Children: Looked-after Children

Baroness Hollins Excerpts

Thursday 25th October 2012 Lords Chamber

[Baroness Hollins]

My Lords, I thank my noble friend Lord Listowel for securing this debate and for his important opening speech. I worked for many years as a child psychiatrist and a psychiatrist with children and adults with learning disabilities, and have had a research and clinical interest in the mental health and behavioural consequences of abuse.

My daughter is also a consultant psychiatrist working with troubled parents and their infants, so I will start my contribution by reflecting on the importance of secure attachments for all children. As my noble friend said so powerfully, children who have been rejected, neglected or abused have to learn to love and learn to trust—possibly for the first time. Early intervention is critical, and we know from American research that family health partnerships are effective in reducing the need for care away from the child’s own family, and have longer-term intergenerational benefits. Do not forget that a large percentage of girls leaving care are pregnant within a year. The provision of peer mentors is a promising initiative that is being evaluated in a study at St George’s, University of London by Gill Mezey and her team in the hope of easing the transition to adulthood for these vulnerable young women.

Some of the most vulnerable parents are those with learning disabilities. This is a group that I have worked with as a psychiatrist. It is almost standard practice for their children to be taken into care. I will say more about this shortly. I will also draw attention to the high number of children with learning disabilities placed in care. Commissioning the right mental health services is very important. Child and adolescent mental health services treat serious diagnosed disorders, but we need more preventive services too and we need more skilled practitioners who recognise the signs of abuse and its emotional and behavioural impact. This means better training of front-line staff, but also more integrated services and better awareness of the mental health needs of disabled looked-after children. In the light of recent child protection failures, the emotional well-being of looked-after children must be first and foremost. It is the key to the prevention of abuse and exploitation, and it is equally important in the healing process after abuse has occurred. What we see time and time again is how crucial early identification and intervention are for those entering the care system. Crucially, since the national child and adolescent mental health services review report in 2008, little seems to have changed according to both young people in care and professionals.

Children under five raised in institutions experience more psychiatric disorders, but those placed in stable foster homes have much better mental well-being and securer attachments. One review of data sources in England estimated that disabled children constitute between 10% and 25% of the looked-after population. Disabled children may be particularly vulnerable to abuse and neglect, which is a common reason for entry into care. The NSPCC reports that children with disabilities are 3.8 times more likely to be neglected, 3.8 times more likely to be physically abused, more than three times more likely to be sexually abused and four times more likely to be emotionally abused than other children. Children with learning disabilities in care are even more likely to run away than other children.

Disabled children in England are a distinct subgroup who are less likely to achieve a permanent placement. Research suggests that disabled children are more likely to display a high level of behaviour that their carers find challenging. This is particularly relevant when we think about stability. Evidence suggests that emotional and behavioural problems have a strong association with placement breakdown. Research shows that the prevalence of mental disorders decreases with the length of time a child has spent in a stable placement. Half of those who have been in their current placement for less than a year have mental health problems compared to a third of children who have been in their current placement for at least five years. That is an improvement.

The findings show that, despite various changes in policies and provision of care, the prevalence of children with recognisable mental health disorders—around three-quarters—has not diminished. For those trying to access services, Sheffield City Council and NHS Sheffield found that in February more than 260 looked-after children had been waiting for child and adolescent mental health services for more than 18 weeks, with some facing waits of up to 44 weeks. This is not acceptable. Services are not flexible enough. Children are expected to go to them instead of the services being flexible and approachable, which these children need.

Difficulties that local authorities have in finding placements for disabled children result in inappropriate placements, including the use of 52-week-a-year boarding schools or, and I myself know of examples of this, disabled children being placed in respite provision, where every week different children will be sharing their corridor, their bathroom and their mealtimes. Permanent placements for disabled children in respite facilities are not acceptable. Disabled children might be placed in adult residential facilities rather than family placements. Local authorities have also documented an increased use of out-of-area placements for disabled children so they are likely to live further away from their families and communities, creating problems in monitoring and problems for their families in maintaining contact. This is especially the case for children with learning disabilities, who may sometimes require psychiatric in-patient admission as well. There are very few specialist units that would accept children with a learning disability who had mental health problems or challenging behaviour. One of the learning points from the Winterbourne View abuses was that abuse is more likely to happen when the person is placed far from home. The victims in that case were adults, of course, but we should have the same concerns for disabled children who are placed away from home.

Then there are the children with a mild or borderline learning disability. They are unlikely to attend youth groups of any sort and often have a background of abuse, making them more vulnerable to sophisticated grooming techniques. This form of exploitation, as we know and have heard today in several speeches, often begins with positive attention from adults, something that these children particularly crave. Flattery and gifts are a new experience for them and they welcome it. They may not have the insight into social behaviours and relationships to determine that while this is how things are beginning, it is most certainly not how they will end.

The education of front-line staff is necessary with regard to spotting the tell-tale signs of possible abuse: a new mobile phone, new clothes or an older man presenting as a boyfriend. Not only is education necessary but the empowerment of front-line staff and carers to communicate their concerns to relevant bodies is essential. Carers may not have the confidence that they have the skill set necessary to make a judgment call over a complex situation. They may feel that they are not expert enough to determine a young person’s capacity to engage in a particular behaviour. These carers need support and training to help them with these difficult situations. Even for a professional it can be difficult to make a capacity assessment on a 17 year-old girl with a mild learning disability, a complex social background and mental health issues who is engaging in sexual behaviours.

Education is also needed before children reach care. Many parents try to use social services to assist them with the emotional and behavioural difficulties that they are experiencing with their children, but they often do not get past the duty desk. Those who do not meet the threshold criteria for a service but who often have a need for mental health services may not be recognised, and may not know where to turn for help. A survey of 440 childcare social workers found that 30% were unaware of local resources available to support the children and families of, for example, those with ADHD. Many inexperienced practitioners did not recognise the importance of psychiatric assessment.

Without appropriate support, training and confidence, how can we expect carers to know that they are the ones probably best placed to carry out such an assessment and, if required, intervention? Empowering those who care is the key to offering these children the protection that they deserve and the chance to enjoy the innocence of childhood.