Early intervention can prevent illness and death
02 April 2007
Heroin addicts, unless they are extremely fortunate, are likely to have shorter lives than the rest of us. Their lives can be curtailed by overdoses, by infections and increasingly frequently in our country by a bullet from dissatisfied members of the drug dealing community.
When I worked with women who were pregnant or had just given birth in the Rotunda who had deep vein thrombosis about the 1980s a new situation arose. Heroin addicts with peripheral veins in the arms and legs so damaged that they could no longer be used for intravenous injection would inject into the groin giving rise to deep vein thrombosis. It is amazing none of these young women died of a pulmonary embolus.
A tragic case of the killing of one young mother of two (let us call her A) by another even younger mother of two (B) was described in our newspapers recently. B, who was eventually convicted of manslaughter, was the daughter of a heroin addict who, with an accomplice, had killed the girl's father, also a heroin addict, with a sword some years ago. B's life had a background of drink, drugs and violence.
The family life of A, the girl who was killed was not described but there was violence in her background, too. Her school principal said as reported in The Irish Times, 22 March 2007 that "he had written to the board of managers at Scoil an Spioraid Naoimh in Laytown stating that the safety of pupils and teachers could not be guaranteed while she was in attendance". It emerged that a psychological assessment had been sought for her when she was 10 years old but it had taken three years for this to be carried out. She was then diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) which could hardly be described as her fault.
A's disruptive behaviour continued outside school - her sister said she had once kicked her unconscious and broke her jaw in an argument about a mobile phone. And it was A's aggressive actions when she met B in a shop where she punched B on the nose and drew blood which initiated the altercation which ended with B stabbing her to death.
Sadly, too many teenagers are involved in drink and drugs but the reason I was particularly depressed by this case was because of the failure of our school psychological services to get to children when need arises. Suppose A, who probably was disruptive much earlier in her school career then by the time she was ten, had had help earlier. Would her behaviour have been modified? She might be alive now.
We brought through the Oireachtas recently a bill regarding the disruptive behaviour of some children in school and the effect this had on other students and teachers. It was felt that the existing legislation did not take sufficient account of the rights of those children who were in school to receive an education and where this was being made impossible by the actions of one of their peers. Appeal mechanisms have been set up for the disruptive child which must be gone through before he or she was excluded, but excluded for the common good the pupil now can be.
This really had to be, when one reads accounts of the problems such as the school principal of A had with her. But are we any better off now regarding psychological services for school children than when A was at school?
The Education of Persons with Special Educational Needs Act 2004 (EPSEN Act) stipulates that when a psychological assessment is sought for a school child it must be made available within one month and be completed within three months. It may be sought by the Principal of the school the child attends or by the child's parents or a health board. The request can, however, be refused by the National Council for Special Education. The Assessment shall be carried out by persons which include one or more of the following: - a psychologist, medical practitioner, the principal of the child's school or a teacher nominated by the principal, an appropriately qualified social worker and a therapist who is suitably qualified to provide support services in respect of the special needs of the child.
The parents participation is considered essential and an assessment cannot take place without the written consent of the parents. One hopes they would always be cooperative.
I cannot tell how well the Act is working in practice. A recruitment campaign for educational psychologists began in January and the scheme for commissioning Private assessments was to be revised then too. It is to be hoped that the Society of St Vincent de Paul is no longer being asked by cash-strapped parents to pay for psychological assessments for children by private practitioners.
Money is needed for all those services and the same goes for child psychiatry
Finally, back to heroin - would those who are proposing to legalise drugs such as heroin explain exactly how they propose to do so. Having seen the destruction of young lives with this dreadful drug I can only look on the prospect of it being made legally available with horror. (By this I do not mean that controlled supply to addicts should not be legal if that is considered advisable.) B and her mother are now both in the Dóchas Centre in Mountjoy and heroin has been important in their entry there.
Senator Mary Henry, MD
