The 2019 annual report of the National Review Panel (NRP), the independent body that examines the deaths of children known to the child protection and welfare system, is published on Monday.
The NRP was established in 2010 following the publication of the Ryan Report and an embarrassing admission by the HSE that it could not properly account for the number of children who had died either in care or involved in its services.
As 2020 is the 10th anniversary of the establishment of the NRP, the 2019 annual report includes an overview of the number and causes of death of young people known to the child protection and welfare services over the past decade.
Overall, 206 deaths were notified, averaging 20 a year. These figures are not over representative of the deaths of children and young people in the population in any given year, but some trends are evident.
While the overview demonstrates that the largest proportion of deaths are from natural causes, in keeping with mortality rates generally, it also provides the stark statistic that almost a quarter (49) of the young people whose deaths were notified to the NRP over the past 10 years died from suicide.
Their ages ranged from 12 to 20 years. Other causes of death included accidents, drug overdose and a small number of homicides, but the suicide rate is the most outstanding. A recurring pattern in these cases has been the inability of families to connect their children with the appropriate services.
‘Treatable mental illnesses’
In addition to their contact with social services, many of the young people concerned had been referred to Child and Adolescent Mental Health Services (CAMHS) by general practitioners when they first exhibited suicidal symptoms or indicators of self-harm. While some undoubtedly received an excellent service, NRP reports have demonstrated a recurrent theme whereby young people who are emotionally distressed, self-harm and attempt suicide are considered ineligible for CAMHS services if they do not suffer from what is classified as a “treatable mental illnesses”.
The NRP has been informed that while young people who show suicidal ideation undoubtedly have mental health needs, CAMHS as a medical psychiatric specialty has no role in their care. The default position for GPs and other practitioners still tends to be referral to CAMHS for troubled and self-harming young people which often results in confusion and frustration.
While a number of non-clinical community services provide valuable therapeutic support, there is no consistency about their provision across the country nor a clear pathway to clinical services if they cannot provide enough.
Both the 2017 National Youth Mental Health Task Force Report and newly published Department of Health mental health policy, Sharing the Vision, aspire towards inclusivity and integration, but neither provides any clarity or reassurance for families with sons and daughters whose mental health problems can take their lives.
As the NRP reports show, the children and young people who died while in contact with social services had many complicating features in their day-to-day existence and, in many instances, their parents’ lives were affected by mental illness, addiction and domestic violence. The children themselves frequently had needs related to disability, autism, education, addiction and psychological disorders which stretched their parents’ capacity to provide for them.
Integrated approach
While the child protection service was found wanting in certain cases, the main deficit in services experienced by a child may have been in relation to child health, mental health, housing or education, all of which strongly indicate the need for a more integrated approach to child protection and welfare than the one currently available.
The overview presented in the NRP annual report provides a window into the lives of children who encountered services but sadly did not live to gain long-term benefits from them. Upcoming reform in the childcare legislation provides an opportunity for the development of a whole of government, multi-agency approach that is sorely needed.
Dr Helen Buckley is chairwoman of the National Review Panel