Sir, – The report on child deaths made for harrowing reading. It did not, however, come as a great surprise to those of us at the front line in areas of deprivation, from which the majority of these cases emerge. The report outlines the many shortcomings in the system in the tragic cases described.
I have worked as a GP in such an area for 17 years.
As a GP it is a great privilege to care for someone from birth to death. It is grim to discover that death comes much sooner than expected depending on your address. It is truly painful to witness the progression from bubbly toddler to troubled eight-year-old, disruptive 12-year-old and finally the descent into addiction or other self-harm as a teenager. There are many opportunities where intervention might help. Parenting in these families can be very fragile and chaotic. Flexibility, responsiveness and support from the system are critical if there is any hope of meaningful change. The reality today is that when I encounter a family in crisis (whether parents or children), almost all the doors are closed altogether.
There are two HSE-funded family therapy services in this area which are not accepting new referrals. The very effective adult counselling service is also closed to new referrals and about to have its funding cut further. The eight-month waiting list for child psychiatry has been compounded by its “temporary transfer” to a distant part of the city (for cost reasons) effectively rendering it inaccessible to those who need it most.
I referred a disturbed young 20-year-old woman (where there is serious concern about her three- year-old) to the adult psychiatry service on March 3rd; she is being seen this week. Neither the local adult psychiatry nor addiction psychiatry service deals with alcohol problems which require specialist help. When the inevitable child protection referral arises, there is a six-month waiting time unless there is an acute risk to the safety of the child. This is how it is, today, in areas of deprivation, where the health service itself compounds the inequality created by society, by failing to resource services according to needs.
As the Government promises to act on this report, Minister for Public Expenditure and Reform Brendan Howlin is warning that the HSE needs to cut its spending further. There are, however, choices about where money goes – there always seems to be money to fund a prison place (€77 000 per year in 2010), so often the alternative outcome to HSE care, of the trajectory outlined above.
The fate of the children in this report is a reflection of our collective indifference to poverty and exclusion, not just the indifference of the State. Otherwise why have reports been published for years clearly describing these failings in the system, with little or no action?
Politicians respond to public pressure, but the public is largely silent on this issue. We like to think in this country that we care deeply for our children and perhaps we do. We just don’t care that much about other people’s children.
Until we as a society take responsibility for all the children of this country, especially the most vulnerable, nothing will change. – Yours, etc,