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A REVIEW OF the death of a 15-year-old girl who was known to the child and family agency has highlighted gaps in mental health services for young people.
The girl, referred to as Niamh in a report by the National Review Panel (NRP), first came to the attention of Tusla when she was 14.
She had an older boyfriend and had been found to be under the influence of alcohol and drugs. She also had some health problems and a history of self-harm.
At the time of her referral to the child and family agency, she had already been involved with the Garda Juvenile Liaison services for nine months and had been sporadically attending an addiction service.
The report states her mother and father, who were separated and in new relationships, were very concerned about her welfare and open to support from services.
Niamh was initially admitted temporarily to foster care, in line with her own wishes, but she returned home after a plan was agreed between herself, her mother and support services.
The counsellor at the teenager’s addiction service was unsure about Niamh’s motivation to change and believed that she needed residential addiction treatment, but the report states “unfortunately no such services were available for girls of her age”.
There was also concern after the girl’s return to school that she was at risk because of the people she was spending time with, who were considered to be a “negative influence” on her.
On one occasion she left school without permission and was arrested for assault. She was later arrested again because of “drunken behaviour and fighting”.
It was decided to place her in the care of her father, who was described as “agreeable to the plan but annoyed at the lack of previous communication” from the social work department about what had been going on with Niamh.
After some time with her father, she returned to her mother’s home and appeared to do well for a period of time, though she expressed a wish to leave school after her Junior Cert.
A few weeks later she was in trouble in school after apparently taking medication that had not been prescribed for her. The question of care arose but her family was not in favour and she was referred to Child and Adolescent Mental Health Services (Camhs) due to concerns about her drug use.
Niamh was not considered eligible for these services at that time.
A year after her referral to Tusla, she was reluctant to engage with services on a consistent basis. She was keen to attend Youthreach, an education, training and work programme for early school leavers, but she was still too young.
The report notes there was a gap of three months between social work contacts around this time. Niamh began to express suicidal thoughts and was referred by the
addiction service to Camhs again.
She attended the local hospital with her mother for a psychiatric assessment where she was found be having paranoid thoughts, but no active suicidal ideation or intent to self-harm. She was put on a waiting list for Camhs.
Over the following weeks, her social worker had difficulty trying to contact Niamh and her mother but “network checks indicated that she was doing fairly well”.
She had been charged with outstanding offences and was due a court hearing, but had not come to recent garda attention.
However three months later she took her own life.
In its recommendations, the review notes that it is “outside the remit of Tusla to address the gaps in mental health services for young people that currently exist”.
It recommended that the matter be drawn to the attention of the Department of Health and the HSE “in order to reinforce the need to provide services for young people whose clinical diagnosis does not fit within eligibility guidelines operated by Camhs”.
“The review also notes that there were no residential addiction services for girls and recommends that this matter is also brought to the attention of the HSE.”
Baby Oscar’s story
Another review published today by the NRP, which is an independent body, examined the death of a baby boy.
Oscar died of Sudden Infant Death Sydrome (Sids) two weeks after he was born with traces of cannabis and cocaine in his system.
His mother, Sandra, had an older child and was described as “a vulnerable single parent who had a history of drug misuse”.
She had lost her parents as a young child and been brought up by her grandparents. Her grandmother was still alive and continued to give her support, as did other family members.
She and her daughter, Ruby, had been known to social work services for a number of years; her main difficulty at the time of the first referral was management of Ruby’s behaviour which had been quite sexualised at times.
“The behaviour was considered at the time to be self-soothing, as it usually coincided with periods where Sandra was not coping well,” according to the report.
Sandra was attending an addiction service, where she was on a methadone programme, as well as a family support service.
“She very much wanted to overcome her addiction, but struggled to adhere to the prescribed regime and continued to use cannabis and sometimes other substances,” the report notes.
Sandra herself was resistant to the notion that her use of cannabis, which she considered harmless, was impacting on her parenting capacity.
When Ruby was five years old Sandra became pregnant and became homeless at the same time. At that point, further referrals were made about her drug use and parenting of Ruby.
There were also concerns that the unborn baby’s father, who was also Ruby’s father, may be abusive.
A new social worker was allocated. From that point onwards, there was regular social work contact with Sandra, and liaison with her key family support worker who saw her three times a week and provided considerable support.
Ruby was referred for a child sexual abuse assessment. The social worker cautioned Sandra about her cannabis use and its impact on her unborn baby. Sandra secured emergency accommodation and had made practical preparations for the birth.
When Oscar was born he had cannabis and cocaine in his system when he was born. Sandra denied knowingly taking cocaine, but acknowledged that she had smoked a joint two days before his birth which may have contained it.
Oscar was considered to be doing well and was discharged with Sandra after three days.
Over the following days, Sandra had telephone contact with her social worker and was visited by the family support worker and the public health nurse. Although very tired, she appeared to be coping well. Oscar passed away at two weeks of age from Sids.
The review found Oscar’s death was not related to any deficit Tusla’s services. It found that the early management of her case was not helped by changes of social workers, but there is evidence of more active oversight during the final six months of the review period.
Baby Kim’s story
The third report published today relates to the death of another baby, referred to as Kim.
She had been born three months prematurely and needed specialist care. Her mother Kate had an intellectual disability and had been educated in a special school. Both parents are members of the travelling community.
There were concerns about Kim’s parents’ abilities to provide adequate care for her and it was agreed that she would be mainly cared for by extended family. At three-months-old, the baby was discharged from hospital to her maternal grandmother’s home.
Soon afterwards, the family moved to a different area and after a few weeks Kate moved again with the baby to live with the father, Joe, and his mother.
Kim became ill here and was admitted to hospital when she was five-months-old. There were concerns about both her parents’ capacity to meet her needs.
Her diet needed special attention and she was to be assessed by the Tusla early intervention team. When making plans for her discharge, it was considered that her paternal grandmother’s accommodation was unsuitable for a baby and she was discharged to the primary care of Kate’s mother.
A social worker was allocated to the family and they were linked with a voluntary agency which was helping them in efforts to get adequate accommodation.
A public health nurse for Traveller health was also involved. Kim was considered to be well cared for and was developing well, but over the next few weeks the family had to leave their accommodation and had to return to “a cramped campervan”.
All the services involved advocated for suitable housing for the family; the housing department informed the social work department that the family had been previously housed on a number of occasions and had left their accommodation.
According to the report, the baby continued to do well and her hospital consultant considered her to be making excellent progress.
However at ten-months-old Kim passed away from Sudden Infant Death Syndrome.
‘An unthinkable tragedy’
Speaking today about the publication of the reviews, chair of the National Review Panel Dr Helen Buckley said she wanted to extend her sympathies to the families, friends and all those affected by the deaths o these three children.
The death of a child is an unthinkable tragedy and one which affects families, friends and communities.
Although she said the reports show evidence of good practice in Tusla, it had also identified learnings such as the importance of comprehensive assessments and the effects that parental substance misuse can have.
She also said research suggests that the risk of harm to children increases with the impact of multiple adversities.
“Learnings should be considered to ensure that children receive timely, appropriate and coordinated responses,” Buckley said.
“One of the reports highlights the lacuna that exists where young people who are suicidal, with addiction and behavioural issues are not considered eligible for a mental health service.
“This service gap has been identified many times by the NRP and needs urgent attention from the HSE and the Department of Health.”
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