Working in a kids hospital is mostly joyful. Obviously it is sometimes sad. Then every now and then it is deeply distressing. While meeting families dealing with terrible illness and sometimes death very much features, the worst cases I recall have been those where children have been victims of some form of abuse. Whether through neglect, some form of inflicted harm or non-accidental injury these are the cases that send the teams retreating into silence.
New News of Old Deeds
In Australia at the moment, details emerge daily of horrifying child abuse within institutions stretching back decades as part of a Royal Commission into Institutional Responses into Child Sexual Abuse. Recently, cases involving homes run by The Salvation Army have been receiving coverage. Previously the Catholic and Anglican churches have been under the spotlight. More institutions will follow.
The stories of abuse revealed would shake most people. What is equally shocking is the response of the institutions involved at all points in the timeline when evidence of abuse emerged. The motifs emerging have become all too common. The most vulnerable targeted by those in whom no trust should have been placed. Evidence emerging but the focus being on support for the perpetrator who is moved on or protected from prosecution. Stories have even emerged of other people in positions to help, including the police, returning children to homes they’d managed to escape.
This spreads the taint far further than those few bad apples. The temptation, now that the various institutions are seeking to make the effusive apologies and payouts so clearly warranted, is to believe that this Royal Commission will allow a resolution of old stories so that everyone can finally move on. The hope seems to be that we are dealing only with a chapter of history, and we are taking the final steps to display that past behind glass cases in a museum.
The Here and Now
The stories emerging date back as far as the 1950s. Clearly times were different. It’s easy to think that people didn’t speak up at the time because that’s not how society worked. Those of us who weren’t around have to use whatever available cultural touchstones we have to understand those times. Viewed through the haze of ‘Happy Days’ reruns or the lauded reconstruction of ‘Mad Men’, maybe it’s easy to assume it all arose from a different set of values.
However, we’re speaking of times over the ensuing decades too. This is a time well within the lifespan of my parents. Pondering that makes me wonder if values really have shifted so drastically. These cases of abuse happened within institutions that clearly harboured some disturbed individuals. They also counted in their number many people doing lots of good, and yet many of those people didn’t speak up. Would the shift in attitudes that has happened be enough to protect children now?
Actions and Words
When I look at the system I work in, the intent to protect is clearly there. As a health practitioner in NSW, there is guidance available as to how to go about reporting any concerns of harm in children and I’ve been trained appropriately. The problem is recognised, spoken about and a framework is well and truly in place. The talk is all there.
I’ve actually had occasion to report a couple of cases. The reporting side is fairly straight forward and the system that is in place should ensure that cases are unlikely to be swept to a dark corner without concerns being raised. These are good steps to preventing future institutional abuse. Our problem locally seems to be that we haven’t set up a system that allows for action to be taken.
Early last year, an excellent (but sobering) series from Lisa Pryor illuminated all too clearly a system that cannot act through an overwhelming lack of resources. When working in medicine outside the hospital, we define a disaster as pretty much any situation where the number of casualties you have to deal with exceeds your available resources. That story covered in the link meets that definition many times over.
The benefits of intervening to remove children from risk are not disputed. The long term effects on individuals exposed to abuse are well known. The evidence is there that we are not providing the necessary resources to those prepared to take on this gruelling job and I don’t see much of an outcry. I’m struggling with why we don’t make the link between the horrors emerging in the Commission and the need to complete the construction of a system that can meaningfully prevent history repeating.
The staff of DOCS are seeing stories like this every day. We’re also hearing stories from staff in detention centres of significant concerns that treatment of children in those situations amounts to abuse (there’s more on that here). Staff there are already flagging the Royal Commission they expect to come. Is a system that can see and hear the evil but not act really learning the lessons from those old institutions?
Without the ability to act on concerns, without the capability to step in to stop things happening where a flag is waving, have we really done enough to prevent more stories emerging?