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Twelve-year-old Sabera Miah was known to the multi-agency preventative (MAP) project, which works with young people in secondary schools who are at risk of developing mental health problems. She had been experiencing emotional difficulties at school.

However, having disclosed physical abuse by her father, the manager of the MAP project, Maswood Ahmed, was concerned that investigations were stalling. Although its remit is not foremost child protection, "the possibility of emotional damage and subsequent mental health problems were sufficiently concerning for us to push for action on this case", says Ahmed. Sabera was then placed on the child protection register - under two categories: physical abuse and emotional abuse.

"We were contributing to the care and protection plan, but this was taking time, and we began to see the situation deteriorating," says Ahmed. Indeed, a couple of months later Sabera took an overdose of epilepsy medication. And a few days after discharge she was re-admitted after taking a second overdose. "This finally made people wake up to the seriousness of Sabera's mental health. To us it became clear that these acts were symptoms of someone very much emotionally troubled," says Ahmed.

"It was a complex situation. Sabera had clearly understood that by displaying suicidal tendencies she suddenly commanded a lot of anxious attention."

Despite it being a risky step to take, all agencies agreed that it would be best for Sabera to return home. "While the area team social work input continued, a social worker and youth worker from my team began working with and supporting Sabera, ensuring time and space to express her feelings and worries," Ahmed says.

Ahmed also thought it important to engage with the mother as the non-abusive parent. "We started to involve her in a mothers' support group. We found out that she was a victim of domestic violence. This had made her feel, at times, helpless in dealing with her own problems, which was why the children weren't best protected."

Both parents admitted they needed to change their approach and attitudes towards Sabera. "We made a specific programme to help them recognise problems in their behaviour and how that impacts negatively on Sabera's behaviour," says Ahmed.

MAP set about boosting Sabera's confidence. "We engage young people to participate in holiday and out-of-school recreation activities that can improve self-esteem," says Ahmed. "We gave her specific but achievable tasks that gave her a sense of achievement and self-worth. These led directly to a remarkable improvement in her attitude and behaviour." Home life was also improving with no reported violent incidents.

Educationally, however, Sabera remained de-motivated and underachieving. The family suggested that she be sent to Bangladesh to be educated in a private religious institution with a more discipline-oriented approach. "We were concerned about that because this was an alien situation for Sabera," says Ahmed. "She did not know the country and would be in the care of extended family. She may face difficulty adjusting to the educational and social environment." More worryingly, and still on the child protection register, she would be escorted there by her father.

"We could have taken legal steps to prevent her leaving the country, but decided ultimately to let her go," says Ahmed.

However, Sabera was enthused by the idea. She also thought that if she remained in Britain she would slip into drug use, as had her friends and older brother. Also, it was felt that the family could be trusted, given their co-operation so far.

A multi-agency case conference decided to keep Sabera's name on the register for emotional abuse, carry out checks on the institution and monitor progress by telephone.

Although having reservations, Ahmed thought it might be a positive experience. "People going from this country are seen in almost the same regard as celebrities," he says. This would undoubtedly benefit Sabera's self-esteem. To a large extent this happened. Although Sabera returned to the UK after six months, it proved a positive experience. Her behaviour has also improved. She did re-engage with education, but progress was stilted, and is now awaiting placement in a residential school conducive to her learning needs.

The MAP project will continue to work with Sabera, helping her settle in her placement before withdrawing. You could say that with the project's help Sabera's good mental health and, indeed, future, has been well mapped out.

Case notes

Practitioner:   Maswood Ahmed, manager, multi-agency preventative (MAP) project. 

Field: Working with young people in secondary schools who are at risk of developing mental health problems. 

Location: London. 

Client: Sabera Miah is a 12-year-old girl, living with her parents and brother.  

Case history:   Sabera, who has special education support, was referred to the MAP project - a multi-agency team comprising social workers, youth workers and clinical psychologists - just after she started at secondary school. Teachers, who were familiar with the MAP project's work, felt she would benefit from one-to-one support to help with some emotional difficulties. An initial assessment identified some problems at home but remained inconclusive. Soon after this assessment, Sabera arrived upset at school one morning and disclosed that she had been struck by her father with a hockey stick. She had some bruising on her body.  

Dilemma: As the complexities of the case were revealed it became clear that although she had been physically abused by her father and emotionally abused by both parents, Sabera had a strong attachment to her home environment. As a result she would refuse placements in foster or residential care.  Risk factor:  Permitting Sabera to remain in the care of her father (in particular) and her mother put her at risk of further abuse.  Outcome: Sabera's relationship with her parents is improving and she is awaiting a residential school placement.

Independent comment   

The MAP project appears to be a good,  co-ordinated, assertive and proactive service with a mix of youth workers, social workers and clinical psychologists, writes Eric Davis.  

Probably the most important factor facing Maswood Ahmed was that Sabera was referred to a service that was culture- and youth-friendly and which appeared to communicate well internally and externally with other youth-connected agencies. Lack of communication where there is a known element of risk often results in a poorer outcome for the at-risk individual.  

The MAP team was faced with difficult decisions connected to Sabera's care and well-being. Sabera wished to remain with her family despite clear evidence of physical and emotional abuse. The dilemma for the MAP team was to foster a sense of alliance with the family while keeping in mind child protection issues.   

Sabera travelling to Bangladesh also raises complex issues. The element of risk remains, not least because of her father's presence. Here, the father could be seen as trying to exert more control from a dominant position. From Sabera's viewpoint several advantages accrued.  

The MAP team weighed up the risks well. For the future, the MAP team should be encouraged to assemble a risk management plan which indicates the risk factors for Sabera and which attempts to specify the conditions under which she may remain with her family. 

Eric Davis is consultant clinical psychologist with Gloucestershire NHS Partnership Trust. 

Arguments for risk 

• While unhappy about her parents' traditional attitudes Sabera had a strong attachment to home and, by working with the parents on changing their attitudes and approach to parenting, she could remain at home with safeguards in place. 
• Sabera had serious emotional deficits and these needed to be repaired by working with the family together. To move Sabera out would be counter-productive and add to - not mend - her sense of physical and emotional isolation. 
• Work on Sabera's self-esteem and confidence was seen as crucial for her emotional self-worth. While venturing somewhat into the unknown, the proposed move to Bangladesh, although fraught with concern, could offer positive benefits. Also Sabera herself was enthusiastic about the idea and to deny her might cause resentment.  
• The only way to prevent Sabera from leaving would be through legal action and this was felt excessive given the positive developments made with the family.     

Arguments against risk 

• With the father's history of domestic abuse, it is difficult to see how Sabera can ever be placed at home safely. A traditionally male-dominated household, discipline and obedience are seemingly physically enforced. 
• Similarly, it appears that the father was the main mover behind the plan to send Sabera to Bangladesh. The fact that he escorted her alone also raises concerns. Seeking to isolate his daughter and keep her with unknown (to social services) members of his extended family could be seen as a plan to silence Sabera and to bring her into line.  
• That the education she was to receive was to be provided by a religious institution with traditional ways of discipline and compliance might not be conducive to promoting self-esteem and confidence. The potential social and educational isolation of being in a foreign country - albeit the family's heritage country - could be seriously damaging to Sabera's frail mental health.