Lack of care places for children with mental health issues ‘very concerning’

A lack of suitable care placements for seriously disturbed and mentally unwell children is highlighted in the latest bulletin of childcare court reports published on Tuesday.

Domestic violence and the ongoing impact of the pandemic on vulnerable children also feature strongly in the 53 reports from the Child Care Law Reporting Project.

The project, led by Dr Carol Coulter, was established in 2012 under the Child Care Act to report on and examine court orders made under the Act, mainly relating to taking children into care.

The impact of domestic violence features in six cases, while difficulties obtaining appropriate treatment for children with serious mental health issues feature in four. Neglect arising from addiction, cognitive disability or parents’ mental health continues to give rise to care applications.

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Dr Coulter said it was “very concerning” that it appeared so difficult for children with mental health problems to get the assessments and treatments they needed, including inpatient treatment, in a timely manner. “Children’s mental health facilities clearly need increased resources,” she said.

One of the most serious reports concerned a boy younger than 11, and considered a risk to his mother and siblings. It was thought he endured physical and emotional abuse at the hands of his deceased stepfather.

As no suitable residential place was available due to his young age, he remained at home with supports from Tusla. His siblings had had to be removed from the home due to his violence and, “despite his tender age, he was already drinking alcohol and using cannabis regularly”.

“He was described as violent, abusive and showing no empathy for other people. The mother’s lawyer said the other siblings were getting on well and were never a cause of concern but that this boy was ‘out of control’ since early childhood.”

Supports refused

Tusla agreed he needed “an urgent residential placement”, but nowhere “either in the public or private sphere was willing to take him”. Supports had been refused by the family. The boy’s school and grandmother had made referrals to Tusla.

A 29-day extension to an interim care order, during which he remained at home, was granted. Within the next 21 days a place was found for the boy in another part of the country. The case was given a later review date.

In another case a brother and sister, under an interim care order, were in the same foster placement for almost a year. Their father, who inflicted domestic violence on their family, had threatened to kill the children and then himself, a social worker told the court, and the mother’s capacity to protect the children was “limited”.

The prevalence of domestic violence in care applications, said Dr Coulter, underlined “the need for greater focus on the impact of domestic violence on children”.

In a case with a more positive outcome, a teenager in care since he was seven, who was now almost 18, wanted “to thank everyone who has helped him over the years”.

At a hearing to review his after-care plan, Tusla’s solicitor said “there had been a significant history” to the case, with “many difficulties, issues and problems”.

The report said the solicitor told the court the child would continue at school until he had completed his Leaving Cert and “he had expressed interest in studying the social sciences with a view to working in social work”.

The boy’s advocate said it was “truly an achievement for the boy to get this far”, and he had asked her “to thank everyone who has helped him over the years and wanted to thank the judges for protecting him all this time”.

CASE STUDY: TEENAGE BOY IN ‘HOSTAGE’ INCIDENT

A teenage boy, suffering “significant and immediate” mental health problems needed an in-patient psychiatric bed. The district court heard gardaí had been called to 37 incidents, including “a hostage and/or suicide incident” when he threatened his parents and spoke of killing himself.

His parents said the bed in emergency accommodation for homeless children that Tusla were offering was “not at all appropriate”. They said he was “very vulnerable” and needed a private, secure placement. A secure bed was urgently needed, they said.

Tusla said a bed was immediately available in the hostel, and another short-term placement had been identified. A “wrap-around service” was being provided at home, it said.

The boy’s independent advocate described him as “charming and articulate”. She said: “He wants his drug and alcohol use to stop. He fears that if it doesn’t stop he is not going to survive.”

The hostel was “completely unsuitable for his needs”, she said, and she asked the court to consider “bypassing the Tusla protocol” to make a direction for a private placement.

His parents’ barrister stressed both the HSE and other professionals agreed the teenager needed an inpatient admission for assessment. “We are left in this situation all the time where State institutions are saying this person requires [that service] but it is not available.”