Tragedies to Come
- Author:
W H. Allchin
A book on the Mary Bell case acts, once again, as a depressing reminder that psychiatric facilities for children and adolescents are dangerously inadequate and that, until we devote enough resources and mobilise the right skills, further tragedies may still occur.
Gitta Sereny’s clear and readable book* will help many people, who had only the Press accounts to guide them, to make some sense of the story of Mary Bell. She also tries to draw out the lessons to be learned both by professional workers, and by society at large.
It is strange that so often the knowledge of deficiencies in the caring services has to be brought into the open by writers and journalists. The workers in the field know what is wrong but somehow still lack an effective voice in trying to reach either the politicians or the public.
The book gives a good account of the events leading up to the trial and of the trial itself. The author expresses her disquiet at the impact of trial procedures on the two girls, Mary aged n, and Norma aged 13, a disquiet which was shared by many other people who attended the trial. I think that she is here touching on the larger question of the age of criminal responsibility, and this itself, in addition to the way in which children may best give evidence, needs further examination and reform.
However, the findings of the Court are not in question, it is the events which followed which have caused such widespread anxiety.
The author has been able to provide authentic background information, mostly from Mary’s relatives, but with no direct contact with Mary’s mother, and little with her maternal grandmother. A picture emerges which reveals features which will not surprise anyone who is involved in the care of children and adolescents with a history of disturbance or deprivation.
This leads on to a discussion of the psychiatric diagnosis of psychopathy. There was no argument about this diagnosis of Mary at the trial, and there seems to have been continuing agreement among the highly experienced psychiatrists who examined her that she was, without doubt, psychopathic. The author gives brief and clear consideration to the genesis and nature of psychopathy, and this should be easily grasped, even by those not immediately familiar with the topic.
The Case of Mary Bell, by Gitta Sereny. Eyre Methuen ?2.75.
But the book makes its strongest challenge when discussion centres on treatment possibilities for children such as Mary Bell, and on possible preventative measures.
So let it be clearly said, yet again, that psychiatric provisions for children and adolescents are seriously and dangerously inadequate. At the moment, highly disturbed or damaged young people may be found in remand homes, community homes (ex-approved schools), detention centres, special schools, adult prisons, adult psychiatric hospitals, residential homes and hostels provided by local authorities, and finally in the special psychiatric units run by Regional Hospital Boards. But special units are still quite inadequate in terms of numbers of places and are often struggling with staff shortages and lack of facilities.
The network of outpatient clinics provides barely more than a skeleton service, again with staff shortages and long waiting-lists. And the absence of places in suitable day centres or hostels makes for further frustration for those attempting to care for or supervise some of these disturbed youngsters. Social workers and probation officers still have over-large caseloads and tend to have to function as troubleshooters, rather than being able to build up long-term stabilizing relationships with their clients.
The problem presented by Mary Bell underlines some inescapable facts. Units caring for disturbed young people need to be small and highly specialized. Unintegrated or deprived youngsters need a special milieu carefully designed for them. The work now being done at the Cotswold Community by Richard Balbernie and his staff and boys shows that it can be done. But it is no easy task. As a national community we can no longer get away with cheap and unsophisticated provisions.
One of the main difficulties is providing adequate personal therapy in conditions of physical and psychological security.
The Home Office plans for special units were not far enough advanced for Mary Bell to be found a suitable place when she needed it. And the plan which was improvised for her not only had obvious shortcomings from Mary’s point of view, but also may have exposed staff members to stress and strain and manipulation with which it was not easy to cope.
Psychiatrists themselves are not agreed about treatment measures. Many would feel, as I do, that Mary Bell (and many other youngsters for that matter) needs skilled individual therapy as well as a proper environment. There are few situations where longterm individual psychotherapy undertaken by people themselves analysed and trained in the work are available.
Psychiatrists visiting hostels, children’s homes and other residential centres would not have the time, and outside London it is not easy to find the help of trained non-medical analysts or therapists. Even where individual therapy of significant intensity is not indicated, it is still necessary for someone to be ‘tuned in’ to the level of the patient’s experience in order to guide the other treatment measures such as education, physical activities and the like.
But it would be foolish to conclude on a gloomy or hopeless note. There are, working in the field, a variety of people with enormous skill and dedication. There are institutions of varying kinds which can all make a contribution. In general, even taking into account differences of viewpoint and the uneven distribution of skills and facilities, it seems to me true to say that we know rather more than we can attempt to put into practice. We have learned from the Seebohm re-organisation, and will learn again from the coming changes in the N.H.S. that a re-organised insufficiency remains an insufficiency.
Until the community as a whole decides to will the means, we in the field will struggle on, making do, and improvising. Until we devote the resources and mobilize the skills on a sufficient scale, tragedies such as that which encompassed Mary and Norma Bell, and the two little boys may still occur. But now we cannot say that we have not been warned.
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