Australian Royal Commission Research Articles

Overshadowed voices in media reporting on truth-telling commissions

Over the past decades, truth-telling commissions aimed at uncovering, confronting and providing justice for the past treatment of children have been established in many countries, including the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (RCIRCSA 2013-2017) and the Norwegian Truth and Reconciliation Commission (TRC) (2018-2023). Journalism plays important roles both in triggering commissions of inquiry and in attracting public attention to their work and findings. This paper investigates media reporting on the RCIRCSA and the TRC. The Commissions were not similar in scale, scope or legal powers, however, they both generated spaces for public listening to stories about the consequences of past policies and present practices of child removal, abuse and racism that potentially could change the grand narratives of each nation. Our findings suggest that future commissions should pay particular attention to the structural power of news logics and mediation. We find, despite the widely different cases, consistent patterns of uneven and hierarchical media reporting and overshadowing of First Nations voices and aspirations.

Towards sustainable development: Assessing social sustainability of Australian aged care system

AbstractThe importance of social sustainability, one of the three pillars of sustainable development, is increasingly recognised. Its implementation in the aged care system enhances stakeholders' quality of life and supports sustainable societal development. However, there is limited global research on social sustainability in aged care. This study aims to assess the overall social sustainability of the Australian aged care system and propose measures for its improvement. A conceptual framework was developed and applied to analyse the Final Report: Care, Dignity and Respect by the Australian Royal Commission into Aged Care Quality and Safety. The findings reveal that Australia's aged care system demonstrates significant deficiencies in social sustainability, with unequal access to care, services and facilities, and inadequate health and comfort for the elderly and their families. Employees contend with issues of unfair employment, insufficient compensation, unhealthy work environments, and inadequate education and training. Several measures are proposed to enhance social sustainability. This study provides a comprehensive analysis of social sustainability in the aged care system within a Western context. It enhances our understanding of the components of social sustainability in aged care, assesses its current status, identifies existing challenges, and provides possible directions for improvement. The insights from Australia's experience and potential solutions could inspire other countries to recognise the importance of social sustainability and reform their aged care systems towards sustainable development.

Amplifying victim–survivor voices: media power, collective action, and ultra-Orthodox Jewish identity in the Leifer case

This article underscores the transformative impact of victim–survivor voices in reshaping public discourse on child sexual abuse (CSA). The research project took as the backbone for analysis the Malka Leifer case that spanned 15 years and is linked to the Australian Royal Commission into Institutional Responses to Child Sexual Abuse's report of Case Study 22, which examined responses in ultra-Orthodox Jewish schools to child sexual abuse. Adopting a mixed methods research approach, this study combines qualitative media analysis of 102 news articles and 8 in-depth focus groups to investigate the impact of media outlets in amplifying victim voice and influencing public discourse, and how this impacts the subjects of mediatised public crises. Drawing on the theorising of Couldry and Cottle, the article considers the capacity and limitations of survivor-advocates to leverage media power in the contemporary media system. By exploring the ‘Privileging Victim Voice’ frame, this paper sheds light on how victim–survivor advocates utilised mainstream, local religious, and social media to solidify their central place in the narrative and its reportage. The media analysis served as the foundation for a ‘peer conversation’ style of focus groups with Jewish community members to investigate local impacts of the case's media reportage. The focus group methodology sought to represent this diverse community as wholly as possible. Findings reveal the significant power of journalists’ framing and sourcing practices, and how Jewish institutional child sexual abuse is framed by media outlets within the Australian media landscape. Further, it showcases the broader implications of public inquiries, such as Australia's Royal Commission, in empowering victim–survivors and centreing their narratives in media reportage.

Registered nurses’ confidence related to undertaking a leadership role in residential aged care: A clinical leadership self-assessment survey

BackgroundThe Australian Royal Commission emphasizes the importance of registered nurse leadership in providing safe, high-quality care to older adults in Residential aged care. Nurse leadership has important ramifications for effective multidisciplinary care as well as recruitment and retention of the aged care workforce. Registered nurse leadership plays a crucial role in enhancing resident outcomes in Residential aged care, however there are limited studies examining self-perceptions of confidence and competence of nurses running Residential aged care, particularly after hours. AimTo examine registered nurse leadership via self-reported confidence and competence in Residential aged care. MethodsA cross-sectional research design with ten facilities in Western Australia was used, including a survey tool that relied on the Clinical Leadership Competency Framework. Cronbach's alpha test was used to ascertain internal reliability and replicability. The Strengthening the Reporting of Observational studies in Epidemiology guidelines was used to guide the study. Inferential statistics were used for data analysis. Data collection occurred over a six-month period, involving registered nurses employed by a single Residential aged care provider in Perth, Western Australia. Participants rated their leadership confidence on a 5-point Likert-type scale ranging from 1 (never) to 5 (all the time). FindingsFrom a sample of 100 registered nurses working in aged care after-hours, 90% reported high levels of self-confidence. The survey results showed that those who have more than 10 years of experience reported highest confidence in managing services. Registered nurses over 50 years old self-reported highest confidence in personal qualities, managing, and improving service domains. DiscussionRegistered nurses run residential aged care, and this time of aged care reform provides an opportunity to examine associations between registered nurse leadership and resident outcomes and provide avenues for improvements in working environments and resident experiences. ConclusionThe findings have important implications for Residential aged care providers in establishing effective leadership mentoring programs to support registered nurses in improving their confidence and ability.

Best practice models of aged-care implemented for First Nations people: a systematic review aligned with the Good Spirit Good Life quality of life principles

BackgroundAged-care programs that are based in First Nations worldviews are believed to translate to improved quality of life for First Nations Elders. First Nations perspectives of health and well-being incorporates social and cultural determinants in addition to traditional Western biomedical approaches. This is exemplified by the Good Spirit Good Life (GSGL) framework, which comprises 12 strength-based factors determined by First Nations Elders as constituting culturally appropriate ageing. Our objective was to conduct a systematic review of existing aged care models of practice to determine the degree of alignment with the GSGL framework. Recommendations of the national Australian Royal Commission into Aged Care Quality and Safety informed this work.MethodsWe conducted a systematic search of academic and grey literature in the PubMed, Scopus, Ovid Embase, and Informit online databases. Inclusion criteria comprised English language, original research describing the implementation of First Nations culturally appropriate aged care models, published before August 2022. Research that was not focused on First Nations Elders’ perspectives or quality of life was excluded. We subsequently identified, systematically assessed, and thematically analyzed 16 articles. We assessed the quality of included articles using the Aboriginal and Torres Strait Islander Quality Assessment Tool (ATSIQAT), and the Joanna Briggs Institute (JBI) critical appraisal tool for qualitative research.ResultsMost studies were of medium to high quality, while demonstrating strong alignment with the 12 GSGL factors. Nine of the included studies detailed whole service Models of care while 7 studies described a single program or service element. Thematic analysis of included studies yielded 9 enablers and barriers to implementing models of care.ConclusionsBest-practice First Nations aged care requires a decolonizing approach. Programs with strong adherence to the 12 GSGL factors are likely to improve Elders’ quality of life.

Restrictive practices in community services for people with intellectual disabilities at risk of behaviours that challenge: insights and omissions of the Disability Royal Commission

People with intellectual disabilities commonly experience violent, abusive, and restrictive contexts, particularly those who are at risk of behaviours that challenge, behaviours that often are a sign of trauma, fear, pain, and loss of power. For example, the use of physical restraint and psychotropic medication to manage behaviours labelled as challenging is prevalent in services for people with intellectual disabilities, and has a negative impact on their wellbeing and quality of life. The Australian Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability has recommended a reduction in the use of restrictive practices, and that they only be used as a last resort. However, there is a risk that a narrow focus on behaviours labelled as challenging and their management through legislation, procedures, and authorisation by writing behavioural support plans fails to properly address the concerns of people with intellectual disabilities at risk of behaviours that challenge. There might not be enough incentive for the system-wide change required to properly meet the needs of this specific group. The closure of group homes, as recommended by the Commission, is appealing, given that abusive and restrictive practices are repeatedly uncovered in these settings. However, this might add to the precarious situation unless significant social change is made. Instead, perhaps more feasible, a plan to enable group homes become truly a home, safe and with highly skilled support available, should be developed. A framework based on the concept of capable environments might aid in this endeavour.

Dementia care for people from culturally and linguistically diverse backgrounds: Qualitative secondary analysis of the Aged Care Australian Royal Commission data.

Understanding the concerns and experiences of people living with dementia from culturally and linguistically diverse backgrounds is critical to ensure culturally appropriate care is delivered. This study aimed to describe the current experiences and concerns of older people from culturally and linguistically diverse backgrounds using the publicly available evidence from the Australian Royal Commission into Aged Care Quality and Safety. This was a qualitative secondary analysis of the Australian Royal Commission into Aged Care Quality and Safety data to explore new and nuanced insights about care for culturally and linguistically diverse people living with dementia. Using the keywords to search the data corpus, we extracted a topic-specific data set focused on dementia care and cultural diversity. Thematic analysis was used to identify and describe the present practices and challenges. Our findings showed that the need for cultural connection for older people from culturally and linguistically diverse backgrounds increases as dementia progresses. Access to culture-specific food and music facilitated connection with their culture of origin. Many older people from culturally and linguistically diverse backgrounds with dementia reverted to their language of origin; however, the inability to communicate due to a lack of language support impacted their health and well-being, and care provision. Further work is needed to provide the necessary cultural experiences and language support to ensure comfort and equity in the provision of dementia care for Australians from migrant backgrounds.

Chemical restraint as behavioural euthanasia: case studies from the Royal Commission into Aged Care Quality and Safety

BackgroundThe prescription of psychotropic medication to older people living with dementia in residential aged care has become an increasing concern. The use of prescription medication is often prefaced as a way of preventing harm to self and others. However, the use of such medications has been considered a way of managing some of the behavioural and psychological symptoms of dementia. Using a large secondary data set, this study aimed to identify the precursors and mediating factors that influence the use of chemical restraint of older people in residential aged care.MethodsPublicly available documents from the Australian Royal Commission into Aged Care Quality and Safety were used as the data corpus for this study. Keywords were used to search over 7000 documents to extract a set of topic-related content. We identified the cases of seven people in respite or permanent residential aged care who had been prescribed or administered psychotropic medication under circumstances that appeared to demonstrate chemical restraint. All documents relating to the cases were collated for our data set. A descriptive case study approach to analysis was taken.ResultsFour key descriptive patterns were identified: labelling and limits to tolerance, pushing prescription as a solution, coverups and avoiding consent, and family’s fight for liberty. Triangulation across the data and academic literature supports the findings.ConclusionOur findings provide some insight into how chemical restrain happens. Featuring throughout the cases were reports of a lack of workforce capacity to care for and support residents exhibiting dementia behaviours. Prescription of psychotropic medications featured as a “first resort” care solution. Family and friends found such approaches to care unacceptable and frequently challenged the practice. Where consent for prescription was explicitly denied, more covert approaches are demonstrated. Family awareness, presence, and advocacy were key to challenging the practice of chemical restraint. Shortfalls in the capacity of the current workforce come into play here. However, workforce shortcomings can no longer mask this ubiquitous practice. Just as importantly the spotlight needs to be turned on the prescribers and the providers.

Supporting survivors of institutional child sexual abuse during the COVID‐19 pandemic: A qualitative study of not‐for‐profit community and legal organisations in Greater Western Sydney

AbstractBefore, during and since the Australian Royal Commission into Institutional Responses to Child Sexual Abuse (2013–2017), not‐for‐profit community and legal services have been critical in supporting survivors of institutional child sexual abuse. This qualitative study aimed to explore the perspectives of community and legal service practitioners operating in Greater Western Sydney regarding the ongoing impact of the COVID‐19 pandemic on the service system for survivors of institutional child sexual abuse. Semistructured interviews were conducted with 21 practitioners at 15 community and legal services. Through thematic analysis, the study identified five areas of concern regarding service provision and COVID‐19, including difficulties in navigating shifts to remote service delivery; changes in service accessibility; complications in accessing the National Redress Scheme; safety challenges for clients; and safety challenges for practitioners. The research identified a need for services to finesse frameworks that ensure remote services can be delivered safely for clients and practitioners alike. Priorities include adequate funding for technology and infrastructure, supporting survivors of abuse perpetrated online and encouraging effective coping strategies for practitioners who undertake trauma support work from home. Future research should consider how shifts to remote service delivery have impacted survivors of different demographic groups and the survivor support workforce.

The Slow Emergency of the Future

This article explores The Shadow Whose Prey the Hunter Becomes (2019) by Back to Back Theatre, an ensemble based in Geelong, Australia, whose members are perceived to have intellectual disabilities – a unique position from which Back to Back comment on the categories of identity and modes of perception of ableist society. Shadow is, in part, a response to the launch of the Australian Royal Commission into the Violence, Neglect and Exploitation of People with Disability in 2019, which has since confirmed that these conditions are widespread, systemic and of urgent attention. Shadow positions the typically able-bodied spectator as the subject of a negated future in which their fate cannot be disentangled from that of those with whom they believe to have little in common. A group of activists warn spectators of an apocalypse brought about by the invasion of artificial intelligence, wherein the spectators’ survival will be threatened by precisely the same circumstances that those who live with disability currently endure. Such a circumstance is the apotheosis and stakes of what Theodor Adorno calls ‘identity-thinking’ – the reduction of a heterogenous world to knowable and finite concepts and categories at the expense of, and respect for, difference, or the nonidentical. I consider how identity-thinking is a form of ‘slow violence’ (Rob Nixon (2011) Slow Violence and the Environmentalism of the Poor, Cambridge, MA: Harvard University Press) that manifests in the forms of intolerance and oppression Shadow engages with. I employ negative dialectics, conceived by Adorno as way of resisting such violence, to examine how Back to Back reveal the urgent stakes of identity-thinking and grapple with the possibility of a future in which survival is a collective pursuit.

‘Vulnerable Monsters’: Constructions of Dementia in the Australian Royal Commission into Aged Care

This paper argues that while regulatory frameworks in aged care authorise restraints to protect vulnerable persons living with dementia from harm, they also serve as normalising practices to control challenging monstrous Others. This argument emerges out of an observed unease in aged care discourse where older people living with dementia are described as ‘vulnerable’, while dementia behaviours are described as ‘challenging’. Using narrative analysis on a case study from the Final Report of the Australian Royal Commission into Aged Care Quality and Safety (RCAC), this paper investigates how the RCAC (re)produced constructions of persons with dementia as ‘vulnerable monsters’. Drawing upon monstrous theory about ‘unruly and leaky’ bodies, extracts from the case study reveal how the RCAC repeated and reinforced monstrous constructions of dementia. Dementia behaviours, particularly ‘wandering’, were constructed through a dehumanising crisis frame that produced ‘challenging’ bodies and legitimised ‘last resort’ normalising practices, such as physical and chemical restraints. In failing to resist monstrous constructions of dementia behaviours, the RCAC accepted and authorised a regime of scaled responses leading to restrictive practices for control of challenging bodies in aged care. Although dementia care and restrictive practices received substantial attention in the RCAC, this paper reveals a missed opportunity for deeper review of institutionalised use of restraints that has relevance for ongoing reform of Australian aged care following conclusion of the RCAC.

Does pain matter in the Australian Royal Commission into Aged Care Quality and Safety? A text mining study

BackgroundPain is often poorly documented, assessed and managed in the Australian aged care sector. The Australian Government called for the Royal Commission into Aged Care Quality and Safety (RC) to investigate the serious concerns, neglects and abuses including the inadequate pain management seen in the sector. This study examined the degree to which the RC discussed the issue of pain in their published reports and recommendations. MethodsA text mining study with a computer-assisted term frequency analysis identified mentions of the word “pain” in the text of two key reports produced by the RC: the Interim Report and the Final Report. Main outcome measures included frequency of mentions of “pain”, cumulative percentile rank of the word “pain”, proportion of words that were “pain”, and frequency of mentions of the word “pain” in quotes. ResultsThe word “pain” was mentioned often in the Interim Report (n = 10, 0.03% of all words, 87th percentile) and the Final Report (n = 218, 0.05% of all words, 97th percentile). However, the word “pain” was absent from final recommendations of the RC. ConclusionsAlthough the RC discussed pain in their reports, the topic was omitted from recommendations, reflecting a lack of attention to the presented evidence. Without specific recommendations for pain management, a disconnection may arise between targeted polices, programs and funding schemes, and the clinical practice. Thus, older adults living in the community and residential aged care homes may remain vulnerable.

Our dementia challenge: arise palliative care.

While many of the maladies of the 20th century are steadily coming under control, the march of neurodegenerative disorders continues largely unchecked. Dementias are an exemplar of such disorders; their incidence and prevalence continue to rise, in large part due to a steadily ageing population worldwide. They represent a group of chronic, progressive and, ultimately, fatal neurodegenerative diseases. Dementia has remained therapeutically recalcitrant. It is not a single disease, and becauseofthat, we cannot expect a single panacea. While primary prevention rightly gains prominence, those with established disease currently require a shift in focus from curative intent towards improved quality of life. Enter palliative care. The sheer number and complexity of needs of patients with dementia, from the physical to the psychosocial and spiritual, necessitates the engagement of a wide range of medical disciplines, nursing and allied health professionals. One of those disciplines, as highlighted in the recent Australian Royal Commission into Aged Care Quality and Safety, is palliative care. This paper shall expand upon that role in the overall context of care for those with dementia.

Reconceptualizing Stigmas in Aged Care: A Typology of Stigmatizing Discourses in the Aged-Care Context.

Stigmatizing discourses surrounding aged care is complex. The stigma associated with people working in aged care is often conflated with negative evaluations about older adults who receive care and/or the institutions and systems that provide these services. This lack of nuance hampers productive dialogue in gerontology required for making sense of the stigmas attached to entities and systems. We propose that an interdisciplinary approach drawing on gerontology, psychology, and linguistics would facilitate a greater understanding of the stigma of aged care. Specifically, a discourse approach underpinned by Stigma Theory and Systemic Functional Linguistics can clarify the different stigmatizing discourses associated with aged-care entities and systems, and inform priorities for interventions targeting each discourse category identified. APPRAISAL, a linguistics framework, was employed to analyze evaluative language in 660 submissions published in the Australian Royal Commission into Aged Care. Through applying predefined language-based criteria, we distinguished between multiple stigmatizing discourses that were interrelated but conceptually distinct in terms of attitude types and targets. Twelve categories of stigmatizing discourses derived from the linguistic analysis established a typology. This typology conceptualized different ways stigma can be meaningfully understood in the aged-care context. By employing this typology, 12 intervention priorities were also identified. This interdisciplinary approach enabled us to examine the diversity and complexity of the social construction of stigma in the public domain. We argue that understanding these linguistic patterns can assist with designing targeted aged-care interventions and policies.

Child Sexual Abuse, Alcohol and Other Drug use and the Criminal Justice System: The Meanings of Trauma in Survivor Narratives for a National Royal Commission.

Adverse childhood experiences, including childhood sexual abuse, have significant immediate and lifelong effects including higher risks of alcohol and other drug use and contact with the criminal justice system. The concept of trauma to describe adverse experiences and later behaviours provides potential to reshape prevention and responses for victims. We draw on survivor accounts to a national enquiry, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, to examine the ways in which trauma is narrated in adverse childhood experiences, alcohol and other drug use and contact with the criminal justice system, and how trauma is interpreted by others in the context of policy and legal findings. These accounts showed damaging and unjust experiences of childhood, which were compounded by subsequent contact with the criminal justice system. Trauma seems to be important to both the experienced narrated by survivors and the synthesising of these experiences into narratives. National enquiries play important roles in listening to survivors and advocating for reform. There is a risk, however, that they will fail to result in substantive change, and function primarily as a forum for bearing witness to trauma, but not preventing it.

Review: Religious Confession and Evidential Privilege in the 21st Century, edited by Mark Hill QC and A. Keith Thompson

This book of essays investigates legislative and judicial trends toward abrogating the confidentiality of religious confession in Australia, Europe, and the United States. The larger issues, of course, are freedom of conscience and the limits the state may try to impose upon religious groups, most particularly in cases of child abuse. The three essays in Part I criticize the recommendations of the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, which advised states to remove legal protections for confessions made within a religious setting. Part II considers examples from Europe, where, given the establishment of religion, canon law was part of state codes. Confessional privilege there was largely sacrosanct until the twentieth and twenty-first centuries. Part III examines the situation in the United States. Clergy sexual misconduct has driven state legislatures to remove confessional protections, and led to a general decline of religious freedom in that nation.Of particular interest to readers of Nova Religio may be the final essay in the book, which argues that the Church of Scientology has a legitimate claim of confidentiality to shield communications between parishioners and ministers. Since Scientology auditors perform the traditional role of ministers, learning private and personal information in the process of aiding self-realization or problem-solving, auditing meets all the requirements for constitutional protection.The contributors to this volume all view the erosion of confessional privilege as an attack on the free exercise of religion. The editors decry the West’s “growing disinterest in freedom of conscience and religion” and point to its neglect of “Uighur Muslims in China, Rohinga Muslims in Myanmar, Bahais in Iran, Jehovah’s Witnesses in Russia and Christians in general in Iraq” (15). Readers interested in issues of religion and law and the protection of religious rights will want to read this book.

Emergency department transfers from residential aged care: what can we learn from secondary qualitative analysis of Australian Royal Commission data?

ObjectivesTo use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency...

The role of palliative care nurse practitioner in promoting end-of-life care in residential care facilities

Background and objective: The neglect of older people at the end of life in residential care documented in the Australian Royal Commission into Aged Care and Quality and Safety mandates urgent solutions to improve care. This integrative literature review aimed to explore the potential role of the palliative care nurse practitioner (PC-NP) in promoting quality end of life in residential care.Methods: Databases Medline, Emcare, PsychINFO and CINAHL were searched from January 2010 to April 2022. Full text of primary articles meeting inclusion criteria encompassing residents living in residential care settings, the role of the PC-NP in supporting quality dying were obtained and independently screened to determine final studies for review. Findings were thematically analysed. Two reviewers independently extracted data and assessed level of evidence and quality ratings for both quantitative and qualitative studies.Results: Of 12 articles meeting eligibility criteria, four specifically focused on the PC-NP or the palliative care nurse in residential care, seven examined the generic nurse practitioner role, and one the aged care nurse role in supporting palliative care. Themes common to all roles including positive patient outcomes, advance care planning, hospital avoidance, staff education and enhanced communication with families. Themes specific to the PC-NP included meeting end-of-life needs, end-of-life prescribing, and enhancing the role of the General Practitioner.Conclusions: Although reflected in only a handful of studies, this integrative review has provided preliminary insights into potential contributions of the PC-NP to quality end-of-life care for residential care residents.

The Impact of Critical Life Points and Events for Survivors of Institutional Child Sexual Abuse: Understanding Trauma and the Role of Compensation in Recovery.

Although the impact of child sexual abuse (CSA) is well documented in the international literature, little is known about the critical points of recovery across the life course for survivors of institutional CSA. The aim of this study was to identify critical points, or events across the life course that may increase, or decrease, a survivor's vulnerability to the complex traumatization of institutional CSA (ICSA). The sample consisted of two hundred and forty-eight witness statements extracted from the 56 publicly available case studies presented to the Australian Royal Commission into Institutional Responses to Child Sexual Abuse during 2013-2016 (Commonwealth of Australia, 2017). A content analysis and thematic coding of the statements identified seven main themes in the witness statements (Gender, Organization, Triggers, Trauma, Mental Health, Intervention and Compensation), that appeared to be critical events across the life course. The themes were transformed into variables for further analysis using SPSS. Significant Likelihood Ratios were found between associations with the organization where the abuse occurred and between triggers and breastfeeding/sensory, breast feeding/childcare, emotional and physical distress, and mental health (p < 0.01). Significant associations were also found between receiving compensation for the CSA and triggers, trauma, breast feeding-sensory and childcare (p < 0.05) and gender and breast feeding (p < 0.05). Overall, the findings showed that triggers can be random across the life course occurring mainly through indirect association, or in situations that evoke memories of the CSA, and that receiving compensation can assist survivors in their recovery journey. The findings also indicate the need for health care professionals to be aware of the critical points in a CSA survivor's recovery and how triggers may impact on their mental welling throughout the life course.

Therapeutic politics and the institutionalisation of dignity: ‘Treated like the Queen’

This article draws on theories of therapeutic politics to explore the role of institutionalised dignity as a medium for the social and political participation of traumatised people. Using the Australian Royal Commission into Institutional Responses to Child Sexual Abuse as a case study, the article offers a psychosocial account of shame and humiliation as key characteristics of the phenomenology of trauma, and presents dignity as the organising principle of a therapeutic politics. Through interviews with survivors of child sexual abuse who testified to the Commission, as well as former Commission staff, the article describes the practices and structures of dignity as they were institutionalised within the Commission. We suggest that institutionalised dignity can ground and guide the theory and practice of a therapeutic politics and institutional responses to trauma, violence and abuse.