Tuesday, May 18, 2010

Changing the law to treat children... in which direction?

In the paper today:
an article about a jurist who wants to add an extra law to enforce treatment on young people. She states that some children don't get the psychiatric treatment they should have, because laws act opposite to each other.

Like that at a certain age both child and parents need to agree with institutionalising.
The law provides institutionalising without agreement, but with agreement of two independent psychiatrists and a signature of the mayor for those who are a danger to themselves and/or to others, but there's no way to have someone put away quickly for treatment just because some treatment provider thinks it's necessary.
The only ways left are either to bring the psychiatric patient to court and have a judge decide, or to have a judge decide the parents are not fit to act in the benefit of the patient.

This law is to protect psychiatric patients against all too zealous socalled professionals.
During more than 25 years I've heard stories from people, this law has provided protection to many people.

When a jurist comments on laws which involves quality professional knowledge in another area of expertise than law alone, dangers are idealism to better the world overshadows a sense of reality.

Forcing treatment on people results in aversion, research in the past has shown, and forced treatment not only isn't effective as it should be when accepted with motivation, it also brings people further away from more treatment in the future.
In young people it can cause lifelong agression towards the medical world.

Yet, there's a jurist, Vivianne Dörenberg, who states that the law should enable institutionaliseing and forcing treatment on young people in a faster and far more easy way.

She provides the example of a 14 year old boy with behavioral problems, who skips school because he can't deal with many pupils in the same classroom and who tries to escape from contact with the outer world.

A very nice example, because we shouldn't need a law to force this kid into treatment.

This child is an example of the failing educational system.
And an example of the failing care/health system.

This child went to school, didn't fit in, and nobody took action.
That's not only the responsibility of the parents, like she states.

All children are seen by a doctor and community nurse (followed by a schoolnurse) from day 1, and parents have plenty of opportunity to discuss any problems.
There's a vast amount of parents who discuss the peculiarities of their children and won't get a proper answer.
Many autistic children are not diagnosed in time, because parents are told that this child needs more time to develop social skills, but it'll happen. Just be patient.

These children are seen by teachers, should be the concern of schoolcare professionals.

With other words:
Help is available in the early stages, but professionals don't always listen to the concern of parents.

The past years I've seen quite some examples of schools ignoring the problems of children and youngesters with the motivations
  • that the kids will outgrow their problems,
  • that it's up to the parents to correct unwanted behaviour (under schooltime? At least work together and make a plan to attack the problems systematically and structurally),
  • that teachers are no therapists,
  • that no bad behaviour shows during schooltime,
  • that other children have the same problems too,
  • etc. etc.
I've seen a school dive away for responsibilities in all these ways with the result that children became bullies, behaviorally disturbed young people who tormented children in need for care and extra attention, that dyslextic young people didn't get the assitance they needed to learn to read properly, children became afraid for peers, children lost trust in grown-ups, etc etc.
Soon after a pedagogue started to work at the school her schedule was full, because parents finally saw someone who might answer their question for help, and things started to change for the pupils.

Should we force the children to be treated, or should those who work in the educational system be "treated"?

The way the schoolinspection works might reveal part of the problems, but when there's a systematical cover-up of lacking care the inspection won't always see what needs to be seen.
Not all parents have free access to the schoolinspector. In fact at most schools parents are chosen by the schoolmanagement to talk with the inspector when he or she visits the school.

Most teachers are well aware of problems, but work their hours and leave the rest for the ever waiting tomorrow.

Back to the example of the 14 year old boy.

When the school would be aware of the problems the boy faces when he sees so many other kids in the classroom, he can be referred to a school with less pupils.
In fact, most children with these problems are.
But the government doesn't want to many special schools, so there's a lack of places.
Provide what's needed for good education, fitting the needs of the child.

Provide each school with the professionals needed to signal problems and to assist teachers to deal with it in the classroom.
These facilities are available outside the school, but they need to be paid for from the school's budget.
Only a limited amount of money is available to diagnose problems.
Only when a diagnosis is available, preferrably from a psychiatry (waitinglists are enormous at places), the procedure to get extra money will be put in motion. It can take a year before money is available to the school to do more for a child who needs it.

Start a schoolinsurance for all children, which provides diagnosis and treatment within the school.
I'm sure far more parents will agree with treatment then.
The treatment will be at the place where the child experiences the most problems, so it'll be able to try out new behaviour under the eyes of the therapist, taking away in the initial stages problems like generalisation etc etc.

In fact, dealing with children and their parents this way guarantees
  • more children will be diagnosed in time
  • children will receive treatment in the early stages of a problem (less cost, quicker improvement, prevention of future severe problems
  • involvement of the teacher
  • treatment at the place where most problems show
  • more acceptance of treatment
  • a perfect startingpoint for treatment at other places too, for instance outside school or at home.
  • neutral place for working together with parents. More chance to work as a team.
In the case of the 14 year old boy the change of law Vivianne Dörenberg wants is not necessary.
She states that parents are not always able to see which treatment a child needs and she even states that family life is too much idealised (whatever that means).

But often parents are not heard when they're concerned, and often the school doesn't take action before it's too late.

The new law of Dörenberg victimises the child, makes the child itself and the parents responsible for a failing system.
Instead of prevention by finding the faults in the system and attacking them to the benefit of the children, Dörenberg choses for repression of people. (And, which is worse, leaving the system the way it is, this facilitating other children to drop out.)

All children are seen by socalled professionals in the educational system from about 2,5 to 5 years of age.
There's no law that brings these professionals to court when they won't listen, when they don't want to see what goes on, when they fail to offer a child what it needs at school, when they accept bullying and other unwanted behaviour.

There's one remark I want to add to the case of the 14 year old:
In the past there were plenty of opportunities for individualised education, so children needing individual attention could get it.
Now there are only opportunities for those who are physically handicapped and/or have autism. Access it terribly difficult, as the young person should be 18 and referred by the UWV.
It's time we erase the age requierement and make this form of education accessible for those who need it.


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