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Therapeutic Services (Abused Children)

Volume 457: debated on Wednesday 21 February 2007

I am delighted to have secured this debate on the important issue of therapeutic support services for children who have suffered abuse. My personal interest stems from my role as a parliamentary ambassador for the National Society for the Prevention of Cruelty to Children, my work as an MP in Dewsbury, and my being someone who has supported ChildLine for many years.

It is a fact that many children who have been abused are not receiving therapeutic services and that such services will help them to overcome the effects of abuse. That situation surely cannot continue, because it devastates children’s lives and damages their life chances.

Last year, I tabled an early-day motion supporting the NSPCC’s campaign to encourage children to speak out about sexual abuse. It recognised that many abused children do not receive the support that they need to deal with the serious and lasting damage caused by abuse and it called for access to therapeutic services. It was only tabled in May of the last Session, and in just two months it received 247 signatures from MPs of all parties. Despite the late tabling, it was the 23rd most signed early-day motion out of 3,158. That clearly demonstrates the importance attached to this issue by Members of Parliament from all political parties.

Before I focus on the problem, I want to acknowledge this Government’s outstanding record. They have rightly made it a priority to improve educational standards for all and to reduce social exclusion, antisocial behaviour and the number of young offenders. I know that my concerns about offences against children are shared, and that Ministers at the Department for Education and Skills, which has primary responsibility for the safeguarding of children, have done a huge amount of work on prevention. A great deal of work has been done between the Department of Health, the DFES and the Home Office on the subject, including the Safeguarding Vulnerable Groups Act 2006. This Government have done more than any previous Government to attempt to prevent abuse and safeguard children from it, so I commend them.

Where abuse occurs, our objective must be clear: to have a society in which all abused children are provided with the support and care they need to enable them to come to terms with their experiences and to rebuild their childhoods and lives. Although I fully acknowledge the work that the Government have done through the victims of violence and abuse prevention programme and the development of sexual assault referral centres for children in London and Manchester, many children still do not receive the help they need.

I should outline the scale of the problem in this country. The NSPCC’s study of the prevalence of child maltreatment found that 16 per cent. of children had experienced some form of sexual abuse, a quarter of children had experienced one or more forms of physical violence during childhood and 6 per cent. of children had experienced frequent and severe emotional maltreatment during childhood. Today, there are more than 30,000 children on child protection registers because they are at risk of abuse, and, on average, nearly 700 children are added to those registers in the UK each week.

Although some children are at risk from strangers, it is often those closest to them, be that a carer, relative or family friend, who pose a significant threat. Some 1 per cent. of children experienced abuse by a parent or carer, 3 per cent. were abused by another relative during childhood and 11 per cent. were abused by people known but unrelated to them. Those statistics are shocking, but they do not give the full picture. Three quarters of sexually abused children did not tell anyone about the abuse at the time, 27 per cent. told someone later, and about a third still had not told anyone about their experiences by early adulthood.

It is difficult to gauge the numbers of children and young people who currently receive therapeutic services to help them overcome abuse. Different forms of abuse co-exist—all forms of abuse involve emotional abuse, while sexual abuse often involves physical abuse, and so on. One detailed study in 2001 on the provision of therapeutic services for sexually abused children estimated that 90 per cent. of children who had experienced sexual abuse had received no substantial support.

Research into the effects of child abuse shows serious and lasting harm to those affected. For them, the horror of abuse does not stop when the abuse stops—it continues into adulthood, often seriously impairing their life chances. According to a recent study by Hammersley and Read, two thirds of people with schizophrenia have been physically or sexually abused as children.

I congratulate the hon. Gentleman on securing this debate on such an important subject. He is probably aware that I have raised the issue many times. I fully endorse his plea for all children who have been abused to receive therapeutic services, but will he join me in asking the Minister about a further group: the children and young people who themselves display sexually harmful behaviour? If they could receive treatment at the earliest possible time, there is a chance that we will tackle the whole problem in a greater way.

The hon. Lady raises an important but sometimes forgotten issue. I endorse her position, and I am sure that the Minister will take her point on board.

An older but extensive five-year study by Martin reported that slightly more than half of the 58 physically abused children that he studied had some type of neurological impairment, and approximately one third had an impairment that was significant enough to handicap everyday functioning. Similar neurological, sensory, and/or psychomotor problems have been identified by other researchers investigating the consequences of physical abuse, while very recent research by Andreas Danese confirms that childhood physical or sexual abuse may also have an impact on adult physical health and well-being, particularly in relation to diabetes and heart disease.

Anxiety and depression, anger and guilt, poor self-image, difficulties in functioning at school and, later, at work, problems with personal relationships and parenting, sexual problems and physical effects are increasingly recognised as the long-term consequences of abuse. Maltreated children are also at risk of a range of psychiatric conditions that may contribute to their reduced ability to function successfully. They include: cognitive distortions; depression and anxiety; dissociation; a decreased sense of self and others; low self-esteem; and altered sexuality. Such people are at greater risk of becoming alcohol and drug abusers and of engaging in tension-reducing behaviours, such as self-mutilation, compulsive sexual behaviour and eating disorders. They are also at greater risk of suicide.

The consequences of abuse speak for themselves, but what of the pecuniary costs? Recent research by the NSPCC on the cost of investigation, protection, prosecution and care estimated the short-term cost of child abuse to be £20,000 per case. Where a child is taken into residential care, a conservative estimate of the cost is £3,500 per week, or £182,000 per child per year. The long-term consequences of abuse include criminality, unemployment, mental health problems and drug abuse, to name but a few.

What is the cost of the NSPCC’s therapeutic work? It is an average of £3,759 per child. It is not rocket science to do the sums, but this is not a quick fix. The Government will have to be prepared to invest to save, and to accept that shifting the pattern of expenditure will take years, not months.

Will the Minister acknowledge that investing money in therapeutic services for these children when they need it would greatly improve the life chances of many thousands of children? This is particularly true of children in care—another priority for the Government. Some 63 per cent. of children and young people entering care do so for reasons of abuse or neglect, yet few of them receive the therapeutic support they need to overcome the effects of this abuse.

I have demonstrated the support that this issue has in Parliament. The Minister will not be surprised to learn that it also has great support among the public at large. During a campaign last year that received little publicity, more than 17,000 people contacted the Secretary of State for Health, backing the need for support services for abused children.

Since this debate was selected, I have been contacted by the Children’s Commissioner for England, Professor Sir Albert Aynsley-Green, who believes that the shortage of therapeutic services for abused children is a cause for great concern. He believes that every child who has suffered abuse should be treated under child protection arrangements and, following a proper assessment, should be given the required therapeutic support. He also believes that it is imperative that victims of sexual abuse are not stigmatised and regarded as inevitable future abusers. The majority of young people who have been abused do not go on to become abusers.

The Government are, rightly, committed to ensuring that comprehensive child and adolescent mental health services are available to all who need them. However, experience of those services is that they are rarely delivered in the longer term to children who have been abused. Despite the acknowledged increase in funding for those services, resources at all tiers of provision remain stretched, and the thresholds for assessment are too high. Children in the care system do not, typically, have access to therapeutic help unless they are diagnosed with a mental health disorder. That is not necessarily an appropriate measurement when assessing a child’s need for therapeutic support, as is demonstrated by the following quote from a foster carer:

“He destroys everything in his sight. He self-harms, doesn’t sleep, doesn’t get on with other members of the family, isolates himself, needs 24 hours of supervision, he pulls his hair out, pulls his finger nails off”.

These services

“won't work with him as he is not in a permanent placement. They see him to monitor his medication but do no one-to-one work”.

Will the Minister consider the following questions? First, is his Department aware of the level of unmet need in this sector? Secondly, will he acknowledge that if the Government’s social exclusion action plan, which I commend, is to be successful, particularly for children in care, therapeutic services must be available to all abused children? Thirdly, what negotiations is he having in his Department and under the comprehensive spending review to ensure that all children who have been abused have access to therapeutic services? Fourthly, will he consider the proposal to fund comprehensive, inter-agency, post-abuse therapeutic provision in three pilot areas to demonstrate the effectiveness and impact of such provision, and to create a model for a national roll-out of comprehensive services?

Before the Minister responds, I want to share with him some quotes from real-life case studies. David, aged 10, told his ChildLine counsellor:

“My dad sometimes takes me out after school. Mum doesn’t know but he always comes with another man and they touch me. It hurts, but I can’t stop them. Dad said he will kill mum if I tell anyone.”

Tracey, aged 14, said:

“I’m calling about my dad.”

There was a long pause, and then she said:

“My dad does things to me. I don’t like it. It’s been going on for a year when my mum goes out to work. It makes me feel dirty.”

She had not told anyone about it before. Emma, aged 16, said:

“My mum and dad make me have sex with men for money. My dad takes my clothes off and then the men jump on me. I tried to get away once but my dad dragged me back by my hair.”

Marie, aged 14, had run away from home, and called ChildLine about her dad, who had been sexually abusing her since she was 11. Every time it happened he said:

“if you tell anyone I'm going to kill you”.

She wanted to tell her mum what was happening but was afraid of what her mum might do. Marie had run away from home several times, but always went back because

“I've got no money and I don’t know where to go anyway.”

Marie agreed that the police could pick her up from the phone box.

I do not underestimate the Government’s commitment to this work. Only this month, the Prime Minister, speaking at the NSPCC’s full stop campaign event, said that

“each one of those statistics in their thousands represents a young person that has been through probably a deeply traumatic experience where if they are not given that help that experience can stay with them and possibly change and warp their lives for the rest of their lives, then each one of those numbers is a young person with a life that can be rebuilt rather than a life that is destroyed as a result of the experience that they have been through.”

I know that the Minister will agree that expenditure in this area today saves substantially greater expenditure in the medium to longer term, and that, far from it being a cost, it is an investment in our children and our future.

I congratulate my hon. Friend the Member for Dewsbury (Mr. Malik) on securing this Adjournment debate on an issue that should be of supreme importance to every Member of the House and every person in our society.

The sexual abuse of children is not new in our generation, but perhaps it is more spoken about and more open than ever before. The more it is spoken about and the more open it is, the more society begins to realise the devastating consequences for children and young people who go through the experience. The reality of the impact on the child or young person should be outrageous enough for us to believe that we need to act. However, we should remember that the impact is often lasting for the child or young person’s future life. We should also remember that those children and young people often become parents, and that that damaging experience as a child can affect their experience of parenting and bringing up their own families. That is not the only horrendous impact on children and young people. There is also an impact inter-generationally, and on our community and society in a variety of ways.

As my hon. Friend has said, there is strong evidence to suggest that if we can intervene quickly and early and ensure that such children and young people have access to appropriate professional and therapeutic services, the economic and financial gains are indisputable. Failure to do that will lead not only to many more members of society being incredibly damaged, but to a knock-on effect on the social fabric and economic success of our country. Early intervention, and understanding the importance and power of the issue is incredibly important.

We must still ensure that in the context of any debate about the sexual abuse of children we must first do everything in our power to use all the resources at our disposal to minimise for every child the risk of being sexually abused. We still have responsibilities to ensure that the social and health care system works properly in an integrated way to safeguard children to maximum effect. We all know of the horrendous cases that are highlighted in the media, and we also know that 99 per cent. of the function that social workers fulfil leads to the protection of many children at risk. In debates such as this, we should pay tribute to the professionals on the front line who battle every day to support some of our most vulnerable children. No Member of this House, however hard we work, can totally understand the emotional experience of being a professional social worker in child care, perhaps with a case load of 20, 30 or more children and young people who are at risk of being or have been abused.

The system has grotesquely let down children in some circumstances, and those circumstances have been brought to the attention of this House and our society over the years. The everyday heroes who protect children in a most remarkable way are rarely given credit in such debates. We must consider the progress that has been made in recent times. Having reflected on that progress, we must consider how we can do even better in the future. I shall spend a couple of minutes articulating some of the positive action that has been taken to try to improve the situation for children who have been sexually abused.

The Department of Health, together with the Mental Health Foundation, has funded a study into psychotherapy for girls aged six to 14 who have been sexually abused. It will not come as any surprise to my hon. Friend or to other Members that the study found high rates of depression, anxiety and post-traumatic stress disorder. For those children psychotherapy was an effective treatment, and in those circumstances it had lasting benefits.

In my days as Minister with responsibility for young people, which seem like a long time ago, I spent a lot of time during 2001-02 just talking to young people. One experience that shocked me were conversations with young girls, who frequently told me that self-harm was a major issue among themselves and their friends. We, as a society, have not even begun to highlight or to focus on that issue or on what is happening in the real world. However, I do not want to be misquoted: I am not saying that self-harm is always related to sexual abuse, because that would be entirely misleading and inappropriate. There is, none the less, evidence that some self-harm is directly related to children and young people who are being sexually abused. I wanted to use the debate to flag up the issue of self-harm among youngsters, and to say that throughout the Government, we have a responsibility to take it seriously.

I shall move on to other developments. In November 2006, our Department and the Department for Education and Skills published a report that considered the progress made in promoting the mental health and psychological well-being of children and young people. It highlighted that although Child and adolescent mental health services have made enormous strides in recent years in helping more children and families, and in doing so more promptly, there is still a need for substantial improvements to services.

Information from the CAMHS mapping exercise for 2005 shows that in the last three years the number of CAMHS staff has increased by more than 40 per cent., and that the number of cases seen also increased by more than 40 per cent. During the same period, recorded annual expenditure on CAMHS increased from £283 million to more than £500 million. I remain committed to ensuring that we continue that progress.

We will report very soon not only on the target that we set for the development of CAMHS services throughout the country, but on how I intend to maintain the pressure in the system, particularly in the health service, to ensure that once the target period is over we keep our eye on the ball to maintain investment and to focus on the importance of CAMHS services. It simply will not be enough to say, “Here is the target and here is our report on how we have done against it.” The prioritisation of CAMHS services in the national health service is equally important.

We work closely with the Department for Education and Skills on those issues. We also work with other organisations. For example, with the National Institute for Health and Clinical Excellence we are working on guidance on the identification and recognition of all forms of child abuse. Guidelines are expected in late 2008.

We are working with the Home Office, the DFES, the National Society for the Prevention of Cruelty to Children and other voluntary sector organisations, providing services for sexually abused children through the joint Department of Health and National Institute for Mental Health in England victims of violence and abuse prevention programme. The objective is to equip professionals and services to identify and respond to the needs of children and adolescents who have been sexually abused, raped or sexually assaulted, or of victims of sexual exploitation through prostitution, pornography and trafficking. I look forward to seeing the national service guidelines that the programme will publish later this year on therapeutic and preventive interventions with sexually abused and exploited children.

With the Home Office, the Department of Health has been supporting the establishment of sexual assault referral centres, a joint service for victims of rape and sexual assault provided locally by health and police services and the voluntary sector. St. Mary’s hospital in Manchester and The Havens in London, as my hon. Friend has said, have piloted children’s services, and they are being evaluated.

We are also working with the Home Office on behalf of young people who sexually abuse, a point made by the hon. Member for Mid-Dorset and North Poole (Annette Brooke). Many were victims of abuse in their childhoods. We have recently published two research reports: one provides evidence that interventions can be effective in preventing new or continued abuse; the other studies links between sexually abusive behaviour and emerging severe personality disorder traits in childhood. That makes it all the more important to provide early and effective interventions.

To support that work, a national strategy is nearing completion, and with it we will publish guidelines on therapeutic and preventive interventions. That directly responds to a point that the hon. Lady—to her credit—has raised time and again in this House.

It is not often that I credit a Liberal Democrat Member with anything in this House.

My hon. Friend the Member for Dewsbury knows that I have met the NSPCC formally to discuss the issues before us. I also want to pay tribute to his role more generally as an ambassador for the NSPCC in this House. He does a tremendous job in ensuring that the voice of children is heard loudly.

Reflecting on last week’s report about our international standing on children and young people’s well-being, I was concerned about the way in which it was presented, because it did not make any reference whatever to the Government’s every child matters programme, children’s centres, Sure Start, universal nursery provision, massively expanded child care or the beginning of work on emotional and social behaviour in primary schools. None of that work will feed through for a generation.

This Government are often accused of going in for short-term initiatives and for headlines, but there are no short-term political benefits in investing in such early years prevention. No other Government in the history of this country have done as much as this Government to create an architecture in which such early intervention is offered to families during the earliest years, when the greatest difference is made.

Although I am not complacent about that international study, on which we must reflect, we must balance the coverage of the issue before us. None of the findings has reflected on the new approach to early intervention and to early years provision that this Government have created for the first time in the history of this country. It was sadly lacking from the debate that rightly took place about the way in which we should react to the fact that our children and young people are regarded as not being as well and as happy as we would all want them to be.

Currently, a child who is sexually abused does not automatically need access to mental health services, and universal health services may be adequate for addressing some needs of those children and young people. However, we have agreed that later this year there will be a scoping event to bring together all people with an interest in the provision of services for sexually abused children. That will take place in direct response to my meeting with the NSPCC and to my conversation with Mary Marsh, who does a wonderful job.

We must reflect on whether the policy is right. Should we as a country say that a child who is sexually abused ought to have automatic priority access to child and adolescent mental health services? That is not the current position, but the NSPCC has a strong case when it argues that it ought to be the presumption for children in such circumstances. My hon. Friend has raised an important issue, and I promise him that the Government and I take it exceptionally seriously. I expect to see some real progress in the months ahead.

Question put and agreed to.

Adjourned accordingly at Five o’clock.