The Risk Factor: A therapeutic school helps a neglected, traumatised boy rediscover his identity

A young, neglected boy who has had several traumatic experiences and a history of failed foster placements arrives at a therapeutic school headed by John Diamond. Graham Hopkins finds out what happened next.

CASE NOTES
Practitioner: John Diamond, director, Mulberry Bush School
Field: Therapeutic care and education for children with severe emotional and behavioural difficulties
Location: Oxfordshire
Client: Danny Marsh*, now 7, lived at home with his mother, Shelly*, sister, Mandy*, and baby brother, Nathan*.

Case history: Owing to his mother’s poor mental health, Danny was often neglected and spent time wandering the streets with his older sister, Mandy. When Danny was five and Mandy seven they were both abducted and sexually abused at gunpoint in a flat only 10 minutes from their home. A few months’ later, Danny was in an upstairs bedroom while Nathan slept in his cot. Shelly and Mandy were also asleep. Finding himself on his own again, and with his mum’s cigarette lighter, Danny set light to some material which burnt faster than he had expected. He tried to extinguish the flame with a glass of lemonade but it was not enough. Shelly, Mandy and Danny managed to escape from the house, but the blaze became an inferno and his baby brother died in the fire.

Dilemma: The overbearing burden of guilt and low self-esteem that Danny carries with him may prevent him ever coming to terms with his own life.
Risk Factor: His controlling and aggressive behaviour could leave him vulnerable to placement in a secure unit.
Outcome: Placed in a residential therapeutic setting, it is hoped that stability and positive adult role-modelling will enable him to move on from the past.

Neglect is the most neglected form of abuse. And while it lacks the instant shock of, or response to, physical or sexual abuse its consequences can be, nonetheless, fatally damaging.

Danny Marsh was neglected. His mum, Shelly, had mental health problems and repeatedly found herself in abusive relationships. From a very early age, Danny was left to his own devices and would often wander the streets with his sister, Mandy. One such occasion resulted in both children being sexually abused at gunpoint. Shelly’s then boyfriend repeatedly told Danny how awful he was to have allowed that to happen. A few months later, Danny, again left alone, accidentally set fire to his house – killing his baby brother.

Around the time that the official inquest into Nathan’s death was taking place, Shelly’s then boyfriend held a knife to Danny’s throat and told him that because of the incident Danny did not deserve to live. He also incited Shelly to kill Danny. Although she refused, she laid all the blame for Nathan’s death on Danny.

Following the inquest, Danny was placed in care. “He was so badly traumatised that his behaviour oscillated between being cut off and withdrawn to aggressive attacks on other children,” says John Diamond, director of Mulberry Bush School, where Danny was placed last year following several other failed foster placements. “Staff found him to be deeply mistrustful and avoidant of relationships.”

Danny was quiet at first and fairly compliant. However his seventh birthday signalled the end of any honeymoon period. “He was getting older and perhaps he was becoming more in touch with the despairing and chaotic background from which he came,” says Diamond. “From then on he became very controlling of the adults around him and any experiences involving food and mealtimes. His behaviour deteriorated again and he became more defiant and aggressive towards adults.”

Danny moved into one of the school’s four care and treatment households where staff work on helping him develop a more reflective and thinking attitude. Household and education staff have worked closely together to provide Danny with opportunities to develop relationships and with communication, and to help him manage and understand the sense of his neglect. “We’re giving him the chance to be more of a child to be alongside and develop trust in adults. We’re using creative ways for Danny to talk more about his feelings.”

Diamond continues: “As he peels back the layers of his life and understands how he has been let down by adults, not looked-after, and left to fend for himself, he will go through periods of strong feelings about a sense of injustice and being let down. There will be times where he will go into more depressive stages. I see our work over the next two years supporting him through those stages of growth and development.”

Despite his behaviour, in therapeutic sessions Danny began to talk of feeling a terrible guilt for his actions. “He has said that he wishes the lemonade had been, in his own words, ‘a lot of water’. Because of the absence of mature and caring adults in that place at that time, he is left with this burden of guilt and shame for life,” says Diamond.

Danny now appears to Diamond to be more settled in school. “He seems to me to be more relaxed in just his facial expressions, and is making good use of the opportunities around the school – he’ll be coming on a camping trip with us this year.”

The plan is to offer Danny two more consistent and stable years alongside mature and caring adults. For Diamond, Danny still has a lot to learn about how to get on with people and to be able to learn in a classroom situation. “He responds well to praise. We hope that, as his personality strengthens and his self-esteem grows, he will, little by little, be able to leave the pain and chaos of the past behind, for a brighter and more productive future.”

* The names of the young person and his family have been changed.

ARGUMENTS FOR RISK
• Continuity and stability of a three-year placement are the basic tenets of re-integrating a child back into the home, family and schooling.
• Time is essential. Relationships simply take and need time.
• Once the trust and relationships are in place, other outcomes will then have a chance to follow. “We’re working through the emotional blocks he has to learning,” says Diamond. “We’re focusing on one-to-one learning and providing space for him to express his feelings through art and creative work and he’s learning to co-operate as a member of a group. Once he has to come to terms with his social and emotional issues, we believe the cognitive and more practical learning can then take place.”
• The school is also providing essential respite for his foster carers, allowing continuity at home. For the 38 weeks he is at Mulberry Bush they can recharge their batteries and prepare themselves for managing him at holiday times.

ARGUMENTS AGAINST RISK
• A dedicated three-year placement is very expensive. However, Diamond defends the need for time: “Our job is to provide a protective environment – almost a sanctuary – in which emotional growth can take place.”
• Residential placements are run a poor second to family placements. “Commissioners are either slow to use residential placements or are quite aggressive in removing children from therapeutic places to foster parenting,” agrees Diamond. “But we know that until the child is ready emotionally, the risk is that foster placements will break down. The child might not feel ready to be part of a family and need more neutral space to grow emotionally. They might not be ready to deal with the expectations of living as a family, or for the whole concept of what a mum and dad means – especially when they’ve been deeply failed by parental figures in the past.”

INDEPENDENT COMMENT

When placing a child as young as Danny, foster care would normally be an automatic choice, and one which might be made without much reflection, writes Patrick Ayre.

However, in this case, it might be difficult to sustain the levels of emotional and therapeutic support needed in a traditional foster care setting.

Danny’s experience of sexual abuse and loss accompanied by guilt are perhaps the most striking of the challenges placed in his path. However, it is essential to recognise that these occurred within the context of chronic neglect.

Severely neglected children are expected to make decisions and carry responsibilities which far outstrip their social and cognitive abilities. The pattern of demand which this places on them can radically distort their emotional and social development. This may result in them appearing unduly confident in their decision making abilities and excessively assertive and controlling. However, at the same time, they may judge themselves very harshly and have low self esteem, little faith in other people and severe difficulties in forming relationships.

With a history like Danny’s, there is always a temptation to focus heavily on the more dramatic forms of harm which have occurred. However, he was fortunate that, in the end, a placement was found that recognised the importance of rebuilding the central social and psychological core of his personality.

Patrick Ayre is a writer, independent child care consultant and senior social work lecturer, Bedfordshire University

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Graham Hopkins