About 155 high-support places are needed for children at risk, and at least 50 places are required urgently, the High Court was told yesterday. It is estimated there are only about 50 such places presently available, leaving a shortfall of about 100.
The court was told that because of an alarming increase in substance abuse among children in the Eastern Health Board area, the numbers requiring places in special units may also rise.
Mr Justice Kelly was told that the number of children presenting for treatment for substance abuse had risen from 366 in 1990 to 1,170 in 1997. The court was dealing with the case of a 15-year-old boy who is in care and is detained in a remand centre.
Reports presented to the judge yesterday on behalf of the Minister for Health and Children and the Eastern Health Board outlined details of progress made towards meeting the need for such places.
In its report, the EHB stressed that high-support services were just one component of a graded scale of child-care service provision. It estimated some 60 children in its area may require high-support places. It also stressed substantial problems in recruiting properly qualified staff and noted significant increases in the level of State funding for child-care services in recent years.
The board said a 24-bed secure unit at Ballydowd should be completed by March 2000 and the 24-bed Portrane high-support unit was at the planning stage. A stepdown facility to help children move from a high-support unit to less restrictive care was in development, and sensitive negotiations were under way in relation to a facility which could substantially reduce the demand for interim accommodation for children.
The report also noted that a youth homeless forum would be established on February 25th; a five-year plan was being prepared on services for children and families; a regional strategy was being developed on foster care; and the EHB was increasingly taking over responsibility for services formerly run by religious orders and charities.
The board said it was increasingly concerned that high-support services may be seen as the only appropriate model of child care and it was its policy that children remained out of the care of their families and in health board care only for such time as their best interests required.
Mr John Collins of the childcare policy unit of the Department of Health said it was intended that a range of services be put in place to keep the number of children requiring admission to special residential care to a minimum. The Department was planning the provision of more family support, early intervention services and specialised fostering places.
Each health board was reviewing its need for high-support places, and revenue would be allocated for these.
The State would be divided into three regions for the provision of high-support accommodation: the EHB region, the northern region and the southern region. Forty places would be made available in the northern and southern regions within two years; £2 million in revenue and £3.5 million in capital was being earmarked in 1999.
Mr Collins said £2.4 million was also being allocated this year for family-support projects over all health board areas, providing intensive intervention within family and community settings. About 240 families were expected to benefit.
After receiving the reports yesterday and following the evidence from Mr Collins and submissions on behalf of counsel for the boy, the Minister for Health and the State, Mr Justice Kelly said the issue of provision for vulnerable children had been "a running sore" before the courts for several years.
The High Court had in 1995 declared in the case of an at-risk boy that the State had a constitutional obligation to provide as soon as practicable appropriate treatment for that boy. Many similar cases had since come before the courts, which were entitled to expect the executive would give effect to the declaration in the 1995 case through concrete action on behalf of vulnerable minors.
In July 1998, the judge said, he concluded the State had failed to do so and had reluctantly made an order directing the State to proceed with the building of two units at Portrane and Ballydowd for troubled children. He had also concluded the courts would have to monitor the progress of the executive in ensuring the rights of minors were given effect to.
To that effect, he had directed last month that the court be informed of what measures were being taken to address the short-term needs of children requiring high-support places. That information showed a serious situation.
He was satisfied the EHB was continuing to do its best and progress was being made on securing short-term placements. He did not underestimate the difficulties faced by the EHB, especially in relation to the recruitment of staff. Dealing with such children was difficult and unattractive and not over-compensated for in relation to salaries.
The judge also recognised that progress made by the State had been substantial in recent months and "vastly in excess" of progress made between 1995 and July 1998 when there was "an administrative torpor". He was satisfied the progress made in the recent past would not have occurred without the intervention of the court and the criticism it had voiced.
That role was reluctantly undertaken by the court, but it was necessary to put flesh on the constitutional rights declared in 1995 but not respected within a reasonable time frame.
Mr Justice Kelly returned the matter to March 25th.
