Children in residential care have higher risks of mental health problems - Psychiatrist | Sunday Observer

Children in residential care have higher risks of mental health problems - Psychiatrist

20 February, 2022

Most children in residential care have both parents, but forced into alternative care due to unfavourable conditions at home  - Study

When a child has lost both his parents, or abandoned by his parents due to dire economic conditions, unfavourable home environments  caused by alcoholism and mental and sexual abuse, where is he likely to end up in?  The answer is, though far from satisfactory, it seems to be in a residential care. Recent reports of rising cases of mental and physical abuse reported in such child care institutions have now raised concerns among health officials and child activists who are demanding that state institutions dealing with children in care, as well as governments make safe alternative care a priority in their agenda.     

The number of children in residential care is mind boggling. According to the United Nations Children’s Fund (UNICEF) report in 2009, up to eight million children are in institutions worldwide. An analysis of the current status of Child Care Institutions and Institutionalised Children in Sri Lanka carried out in 2013, there were 14,179 children in 414 institutions located in all nine provinces in Sri Lanka at the time.

The tragedy is that they are escalating by the day and no effective mechanism has yet been found to halt this never ending stream of violence and abuse that takes place behind the walls of our residential child care institutions that inflict lasting mental scars on the young innocent inmates.

To find out more about the wide ranging health impacts on institutionalised children  who have over a long term or short term period been subject to the trauma of abuse while in care, The Sunday Observer spoke to  Consultant Child and Adolescent Psychiatrist, Colombo South Teaching Hospital and Head, Department of Psychiatry, University of Sri Jayewardenepura, Dr Yasodha Rohanachandra.

Following are excerpts of the interview.

Q: Institutionalised Care of children and adolescents has come in for a lot of flak these days following recent reports both globally and in Sri Lanka of children who have been battered, bruised and abused by their caretakers. I understand that contrary to popular belief most institutionalised children are not orphans but have been forced into residential care by their parents for various reasons. What has driven them to take this desperate step?

A. I agree. According to a recent Sri Lankan survey it was found that 31 percent of children in residential care have both parents, 50 percent have one parent and only 18 percent are orphans.  According to this survey, the main reasons for institutionalisation of children were economic hardships, inability to provide education, disabilities, parental physical or mental illness and parental divorce and second marriages. Unfavourable conditions at home due to domestic violence, divorced parents, parental alcoholism, parental imprisonment, or migration of the mother were other common causes. This was especially true for female children, due to the higher risk of sexual abuse for girls in such home environments.

Q: But isn’t putting them into institutionalised care, especially if they are not registered with the government, worse?

A. Yes. As a psychiatrist I can tell you that children in residential care are definitely at a higher risk of developing mental health problems compared to their peers. Studies suggest that almost 50 percent of the children in residential care fulfill criteria for a mental illness. Institutionalised are children are more likely to display hyperactivity, poor attention, emotional dysregulation, increased anxiety, attachment disorders, and poor peer relationships.

Q: What about Sri Lankan children?

A. survey on institutionalised children in Sri Lanka carried out in 2013 found that nearly 70 percent of the children reported to have psychological distress. Children in alternative care are also at a higher risk of suicide and engaging in criminal behaviour. Experiences prior to entering residential care such as abuse and neglect; and social deprivation in institutions can both predispose to mental health problems in these children.

Q: What are the adverse long term effects on them?

A. As children in institutionalised care live away from their families and friends for prolonged periods, this can hinder their social development. Further, prolonged institutionalised can make reintegration into society challenging, as the children will lack social awareness and skills and more importantly have weak links with family and peer networks to support their lives outside care facilities

Q: So does this mean that such children have special needs which require urgent attention to prevent further aggravating their mental problems?

A. Yes.  A survey done in 2013 has revealed that 33 percent of the children in institutionalised care in Sri Lanka have special needs. However, it was revealed that almost one-third of them are not being regularly monitored by a specialist. In addition, as mentioned above, although there is a high prevalence of mental health problems among these children, their access to mental health services is poor. Developed countries have established community-based child and youth mental health services providing separate services for children in institutions. However, no such services exist in Sri Lanka.

Q.The staff who manage these homes- do they undergo a proper training process before taking on their responsibilities?

A. To be frank, from what I understand, the staff at residential care institutions lacks competent education, social work skills and the majority has no training in counselling. The intimate relationship with caregivers at the institution is a major determinant of a child’s satisfaction in residential care. Having untrained personnel who lack understanding of child development, child psychology or counselling leads to conflicts among staff and children in these institutions. The Human Rights Commission of Sri Lanka has documented cases of abuse, including corporal punishment, by caregivers at institutions. There is a dire need for a strong monitoring system that holds caregivers accountable, thus preventing the re-victimisation of children. There is also a strong need for training and education of caregivers, with appropriate resource allocation to attract qualified individuals to the child care sector.

Q. What is the maximum period allowed for a child to be in institutional care especially if he has a family to take care of him/her?

A. Several studies done over the past few decades have pointed to serious inadequacies in care and protection in both state and non-state residential care facilities in Sri Lanka. Children are referred to child care institutions for a maximum period of three years, with the recommendation to make arrangements to send the child back to their family by the end of 3 years. However, studies show that the majority of the children have stayed on an average of 2-5 years in the institutions and some children have stayed in institutions for up to 10-15 years. Such prolonged institutionalisation makes reintegration into the society especially difficult.

Q: Which Department is in overall charge of these homes?

A. The Department of Probation and Child Care Services is responsible for providing alternative care for the children who are without adequate parental care and protection and children in conflict with the law. Alternative care is a formal or informal arrangement where a child is cared for outside the parental home, either due to a decision by a judiciary or duly accredited entity, or at the initiative of the child, parents/guardians, or in the absence of parents, spontaneously by a care provider. According to the National Policy for Alternative Care of Children in Sri Lanka, every option should be considered to keep a child within his or her own parental home prior to alternative care services.

Q. What about school attendance?

A. According to the recent surveys, overall school attendance of institutionalised children in Sri Lanka is very positive with only 8.9 percent and 1.9 per cent not attending. Most institutions provide educational facilities and conducive environments for children to engage in their educational activities. However, it is reported that some school principals did not like to enroll children coming from the institutions fearing that the standards and the social recognition of the school would be endangered. In some instances, both teachers and students were reported to be not very cooperative with the children coming from the institutions. Moreover, a significant proportion of children in institutions have not attended school regularly before entering residential care. This lack of early schooling makes them lag behind their peers and makes it difficult for them to enter classes that match their age. All these factors combined may make school an unpleasant experience for some institutionalised children.

Q: Since we are talking about foster care, can you define what it is?

A. Foster care is defined as care provided by authorised couples or individuals in their own homes for a fee. Emergency foster care has been proven as a successful model in other parts of the world, to help children and families in crises as a provisional and temporary support mechanism. The National Child Protection Authority (NCPA) has been in the process of developing Foster Care Law Reforms in Sri Lanka. However, this has not yet proceeded further.

Q: What other options are available as an alternative to foster care in Lanka? 

A. While there are several alternative care options, institutional care continues to be almost the default option when children require care and protection in Sri Lanka. As a result, even the children needing short-term support have been placed in long-term residential facilities

Q: Is there something that we as a civil society can do to help them?

A. You can help in many ways.  Society commonly stigmatises children in institutions as orphans. Most people also believe that these children can be used as objects for their charity work and practice giving alms to these institutions for good karma. These children are expected to be grateful to the donors for their contributions. I have seen instances where children are made to sing songs and perform for the donors as a way of thanking them.

Although it may be done in good faith, viewing these children as helpless victims that warrant our pity, strips them of their dignity and self-respect and will make these children believe that they are worthless and are inferior to others. In addition, nowadays, people donate things to these children, take pictures and post them in social media, as a measure of fulfilling their ego. Zero measures are taken to maintain the dignity and confidentiality of youth. It is important to focus on the legal and ethical aspects of taking pictures of these children without the consent of guardians or responsible state parties. So if you want to help these children or donate, please do so anonymously or confidentially and leave your camera behind.

Q: Have you any contact numbers where our readers can reach you for more information on this issue?

A. Further information can be obtained through the official website of the Department of Probation and Child Care Services.