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As demand grew, State was shutting residential units for children in care

An estimated 200 children with complex needs require residential placements, yet cuts and staffing issues mean there are now just 12 special care beds available

Shortcomings in care for vulnerable children have been known about for over a decade, but have received little attention at a policy level. Photograph: Pablo Rodrigo Sanchez Remorini/Agency Stock

Carol Coulter
Wed Mar 27 2024 - 06:00

The problems in Tusla’s “special emergency arrangements” (SEAs) for children in care highlighted in Monday’s The Irish Times represent the culmination of a crisis in the State’s provision for children with complex needs that has gone on for years. While the increase in the number of unaccompanied minors has exacerbated this crisis, it has not caused it. As the report points out, a third of the 180 children in SEAs are not newly arrived migrant children, but were children for whom regular placements, in foster care or group homes, were not available or not suitable.

In many of these cases such placements had broken down, usually due to behavioural problems among children who had experienced varying levels of trauma in their short lives, or suffered from mental health problems or other disabilities. Appropriate specialist care is needed for such children, but it has not existed for years, apart from the provision of a very small number of places in what is known as “special care”.

Early in 2000 then High Court judge Peter Kelly, after hearing a number of cases of vulnerable children shunted between three government departments, issued a court order requiring several ministers to provide places for such children. Although this order was later overturned by the Supreme Court, the HSE subsequently set up 14 “special care” and “high-support” residential units. The former took children who needed to be detained for their own welfare and protection and in order to receive appropriate therapeutic intervention and education; the latter also provided therapeutic support for troubled children, but did not have authority to detain them.

However, in 2005 “rationalisation” of residential units began, and between then and 2013, 86 units (including non-specialist ones) were reduced to 45. All the high-support units were closed by 2014, with a loss of 93 beds for children with complex needs. Now only the special care units remained, but their bed capacity of 24 has since been reduced by half due to severe staffing problems, which Tusla has said was caused by statutory restrictions on pay in an area where very high demands are placed on staff. Those working in the area estimate there are some 200 children with complex needs requiring residential placements.

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Children in special care are especially vulnerable and may be in danger of self-harm or exploitation. They need tailored therapeutic intervention and under a High Court order can be detained for a period of three months in order to receive such care, though this is often extended, and three months is not usually enough to address their problems.

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However, the number of special care places is grossly inadequate. This has led to some children in need of special care not being admitted, and last month the Supreme Court ruled that Tusla breached its “explicit and unambiguous duty” by failing to formally declare that two acutely vulnerable teenagers needed to be temporarily detained in special care units. The Supreme Court found that the 2011 Child Care (Amendment) Act, which put special care on a statutory basis, contained an “implicit promise” that the requisite funding would be made available for special care.

The lack of beds in special care is not the only problem. Many children are too troubled for regular foster care, but do not meet the criteria for special care. In addition, children can only stay in special care for a period of months, and are likely to continue to need some specialist support when they leave, but there are no step-down or intermediate placements, with specialised staff, for such children.

These problems have been known about for more than a decade, but have received little attention at a policy level. In 2014, the year the last high-support unit was closed, the Child Law Project reported that there was no bed in special care for a boy who met the criteria due to antisocial behaviour and drug use. There were 14 children on the waiting list at the time. Early the following year the High Court heard there was no step-down place for a boy returning to Ireland from Boys Town residential centre for vulnerable young people in the US. In 2016, the project published a report on a teenager detained in a psychiatric facility abroad and deemed ready for discharge, but there was no appropriate facility in Ireland to permit her return home. In 2017, the High Court heard there was no suitable step-down placement for a boy who had been sexually exploited by adults before his admission into secure care, from which he had been discharged.

This is just a small selection of cases before the High Court almost a decade ago, and which continue today, where the lack of appropriate places for children with behavioural and other difficulties was highlighted, often leading to repeated despairing calls from judges hearing them for the recurring issues to be addressed by the Government. Yet there is no evidence of planning by the State to provide for the varied and complex care needs of children who cannot live at home or in regular foster or residential care. Such planning requires provision for both capital expenditure on appropriate accommodation and workforce development, so that there are sufficient specialist staff, properly remunerated to meet the challenges such children bring. Instead, they have been largely left in the hands of the private sector, which has grown exponentially, and in very recent years to private providers of SEAs who operate unregistered and uninspected units. The results are entirely predictable.

Carol Coulter is executive director of the Child Law Project, a director of Don Bosco Care and former legal affairs editor of The Irish Times. She writes here in a personal capacity.

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