The overseas placement of Irish children will continue, writes Noel Baker. It’s time to ensure the ‘before’ and ‘after’ services deliver.
MOST boys in the latter years of primary school are interested in kickabouts, or riding their BMX, maybe building a den. Not this boy.
“He tried to commit suicide,” his mother says. He tried to do it front of her. “At [that age] you wouldn’t expect that,” she says. He told her that voices in his head were telling him to harm himself and worse. She now believes he had a breakdown. She called the GP, but he had gone home, and tried a clinic, but nobody was answering. She straightened the boy out and put him in the shower.
Mental health problems as profound as this randomly selected case are thankfully rare in children, but the most recent Child and Adolescent Mental Health Services (CAMHS) report, published this month, shows that about 17,000 young people are routinely using mental health services in Ireland, mostly in community settings.
There are 60 adolescent mental health beds in this country. Martin Rogan, former assistant director for mental health in the HSE, points out that when the report of the expert group on mental health policy published its Vision for Change document in 2006, there were just 12 beds. It’s progress, but he admits: “One of the pieces in the spectrum not in place is kids that need secure and longer-term admissions.”
The mental health/care system overlap is obvious — 18% of those who use CAMHS are known to childcare services. Were you to add in the criminal justice element, then some teenagers could be represented as a three-circle Venn diagram.
The services they require, however, remain distinct. In his recent, pleasantly frank interview with this newspaper, Child and Family Agency (CFA) chief executive Gordon Jeyes spoke of bringing the “parallel lines” of child welfare and juvenile justice together into a single stream; it’s not too fanciful to think he would also like to see the mental health side come under his roof as well, but as Mr Rogan points out, that is a matter of “significant debate”.
“There is a lot of overlap,” Mr Rogan says, “not just the mental health needs but the care needs.” However, most admission to CAMHS come from primary care, so if adolescent mental health was part of child welfare services, he wonders if parents wouldn’t feel that admitting their son or daughter to CAMHS was somehow “a reflection” on their capacity as parents.
“Who manages the white space?” he asks. “There are certain advantages in CAMHS being in the CFA and some downsides to that, and the view for now is it should remain a component in mental health [services].”
At the farthest reaches of the Irish care system are those children in an overseas care placement, a scenario often referred to as a last resort. The number of children currently in out-of-state secure units is comparable to figures for previous years, but St Andrew’s Healthcare in Northampton has by far the largest cohort.
They may represent just a fraction of the 100 adolescent beds available on its vast campus in the English city, but it is still notable how the numbers have grown in recent years. Paul Clarke of the London-based Potential Organisation, which two years ago wrote a report for the Department of Children and the HSE on how the Irish system could be improved, says the Irish contingent there is effectively a unit-full.
By the time Mr Clarke was leaving Ireland following his work here (he praises Ballydowd, Ireland’s main special care centre, as “very good”) the issue of placements in units in Scotland and in St Andrew’s Healthcare was coming to the fore.
“We had concerns about that,” he says. “Although these units may have specific skills, I do not think it’s beyond Ireland to put in place these specific skills.
“No matter how well [the children] do they are going to come back to where they came from. We were concerned that it was not wrong but it was not necessarily right.”
He knows St Andrew’s — “It’s good and it’s got a good international reputation” — but says the services there could, in time, be replicated here.
“It’s not a scandal but it’s a serious concern,” he says of the placements.
“These kids have the right to Irish law but Ireland needs to ask serious questions: How many, what are their needs, what can we do for them ourselves?”
It is agreed by senior figures such as Mr Jeyes and Children’s Minister Frances Fitzgerald that, realistically, the out-of-state placements will continue. Mr Rogan agrees, but says when the 10-bed adolescent mental-health facility is open in Portrane, Dublin, by late 2017/early 2018, many children that might otherwise be considered for a place in St Andrew’s or elsewhere might not need to travel outside of Ireland.
In addition, not every out-of-state placement requires intensive mental-health treatment. Mr Rogan says that, sometimes, even dramatic presentations at the beginning turn into stabilising behaviour over a period of time. “If you look at those admitted in Ireland, our ethos is ‘at home, in school, out of trouble and doing well’,” he says. The same is true of those ‘out of state’.
He is happy with the level of oversight provided by mental-health experts from Ireland to those Irish children based overseas, but other people who spoke to the Irish Examiner for this series suggested they wanted more: For example, wondering should the Health Quality and Information Authority have a role in inspecting or monitoring the placements of Irish children in other countries.
There are other issues, too. Firstly, the comparative costings showing it is more expensive to have a child in an Irish unit than an overseas one. Secondly, according to one barrister, the claims that the waiting list for secure care and high-support places in Ireland was “as bad as ever”. Another professional, involved in a different aspect of the care system, claimed there was a lack of clarity regarding certain legal aspects of placements, adding: “We are waiting for someone to challenge this.”
Concerns have been raised regarding the lack of appropriate facilities here, particularly when the process of balancing a child or vulnerable adult’s right to be treated in their own country takes place in circumstances where some key services available in, for example, St Andrew’s, are not available here.
One legal source asserts that children and adults have been sent abroad to be detained in a secure psychiatric facility in circumstances where such detention would not be permissible under our own legislation. But the High Court has an obligation to take into account the holistic circumstances of a child, not just the question as to whether they have a mental disorder.
The High Court has inherent jurisdiction to vindicate a child’s right, if necessary, by detaining them against their will. It is a tricky balancing act. Some of those involved in aspects of the process feel it is time for a broader debate on this issue.
A guardian ad litem — the voice of the child in legal proceedings — believes there are other long-term questions over out-of-state placements, claiming: “Surely we are storing up a lot of legal cases for the long term?”
Who knows? However, with the development of the legal mechanisms guiding the process it seems a much more remote prospect. The Brussels IIA regulations (Brussels II bis) — expressly, Article 56 — is the mechanism which allows a judgment placing a child in care in another member state to be recognised. The authority making the placement of a child in foster care or institutional care, such as the CFA, first consults with the ‘central authority’ or other competent authority in the member state where the placement is to take place. If all that sounds straightforward, congratulations — to the non-legal mind, certain aspects of overseas placements seem incredibly complex.
Geoffrey Shannon, a government-appointed child law rapporteur, tends to be ahead of the curve when it comes to children’s issues. In the past, he has expressed concern at the practice of Irish children being placed overseas.
“The system [in Ireland] is unable to cope with children with severe emotional or behavioural problems,” he says now. He criticises the legal expenditure in this area — put at €18m one year — claiming the costs are “staggering, especially when you consider not every child has an allocated social worker”.
“As a society we have mandatory moral obligation to prevent harm to the most vulnerable sectors of society,” he says. His work as co-author of the Child Death Report, which looked at deaths of young people known to the care system, highlights what he sees as a major problem. “Care is done to [the children] rather than for them.”
The current situation, in which more high-support and secure places are likely to be provided, is “an opportunity to demonstrate new thinking”, Mr Shannon says, a time to end “the sporadic nature of aftercare” and to track the outcomes of young people who spend time in the care system.
In the past, there has been a failure to reintegrate those who lost touch with services, he argues, adding that there needs to be a “radical root-and-branch review of legal expenditure in child cases”. Mr Shannon says cases should be dealt with in the same court and could be devolved from the High Court to the district court.
The children placed out of state at a given time are a small but select group, representing a tiny fraction of the more than 6,000 children in care, the majority of whom are living ordinary lives in foster families. It could be argued out-of-state placements are themselves becoming a little more ‘normal’ in some ways. Freedom of Information material from the CFA shows there were “limited complaints made by families of children in out-of-state care” in the past two years.
The complaints — about frequency of access visits or phonecalls to the service providers not always being answered — were typically resolved locally, although issues of distance and absence are obvious. Of those children who have been out of state since 2010, all were offered aftercare. There were also “limited numbers” of incidents resulting in injury to Irish children in secure out-of-state care. One injury was recorded as a child reporting being hurt following the use of restraints, but the CFA said some children had no injuries at all.
It’s never going to be popular with everyone. As one person familiar with the placements put it: “Think of yourself being put in a place, and then another place, and another place, and everyone rejecting you, and at the end they send you to a totally different country.” For others, it is the moment at which things start to turn around.
Ireland is playing catch-up regarding parts of its care system, but with the rebooted Ballydowd and Portrane build, things are happening. Yet by the time the overhaul is complete, some children who have been through the departures and arrivals halls will have alighted somewhere else — adulthood. As the saying goes, the past is a foreign country.
* Supported by the Mary Raftery Journalism Fund
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