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Children and Trauma – Where the gaps in the system are glaringly exposed

12th July 2021

Children and Trauma – Where the gaps in the system are glaringly exposed

Steven Santy, Senior Associate in the Personal Injury team at Higgs LLP, looks at the heart-breaking reality of children struggling to access crucial mental health support after trauma

My articles often relate to situations that I encounter on cases which I think should be highlighted.  Here, I talk about the how children who suffer psychiatric injury following trauma can slip through the gaps when it comes to getting the help they need.

I act for a lady who had just collected her two children from school.  She was crossing the road with them when she was hit by a car.  Whilst she took the brunt of the impact herself, suffering a number of serious physical injuries, her children – particularly her seven-year-old son ‘R’ – were understandably traumatised by the events of that day.

My team and I have been able to support both mother and children over the course of the past 15 months since the incident.  We have worked collaboratively with the insurer of the car to provide a rehabilitation case manager who implemented and oversaw an intensive programme of therapies in the private sector, notwithstanding the challenges of the pandemic, with the result that R’s mother has now been discharged.  Ordinarily this would mean that she is able to get on with her life.  But unfortunately, this is not possible in light of what R – now eight-years-old - is still going through.

R suffered minor physical injuries, but it is the emotional effect of what he saw that day which has turned his life upside down.  I organised an assessment with a paediatric psychologist who reported that R had become preoccupied with death and had developed a fear that he and his family would be involved in another accident and would die as a result.  R’s mother reported that he could become overwhelmed by his emotions, would have “meltdowns” and would say that he “hates his life”.  Additionally, R was sleeping poorly and would have trouble getting to sleep without his sister present.  A total of 12 sessions of cognitive behavioural therapy was recommended and funding for the same obtained by the insurers of the car.

Unfortunately, a period of some six months went by before therapy could commence due to difficulties organising face to face treatment – considered essential for R - during the pandemic.  Furthermore, once underway, R found it hard to engage in the sessions and was understandably reluctant to speak about the accident.  His mother expressed that R was suspicious of professionals and was hesitant to get close to them.  It was advised that a slow approach to intervention is taken and that time is spent forming a safe and trusting relationship between R and his therapist.  And once he feels more comfortable, work could start to address the problems at hand.

But, as is often the case, things did not go to plan.  R’s anxiety and behavioural challenges continued.  He was too anxious to attend school and stayed at home, impacting upon his education.  R struggled to interact with the therapist, who indicated that R was not stable enough to engage in trauma work.  In any event, R was now refusing to go to the sessions and would become physical if pushed to attend.  

A paediatrician that reviewed R outside the litigation process made a referral to Child and Adolescent Mental Health Services (CAMHS).   CAMHS is an NHS service that undertakes to assess and treat young people with emotional, behavioural or mental health difficulties.  There are local NHS CAMHS services around the UK, with teams made up of nurses, therapists, psychologists, child and adolescent psychiatrists (medical doctors specialising in mental health), support workers and social workers, as well as other professionals.  But unfortunately CAMHS are inundated with referrals and it can take up to six months before a child is assessed.

As R began to self-harm and talked about wanting to die, there was an option of a more urgent referral to the CAMHS Crisis Team.  But this was also a non-starter; they indicated that because R was merely threatening to harm himself and had not actually harmed himself, with his mother as a protective factor, they could not intervene or offer any support.

It seems incredible that a young child can be experiencing such poor mental health that he/she is threatening to self-harm and even end their own life, yet it is only after they have followed through with those actions, will statutory services intervene.  

R’s mother looked to Social Services for help too.  They will often manage a child through Children’s Services within the Community Mental Health Team, who can also be influential in terms of escalating/accelerating the referral through to CAMHS Crisis Team.  But on this occasion, this also drew a blank.  R was off school due to ill health but liaison between the Local Authority and the school was disjointed.  There was no support offered to transition R back into school and no educational provision at home.  In fact, after 15 days of absence, the first contact from the school was merely to request proof of illness – which was provided in the form of a report from R’s psychologist.  

Nevertheless, R’s mother kept receiving letters from the school advising her to bring R back to school, failing which they threatened to take the matter further.  

Finally, R’s GP was approached to see if perhaps he could prescribe some medication to help in the short term, in the hope that therapy could re-commence.  However, he indicated that he is unable to do so, stating that only a specialist paediatric clinician can do so – which can be pursued by CAMHS once the assessment, in however many months’ time, takes place.

This is a cruel and unacceptable situation, where children suffering the effects of emotional trauma are essentially cast adrift from statutory services until it is too late.  With the result that all too often, a minor reaches maturity and finds that their poor mental health is merely being managed at the expense of the State rather than being treated with a view to improving the outcome.

As R’s mother said to me: “There is just no support for parents who have children with additional needs and particularly mental health illness.  There are huge waiting lists for CAMHS who said they could not help me earlier unless my son actually seriously self-harmed or killed himself as he was threatening to do every day, taking knives to his arms and saying he didn't want to be here anymore at nine-year-old.”

Thankfully, R is now accessing school on a phased basis, supported with a reintegration plan.  I have also been able to consider options in the private sector, including referral to a paediatric psychiatrist, whose help can hopefully stabilise R sufficiently such that he can return to therapy and start to recover.  

But many children out there will not have the benefit of a legal team to fight their corner or an insurer to fund “safety-net” private medical treatment.  The challenge of course is how we ensure that statutory services are suitably resourced to be able to step up to the plate and offer young people the help that they so desperately need.

At Higgs LLP we support clients who suffer serious injuries as a result of all types of accidents and illnesses.  If you would like advice on pursuing a negligence claim, please get in touch.

 

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