For a while every day at work was the same. Helen would pull into the driveway of her workplace scanning the building for broken windows. Inside she might find pictures smashed, lumps kicked out of the walls and colleagues who, at the end of a 24-hour shift, were at the ends of their tethers.
“They might have been bruised from being kicked and punched or having objects thrown at them,” she says. “They might have had their hair pulled out in clumps. They might have been bitten. They have been threatened with knives. They have been threatened with a kettle of boiling water. They have been threatened with rape.”
Helen is the manager of a residential care unit for young people aged from 12 to 17 in south Co Dublin. The source of this trouble was two traumatised teenage boys.
Earlier this year Social Care Ireland published a survey of 402 social-care workers. It noted that Tusla, the child and family agency, had recorded more than 800 violent incidents in which staff in residential care had been affected by aggressive or violent behaviour in the first half of 2016.
All social-care workers in children's residential services and 92 per cent of those in the disability sector, where most workers are women, had experienced violence at work. "And 18 per cent of social-care workers experienced violence as a daily or weekly occurrence," says Catherine Byrne, who wrote the report with Phil Keogh.
Staff at the Oberstown child-detention centre are to go on all-out strike next month, citing regular violence and insufficient protection for staff.
Assaults are a “regular hazard” for staff at the north Co Dublin campus, according to the Impact trade union, and the sector has “ a long history, and continuing reality, of violent assaults on workers”.
As a former care worker in the disability sector I've experienced this violence myself. Over 18 months or so I had my nose bloodied and my face scratched, and I worked with an ever-present possibility of violence. And it is "violence", says Noel Howard, of Social Care Ireland. "We should call it what it is and not hide behind euphemisms like 'challenging behaviour'," he says.
This violence at work has become normalised for care workers, says Byrne. “It’s been stated in interviews that this is ‘part of your job’, but it should never be part of anyone’s job that they be physically assaulted in work.”
One manager was reported as saying of a survey respondent, “If she can’t take a few slaps she shouldn’t be working here.” Staff often internalise this message. Byrne talks about the effects of sustained exposure to violence. “In terms of emotional impact it’s huge,” she says. “People talk about anxiety, sleeplessness, hypervigilance . . . the fear they won’t walk out of their job at the end of the shift.”
Lack of support
But the big issue, she says, “is not the violence itself but the lack of management support”.
The vast majority of children in care are living with foster families, but when foster placements repeatedly break down, and children and young people, in Noel Howard’s words, fall through the net, they are referred to residential units, where they live with other children and a staff of social-care workers.
These include some statutory units run by Tusla, others funded by the HSE but run by voluntary organisations, and a third category run by private agencies. (The disability sector has similar divisions.) Tusla also runs secure special-care units where particularly vulnerable children are referred by the courts rather than by social services.
The lack of support Byrne speaks about is worst in private residential centres. These have the highest level of assaults and tend to deal with the most difficult clients, yet their social-care workers are often on zero-hour contracts and relief contracts.
“If those staff members are injured or need to be hospitalised, or have medical bills, they get no support to pay those expenses, and they’re also losing out on work,” Byrne says. “So their fear level goes up even higher.”
And, whereas in better units in the voluntary and statutory sector, workers are debriefed, well supervised and offered counselling after an incident, often in the private sector there is little or no follow-up. In some places, Byrne says, if agency staff were injured, the only support they received was from other staff, “who took it upon themselves to ring to see if they were okay”.
A social-care worker named Carol (not her real name), who has worked in disability services in the private sector, recalls an incident that occurred when she was pregnant. “An autistic child became distressed and started acting out,” she says. “My instinct was to step back, but he was exhibiting severe behaviour, and I [intervened] to protect an elderly colleague. The child jumped from a height on to my head, grabbed my head and pulled me to the ground, and proceeded to kick me in the stomach until my colleague helped me away on my hands and knees.”
What happened by way of support? “Absolutely nothing,” Carol says. “I was back in work the next day.”
Carol spoke to her manager, who knew she was pregnant, but her roster wasn’t changed. A week later she found herself in the same situation with the same child.
She recalls another incident in which a client picked her up and threw her – “I don’t think he meant to hurt me” – and another in which a client kicked her so hard that she thought she had broken her leg and spent a night in the emergency department.
Carol’s doctor visits were never paid for. Incident reports were often not even filled out. People do this work, she says, because they care about the children in their care, but repeated instances of this kind affect their ability to do the job.
“In my 10 years in eight different units, all bar one or two had extreme levels of violence. I’ve seen my colleagues beaten black and blue, and they hobbled home for an hour and then came back to work. Violence was very much normalised.”
Everyone interviewed for this article stresses that they do not want to demonise the people in their care, who are always vulnerable and frequently traumatised.
Helen speaks of the two boys from her unit with sadness. One of them, she says, couldn’t speak properly and had never learned to tie his laces. The other, she says, was brought into care very late and was very angry. “He had learned a different way to survive,” she says. “Everyone had let him down. He had survived minute by minute. He couldn’t take acts of kindness. Every time we were kind to him he found it very difficult. He didn’t want to be there.”
She believes that he was inappropriately placed in her unit, but she says, social workers “kept telling us they had nothing else for him”. So they put up with the blows and the bites and the threats.
When faced with this sort of violence, staff resort to “therapeutic crisis intervention”, one of several mechanisms for dealing with challenging behaviour, which largely leans on de-escalation techniques. “You manage the environment,” Helen says. “You remove sharp objects. You lock the kitchen . . . I put locks on doors in the house that never had locks before. The child was given a space that was safe to rant and rave in, and kick the walls, and at the same time staff stayed close enough to monitor and to de-escalate.”
There were also, she says, two frightened young girls living in the house who had to be protected and kept away from the violence. “We tried to reassure them, but they could still hear the shouting and screaming.”
The Garda was called in extreme situations, but gardaí have no power to detain a young person without charge, “and you don’t get into this work to criminalise a child you’re working with”.
Physical restraint is only ever used as a last resort, when a young person looks like they’re going to harm themselves or others. “It’s great in theory and in training,” she says, “but in reality, after this has been going on for hours, everyone’s adrenaline is going, and you’re half-exhausted.”
Even in the midst of all this, she says, staff are thinking about the needs of the child. “What is he really saying? What is he really angry about? You talk to him . . . You acknowledge that someone should have looked out for him more, that he deserved better, because it’s true. Some kids respond to that. Others reach that point [where] they can’t even hear you.”
By the time one of the boys was moved to a more appropriate place, and the crisis had subsided, members of staff had been to A&E, half of them were on sick leave, and the others were working extra shifts, to compensate.
Helen says she was lucky that her organisation was supportive and that the unit is currently a bastion of ordered calm. A psychotherapist came and spoke to them. They were encouraged to process what had happened. Nonetheless, when it was all over she collapsed.
“I took two weeks of sick leave, and for the first time I questioned whether I would go back again . . . I’ve been in the job 25 years, but it’s the last two years that have really rocked me. The system is so broken, and our voice is unheard and our expertise and professionalism are not acknowledged.”
Noel Howard says that such demoralisation is common across the sector. He says that violence is on the increase and that workers are often made feel to blame for their own injuries. Bodies such as Hiqa, he says, often offer censure when things go wrong but little constructive guidance on how to better handle the same situations.
Sick leave
Ultimately, the prevalence of violence leads to high rates of sick leave (for those who can take it), a high turnover of staff (making things even more volatile), particularly in the private residential centres, and as a result worse outcomes for the people in care.
Social Care Ireland would like to see a number of changes, including an end to inappropriate placements, stress-inducing staffing restrictions and so-called zero-hour contracts. It would also like to see proper counselling and debriefing processes for staff in the wake of violent incidents, ongoing supportive supervision for staff, and access to occupational-injury leave for anyone hurt on the job.
Howard believes that there is complacency about workplace violence within the HSE (which took two months to respond to the report), in Tusla and across private agencies. People become carers because they want to help people, he says. If the violence they experience continues to be normalised and downplayed, “it will become an ineffective, floundering profession where people are always at their wits’ end”.
