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Friday, 02 May 2008

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Issue 168 front coverHolyrood magazine is the fortnightly insiders guide to understanding the complexity of Scottish politics and policy developments and is widely regarded as being the leading publication for political news and information in Scotland.


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Following lurid headlines about rioting, absconsions and violence in one of Scotland’s seven secure care homes, Rory Cahill is given exclusive access to one of the units that houses some of Scotland’s most troubled young people

 

Tamara was eight years old when her father took her to Amsterdam’s red-light district. Officially, he abandoned her, but in reality, he almost certainly sold her to a pimp. Nobody knows exactly what happened to Tamara over the next six years but it would be safe to say you could assume the worst, multiply it by a thousand and you wouldn’t even be close. It was only when Dutch police raided a brothel and picked her up that Tamara was rescued and Interpol got involved. Interpol found she was on a missing person’s list and returned her to Scotland.
It quickly became apparent that Tamara’s experiences had left her in need of the most serious care possible. She was utterly, unmanageably violent, and quickly moved from residential care to a secure care unit but even there, her continual assaults on staff and other residents left those trying to help wondering if they would ever be able to provide her with some measure of comfort, or the means to begin to understand and comprehend what had happened to her, and devise a way in which she could learn to live a life of sorts.
But Tamara refused to allow anyone to come near her, either physically or emotionally and her violence continued unabated. It was decided that the all-female environment at the newly refurbished 24-bed Good Shepherd secure unit in Bishopton might offer Tamara, who was by now 15, a more supportive environment.

Maria Harte, the Head of Secure and Close Support at Good Shepherd fights back tears as she explains how, despite the very best efforts of staff – many of whom were subjected to repeated assaults by Tamara – little or nothing could be done for her.
“She was just not going to allow us to reach her, she was just so angry at the world. She used such extreme violence, she’d hit, kick, throw things, it didn’t matter what. She’d howl and howl and then just collapse into the foetal position. Finally, she very seriously assaulted one of our staff, to the point where the staff member had to be taken to hospital with a footprint on her face,” she says.
Tamara was taken away from the Good Shepherd in handcuffs by police and eventually ‘unrulied’ by a Sheriff – given an unruly certificate, allowing her to be remanded in custody in an adult prison or young offenders institution, which houses 16-21 year olds. But on the night that she seriously attacked the staff member, the police who took her away decided that she would be best served by being placed in a homeless shelter until she faced court, a decision that Harte said was the worst possible option, leaving an already vulnerable youngster in a dangerous and unforgiving environment.
What became of Tamara? She was sentenced to prison for the assault on the Good Shepherd staff member and as she had turned 16 in the intervening time, was sent to the young offenders institution at Cornton Vale, and would transfer to the adult wing when she turned 21. Beyond that? Most likely, a horrific cycle of heroin, further sexual abuse in the form of prostitution to pay for heroin, and more bouts of Cornton Vale until one day, she dies, says Harte.
“But you have to hold onto a little bit of hope, you have to think that maybe one day, further down the line, something we taught her, or said to her here, will help her, that maybe we planted some sort of seed.”
And while Tamara’s case is one of the most extreme ever seen in the Scottish secure system, the ‘average’ case still involves abuse and suffering on an almost unimaginable scale.
One of the current residents, a 13-year-old, was beaten daily by her mother with fists, feet and anything else that came to hand. Staff suspect strongly that her mother also sold her to men for money and drugs. The girl cannot stand to know that her mother is even in the same building as her, and Children’s Hearings have to be conducted via video link.
Harte says staff reached a breakthrough with the girl a few weeks ago when she allowed one of the staff members to hug her:
“Before that she just wouldn’t let anyone touch her for any reason. Even getting them to smile is such a breakthrough sometimes.”
Good Shepherd staff are beginning to learn the indicators which give a clue to which girls might have the most serious issues.
“We’ve found that girls whose mothers have died, especially those who have committed suicide or died from drugs, tend to have the most deep-set problems. It’s like it’s the ultimate rejection,” says Harte.
There are 125 secure care places in Scotland spread across seven locations, up from 92 in 2005, although current capacity has been reduced by 31 after the recent riots at St Mary’s, Kenmure. They house young people aged between 13 and 18 who are either sentenced to deprivation of liberty by the courts or the Children’s Hearing, or young people whose behaviour is deemed to pose a great danger to the young person themselves. The units are the last resort for the system – the vast majority of those inside them will have been through the full gamut of options on offer – residential care; residential schools, fostering – before arriving at a place like the Good Shepherd.
The units are run by local authorities, some by not-for-profit organisations and charities, and a small number managed by private-sector operators. The Good Shepherd Centre is the country’s only dedicated facility for females, something made possible by expansion of the secure care estate under the previous Executive.
Former Justice Minister Cathy Jamieson says she was keen to ensure that the changes to the estate not only improved capacity, and facilities, especially in some of the older institutions, but also allowed at least one dedicated female-only centre.
“I was very concerned that having seen some of the old secure units and been aware of the conditions, there were issues about the physical environment that staff were working in, but also, I wanted to make sure that we had the right shape and size of secure estate so I was very keen that we have a facility for girls and young women rather than it all being mixed. And I also wanted to increase the capacity so it wasn’t about taking more young people, it was about ensuring we had the ability to meet the needs of young people because some are in secure care because of their offending behaviour, others because they are a danger to themselves.
“So part of it was about getting the buildings and infrastructure upgraded and improved, but part of it was about what happens inside the buildings, in terms of getting the right staff in place to support the young people and hopefully turn their lives around,” she says.
At a cost of £9m to build and with a weekly bill of £4,984 per bed – compared to £1,500 a week per bed for long-term care in the NHS, or £700 per week in prison – you would hope the facilities at the Good Shepherd are first class, and indeed they are.
But are we getting value for money from secure care, especially given that the average cost per bed per week has risen from £3,458 in 2005/05 to just under £5,000 per bed per week now? Improved facilities at St Mary’s did not stop young people rioting and then escaping, amid much damage to the newly-refurbished building, resulting in three of the young people being transferred to the prison system, entirely what secure care is supposed to avoid. Similarly, the dismaying procession of young people who have been in secure care ending up in adult prisons once they leave the juvenile system continues unabated.
The question of value becomes especially pertinent when we consider that Justice Secretary Kenny MacAskill has made plain his desire that no child under-16 in Scotland should be held in prison for any reason. To this end – and to the applause of Children’s Commissioner Kathleen Marshall and Her Majesty’s Chief Inspector of Prisons Dr Andrew McLellan – MacAskill has moved to do away with unruly certificates. By definition, this will mean greater demand for secure care places, and thus more cost. But as Jamieson points out when asked why she didn’t get rid of unruly certificates in her time as Justice Minister, without the “safety valve” the certificates offer, what would the staff at the Good Shepherd have done when faced with an uncontrollable young person like Tamara, who presented a clear and present danger to staff?
Walking around the Good Shepherd – which is run by the Cora Foundation, a not-for-profit company established by the Archdiocese of Glasgow, that also manages St Mary’s – it is easy to see where the money went and continues to go. The education wing boasts a dedicated art room, science room, home economics room and music room as well as numerous classrooms. Class sizes are never more than four, and even then contain a number of teaching aides as well as the lead teacher. Indeed, Harte says that a member of staff is with the girls at all times, from when they get up until they go to bed.
There is a fully equipped gym that would be the envy of many professional sports clubs and an indoor basketball court-cum-exercise area. The units, where the girls live six to a building, have a large common area that feels more like a well-appointed holiday chalet and the bedrooms themselves are quite spacious, complete with en-suite bathrooms and televisions, albeit ones that can be turned off remotely by staff.
Girls are allowed Xboxes if they work within the rules set down, and they eat from a varied range of healthy fresh meals. “Chips only once a week,” says Harte brightly. Bedtime is 10pm and the girls are allowed to get themselves up in the mornings, on the understanding that they are ready in time for school. After school and on weekends, there are a wide array of activities, from petting zoos brought in especially for the girls, to various members of staff – there are 106 in total for 24 girls – giving up their own free time to take girls into local towns.
Access to secure units for journalists is rare, bordering on non-existent. And it is easy to see why. A tabloid journalist seeing the level of provision for these young people would salivate at the headlines: “Five Grand A Week For Xbox Neds”, “You Pay For Neds To Play Drums All Day”.
But of course, there is far more to the story. When Holyrood was visiting, one girl was indeed playing a drum kit under the instruction of a drum teacher who had been brought in for the occasion. The girl also had savage red streaks of scar tissue down both her forearms from self-harming

Quotation When Holyrood was visiting, one girl was indeed playing a drum kit under the instruction of a drum teacher who had been brought in for the occasion. The girl also had savage red streaks of scar tissue down both her forearms from self-harming Quotation
. She was also being held in secure care, not because she had committed any major offence, but because it had been deemed she posed a serious danger to herself.
“About 70 per cent of our girls self-harm, and we are always finding ligatures. Even though all the rooms are especially designed to have no points the girls can use for ligatures, they still find a way. We do a risk assessment on the girls before they are allowed an Xbox because they take them apart and use some of the parts to self-harm. They can be so innovative like that,” says Harte.
The Care Commission, while generally praising the work of secure units and the people who work inside them, highlighted a number of areas where it felt improvements needed to be made in its 2007 report ‘The Quality of Care Services in Scotland.’ The key areas of concern for the commission were child protection issues, diet and the provision of food and recruitment policies, all of which will be addressed by individual reports in the coming month.
But what about St Mary’s? The Care Commission registers all secure units and has the power to de-register them too. Riots and escapes must call into question the ability of St Mary’s to safely and effectively deliver its services.
Ronnie Hill, director of child services regulation at the commission says that deregistration of St Mary’s is not on the agenda:
“We are in regular contact with the governors of St Mary’s and we will inspect St Mary’s to ensure that repairs being made and that the plans being made will make it fit for purpose. This is not to say that St Mary’s registration is at risk, but we will work with the local authorities and St Mary’s to see that the situation is addressed before young people are placed there again.”
For Michelle Miller, convener of the Association of Directors of Social Work’s Children and Families standing committee, there are questions to be answered over whether secure care represents the best possible use of limited resources for dealing with exceptionally troubled young people.
Miller points out that during the consultation over the extension of provision of secure care places, which took place in the early part of this decade, many professionals suggested that while the physical condition of the existing estate certainly needed improvement, much of the money that was spent on provision of new places – which would then require further increased spending to maintain them – could have been better used on interventions in the community, or in other forms of care, like residential care or fostering.
“The reality is that secure care is extraordinarily expensive and there is always the danger that we will use it because it is there. What we need to do is recognise that there are kids with very high levels of need and only limited resources to deal with that
Quotation The reality is that secure care is extraordinarily expensive and there is always the danger that we will use it because it is there. What we need to do is recognise that there are kids with very high levels of need and only limited resources to deal with that Quotation
. We have to ensure we get the best quality that reflects our investment because just because something costs a lot does not always mean it is the best,” she says.
One area where Miller expresses concern about the returns we are seeing from funding is in the educational achievements by young people in all forms of care, including secure care. Given the exceptionally high quality of resources, as well as tiny class sizes, shouldn’t we be expecting more from children in care?
“If you were paying £5,000 a week for your child to attend somewhere with those kinds of facilities, you’d expect them to get more than just two Standard Grades in Maths and English. You can throw enough money at anything and provide a Rolls-Royce setting, but what’s important is that you get Rolls-Royce outcomes and generally, young people in care have educational outcomes that lag far behind the average universal outcomes,” she says.
Claire McCormack, one of the staff – a residential care worker – says she won’t accept anything else than a Rolls-Royce outcome. Casually dressed – staff do not wear uniforms of any sort – McCormack has degrees in law and sociology, and says her job requires immense dedication.
“It’s a 24 hour a day thing. Even when I get home, I’m thinking about the girls, wondering what they’re doing, or planning what we’ll do the next day in my head. And I stay in touch with some of them when they leave, they give me their phone numbers, and we’ll meet up for lunch or something, just keep the relationship going,” she says.
And what about the assaults? Has she ever been attacked by one of the girls?
“Well, I don’t feel like I’ve ever been targeted, it’s more the girls lashing out. But yes, I’ve been attacked. They punch and throw things and they tend to bite a lot. Biting is a big thing,” she says.
In those cases where girls become extremely violent, staff employ TCI restraint methods which, they say, are perfectly safe, although this is one area where practice is being looked at by the Care Commission.
Even at 14, Aleesha looks like she could deliver a nasty bite if she wanted to, but staff say she is one of the biggest improvers in the unit. When she arrived five months ago, she used to hide behind a hood with her hair hanging down over her face, literally shielding herself from the world. Now, with a brash, very short haircut, Aleesha is more confident in taking on the world.
What is life like at the Good Shepherd?
“It’s good as long as you follow the rules and stuff. I really like doing the art classes,” she says.
Like many teenagers, Aleesha is shy and extracting answers from her can be painful, but she is very forthcoming on one thing.
“When I get out, I’m no’ going back into drinking and drugs with my pals. They put you in the police station cells and that was horrible.”
Elizabeth Morrison, assistant director at advocacy group Who Cares? Scotland, says that focusing on pounds and pennies only misses the fundamental point of secure care.
“Secure care has to provide reasonable physical living standards for these young people, and provide specially trained staff and these things just do not come cheap. These are some of the most vulnerable young people in Scotland, and it’s hard to put a price on their needs, it’s not a question of money.
“But the key function of secure care has to be providing safety for these vulnerable young people and most young people report to us that they feel safe in secure care,” she says.
So what about the future for secure care in Scotland? The incidents at St Mary’s do not bode well. If youngsters being held in the most up-to-date facilities the country can offer still riot and escape, what more can we do? Throwing yet more money at the problem is one option, but how much more money can we afford – or do we want to – throw? Perhaps we need to recognise that this is a problem that will never be solved, one that will only ever be managed.
Asked what advice she’d give to Kenny MacAskill or any other minister charged with managing Scotland’s secure care estate, Jamieson is frank:
“This is not something you can ever think that you have fixed and then take your eye off the ball. I spent a lot of time personally looking at the programme for the new secure estate and getting the right mix. You can’t ever think, ‘I’ve got it right so I can leave it alone’, you must constantly look to make sure that it is doing the job. It is an area that is difficult for the staff; it’s difficult for the people who take the decisions to put young people into secure accommodation and it’s one that merits a close eye for the ministers to make sure that we are actually getting the services that young people need.”


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