The phrase "tip of the iceberg" has been used to describe our current awareness of child abuse. In fact it's much worse than that. Only one in 10 cases validated by health boards are taken up by the Director of Public Prosecutions. Of these only a quarter result in successful prosecutions.
For most of us these are the only cases we ever hear about - just 2 1/2 per cent of incidents considered valid by the health boards. And that figure does not include unreported incidents.
It is startling to realise that the almost constant stream of cases of physical, mental and sexual abuse and neglect that we read about represent such a tiny fraction of the real problem. Those figures are the strongest argument for mandatory reporting, but also demonstrate one of the greatest obstacles to its implementation.
Child abuse is very difficult to prove in court. As the Irish College of General Practitioners (ICGP) pointed out in its position statement, the symptoms can be difficult to decipher.
"If a child has a bad nappy rash and a sore bottom it could be due to eczema or wet nappies. Child abuse would also be on the list, but way down the list."
So, of the cases reported few would stand up to strict legal examination. This would leave those who report the cases open to being sued by the people they have reported.
In order to reduce this problem an informal system should be put in place to allow those who are worried about the possibility of abuse to talk to health board experts before making an official report. This system is doubly important as the professionals likely to be included under mandatory reporting requirements are not just doctors and social workers. Anyone working in child care, whether they run a playgroup or creche or are involved with young people in sporting or leisure activities, will be covered.
Ultimately, though, the solution will have to be a form of immunity from prosecution for those who have either made a genuine mistake or who have reported an actual but unprovable incident. While the legal elements of such a solution are bound to be complex both to design and implement, they are vital if mandatory reporting is to be effective.
Doctor-patient confidentiality is at the core of the ICGP's case to introduce a voluntary system of reporting. It claims it is the knowledge that whatever a patient says to their doctor will not be repeated to any third party without their permission that allows the patients to reveal incidents of abuse in the first place. It is a clever argument that suffers from two major flaws.
Firstly, it is impossible to prove or disprove that reporting will suffer. Secondly, it ignores the real problem. If a doctor cannot report a case without the patient's permission he/she is left with almost no other options.
Most general practitioners are not trained in the complex psychological treatments that the abused child would need, nor is the doctor in a position to remove that child from contact with the abuser. Effectively the doctor is forced to take a back seat and let the abuse run its course. That is simply not acceptable. One other argument for mandatory reporting that has been largely ignored is that it seems to be what people want. In December 1997, an IMS/ISPCC survey showed that 91 per cent of people questioned favoured its introduction.
That same survey also showed that less than half surveyed felt professionals could be relied upon to act swiftly and effectively in reporting known or suspected child abuse. Finally, less than one third of those surveyed believed that the current health board and Garda response was effective in preventing abuse and protecting children.
When the Minister of State with special responsibility for children, Frank Fahey, decided to reverse the Government's position on mandatory reporting he defended his actions by claiming professionals could be trusted to report abuse. It would seem he is in a minority in that view.
In fact, Mr Fahey has so far been strangely indecisive on the whole issue. Fianna Fail and the Progressive Democrats both included a commitment to the introduction of mandatory reporting in their election manifestos. Shortly after the Government was formed Mr Fahey announced that mandatory reporting would not be introduced, and indicated that he had consulted the Minister for Health and the Taoiseach.
Then the Minister of State for Foreign Affairs, Liz O'Donnell, told the UN that mandatory reporting would be introduced. It took an appearance by the Tanaiste, Mary Harney, on RTE's Questions and Answers to clarify the situation, and finally in the Dail this week the Taoiseach restated the Government's intention to introduce it. ail this week An issue as important as the health of our children should not be subject to such confusion.
Mandatory reporting is an important step in dealing with child abuse. But it should not be seen as a panacea. It will help us to protect children by removing them from abusive situations. It will allow us to offer treatment to the abusers. But all of this will happen only after the abuse has started. Arguably the most important measures that must be taken are preventative. And prevention can only be achieved through education.
Educating those who need it will be a seriously expensive undertaking. All the organisations that work with children in any capacity must be made aware of the warning signs to look out for. The judiciary needs to understand in more detail the nature of the cases it presides over. The gardai deal well with the problem already, but have yet to be formally trained. On top of that every parent should be brought up to a certain minimum standard in parenting skills.
Often abuse starts when parents find themselves unable to deal with children's demands. Their patience runs out with a child that will not stop crying or seems determined to misbehave. Because they have never been taught the appropriate responses they often resort to violence. And if treating the child violently seems to work, it is logical, and tempting to repeat it whenever a similar problem arises.
The task facing Mr Fahey is enormous. He will have to secure huge amounts of money from the Department of Finance and implement a health education programme on a grand scale. Whether he even attempts these actions will be the key indicator of how seriously he, as the Minister with direct responsibility for children's welfare, takes his job.
Whether we, the public, pressurise politicians to put these measures in place will show how seriously Ireland takes the health and welfare of its children.