A 14-year-old girl who took her own life was “blocked” from getting “adequate” mental health and social services in her community, a new report says.
The review of the circumstances around the teenager’s death found that neither Tusla social workers nor the HSE’s Child and Adolescent Mental Health Service (Camhs) communicated adequately with each other about the serious risk the girl was at.
Each agency had a different view of why she was seriously self-harming and each assumed the other agency was taking the lead on protecting her.
It says this is a “recurring problem” leading to serious dangers for a “specific cohort of children and young people at the margins of Camhs and Tusla”.
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The child, named “Sophie” in a report published by the National Review Panel (NRP) on Tuesday, had a “normal” and happy childhood, but “had become very troubled in her early teens”.
The NRP is an independent body that reviews deaths and serious incidents involving children in Tusla care or known to the agency.
It notes that Sophie became withdrawn in her teens and was self-harming, resulting in her needing hospital treatment. About three months before Sophie died, medics at her Camhs inpatient unit contacted Tusla asking for community services on her discharge.
Her parents were finding it “very difficult to keep Sophie safe”, says the report.
Social workers met the family, found her parents to be very committed, put them in touch with local services and closed the case as there were no parental child protection concerns.
“Sophie’s disturbed behaviour continued and after a self-harm episode she was readmitted to a residential psychiatric service who re-referred the case to [Tusla] requesting ‘wraparound’ community services on her discharge,” says the report.
Tusla arranged supports to begin on the girl’s discharge home. However, Sophie died by suicide during an overnight visit home before being discharged.
The NRP says Tusla’s social workers were overly positive about the capacity of Sophie’s parents to keep her safe, despite their “self-declared inability to keep her from harming herself” while at home.
“In the opinion of the reviewers, safety planning in this case was largely abstract and lacking in detail.”
Camhs “did not consider Sophie’s high-risk behaviour to be symptomatic of a treatable mental health disorder, while the Tusla SWD [social work department] believed it to be a manifestation of her mental health problems”.
The report says: “The reviewers were struck by the difference of opinion expressed by each service regarding the reason for Sophie’s behaviour and the conviction of both services that the approach they were taking was the correct one and in line with both their remits.”
Sophie’s parents, meanwhile, “had no sense of a holistic approach ... and while appreciative of services, still felt isolated and overwhelmed with the responsibility of protecting their daughter”, says the NRP.
“The orientation of both services appears to have been service-based rather than child and family centred – a recurring tendency that is made worse by shortages and pressures in each service which give rise to gatekeeping.”
Describing the lack of joined-up planning and communication between Camhs and Tusla in cases such as Sophie’s as a “recurring problem”, the report says the case “illustrates yet again that young people with mental health problems that are not classified as mental illness are blocked by policy barriers from getting an adequate service”.
It adds: “The cost of this is borne by the young person and their family who in this case were left feeling constantly stressed and frightened of what Sophie might do.”
A model where community social supports are sourced by Tusla and community mental health supports are provided by Camhs “would critically depend on agreement and co-ordination at a number of levels between the HSE and Tusla ... which has not been evident to date”.
The Departments of Children and of Health “need to take urgent action on the basis of accumulated evidence of the policy blocks preventing co-ordinated work between Tusla and Camhs”.
An “in-depth overview should be jointly commissioned between the HSE and Tusla” of the multiple reviews and reports highlighting “the unmet needs of the specific cohort of children and young people at the margins of Camhs and Tusla”.
In a second report, reviewing circumstances where a child was raped by a male carer in a relative-based care placement, the NRP says there was “an overly optimistic view” during assessment and foster care approval of the male carer’s alcohol consumption and its potential impact.
“His history should have raised serious doubts about his suitability to be approved as a relative carer,” says the report.
