with Complex PTSD had become so severe that I felt compelled to walk out of my last job. But for the support of my family, I would have been at the mercy of the welfare state, which has undergone drastic cuts and which, as widely reported in the media, have particularly impacted upon many people with physical and / or mental health issues.

An online survey of nearly 400 adult survivors of CSA took place in 2016. (10) The survey explored their experiences of abuse, satisfaction with different types of service and the availability of information about services. Its key outcomes were particularly revealing and reflect the complex nature of dealing with the trauma of CSA:

  • The average duration of CSA was 7 years.

  • Over 50% were abused by more than one person.

  • 70% of cases were not reported to the police. Almost 90% of survivors have not seen their abusers brought to justice.

  • 42% did not receive any support until, on average, 12 years after they had first disclosed they had been abused as children, with 50% waiting at least 9 years.

  • 25% used services specifically because of their abuse before ever disclosing.

 Sometimes the fear and the shame is too great to be able to say anything no matter how long ago it happened.

Adult CSA survivor, Focus on Survivors survey respondent

Professor Noel Smith commented: ‘They highlight both the sustained duration over which children are typically sexually abused and the lifelong impact of that abuse. As a society we clearly need to be more strategic in tackling sexual abuse and we are not doing enough to support survivors of abuse’.

Beyond my immediate concern, which is of course for the welfare of survivors, it is important to recognise that there is a significant cost to society, which could be mitigated with an investment in prevention and early identification of CSA as the underlying trauma in mental health services. Many survivors will end up in the criminal justice system mainly through the misuse of alcohol and drugs, whilst others might be regularly admitted to hospitals through other forms of self-harming. The financial costs of failing to treat survivors of sexual abuse is significant – it is estimated to cost £40,000 to keep a person in prison per year.

This cost could surely be reduced through better diagnosis and the wider availability of treatment for survivors of CSA.

The NSPCC estimates CSA costs £3.2 billion per annum (11) , an estimated cost for 2012 which is based on costs for health, criminal justice services, services for children, and loss of productivity to society.


 This article is an edited extract from the book, A Small Boy Smiling by Matt Carey in which he tells a remarkable story of survival and overcoming the trauma, guilt and shame of childhood sexual abuse, teenage alcoholism, sexual anorexia, and post traumatic stress disorder. His lifelong search for peace, love and healing culminates in personal spiritual awakening and a desire to help other survivors of sexual abuse to discover their own healing.

Since the book was published earlier this year, Matt has been busy promoting the book with public talks, and he was recently invited to discuss the book on BBC 5 Live’s Stephen Nolan show. An article (which presents an overview of Matt’s journey of healing) entitled Trying To Make Sense Of It All, had subsequently been published on the Survivors UK and the National Association of Adult Survivors of Child Abuse (NAASCA) websites. A link to the radio interview and the articles can be found at


1.     Rowling, J. K. Very Good Lives: The Fringe Benefits of Failure, and the Importance of Imagination. The quote is taken from a speech J. K. Rowling gave to the Harvard Alumni Association on June 5, 2008 when she accepted her honorary degree.

2.     Bentley, H. et al (2017), How safe are our children? The most comprehensive overview of child protection in the UK 2017.

3.     Office of the Children's Commissioner (2015), Protecting children from harm: a critical assessment of child sexual abuse in the family network in England and priorities for action.

4.     McLeer, S.V., Deblinger, E.B., Esther, B., et al. Sexually abused children at high risk for post-traumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry (1992) 31:875-79.

5.     YoungMinds, Children’s mental health funding not going where it should be, from

6.     Adi Bloom, Need to know: Pupil mental health, from on January 29 2018.

7.     Bettina Friedrich, Raising awareness of mental health issues is not enough, from The Conversation on January 31 2018.

8.     Paul Gallagher, Children ‘hit hardest’ by public health cuts, doctors warn, from i News on January 23 2018.

9.     Denis Campbell, NHS mental health services failing young people, say psychiatrists from The Guardian on Mon 26 Dec 2016

10.  Smith, N., Dogaru, C.M, and Ellis, F. (2015) Focus on Survivors: Identifying barriers to accessing support for those who have experienced childhood sexual abuse. University Campus Suffolk and Survivors in Transition.

11.  The US-based National Centre for Missing and Exploited Children identified 30,661 suspects with IP addresses in the UK in 2016. In 2009, the comparable figure had been only 1,591.