Tuesday, 20 May 2014
CHILDREN'S SERVICES FOR SALE
Last week's revelations from the UK government that Michael Gove's Education Department has formally enabled the privatisation of child protection services has rightly sent shock waves around Local Government trades unionists and those involved in the care of vulnerable children. Social workers are the lead professionals charged with safeguarding vulnerable children. They don't just work for their vocation, on the whole they work from deep convictions about the safety of every child, and from a sense of public service. All that will change if Gove's plans succeed.
The Health and Social Care Act came into force in April 2013 and set the legal framework for privatising on a bigger scale than ever before within the NHS and Social Care. Almost immediately Richard Branson's Virgin Care company took over Devon's Integrated Children's Services responsible for some of the most disabled and vulnerable children with physical and learning disabilities. Since then Virgin Care has become one of many private companies slowly but surely signing up lucrative contracts up and down the country to run not only Local Authority, but NHS services as well. The Bureau of Investigative Journalism reported in 2011 that one in seven board members of the first wave of Clinical Commissioning Groups (previously PCT's) had a link to a private health care company. More than 60% of those with private links were associated with Assura Medical now Virgin Care.
The work of Ofsted is used as ammunition in the ideological arguments being put forward by those peddling the idea that service improvements and the safety of children can be left to market forces and business ethics. Ofsted inspections now include social care as well as schools. Of 50 child protection services inspected by Ofsted in 2012-13 because they had been previously identified as weak, more than one third were judged as still inadequate in terms of their overall effectiveness. The real reason for poor provision is the relentless squeeze on budgets, higher demand, and low staff morale which leads to high staff turnover and increasing use of expensive agency staff. Many child protection services are running with unfilled vacancies as Local Government funding is cut.
Ofsted reports are seized upon to name and shame Local Government social care departments and add to the refrain that staff are feckless, overpaid, poorly managed etc. The solution from the right-wing media is to allow private companies to bring market discipline and business ethics to family's with multiple problems. There is now a momentum building behind this policy aspiration in the context of financial austerity and cuts to public services where we are persuaded that there is no alternative but privatisation. It is another classic case of deliberately running down a public service and make it ready for a business takeover.
Worse, there is some heavyweight intellectual support for opening up Local Government children's social services to privateers- ironically coming from the London School of Economics, often cited as the place where modern social work was defined during the post 2nd World War welfare state political consensus. The LSE's social care guru, Professor Julian Le Grand, is pushing his plan to improve children's social care by privatising it and undermining the basic principles of the Welfare State. Councils in Doncaster, Richmond and Kingston are already experimenting with creating private companies to run social care, while Staffordshire and Bristol have allowed groups of social workers to set themselves up as independent practices separate from Local Authority control. Le Grand has been asked by the government to beef-up his earlier recommendations and is expected to report soon. Just in time to use as ammunition against the protests which will now start against the Gove plans.
The private sector has a woeful track record in these areas of service. The privatisation of Young Offenders Institutions has led to an increase in incidents involving riots, self-harm and suicide. Most inmates come from deprived and disadvantaged backgounds. It is another example of where a former public service has been contracted out to big companies such as G4S and SERCO earning millions of pounds in profits while leading to a poorer service and more problems. The number of young people who have committed suicide in Young Offenders Institutions over the past ten years averages three per year. Last year, there were over 3,000 incidents of violence in youth custody establishments and another 1,500 instances of self-harming- far more than before privatisation.
Vulnerable children are too precious to be left to the ideology and practices of private companies where profits come before people. Gove's policy must be resisted. Over time he has morphed into the most ideological of Cameron's ministers, relentless in his attack on public education and an obsessive free marketeer. The supreme irony in all this is that he was adopted as a baby and benefitted from the care of social workers and adoptive parents who were part of a public service system that put his interests above all other considerations and where money had no part to play. His plans will mean other children now in his situation are to have their futures sacrificed on the altar of free enterprise .
Former Principal Lecturer in Social Work, and co-author of: Safeguarding Children and Young People- A Guide to Integrated Practice (Russsell House Publications).
Monday, 12 May 2014
THE INVISIBLE WOUNDS
Western military intervention in the conflicts in Iraq and Afghanistan are coming to an end, but the legacy will linger for years, especially the invisible wounds caused by Post Traumatic Stress Injury (PTSD). Yet another less glamorous or newsworthy aspect of life in military service tends to be neglected. This is not post traumatic stress disorder but the more ordinary anxiety and depressive conditions which tend to be low key, chronic mental health problems that are less easy to diagnose and treat. These emotional and psychological problems acquired by younger soldiers in battle are not always apparent but are in effect a ticking time bomb which can explode months or years later requiring intervention and support in terms of mental health assessment, drug and alcohol abuse, domestic violence, child abuse, and homelessness.
It does not help that the UK recruits 16 year old children to all three branches of the military and is the only European country to reserve the right to deploy under-18 year olds in war fighting situations. There are clear contradictions in the British government’s use of minors in battle zones with its legal obligations under the 1992 UN Convention on the Rights of the Child (CRC) and the 1989 Children Act to protect and safeguard children.
The Government has ensured that the needs of military power and political control override the best interests of those under-18s in the armed forces. Article 38 of the CRC emphasises the particular vulnerability of children as civilians and soldiers in armed hostilities and recommends signatories refrain from sending children into battle.
If the non-deployment of personnel under the recommended CRC minimum ages would destabilise the unit that they are part of, then the MOD reserves the right to deploy younger recruits. The government claims that once children are trained in the Armed Forces, they are considered to be professionals and are treated as such. They play an important role in their unit, and their removal would undermine the effectiveness and cohesiveness of the unit. This would be demoralising and unpopular among other soldiers and add to the training burden.
The World Health Organisation recognises that young soldiers exposed to conflict situations can more easily develop Post Traumatic Stress Disorder (PTSD) leading to persisting patterns of problematic behaviour and functioning. These problems may not emerge until years later or after the symptoms are revealed by alcohol and drug addiction, domestic violence, self harm and/or criminal behaviour for example. Many young soldiers may be withdrawn, depressed, go AWOL, and display difficulties in social relationships. Or they leave military service altogether.
The majority of army recruits are from poorer socio-economic groups where a higher proportion of children and young people are at greater risk of developing mental health problems. The British army recruits in low income, high unemployment, and disadvantaged areas where children with few academic or career prospects are able to sign up to 6 year minimum service contracts at 16 years of age- captivated by glamorous images of travel, adventure, machismo, national pride, and employable skills training.
The adverse publicity over the culture of bullying and suicides at military training establishments such as Deep Cut revealed a tiny, previously hidden, glimpse of what many vulnerable young people may also be subjected to on a routine basis once they enter service. While toughening them up for what lies ahead the cost to their self-esteem and emotional well-being is very high.
CD’s/DVD’s computer games and literature that emphasise war as fun, exciting and a professional activity are widely distributed in schools, youth clubs, websites and military recruitment offices. What potential recruits will not realise is that since 1971, twenty four under 18 year olds have died and 10 were seriously physically injured while on active military service in the British army.
Young recruits under 18 years of age are still legally defined as children- even though in the context of uniforms, regiments and all the paraphernalia of the armed forces, these young people may look a lot older than they are. The evidence suggests that, paradoxically, they may be psychologically and emotionally immature due to earlier childhood neglect and deprivation and thus more at risk of developing mental health difficulties under the strain of intense combat.
Suicide rates among young men in civilian life prompted the government to invest new resources in child and adolescent mental health services. Until very recently the yearly rate of suicides among young men between the ages of 16 and 25 had risen steeply since the 1980’s. What is less well known is that the suicide rate among the equivalent age group in the army is actually higher. Among the three armed services ex-soldiers have the highest rate of suicide.
Shortfalls in recruitment targets and retention problems mean it is likely that the military will enlist previously unsuitable candidates and therefore increase the proportion of young recruits at risk of developing mental health problems and ultimately suicide, as a result of a pre-existing vulnerability to mental health problems erupting under the stress of combat- particularly in the current context of relentless, high anxiety conflict in Afghanistan.
The yearly recruitment of under-18s now represents one third of the annual intake into the armed forces. When vulnerable 16 year olds sign up to their service contracts it is doubtful that it is with fully informed consent of themselves or their parent/guardian or really understanding the implications for their future mental health. For many the prospect of a secure immediate future, with a paternalistic employer and a sense of importance will offer some hope in an otherwise bleak and impoverished life with few prospects.
The consequences for a generation of young recruits are considerably worrying. Military commanders recognise that managing the mental health of young recruits is a challenge, and recently, new measures have been put in place to help junior officers spot troubled young soldiers early. However, the use of young soldiers in combat situations in order to maintain operational levels poses an increased risk to their current mental health and will invariably produce invisible wounds leading to long-term problems for them, their families and society long after the physical scars of combat have healed.
PRIVATE PROFITS AND PERSONAL LOSS
The film Starred Up is garnering rave reviews about the talented young actor and gritty screenplay about a young man moving from a Youth Offender Institution into Adult Jail. It is being compared to the ground-breaking film Scum which highlighted the casual cruelty and violence inside. But the reality is that the privatisation of Young Offenders Institutions has led to an increase in incidents involving riots, self-harm and suicide. It is another example of where a former public service has been contracted out to big companies such as G4S and SERCO earning millions of pounds in profits while leading to a poorer service and more problems.
The number of young people who have committed suicide in Young Offenders Institutions over the past ten years averages three per year. Last year, there were over 3,000 incidents of violence in youth custody establishments and another 1,500 instances of self-harming.
These are official statistics so like general crime the numbers are likely to be a gross under-representation. Young people in custody are 10 times more likely as adults to get involved in a fight or serious assault. In 2009 an official report found bullying at a YOI in Rochester to be so serious that victims hid in their cells and refused to come out, even to eat. Last year, at just one YOI in Aylesbury there were 173 incidents of violence experienced and 187 incidents (more than three per week) of self-harm among a mere 400 inmates.
19-year-old Zahid Mubarek was bludgeoned to death by his racist cellmate in Feltham young offender institution in November 2000. Feltham was later described by the Chief Inspector of Prisons as a 'dickensian' institution with a lack of proper management and cruel staff. Last week, the latest inquest into a suicide of a young person found that a series of 12 individual failures by prison staff more than minimally contributed to his death. Jake Hardy was 17 years old and serving six months for affray and common assault, and before entering Hindley had been diagnosed with attention and conduct disorders,and was under the care of a local mental-health team. He also had special educational needs and had previouslybeen bullied at school.
The Home Office estimates that more than 70 per cent of young offenders have an undiagnosed mental health problem before entering the Youth Justice System. Young offender institutions aren't equipped to tackle what are often complex social and mental health needs. Inmates who say they want to go straight complain that the educational opportunities are inadequate. Others use their time to enhance criminal skills and contacts. The outcome of all this is that 70% of those leaving youth custody reoffend within a year
The recent privatisation of the task for transporting young offenders and children on remand in appalling conditions between courts and Young Offenders Institutions may well be contravening the spirit of the United Nations Convention on the Rights of Children, it has emerged. The charity Young Minds has found evidence of how young people are placed under significant mental distress while being transported between courts and YOIs – some of whom are on remand and have not been found guilty of committing any crimes.
According to the UNCRC, children in trouble with the law should be dealt with by a justice system which is distinct and separate from the adult justice system and placing children in such conditions is contrary to article 3 of the UNCRC on the best interest of the child.
The prisons inspectorate, Her Majesty’s Chief Inspector of Prisons, has an expected outcome in relation to courts, escorts and transfers under the outcome of Safety that “children and young people transferring to and from establishments are treated safely, decently and efficiently”.
Reports from visits to Feltham, Bronzefield, Warren Hill, Holloway and Cockham Wood YOIs and prisons by Young Minds found some alarming concerns which provided a further context of the significant risk factors in causing mental distress. This is especially significant when it has been recognised that one of the risk factors is the first few weeks transitioning to a YOI or prison and suicide prevention policies have specifically targeted the early stages of custody (Ministry of Justice ‘Safety in Custody Statistics Quarterly update to June 2012 England and Wales).The prisons inspectorate’s findings at Feltham YOI found that “a quarter of young people said that they did not feel safe on their journey”. The report concluded that young people should not be transported with adult prisoners and young people should not be held in court cells for unnecessarily long periods. Adding: “This was a clear breach of the contractual arrangements for court to prison moves”.
Steven Walker is the author of: Responding to Self Harm in Children and Adolescents (Jessica Kingsley Publishers).
Thursday, 1 May 2014
Child and Adolescent Mental Health Services (CAMHS) are in crisis with teachers now in the front line of trying to support young people with mental health problems erupting in classrooms causing chaos. Stress levels among teachers are rising dramatically as a result. But as well as staff shortages, cutbacks in budgets and increased demand stretching CAMHS services and putting pressure on teachers, there is another consequence that will not garner many headlines- the rising number of suicides and self harm among young people.
The numbers of those young people found to have committed suicide each year are a stark reminder of the painful human cost of a failure by governments to invest in children's well-being and prevent the onset of mental illness. The loss of a young life is always shocking and distressing but in the case of suicide there is an added sense of despair and helplessness evoked. Suicide is now the second most common cause of death in young men and women in the UK yet stigma and shame continue to blight those trying to cope and mental health is never politically popular.
Data from the Office for National Statistics (ONS) provides an opportunity to examine in closer detail what has been happening over the past 30 years, from 1981 to 2011. The official press release highlighted the recent jump in the annual number of suicides. There were 6,045 suicides in people aged 15 and over in the UK in 2011, compared with 5608 in 2010 – a rise of 437 people. The ONS figures showed that the UK suicide rate “increased significantly” from 11.1 deaths per 100,000 population to 11.8 deaths per 100,000 population. These statistics relate to the whole population, so it is worth noting that the corresponding figures for young people aged between 15 and 25 years were: 14.1 and 14.8 deaths per 100,000 population. Young people are thus more at risk of suicide than older people.
However closer analysis of the 30 year data reveals some worrying trends in the context of the current Economic crisis. For children aged 15-19 years there were on average more than 4 suicides every week, while for young people aged 19-25 there were 14 per week. Together on average nearly 3 young people between the ages of 15 and 25 committed suicide every day of the week. Put together the total number of suicides between 1981 and 2011 of young people between 15 and 25 years of age who committed suicide was 21,006. Or an average of over 700 per year.
The figures show that in the peak years of unemployment in 1983/84; 1992/93 and 2009/10 there were higher than average numbers of suicides in young people. As youth unemployment nears 1 million there is no doubt that the numbers for 2014/15 will show record numbers of suicides. Many research studies have shown a correlation between poverty/unemployment and youth suicides.
The recording of suicides by coroners is variable around the country and is understood to be an under-representation of the actual number of suicides in young people officially recorded due to the lack of evidence in many unusual deaths of a corroborating note, or other indication of intent. Coroners are reluctant therefore to record an official suicide verdict where there is any doubt and also to protect the feelings of grieving parents and family.
The previous Labour government launched the National Suicide Prevention Strategy in 2002 with a target of reducing suicides by at least 20 per cent by the year 2010. This period combined with an unprecedented increased in NHS funding and specific hefty increases in Child and Adolescent Mental Health Services (CAMHS) budgets. That target was achieved in terms of suicides in young people, and it happened to co-incide with a period of strong Economic growth. Some MP's are so concerned about CAMHS and that the House of Commons Health Committee is starting a Parliamentary Enquiry. Teachers, Parents, CAMHS staff and young people will draw little comfort from this. The last National Report in 2008 from the NHS demanded increased training for all staff working with young people, more specialist resources and extra investment in early intervention services to prevent problems arising in the first place. 2008 was the year Lehmans Bank collapsed triggering the latest Capitalist crisis and ushering in austerity, a terrible cost in young people's lives and devastating family's lives in ways that are incalculable.
Steven Walker (Author of The Social Workers Guide to Child and Adolescent Mental Health, Jessica Kingsley).