Thursday, May 16, 2013

Integrated health and social care could help victims of abuse

The conviction of seven men for rape, child prostitution and trafficking in Oxford on Tuesday brings to an end another horrific case of child sexual exploitation.

Social services were again in the firing line for failing to protect the girls and Joanna Simons, the Chief Executive of Oxfordshire County Council, was quick to issue an apology on behalf of the local authority. But social workers alone are not to blame.

The ethnicity and culture of the perpetrators has come under scrutiny, as in similar cases in Derby and Rochdale. The disproportionate number of Asian men in sex-grooming gangs was widely reported. While existing data on perpetrators is patchy and unclear, there does appear to be an over-representation. However, it’s also clear that perpetrators of child sexual exploitation come from all ethnic groups in the UK and not all victims are white British girls.

Stereotyping perpetrators and victims does not help to protect young people. But, without abandoning core professional values, social workers need to be confident about identifying and tackling grooming behaviour without issues of culture or ethnicity obfuscating the risk to the children involved.
Child abuse is a social problem

Child abuse is a significant social problem. Data collected for the NSPCC in 2009 found that about a quarter of young people in the UK reported experiencing abuse or neglect as children.

Since the Baby Peter case in 2007, child protection social work team caseloads have increased exponentially. Cafcass, the organisation that represents children in care cases, witnessed a 62% increase in the number of local authority care applications from 2007-8 to 2011-12.

Children in local authority care also have poorer educational outcomes and a greater prevalence of offending and substance misuse behaviour than the general population. This is likely to be because of vulnerabilities that are already there, but risks from being in the care system can’t be overlooked. It isn’t surprising that the prevalence of emotional distress and mental health problems among looked after children is also high.

Childhood trauma isn’t always resolved just because you grow up. It can contribute to the onset of severe mental health problems for many people. Child physical, sexual and emotional abuse increases the risk for all mental health problems, in particular post-traumatic stress disorder. Long-term separation from a parent before the age of 16 has also been identified as one risk factor for psychosis. The connections between problems in childhood and mental health problems in adulthood are well established.

Parental mental health problems are also a significant risk factor for the neglect and maltreatment of children, but mental health services don’t always consider the needs of children. Similarly, child protection social workers are there to act solely for the child.
Integrated working in mental health is at risk

The government wants more integration between health and social care by 2018.

Bridging the gaps between children’s social care services, provided by local councils, and adult mental health services, provided by the NHS, could help to protect children and meet the mental health needs of their parents.

But competing priorities in the NHS and local authorities are pulling them apart. For example, local authorities are concerned that the social care needs of vulnerable adults are not given enough importance in mental health services.

And in the NHS the introduction of so-called diagnostic-led care clusters, which require mental health workers to assign people to different categories such as “problems associated with hallucinations and delusions”, takes an increasingly medical approach that doesn’t value social issues.

A recent evaluation by the Social Care Institute for Excellence highlighted the barriers and opportunities for agencies to work together. A study I published last month in Child and Family Social Work found that those working in NHS mental health services and children’s social care services thought having joint agreements improved how they worked together.

But as the evidence stacks up that integrated community mental health teams are probably the most effective way to engage and treat people with mental health problems in the community, the pressure to cut the budgets of local authorities is leading some to actually pull out their mental health social workers. This is going in the opposite direction to the idea of integrating health and social care.

It’s against this backdrop of disintegrating community mental health services – though Minister for Care and Support Norman Lamb has not appeared to refer to it – that the government wants greater integration of health and social care. It’s potentially good news for many people with both health and social care needs, but cuts to budgets mean some local authority directors of adult social care services may need some convincing about pooling their cash.

To improve services to meet the needs of both children and adults, we can’t ignore the problems that are already there between those already trying to do this – and with less money.

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