A mother who has seen her suicidal 12-year-old daughter shuttled between placements and then held in a locked and windowless hospital room says she is frightened for her child’s life.
Since going into care in Staffordshire nine months ago, Becky (not her real name) has attempted to take her own life on several occasions. Her case throws fresh light on the chronic nationwide shortage of secure accommodation for vulnerable children.
“I am constantly told there is nowhere for her,” said her mother, who cannot be identified for legal reasons. “I fear I’ll soon be arranging her funeral due to the systemic failings in health and social care.”
Becky has been alone in a locked hospital room since 27 January. The room has no window or access to the outdoors, no furniture except for a bed, and she is permitted no belongings. All human contact is conducted through a hatch.
The child’s court-appointed guardian told the high court at a hearing to discuss Becky’s case that she considered “the risk to Becky’s life to be catastrophic”.
In two private court hearings held over the past 10 days, a high court judge, Mrs Justice Lieven, expressed her dismay at the apparent inability of Staffordshire county council children’s services, North Staffordshire combined health NHS trust, and CAMHS (child and adolescent mental health services) to find a placement that would keep the 12-year-old safe.
The judge joined the secretary of state for health and social care as a party to the case, and said she was concerned that the authorities responsible for Becky’s care were treating the girl as “a package that is being pushed from one statutory agency to another statutory agency, and you are all just waiting for me to stop the music”.
Six placements for Becky broke down within the space of one month. Staffordshire county council admitted that in one placement it put her in, “the care [she] was receiving fell far short of acceptable and that some of the … staff’s actions were abusive”.
Describing the local authority as “out of its depth” in its failure to safely manage Becky’s care, Lieven made a transparency order allowing the media to report on the child’s situation, stating “this is the kind of case the public needs to know about.”
The NHS trust last month assessed Becky as needing a paediatric intensive care mental health bed, before different doctors from the same trust decided a few days later that she did not meet the criteria. Lieven said: “To be frank I am worried that there are resource-driven judgments happening in these assessments.”
She observed that Becky was “the second highly dysregulated girl who needs support and is not getting it from the NHS” whose case she had dealt with that day, and stated she was baffled as to why the NHS refused to section teenagers in situations where an adult would be detained for their own protection, and would thus automatically be eligible for mental health services.
In a statement to the court, the trust said it stood by its latest assessment that Becky could not be sectioned under the Mental Health Act “on the basis that while she has a mental disorder it is not of the nature or degree so as to warrant detention”.
For children with complex needs who pose a risk to themselves and others, and who are not eligible to be sectioned, there are just 128 Ofsted-registered and regulated secure therapeutic placements available in England.
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About 60 to 70 children are chasing less than a handful of beds which come available each day in these secure units; many will never get one. Local authorities then have little option but to place scores of children each year in unregulated placements which often cost thousands of pounds a week. Though Staffordshire council has made extensive efforts to find Becky a regulated and secure, therapeutic placement, no provider has been willing to accept her.
The only alternative is to leave children on general hospital wards where often their psychological condition deteriorates, or send them to Scotland, which is however becoming less willing for its provision to be used by English children whose own country has not commissioned sufficient placements to meet their needs.
Becky, whose behaviour last summer became so dangerous to herself and others that her mother could not safely care for her at home, is now subject to a deprivation of liberty order.
On 23 January, an emergency placement in temporary accommodation immediately broke down. Becky became distressed and caused damage to the room and attacked police officers and social work staff. Police charged the 12-year-old with criminal damage and assault, and she appeared at a magistrates court.
While in the cells she took a smuggled overdose of antidepressant medication, and was taken back to the hospital where medical staff had earlier decided she was not mentally ill and could not be detained. Later that same day, the guardian told the court, a local authority panel charged with assessing children’s need for secure, therapeutic accommodation found that Becky did not meet the criteria. The guardian described this decision as “mystifying”.
The next day, en route to another unregulated placement, Becky escaped from the car in which she was being transported, ran along a main road, climbed a building next to the traffic and attempted to jump.
“Becky’s case brings the poverty of resources and placements in the child protection system in England into a sharp focus,” her guardian’s lawyer told the court.
Describing the room Becky is now locked in as a “prison cell”, her mother said: “Becky needs an army, and her soldiers left her fighting alone.”
The court will hear proposals as to Becky’s future accommodation from the local authority, hospital trust and CAMHS at a hearing in two weeks’ time.
Mark Sutton, Staffordshire county council’s cabinet member for children and young people, said: “Looking after the most vulnerable people in our communities is our priority. However, as this upsetting case shows, this can be complex and challenging.
“Although the judge recognised the efforts the council made in finding a placement with appropriate support, nobody wants to see a young person in this situation, even for their own welfare, and as a council we want to see even more done to ensure children get the support they need at the earliest possible stage.”
