A young man who self-harms and has a fractured history in care claims he was the victim of ritual abuse in his early years
The name of the service user mentioned below has been changed
SITUATION: Kieran Collins is 19 and unemployed with no qualifications. He lives in a one-bedroom housing association flat. He was in care from the age of nine when he was removed from his family because of neglect. He was placed with long-term foster carers but they had to give up caring after four years because of serious illness. Kieran was then passed from pillar to post and ended up in a children’s home for his last few years in care. He has minimal contact with the leaving care team.
PROBLEM: Kieran has been self-harming for some years but recently it has intensified. He picks at his skin continually, occasionally stubs cigarettes out on his torso and forehead, and regularly scrubs his body with a scrubbing brush soaked in bleach. Kieran, since he left care, has disclosed to a counsellor at a youth drop-in centre that he was ritually abused as a child. He had previously disclosed this to social services staff while in care but he wasn’t believed because of the discrediting of such abuse in the fall-out from the notorious Orkney, Cleveland and Rochdale cases. The counsellor is trying to find out more but is newly qualified and isn’t sure what to do. And Kieran hasn’t been back in touch – he suspects that the counsellor doesn’t believe him either. The only people who ever believed him were his first foster carers.
A British Medical Association study has reported that looked-after children are four to five times more likely to suffer from a serious mental health problem than children with their own families.(1) This is a damning indictment of the local authority care system which reinforces psychological vulnerabilities rather than healing them through sensitive and consistent intervention.
Kieran’s experiences reinforce these findings. He has poor-self esteem and seems intent on literally scrubbing away the trauma of his experiences. His disturbed behaviour indicates unresolved issues of abuse; these must be addressed before he can move on.
In Milton Keynes, the Options for Independence Team (Ofit) supports young care leavers in all aspects of their lives. The team aims to work closely with mental health colleagues and, in turn, promote awareness in the young person of their own needs.
Joint working often flounders with the social worker desperately trying to access the appropriate service in adult mental health but failing given different perspectives and values operating in each service. The social worker will present a narrative account of Kieran’s needs and look to the mental health “specialist” to provide the appropriate diagnosis and treatment plan. The mental health clinician will struggle to understand his needs and often come to the invidious diagnosis of personality disorder.
Social workers have the skills and insight to help young people like Kieran address their needs without the need for a clinical expert”. Social workers are trained to analyse, reflect and locate needs holistically. Kieran’s leaving care personal adviser should work closely with the counsellor and devise a strategy of support for all areas of his life.
Kieran needs to tell his life story and begin to feel safe. His behaviour and disclosure to the counsellor indicate that he is now ready to address underlying issues.
(1) Child and Adolescent Mental Health: A Guide for Healthcare Professionals, BMA, 2006
● This was written with the Options for Independence Team, Milton Keynes Children’s Social Care.
SARAH DEWEY (WITH JANE ROSS)
If Kieran lived in Milton Keynes he could use the new, open access service – the assessment and short-term intervention team (Asti). We would anticipate contact from the youth counsellor or even from Kieran himself. Should this not be the case the Asti customer liaison officer would attempt to contact Kieran. We would explain to him the nature of the service and ask him where he would like to see us. Should Kieran not be prepared to see us we would consider making an unannounced visit, given the apparent risks detailed by the counsellor.
The key issue with Kieran is engagement; he has been badly affected by his contact with statutory children’s services and probably would view mental health services with suspicion. He needs regular ongoing contact with the same professional; he needs to see that there is benefit for him. There are clear risk issues present given Kieran’s apparent withdrawal from support; we would try and establish a rapport with him knowing that he is likely to be cautious and wary. If Kieran is not prepared to see us we are left with a dilemma. Should statutory intervention be considered, using the Mental Health Act 1983?
Or should further attempts be made to engage with him? Kieran should have a social worker and personal adviser allocated to him given his care leaver status. This needs to be pursued first. Research shows that a statutory response is likely to traumatise him and lead to a negative outcome from the service user’s perspective.
The initial contact sets the tone for the relationship that follows. Unless serious risks are evident, it is better to take time to engage with Kieran. He is making allegations about past abuse and these should be taken seriously. Asti staff would be aware of our advocacy group People’s Voices – who could be contacted to engage an advocate if requested by him.
Kieran has had ongoing contact with statutory services, there are too many risks associated with exposure to the mental health services at such a young age. Every attempt should be made to work with the drop in centre and young people’s services to provide him with the service he needs and avoid any perceived stigma.
Kieran is alleging that a serious crime has taken place and as such this should be investigated, writes Kay Sheldon. Unrelated past events concerning similar allegations should not have any influence It is not surprising that Kieran feels that he’s not believed. When you have mental health difficulties it can be an uphill struggle to have complaints of abuse taken seriously. The allegations are likely to be viewed in the context of your problems: at best there is doubt, at worst complete disregard. Kieran has a right to have the allegations properly investigated.
Even if the allegations are true, it is possible they will be hard to prove. The important aspect is that Kieran is fully informed of what’s likely to be involved and all possible outcomes. He will need to be offered unconditional support throughout the process.
Involving an organisation such as Victim Support or an advocacy service should be considered. The allegations aside, Kieran seems to need psychological help. He has approached a counsellor who wants to help but is unsure as to how. A referral to more specialised help may be an option that Kieran would consider. Ideally, a service for young people with expertise in self-harm and abuse would probably best meet his needs. However, it will depend what is available locally and he may have little choice other than a generic community mental health team.
Kieran has had little stability in his life and feels let down. I suspect that whoever works with Kieran will need to spend some time establishing a trusting relationship with him. Going at Kieran’s pace will also be important so that he feels secure and in control.
It will of course be important that Kieran is involved in defining and planning his own care, but I would suggest an approach should be adopted that does not just focus on reducing his self-harming behaviour. A talking therapy looking at causes would seem particularly relevant in Kieran’s case. This could be complemented by help to manage his emotions and develop coping skills. The approach should also be holistic and should encompass all areas of Kieran’s life. He has missed out on having a parent figure in his life, so ways to make up for this should be considered, such as a mentor.
Helping Kieran gain qualifications with a view to obtaining steady employment should be part of the package. It may be that this is not an immediate concern as Kieran has a lot to deal with but it will be important for him to feel that he has the chance of a good future ahead of him.
Kay Sheldon is a mental health user
This article appeared in the 30 November issue under the headline “A reason to believe”