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Social Work History Network Homicides, Inquiries and Forensic Social Work: past experiences At the March 2009 meeting of the Social Work History Network (SWHN) hosted by the Social Care Workforce Research Unit, King’s College London, Professor Colin Pritchard, research professor in psychiatric social work at Bournemouth University, presented his research on the sadly continuing relevant subject of Child Abuse Related Deaths. He has completed a study covering the major developed countries from 1974 – 2006, with a focus on England and Wales (partially published in Pritchard and Sharples, 2008). Colin emphasised that, contrary to the current reports in the tabloid press and adverse comments by some government ministers, an analysis of data collected over three decades showed that child protection outcomes had improved overall both in England and Wales and internationally. The concept of ‘baby battering’ had been coined in the USA in the 1960s. A decade later, the death of Maria Colwell in southern England had shaken the nation. This tragedy was followed by others and led to a series of government initiatives to enhance inter-agency working. In the main, recent policies such as Working Together (DCFS, 2006) and Every Child Matters (DCFS, 2006) were working well and front line social workers, educationalists, health staff and police, rather than being condemned, generally deserved to be praised for their endeavours. The nature of child homicides is by definition complex. Evidence suggests that, as is the case with child neglect and abuse, its incidence is closely associated with poverty. Yet Government ministers have consistently failed to reflect this link. Colin expressed the view that the often related topic of sexual abuse had previously been eclipsed by Freudian interpretations of children’s developmental behaviour and had only been acknowledged as a serious matter relatively recently. He suggested that over the years the conceptual and systemic connections between child protection and mental disorder had been ‘lost’ in spite of a number of studies that have implicated parental mental illness as a key causative factor in child homicides. He cited the case of Victoria Climbie as one recent example and said that the transcripts of the Aunt’s evidence strongly suggested to him that the child’s Aunt was mentally ill. However, the press simplistically portrayed this tragedy as a child care case. There was a pressing need to recapture the mental health and child protection interface. Colin explained that the reported incidence of undetermined child deaths has always been relatively high in England and Wales, in comparison to elsewhere. However, this may be due to coroners in this country being more cautious than their counterparts abroad and may also reflect differences in data collection. He suggested that undetermined deaths were amongst the most difficult cases for social workers and others caught between policing and supervision on the one hand, and support and counselling roles on the other. It would be simply terrible to wrongly accuse a bereaved parent or parents of causing a child’s death. Funding for resources and services has increasingly been an issue. However, Colin said he had been advised to play down the positive evidence of child protection outcomes. He quoted a former Director of Social Services: ‘Colin, this is good news, but don’t shout too loudly. If the elected members think we are doing well, they’ll cut the budget’. Support systems In the general discussion the importance of expert supervision, as voiced in former SWHN seminars, was upheld as an important component of the child protection armoury. Robust supervision should require that practitioners are observant when they visit their clients and report and record any concerns and discuss these with their supervisors. The case of Baby P had highlighted the importance of reviewing local authority thresholds for legal intervention, in particular cases of neglect which have the potential to end in tragedy for the whole family. The question was asked, in practitioners’ endeavours to keep families together ‘had we lost sight of the ‘rescue’ approach’ ? The issues of attachment theories and feelings of parental rejection on the part of children separated from their families were raised. On a positive note, Colin stated that there was new evidence that looked after children, when compared with children excluded from school, fared better in terms of crime and suicide rates, although they came from more difficult family backgrounds (Pritchard and Williams, 2009). However, it was acknowledged that an expansion in and development of high quality care services would be needed if local authorities were to ‘rescue’ more children from adverse home circumstances, who currently fall just below present day thresholds. Whilst the recent merger between child protection and education was generally considered to have some positive aspects, there were also worries that funding might be directed to education because it ‘had more votes’, at the expense of children’s services. It would take time for the two services and regulatory processes to bed down. However, there was general concern about educationalists heading up child protection, although inter-professional learning between the two professional groups was viewed as potentially positive. In respect of the educational achievement of children in need and ways out of poverty, Colin asked if we had lost the ‘class culture’ link highlighted in the Plowden Report (1967) which had demonstrated the tremendous educational disadvantages of ‘working class’ children in comparison with their ‘middle class’ counterparts. Forensic mental health James Lloyd Williams, member of BASW’s forensic special interest group (SIG) then spoke about the history and role of forensic social work. James commented that people placed in forensic units were often the grown up children of families where abuses and often homicides had occurred. Forensic mental health provision is currently expanding. The care of forensic patients is located in a wide range of inpatient and community settings. High, medium and low secure provision is provided in NHS, private and independent hospitals. However, forensic patients are also placed in residential units, supported accommodation and social housing. By way of general background, in England and Wales the origins of facilities for people with mental illness who have offended were laid in legislation dating from 1573 when powers to detain a ‘mad man’ who posed a serious danger to the public were introduced. The 1744 Vagrancy Act made provision for the detention of mad and dangerous people prison. A Lunacy Act of 1860 allowed for the transfer of the insane from prison to hospital. In 1863 Broadmoor hospital was established followed by Rampton in 1912. The insanity defence rules, often referred to as the McNaughten Rules, were introduced in the mid nineteenth century to exclude sane people from pleading insanity. A new legal criterion of diminished responsibility was introduced under the Infanticide and Homicides Act 1909. Following the review of mental health and mental deficiency legislation from 1954 – 1957 (Percy Report, 1958) (Rapaport and Manthorpe, 2009) the Mental Health Acts of 1959, 1983, and 2007 have governed the detention and treatment of mentally disordered offenders. In the light of a number of psychiatric homicides and the Reed Report (1992) there was an expansion in the number of medium secure units and beds. Special Hospitals such as Broadmoor and Rampton were brought under NHS control. Facilities in these hospitals and also designated prisons have also been developed for people deemed to have Dangerous Severe Personality Disorder (DSPD). DSPD is a relatively recent medically determined category which broadly encompasses people considered to be extremely dangerous who might formerly have been detained under the now abolished legal classification of psychopathy, on grounds of abnormally aggressive or irresponsible conduct. Social work role It was not until 1969 that a social worker was appointed to work in Broadmoor. The Butler Report (1975) promoted the development of forensic social work in hospitals and the community. Forensic social workers became an established part of forensic mental health teams. Taking the best practice from probation and social work they learn by experience and to this day, there is no special qualification for the job. However, the BASW forensic social work SIG, inaugurated in 1984, developed a forensic social work competency framework which was later adopted by CCETSW. Since then the SIG has contributed to the Reed Report, legislative reform and a range of public protection policy consultations. Forensic social work has continued to grow in tandem with the expansion of forensic services from the 1990s. However, it remains a fairly rare specialism. The forensic social worker provides a detailed social history of the patient’s childhood and family circumstances, addressing attachment and systemic issues. He or she also provides a contextual assessment of risk, ever mindful that the main client is the general public. However, the importance of identifying the balancing factors of client strengths is also recognised. Liaison with outside agencies to inform care, treatment, monitoring and aftercare is also a key part of the forensic social worker’s role. Home visits, family therapy or psycho-education, victim work and assessing safe contact with children are other elements of the task. Some patients are never discharged because of the seriousness of their index offence. For those who are discharged, generally under a ‘conditional discharge’ requiring them to adhere to certain conditions such as residence and treatment plans, the forensic social worker provides post discharge support to the patient, victim and family. Community social workers and in some cases probation officers are appointed as ‘social supervisors’ to supervise the patient and to provide regular reports to the Ministry of Justice on progress. A significant part of the role comprises report writing for appeals, care planning meetings and occasionally the courts. The role is both challenging and demanding because in forensic work, practitioners are ‘constantly processing other people’s trauma’. Some patients, because of their insecure childhoods, are expert at dividing team members. Forensic practitioners also have to cope with the outcomes of inquiries and high profile media attention which are generally of a derogatory nature. However, James said that in his experience, the social work supervision provided in high and medium secure settings was generally of a high standard. The families of the patients, in the vast majority of cases, have been known to social services because of abuse, neglect and not infrequently, homicides. The patients have very often experienced serious childhood traumas such as emotional, physical and sexual abuse and many have been in local authority care, where in some cases they have been abused again by staff or others in authority. The whole range of mental disorders is present in the patient group, in particular personality disorders, post traumatic stress disorder (PTSD) and addiction disorders. Managing trauma and risk In response to questions, James acknowledged that determining the best interests of the child in respect of child visits and rehabilitation where violence had occurred, was complex. It was generally a case of accepting a lower base line of ‘no harm’. If a mother had harmed a child or other children in the family, she might have recovered to some extent and contact might therefore be appropriate. The most poignant situations occurred where the mother had been severely psychotic at the time of killing a child and had been unaware of what she had done at the time. The bereavement process was fraught with danger and could end in the mother committing suicide. In attempting to rehabilitate a patient who had often been in hospital for many years, changes in the patient’s social circumstances were inevitable. Marriages had usually broken down, families and communities had memories of the index offence. Not surprisingly, it was often very difficult to place people who had offended against or killed their own or others’ children. In some cases it was necessary to find placements in areas distanced from their former homes or offending locations. Where rehabilitation to the home area is possible, care still needs to be taken as often the families of patients also have their problems. Patients who had been asylum seekers posed particular difficulties in respect of care, treatment and aftercare planning, as there were often huge difficulties researching backgrounds and culture because of political turmoil in the countries of origin. Observations were made that the forensic social work role was a last remnant of the former psychiatric social worker (PSW). James considered that forensic social work was closer to child protection work than to that of adult mental health given its legalistic and high risk nature. Forensic social workers and child protection practitioners shared the same client group and level of public protection concerns. Colin stressed the importance of research and practice approaches that helped social workers to recognise their successes as well as their failures. He was most concerned about the media vitriol and its adverse effects on the ethos and morale of frontline workers. Whilst practitioners should feel encouraged by the child protection statistics, in the case of Baby P, and any child, one death was always one too many. In addition, the account of forensic social work demonstrated that the consequences of child homicides, neglect and abuse were long lasting and far reaching. Acknowledgements also to: Richard Dale Emberton, forensic social work SIG and Professor Jill Manthorpe, SCWRU, KCL. References Butler Report (1975) Report of the Committee on Mentally Abnormal Offenders. London, HMSO. DCFS (2006) Every Child Matters: The Children’s Workforce Strategy – the Government’s Response to the Consultation, London, DCFS. DCFS (2006) Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children, London, DCFS. Plowden Report (1967) Children and Their Primary Schools. London, Advisory Council on Education. Percy Report (1958) Royal Commission on the Law relating to Mental Illness and Mental Deficiency. London, HMSO. Pritchard, C. and Sharples, A. (2008) Violent deaths of children in England and Wales compared to the Major Developed Countries 1974-2002: Possible evidence for improving child protection? Child Abuse Review. 17: 297-312. Pritchard, C. and Williams, R. (2009) Does Social Work Make a Difference? A comparison of former LAC v Excluded from School adolescents as Young Men: crime, suicide and homicide. Journal of Social Work, in press. Rapaport, J. and Manthorpe J. (2009) Fifty years on: the legacy of the Percy Report. Social Work, in press. Journal of Reed Report (1992) Review of the mental health and social services for mentally disordered offenders and others requiring similar services, Vol 1. London, HMSO. If you wish to receive information about SWHN events, please email Joan Rapaport at [email protected] With grateful thanks to Richard Dale Emberton for his contributions to James’ presentation.