Archive for the ‘Child Abuse’ Category

Who can protect our children?

Sunday, August 16th, 2009

Who can protect our children?

4:00AM Sunday Aug 16, 2009
By David Fisher

Our state services fail to protect some of New Zealand’s most severely abused children and allow them to be “revictimised”, according to research published in an international medical journal.

It says the child protection system could be seen as a “poorly controlled experiment” through the inability of government agencies to work together on cases of child abuse.

It follows two cases of alleged child abuse last week in Northland, one of which ended in the death of a 2-year-old. The child in the other case – a 17-month-old – was severely injured.

Social Development Minister Paula Bennett met the families of the two children on Friday. “Protecting our most vulnerable children is of the highest priority to this Government,” she said afterwards.

Bennett will this week announce the reintroduction of the Never Shake A Baby Campaign.

“We are also progressing a plan on how agencies will better work together to ensure an abused child is protected if they have been hospitalised,” she said.

New figures from Starship hospital show the number of children under two with “inflicted traumatic brain injury” has risen sharply over a 20-year study period. They show that in 1988 one child was admitted with an inflicted head injury. Numbers peaked at 13 in 2006 and most recently at 11 children last year.

The report, published in the Child Abuse & Neglect International Journal, was written by two Starship doctors Patrick Kelly and Judith MacCormick, and an Auckland health board social worker Rebecca Strange, who works with child abuse victims.

It studies the fate of 39 children aged under two who were treated at Auckland Hospital for “shaken baby syndrome” during the 1990s. It follows their health and development for up to 17 years.

The “syndrome” has become a term for traumatic brain injury in infants. One of its common causes is hard, physical shaking of the child.

Most of the children are referred to in the report as “survivors” – six died in hospital and two others have died since, one 15-months later after complications from the original head injury. They were also mainly Maori – a staggering 77 per cent of the 39 children admitted to hospital.

By December 2007, the children had grown older – they ranged from nine years to 21 – and concerns about repeat abuse had been raised in 44 per cent of cases. This was a “major concern”, the report said.

It is particularly critical of the former Child Youth and Family service, now part of the Ministry of Social Development. Investigations of “doubtful quality” by CYF meant reports to the agency of fresh abuse against children – even in front of witnesses – would be treated as unproven, when they likely indicated serious risk.

While the report found CYF had records in all cases, it also found two of the child deaths were never referred to police. And it highlighted a death where a CYF worker rejected medical evidence of abuse to accept the caregiver’s explanation that the child had choked on a piece of bread.

None of the surviving children was killed or suffered further brain injury from future abuse, possibly due to involvement by state agencies.

But the authors said the high number who were again seen by agencies was a “major concern” when the object of intervention was not only to prevent death but to keep children safe.

Sometimes the agencies were called in afresh to deal with cases of neglect and failing to meet a child’s needs – the tragic consequence of extended family trying to cope with a child who has suffered brain damage from earlier abuse.

Kelly says New Zealand has seen a steady 20-year climb in the number of children being admitted to hospital with head injuries caused by abuse.

Having two “fatal or near-fatal” admissions in a week was unusual but Starship normally had several children at any time being treated for serious abuse injuries.

“Children die, children suffer serious damage, and sometimes it is the result of a few seconds of uncontrollable rage,” he said.

No one from CYF would be interviewed but in a statement, deputy chief executive Ray Smith said the service had improved.

“Can we do more? Absolutely – and I’m committed to finding new and better ways to keep children and young people safe.”

High hopes for baby scheme
Every new parent in the Auckland area will be spoken to about the dangers of shaking babies in a new government-funded trial.

Dr Patrick Kelly, a paediatrician at Starship children’s hospital, said there were great hopes the programme would save lives. In it parents will be spoken to “in the first few days after [the birth] to talk about the dangers of shaking a baby”.

They would then have to sign a sheet of paper acknowledging the discussion and the ways to avoid abuse.

If successful, the pilot scheme may be rolled out across the country. In the United States it has resulted in a 40 per cent reduction in abuse.

Health professionals at Starship hope to have it running by the end of this year.

The Shaken Baby Prevention Programme is being funded by the Ministry of Social Development, and is based on a programme developed by US professor Mark Dias.

Kelly said the programme was suited to New Zealand’s independent midwife network. The trial was awaiting the appointment of key staff and development of material such as a video.

Read full report

Love and death

Sunday, August 16th, 2009

Love and death

Sunday Star Times

Last updated 05:00 16/08/2009

Photo: Brendon O’Hagan
Many mothers struggle with stress or depression or even serious mental illness and psychosis, yet only the tiniest fraction of those will hurt their child. Is it possible to spot those women?

THE day after the bodies of Kathleen Flowers and her son Dominic, eight, were found in their Auckland home on July 17, a neighbour was telling reporters how the 47-year-old was “a really good mum” who adored her children.

At the double funeral of his brother and mother, Flowers’ older son Alex said: “My mother was amazing. She would do whatever it took to make me happy…”

But mourners also heard from celebrant Sally Avison that Flowers had been severely depressed and had attempted suicide twice before; that she took her own life that day while her husband James was at work; and that Dominic “did not choose his death”.

“We understand,” said Avison, “the nature of his death was peaceful and gentle.” The words are soothing; the reality brutal. Sometimes “good” mothers kill their children.

Melissa Dorward was a “good” mother too. A friend told the Dominion Post newspaper that the 31-year-old, who was found dead on July 12 at her Hawke’s Bay home alongside the bodies of her two young daughters, Keira, four, and Ellah, two, was “a good lady and a very, very good mum very involved with her children, especially sports clubs and other bits and pieces”. Dorward was pregnant when she died, and had two older children, both sons.

Professor Sandy Simpson is clinical director of the Auckland Regional Forensic Psychiatry Service. While he has no special knowledge of circumstances behind the Flowers and Dorward deaths, he says it is not out of the ordinary for mothers who kill while mentally ill which is the case in roughly a third of cases to be described as model parents.

“For some, they’re suicidal and deluded and come to feel they must kill themselves because of how bad the world is and they take the child with them because they believe to leave the child would be a horrendous thing… the symptoms of illness envelop the child and themselves.”The ironic thing to get your head around is that the woman’s judgement is so seriously troubled by illness that she thinks she’s doing the right thing even though she’s doing a horrendous thing.”

In 2000, Simpson was co-author of a study in which he and colleagues interviewed six women who had killed their child or children while mentally ill. Most of the women had been found not guilty on the grounds of insanity, and none had previously been child abusers; there was no history of repeated abuse, and all had a clear intent to kill.

As the women recalled the circumstances leading up to the homicides, the theme of trying to be an ideal parent was common. They talked of the special efforts they made for their children, such as mincing steak instead of buying mince, putting aside time to play with their child to make up for taking them shopping, or of choosing to stay home with the children rather than working.

“You know, I’ve always sort of wanted to be the perfect mother,” said one interview subject.

CHILD HOMICIDE IS rare, especially in developed countries, and homicide by mothers rarer still, with an average of around two cases per year in New Zealand. Between 1991 and 2000, 91 children in New Zealand died at the hands of 101 perpetrators. According to analysis by the government’s chief social worker, Marie Connolly, 30% of killers were fathers, 24% were mothers, 18% were de facto parents, 18% were relatives or others known to the victims, and 10% were strangers or unknown killers.

The most dangerous time for a child is its first 24 hours, during which time homicides are almost always at the hands of mothers. The risk of being killed diminishes steadily with age.

Simpson says women who kill their children fall into three main groups (though there is some overlap between them). The largest group (over a third of cases) is women who are child abusers and end up killing a child without necessarily having wished them dead.

This encompasses such sensational and appalling cases as the 1991 death of Delcelia Witika, two, at the hands of her mother Tania and Tania’s partner Eddi Smith, or the fatal beating of three-year-old Ngatikaura Ngati in 2006 by his mother Maine Ngati and her partner Teusila Fa’asisila. All four perpetrators were found guilty of manslaughter.

This kind of killing, says Simpson, is “really the tip of a rather large iceberg” of family violence. And while they attract most public outrage, they are in the sense the least mysterious. “Most parents know that there are moments when we all feel at the limits of our capacity to cope. [But] most parents of any wisdom put the child down gently and walk away until they regain their composure… The question is, what undermines people’s ability to walk away?”

The answers are familiar and gloomy: the more isolated a mother is, the poorer the parenting she received, the fewer emotional, personal and social resources she has, the greater the odds she will do the wrong thing. Such women, while probably stressed or even slightly depressed, are not typically mentally ill.

A second, slightly smaller, category is “neonaticide”, where a mother, usually a woman in her teens or early 20s, kills her baby in the hours after birth.

“It’s usually a concealed or denied pregnancy of a younger, quite isolated women who may be naive, often from strict religious background, who shouldn’t have had sex and wound up pregnant,” says Simpson.

A recent example to receive media attention was that of the Pacific island student at Otago University who in May 2006 gave birth to a healthy baby girl in the toilet of her hall of residence, then placed the infant in a plastic bag and dropped it from a hostel window. She pleaded guilty to infanticide, a charge that recognises diminished intent due to psychological problems, and was sentenced to community work and supervision, which was later cancelled.

And then there are the women suffering from major mental illness who make a clear if deluded decision to end their child’s life. This makes up another third of maternal homicides.

These women are likely to be older, to be married, and to have already had other children. They are also particularly likely to attempt an “extended suicide” killing themselves but first killing their child, “not out of anger or rage”, as Simpson describes it, “but out of desperation and love”.

Particularly awful is the thought they may have wrestled with themselves for some time before killing.

“It’s usually been a build-up of desperation and feeling that’s there’s no other way,” says Simpson. “Not uncommonly those thoughts were there for some days or weeks; and they were struggling to cope with it or to put them out of their mind.”

The danger sign, says Simpson, is the presence of psychosis.

Psychotic symptoms where there are delusions or hallucinations and a sufferer loses contact with reality can arise from a range of disorders, including schizophrenia, manic episodes, or severe depression.

“It doesn’t matter necessarily which one of those diagnoses you have,” says Simpson. “It’s the delusions and hallucinations and disturbed emotional state that are the key bit, because they are the drivers for how you perceive the world and what you believe you must do.”

Many mothers struggle with stress or depression or even serious mental illness and psychosis, yet only the tiniest fraction of those will hurt their child. Is it possible to spot those women?

Not exactly, says Simpson. Predicting an extremely rare event is usually impossible. “But what we do know is that if everybody with symptoms like this got the sort of care they should have, we will prevent many events.”

Effective treatments for psychotic depression start with medication, followed by talking therapies and the provision of broader support to the person and their family.

“If we treated everyone who had major depression with psychotic symptoms, who is involved in a child-caring relationship, we wouldn’t know which homicides we’d prevented, but we sure would do so.”

But there’s the catch. When Simpson and colleagues interviewed New Zealand women who had killed children while mentally ill, they learnt that a number of them had been in touch with GPs or mental health services, but had felt unable to talk about their fear that they would harm their child. Others had discussed their fears but “the meaning of what they said wasn’t fully understood”.

A wider US study of female fatal child abusers found some had expressed their fears but were told: “You’re a good mother you wouldn’t harm your child, would you?”

The lesson, says Simpson, is that if a mother says she if fearful she will harm her child “it’s a big deal”.

“A complaint like that isn’t a sign that a child needs to be immediately uplifted; that’s the thing that people fear and it’s a big barrier to seeking the help that they need.

“The best way to help is not to diminish that but to say, good on you for telling us how you feel, and let’s see how we can support you.”