HSE (CPS/DCYF) plays numbers game on child deaths

HSE plays numbers game on child deaths
30 May 2010

Three years ago, a child ran away from a residential unit managed by a friend of mine. The child was a 16year-old Nigerian girl, and there was a fortnight-long search for her by gardaí and social workers, after which it was felt she had probably been reunited with her family, and left the jurisdiction.

My friend, however, wasn’t satisfied with this explanation, and followed up on the case himself. Six months later, he discovered, after much digging, questioning and persistence, that she was, in fact, dead.

Somehow the girl had made her way to a hostel in the west of the country, and it was there she met her end. The circumstances of her death were never disclosed to him.

He was simply told that she had died and that such things happened from time to time.

‘‘They told me that somewhere in the region of 250 children have died over the past few years while in state care," he said, incredulously when we discussed the story. ‘‘How does that happen?"

In 2010, this figure has been modified to ‘‘approximately 200’’. Brendan Drumm, chief executive of the Health Service Executive (HSE), would have us believe that it is 37.

Although he did concede that the higher figure could apply in relation to all children who were HSE clients.

To understand this, we must first develop an understanding of the care system and how it functions.

Who are the children who find themselves in the care and under the protection of the state? How does a child access that care system and what are the circumstances which may cause the HSE or another agency to intervene with a family, and bring a child into care?

The answers to those questions are far from simple. In more than 15 years working at many levels within the care system, I have encountered children being taken into care for many reasons. Some had been physically or sexually abused, and were in residential or foster care because it was simply unsafe for them to be at home.

Others had been voluntarily placed in care because their parents were ill and could not care for them; more because their carers were in prison, because family members were alcoholics or drug abusers and the home environment was potentially dangerous or neglectful. Some children were orphans.

Inside the system

Once inside the system, children are cared for by professionals: childcare workers, social workers, family support workers and foster parents, to name but a few. The vast majority of them care deeply and unequivocally about the children they work with day-to-day.

Most social care practitioners work long hours for pretty meagre pay, generally getting very little thanks for it. Social care tends to only get into the headlines when something awful happens - when a child has slipped through the cracks, in other words.

How do children go astray like this once they are on the books of the HSE?

The obvious response is that some children are just too damaged when they find their way into the system to be effectively helped. They have often been outrageously hurt by people they trusted and who should have done right by them, and are too frightened and angry to accept friendship and assistance.

They continue to run away from care settings, to engage in self-injurious and risky behaviour, and to push away any and all adults who try to bond with them. Does that mean that the professionals should stop trying?

Should these difficult, hard-to love children be abandoned, thrown on the scrap-heap? Absolutely not.

But there are always those who will not make it. I have worked with children who I ‘lost’, children who just would not take my hand when I reached out to them. I mourn them, to this day, but I also know I did all I could.

The people who deserve the blame for those children’s misery and pain are the ones who abused and neglected them to begin with, not those of us who tried everything in our power to help.

Yet it is also true that the fault sometimes does lie with the care system and the state.

There are children on waiting lists in every HSE region in the country, children the state knows are living in unacceptable situations - in circumstances that are abusive and neglectful - but for whom there are just not any available social workers.

I know of a foster family who have two very challenging disabled children in their care and who have repeatedly requested the support of a therapist. These parents dearly love the children they have taken into their home, but they fear that if this help is not given, the placement may break down. Their cries continue to fall on deaf ears.

There is a widespread acceptance within the institutions of care in Ireland that the system is so direly underresourced, it is simply not sustainable. It comes down, as always, to money.

When the country had a ridiculous amount of it, the government was more interested in pumping it elsewhere. Now there is none, the attitude of those who hold the purse strings is hardly any different. There has never been the political will to plug the gaping holes in our care infrastructure.

Cases are expedited on a ‘greatest need’ criteria, meaning only the very worst are receiving any level of attention, while others are left to stagnate. The public is made aware of the situation when something appalling happens - or when a child dies.

When is a child in the care of the state?

Drumm, in a rather heated exchange earlier this week, asserted that the figure of 200 had been generated by the media in an effort to smear the workings of the HSE (remember the larger figure given to my friend by a HSE official three years previously) and that the only children we should be concerned about are those in residential care.

The others, he said categorically, were not really in the care of the state at all.

This brings up an interesting and, in many ways, crucial point: when exactly is a child in the care of the state? Does a child need to have been, literally, taken into care, and be living in a residential institution?

Are foster children, who are being cared for by parents who receive a token salary from the state for their efforts, in the care of the HSE?

What about those children who are technically in care, but are living in hostels, where they are left to their own devices for much of the day?

Then, of course, there are those children on supervision orders, where the state is required by law to spend a certain number of hours every week with them.

Where do they stand? What about all the children on waiting lists, who have been acknowledged as needing help, but have not been allocated a worker yet - does the state have a responsibility of care to them?

Under the Childcare Act, 1991, the state has a responsibility to seek out children who are at risk, and do their utmost to prevent them from coming to harm.

The kind of ducking and diving, dodging responsibility and passing the buck we are seeing shows just how seriously our crop of leaders take this responsibility.

Which must leave us pondering just how many children have died while in state care. I am simply going to toss aside Drumm’s figure of 23. It is just creative book-keeping.

Three years ago, the figure given to my concerned friend was 250.

Having spoken to a number of child protection workers over the past few days, there seems to be a belief that this is a deeply conservative figure, and that the true tally may be much higher, possibly even double that which has been reported in the press: ie 500 dead. It is a frightening figure. I pray that Drumm’s much lower statistic is accurate. But I am not hopeful.

My friend never found out what exactly happened to that lost girl. He finally became so disenchanted with the system here, he left altogether, and now lives in Australia.

Child protection cannot afford to lose people of his integrity. If the files on these children ever do become available, it will probably prove that in most cases, everything that could have been done was done.

Where that cannot be said, then serious changes need to be made and, where appropriate, people may have to lose their jobs or even face prosecution.

Even 37 dead children is unacceptable. As a community we have a collective responsibility for each and every one of them, and it is not just HSE officials and politicians who should feel guilty. Shane Dunphy is a child protection expert and a lecturer

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