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Kate Naude had nowhere to take the boy. So she removed all the knives from the kitchen drawer.
She hid anything that could be used as a weapon and brought him back to her house.
Naude, who is a social worker and the manager of MES Christian Social Council in Joburg, had been struggling to place the 13-year-old who had been removed from his home for some time.
The child was violent and aggressive to the point where he seemed beyond the social system’s help. He had spent time in the child psychiatric ward at Chris Hani Baragwanath Academic Hospital.
She tried to put him in a place of safety, but waiting lists were too long.
She got him into a children’s home, but they asked that he be removed.
Eventually, after a long battle, he was placed in Emmasdal Child and Youth Care Centre.
“We do not know where to go with these children,” says Naude, “Some of the social workers lie about the behavioural problems of children just to get them into a place.”
This ongoing struggle to place children or move them when facilities find them too much to handle means social workers don’t get through their case loads.
It feels like nobody wants these “bad” children.
Professionals at all levels of care that The Star spoke to said they were landed with children who were inappropriate for their facility.
Even at Emmasdal, which is essentially the end of the line for these children, staff complained they had children with problems beyond their training or capabilities.
Staff said six of their 29 boys had psychiatric problems vastly more complex than pure conduct disorder.
“We have care workers who are not trained for that type of care,” says the centre’s director Thabo Maila. Once placed in the centre by court order, the process to move the child is extremely slow. And there’s nowhere for the child to go.
“There is no doubt that these children are difficult to care for. They break things, they are disrespectful and aggressive.
“Children who have only ever been shown violence will use violence. Children who have been sexually abused will in turn be sexually aggressive. They have no empathy for others. They will hurt other children or our staff without feeling sorry about it,” says Maretha van Zyl, child-care manager at Abraham Kriel Children’s Home.
“It’s so time-consuming having the child (in the home) because one person has to be constantly looking after that child,” says Sasam Reuben, residential service manager of COACH, a group of three children’s homes.
Lack of staff means homes must choose between the good of the individual who needs a lot of attention and the group.
“We have to think, can we afford to keep (the child) here because he’s a danger to us?” says Van Zyl.
“We don’t have the resources, we don’t have the expertise needed by child-care workers and by educationalists,” says Morgan Courtenay, attorney at the Centre for Child Law.
The effects for more “normal” children exposed to this extreme behaviour can also be damaging.
They experience bedwetting, fear of going to their rooms and nightmares. Even being witness to violence or inappropriate sexual behaviour, regardless of whether they are directly involved can be traumatic – it reminds them of what they experienced at home.
Other children in the home battle to understand why some children appear to get special treatment.
“They break a window, you can’t ignore that. They bully someone, you can’t ignore that. They display sexual behaviour on another child, you can’t ignore that. So the good children end up not getting enough attention from staff, they tend to be invisible at times,” said Hilario Zimudzi, social worker at St Mary’s Children’s Home.
For many homes, those services that do exist, for example Abraham Kriel specialises in severely traumatised children, might as well be invisible because they cannot access them because of waiting lists.
All the homes The Star spoke to reported not having anywhere to place troublesome children.
The desperation that sets in when caring for these children sometimes causes children’s homes to look to other aspects of the state to help them.
Homes reported needing to call police when violent incidents happened or trying to admit children to the psychiatric wards of hospitals so that they are assured the other children are out of harm’s way.
Section 191 of the Children’s Act places these children as the responsibility of the Department of Social Development.
Courtenay says there was a shift to push these children into psychiatric institutions, which is incorrect.
Psychiatric institutions are for the acute care of psychiatric problems.
If a child has pure conduct disorder these children need behavioural, not medical intervention. Mood, anxiety and psychosis can be medicated and bad behaviour maybe a symptom of these things, but a child’s behaviour alone does not necessarily mean they need medication.
“The answer is not in giving medication,” said Professor Deborah van der Westhuizen, head of Weskoppies psychiatric hospital’s child psychiatry unit. “The answer is not in sending them to a psychiatric hospital (for pure conduct disorder).”
Most homes point to a lack of funding as a driver of their inability to handle rising behavioural problems.
“Due to the huge financial crisis, it’s making it impossible for facilities to do what they should be able to do,” says Jackie Loffell, co-ordinator of the Gauteng Welfare, Social Service and Development Forum.
Some prominent voices on the children’s homes circuit did not want to be named in this story for fear they would lose their subsidies.
These institutions source a large portion of funding themselves, with different children’s homes reportedly getting between 15 and 75 percent of their funding from the government.
Loffell says because children in children’s homes are there by court order, and therefore wards of the state, the government should take responsibility for the core funding of their care.
Lack of funding leads to low staff-to-child ratios in homes and as caregivers who are not correctly trained become emotionally exhausted, standards slip.
“Sometimes there are people with good intentions, but not significant training,” said Van der Westhuizen.
“A lot of the child and youth-care workers almost take a view that these children should be normal, they want these children to act as if they were in an ordinary nursery school,” says Courtenay.
Department aware of its moral, legal obligation
Department of Social Development spokesman Dr Sello Mokoena has confirmed that Emmasdal CYCC was the only designated state care facility in Gauteng for children with severe behavioural problems or chronic psychiatric issues.
He said the department had wanted to have a designated place for boys with conduct disorder so they would not need to be referred outside the province. Engineers were currently surveying the building of the former school of industry, JW Luckhoff, with the intention of opening it as a girls’ facility.
Mokoena said subsidies to all NGO and welfare organisations were reassessed annually and adjusted accordingly with inflation.
“Conduct disorder is a priority,” he said. “We are under not only a political obligation, but a moral and constitutional obligation to provide these services.”
What is conduct disorder?
Children with conduct disorder are often viewed as bad or delinquent rather than mentally ill.
They act out to the point that they can’t lead a normal life.
They may be aggressive with people or damage property, impulsive, hard to control and often come across as unconcerned about others’ feelings.
They are insensitive to norms and rules and often struggle to finish school.
The cause could be a difficult family life, socioeconomic factors or a genetic predisposition.
They need a structured environment in which they know their boundaries, but are given affirmation and love.
Treatment can be slow.
If untreated, these children can grow up to have anti-social personalities and will begin to rebel against other systems as they grow older and, potentially, fall into crime.