Connecting Research: Why social workers turn a blind eye and avoid mental pain in child protection

This is Messi's social work and I am Rich Devine, social worker with 15 years experience in child protection and I'm Tim Fischer, a passionate about participation and curious about community. Well Rich, we've got a research and focus episode this way, come way. Yeah, we do. We speak to Margaret Rustin who is a highly respected child and adolescent psychotherapist whose career has been long associated with the Tarristot clinic. She's been a clinician, a teacher, a leader, a writer, helping shape how we think about children's emotional lives, relationships, trauma and development. And as the former head of child psychotherapy in the dean at the Tarristot, she's kind of influenced, I suppose, many, if not generations of practitioners and had a lasting contribution to child mental health services. So we speak to her about a kind of highly influential paper that she wrote some 20 years ago now. And the paper is called Conceptual Analysis of Critical Moments in Victoria, Klembea's Life. So the paper was accepted for publication in 2004, just 22 years ago now. And it might be worth just given a little bit of context before we jump into the interview about Victoria Klembea because I'm sure she would have been covered in a lot of social work programmes. I'm on the podcast tour. What are you after? I'll be finishing like five minutes. Don't even call me dad anymore. I'm not present enough for him to call me on such interviews. No, no, no. That's not what it is, Rich, you've said specifically that he has called you, Rich, it's divine. So an overview of Victoria Klembea. So she was an eight-year-old girl from Coat to Ivory Coast. And her death in London on the 25th of February 2000 became one of the most significant child protection strategies in UK history. And her case exposed lots of failures across social services, healthcare, housing and the police and led to quite significant and major reforms in safeguarding children. So just a little bit of an overview. Victoria was sent by her parents to live with her great aunt Marie Koehwa, who basically promised to provide her with a better life, better educational opportunities. But instead what happened is that Victoria suffered months of severe physical abuse, neglect and cruelty from the great aunt and the great aunt's park and the cold manning. So she was repeatedly beaten, starved, isolated and subjected to pretty horrific treatment. And when she died, she had more than 128 separate injuries on her body. And during the professional's involvement, the kind of months leading up to her death. Victoria, it kind of stood out as a case really because she came into contact with lots of different professionals. So she wasn't particularly concealed or hidden from professional abuse or they made some efforts to do so. So social workers saw police officers, doctors and nurses, there's housing staff. So many professional source signs of abuse, the abuse that the concerns weren't effectively investigated or shared essentially. And so the case highlighted failures in communication, assessment, recording, supervision and interagency working. And there was a big inquiry at the time that was undertaken by Lord Laming. And it reported in 2003 and basically was very, very critical and identified to widespread systemic failures. And it made an astonishing 108 recommendations. But some of the findings were around poor information sharing, lack of professional curiosity, a failure to listen to the child, weak management oversight, inadequate training, supervision and a failure to take responsibility. So the impact on the other thing query led to quite major reforms, as I mentioned, including every type of matters at the time 2003, the children out 2004, the creation of local safeguarding children boards, the great earpsis on multi-agency safeguarding. And so there were lots of lessons that came out of the review. But we spoke to Mark about her paper because she felt that the, well, we'll let her speak for it. But she kind of felt like the review that was undertaken by Lord Laming didn't capture some of the kind of emotional and relational dynamics that might have been played out and therefore missed some opportunities for even more learning about what the practitioner was thinking of the led and how they were, you know, relationally interacting with Victoria and her aunt and her partner. So we, yeah, we get into all of that. So should we jump into it? Yeah, let's do that. And we should say, well, how should we explain this, Rachel, that we start, we did tend to be a two-handed interview, but just to explain that Richard asked the first question. Well, it's easy to explain. I had a migraine and I tried to persevere with the interview and I said it might, I'll try my best, but it might be possible that I did about, but I lasted about two minutes. So I asked the first question and then I have to just literally leave the middle of the interview because I felt like I was going to be sick. So apologies for that, leave them Tim to take the helm. Well, no, we, I think it's worth saying that because Margaret did kindly say, we thought we'd, because the conversation with Margaret did focus on this paper, we put it out as a research and focus about that paper in particular, but we did want to come back and have another conversation with Margaret, a more wide-ranging one and she kindly said that she was willing to do that, but we thought it was really, really useful to put this conversation out about that specific paper. So yeah, and we can, yeah, segue into that, segue into that now. Yeah, let's do it. I thank you for doing the last, Margaret. We wanted to talk to you about a few things, but one of them was a paper that you wrote maybe over 20 years now about the death of Victoria Columbia, or more specifically the response to Victoria Columbia. And I just wondered if you could begin by saying what you felt was missing from Lord Layman's analysis that you kind of wanted to add. Well, I think I'm going to tell you how that paper came to be written, actually, because it'll be relevant to what you asked me. I mean, I think that the Columbia case, like one or two of the others, maybe P, for example, somehow really hit the headlines very, very broadly in the health and social care field. And my colleague who was head of social work at the Tabestock at that time put forward the idea that we would have a one-day conference really discussing the Columbia case and Lord Layman's report. And he asked me to write a paper to contribute to this conference. So I spent a long hot summer reading every word of Lord Layman and thinking about it. It was, you know, it's a very long document and there's a lot to take in in it. And I think that what I felt was missing, what I wanted to bring out in what I did write about it for that occasion. And then it was published subsequently. Was something to do with really trying to make sense of two different things that struck me very much. One was, you know, one of the things that lay me himself. Commented on was nobody ever spoke to Victoria on her own at all the only people who'd ever Done that it were people who were within the system people who didn't really count like the nurse that was looking after him One of the hospitals during one of her hospital stays who happened to speak French, which was obviously a much easier language for Victoria Because she lived in France for quite a long time, but such information was not sought to be relevance That a person like that was never asked. What is your impression about Victoria? What do you know about her the people who actually got to know her a bit? Yes, so I thought her voice was very much missing At the literal at the literal level of what does she say about anything? But on the other hand what was present were very vivid descriptions of how she was how she looked and her behavior As well as what was actually happening to her viewed from outside viewed from outside this, you know, tremendously powerful story of this very very pretty lively girl With the the famous picture that was included on the front of the Laming Report Leaving Africa to come to France and then to England Yes, I think the unbelievably be drag-old bundle of subhumanity that she was reduced to. So I felt that there was a lot to say About Victoria's experience to add to of course, it's you know, it's a it's an imaginative conjecture Nobody asked her and it's an interpretation of the material that was gathered in the Laming Report But I found it very convincing myself. I felt as a child psychotherapist Thinking about what it might have been like to be this child First going to France then coming to England on a false passport Pretending to be something that she wasn't but she had to agree to pretend her name was something else Otherwise the passport wouldn't have worked Yes Then England lots of different places that she lived with her aunt and then with her aunt and my name once he moved in and Lots of different institutions that she At one time or another encountered So to absolutely be wieldering a total absence of anywhere that could have made any sense to her really And um you open the paper Margaret As you just said there about saying that it's struck you the professionals and perhaps the report itself you can correct me on that perhaps report itself Um doesn't attempt to get into The professionals and the report preoccupies is preoccupied with the physical Injuries, it doesn't try to um Get inside what Victoria was Really thinking of and feeling Or indeed the meaning of the awful cruel behavior of her Aunt and her partner What what was the meaning of that? Why did they Do all this to this child because I think the material in the Laming report does help us to imagine How people could end up doing such absolutely awful things Why do you think professionals shied away from that process of mentalizing what was happening For Victoria well, I think the central thing is that the to get close to Imagineatively to the sort of emotional pain the mental pain of a child being treated like this Repeatedly encountering a grown-up world which does not pay attention to her situation effectively It's it's very shaming. It's very shaming of our society at that time Social services the police numerous medical staff in hospitals and so on had been in touch with her nobody You know a long long sequence of people nobody does anything about what should have been happening Yes, and then there's the I mean in terms of the feelings of shame there's also The fact that there's a church involved in this and the idea that What was wrong with Victoria was that she was possessed and of course the possible belief of her aunt that she's You know trying to drive out without these possessive devils. This is the basis for some of the cruelty that was inflicted on her So I think it is very very painful to imagine this To get closer in in one's heart really once head and heart to what it might be like to be a child Going through such experiences And I suppose the other thing that I wanted to say at a kind of broad level is that What was so striking Was that it's not only all these individuals who Seem not to have seen or heard in a meaningful way what was before them But it's also the institutions that they work for which don't ask the right questions and which seem to Allow so much sometimes rank dishonesty, but at the very least Very very poor quality work, and of course it's that side of it that Lord Lening tried to take up I mean he could absolutely see that professional procedures were not being followed by numerous professional Staff in numerous settings and he pointed this out so that his emphasis was very much What's going wrong these people must be trained. There must be better supervision all of which is extremely sensible but as you Pointed out in your question to me. It did leave out Perhaps an explanation as to why it might have happened. Why did people professionally behave so badly? Yes, and you alluded to the farft of the facts there was a dishonesty and yeah Obfacation afterwards. Yes, professionally. I mean, yeah, this is a loss of records. I mean you name it. I mean he used that phrase that some Turning a blind eye. Is that what I call phrase And also the term but defending or Uh, and is that Could it It was it was was there something That is hard for all the professionals to turn to face In this that would be present in another serious incident or another lived experience or lived story of a child Or was there something Particularly that went wrong that was specific in this instance Well, I think I would want to say that every one of these complex child protection cases is particular in and it's really important to remember that the the people who treat children badly and the experience that children having Being treated so cruelly is always quite particular and what brings it about you know when really needs the detail The detail of the story Yeah, I think that Perhaps what was unusual about this case was not only of course that It became so prominent that there was this massive piece of work done and You know a lot of change it legal changes in consequence of long lamings report and a lot of changes in Approaches within probably particularly within social work. So it's not they didn't have any effect But I think when you say well, what is this turning a blind lie? I mean that's a phrase We used in every day language It's also a phrase that was picked up by a psychoanalyst called John Steiner who's written a a great deal about very serious difficulties in states of mind What he linked the turning a blind eye phenomenon to more generally not not just in in terms of this case But I was using his phrase to help me to think about this case But his idea is that the turning a blind eye is very much connected with what he he would describe as borderline pathology And the borderline pathology is very much to do with Sort of knowing something and not knowing it simultaneously And I think that's a very good description of what the professionals faced with this sort of situation can be taken over by Because obviously they did know I mean they could see Victoria's injuries she was taken after all to And seen by doctors on quite a number of occasions You know among many other bits of the story there were local authorities were involved both at the level of social work And at the level of housing and rehousing and the innumerable people Had some contact so in a way they knew something they knew something that was going on It was very peculiar for example They would have really rather clear evidence that what Victoria said was clearly an echo of what her arm to just said in some of these interviews So this is not a child speaking for herself. It's a child saying what she feels she has to say Now that's the sort of thing that should alert professionals to inquire further So there is something that's known but I think because of the degree of distress, mental pain you know guilt on behalf of our whole society that a child could be in such a situation All these awful things that everybody who had really faced up to it would have to confront. There is the retreat to, you know, noticing and not noticing simultaneously. And you, I think, was it Andrew Cooper, you referred to earlier, was he ahead of social work at the time, was it? He was professor of social work. He was very much involved at the same time, and he also wrote about the Laming Reporter, and very much encouraged me to get it published in a social work journal, because he wanted what I'd said to be available to social workers in more broadly. I wish it has been golly, it's been widely read and cited. I mean, obviously that was a bit of a surprise to me, but there we are. That's what happens. Yeah. Well, it seems to me, and just from, I mean, I'm a social worker, but almost a lay, a lay social worker reading of it, that it is that you're going inside and trying to understand victorious lived experience and not turning away from it, it gives the paper its power, but also it has a real relevance for, I think, the day-to-day practice of social workers, you know, this is a very extreme case, but that attention too, and I just think it's interesting what phrase you're used. We know we often talk nowadays about lived experience. That's the kind of category that's become every day, hasn't it, in professional discourse, which I don't think it was at the time of these early events at all, but it's become something that people do feel they should be listening to. But to listen to a child's lived experience, you have to be able to observe the child. You're not going to be giving it on a plate. You're not going to be told it. I ask in questions for the most part. Well, and you do pose the question about social workers and social work practice, and you correctly say that social workers in our training. And I suppose also there's assumed in our disposition and our social workers of vocation and where we would expect to be able to connect, communicate, understand the children and young people, but you leave that question hanging almost in the paper about what were the realistic expectations in that situation. You mentioned Victoria herself, and as a secretive child, is that the phrase used, I think, and how it wasn't going to be easy to sit with that, to sit to see her on her own to be with her to observe, but it should have been done, but it wasn't going to be easy, yeah. No, it wasn't. I mean, I think the word secretive, I used partly because she had been taught by her aunt to keep a secret, which was that I'm not really Anna. I'm pretending to be Anna. And that assault on her, her lived experience of being a person with a name, an actual person. To her family, she's one person, the family that she left behind in the ivory coast. And when she pretends in order to get through border control, et cetera, et cetera, to be somebody else, she's losing contact with her own sense of reality. So I think the idea of something secretive is sort of built into that pretence, which has to take place because she has to pretend to be somebody other than the person that she is. And you referenced a double bind in the beginnings of all of that when her parents send her away. In some ways, this is something that's a status that she's been given a status as the child that can go abroad, can get an education, can succeed. But the other side of that is that she is being sent away from her parents and from from her happy home. That's what struck me very much, that I'm sure that she was felt to be given this by the family as, you know, a wonderful gift. But actually, to be the child who is sent away and not staying at home with everybody else, and it may have been given out of admiration for what her lively little girl she was. She certainly looks at it in that remarkable photograph, as if she would have been reaching for life in a big, big way. Yes. So I'm sure she set off with the idea that this was a great adventure of her life, a wonderful thing. But I don't think that's the only story to be told. And there are accounts of a sparky presence in the hospital, and there are. It could come alive in certain circumstances, and that's very, very important. I think, you know, the language issue is one of them. And of course, as in so many of these cases, I think the ethnicity of this family and people's responses to that is another considerable complication, because there was such a kind of a lot of anxiety about being respectful of other people's culture, et cetera, being respectful of a, for example, of a church that would teach that children can be possessed by devils, and that there's a way of, you know, exorcism or beating it out of them. People find it quite hard to confront these things because of the risk of being accused of being racist. Yes. I think that was another quite big dimension of the people's fear of tackling what they saw. And yeah, in a sense, and circling back to that idea of lived experience, and maybe we have as a reference point in our practice now, she would radically strip of her identity in a heartbreaking, heartbreaking way in that bath in the bin bags. But also, there were these template identities that professionals were overlaying on her. And in the respect that you pull out that professionally who talks about the action aid poster striking, wasn't it? Yes. Very striking. Yeah. Yeah. They're just reaching for a stereotype. And as you say, more in a way that's more ponacious and stereotyping around both places for child without actually relating to the situation that is seen. That's what's so distressing about it. Yeah. Yeah. And a fear and then a fear of the of the art and and which played into them. Yeah, I thought she was a frightening person. I don't yes. That you know, one would have needed firmness and courage to tackle all of this. Can I turn to we might think about what could be some, I mean, the lessons are there in the paper and in the way that you talked about it. Well, I'll get in this conversation, but we might turn to thinking about some what is the learning for social workers now, perhaps in today. But before we do, I just wanted to come to the rich is really a conclusion that you drew in the paper, which is very important, but very, very difficult to read, I think, or difficult to countenance. And that's the fact that hope, I guess hope, can be destroyed. I mean, do you want to say a bit about to develop that a little bit? Well, have I put that into stark? No, I think the stark is what's there. I did want that to be real that when we see that picture of this child lying in a bath in the way that's described with her extra mental around her cold wet dirty. I mean, it's just so absolutely unspeakable image. I think that that is somebody who it seems to me would no longer have had the power even if somebody had walked into that room to say anything. I mean, anybody seeing that would see that there's somebody who needs to be rescued, but I don't think that the child believes that anybody will ever come or that there is such a thing as a world that could hear a child. And I think it's quite striking because of course, once emphasised that, you know, so many people had the chance to see something and make something of it and fail to do so. But we do have to bear in mind the Victoria never drew people's attention to her situation. So the hope of being heard was very weak in her in any case. And my way of understanding that, and I think this very much arises from my experience of working with disturbed young children, is that she had come to see herself as rubbish, as unworthy of being seen as a little girl who should be looked after in an ordinary proper way. She saw herself as shit really. So instead of believing that there would be something that she had a right to say to a teacher or whoever, something's wrong, please help me. never, never, never did. So I think we have got a kind of a conjunction of something that's very wrong in our systems of social responsibility for children in these terribly distressing circumstances. But there's also the question of what the child can do from their side. And I suppose this links with what we were talking about before. When I said that I, and you picked up on that, that she might also have felt really thrown out and rejected by her own family. On the one hand, there's this wonderful thing that she's going to have, but when it turns out to be so anything but wonderful, perhaps the belief was, I'm really a no good child, that's why they didn't want me. And then there aren't an internal resources in this little girl's mind to turn to. So the external reality of her aunt and manning takes over. That's all there is. There's no memory of being loved and felt to be a person of value anywhere. That's what I meant by the death of her. Yes, yes, very profound. I mean, we talked about that phrase lived experience. The other perhaps overused phrase, form of words which can become using quite a cliched way is, you know, this idea of voice, or we might say, you know, the child's agency. And there's a week, one response, and maybe that was just talking off top of my head. But the Lord Laming's response was to look at the systems of support and welfare and how we can gather children up and respond and protect. But that element of voice and agency and ability to act was so extinguished. And it feels so voice and agency which can become a cliche in our services, you know, and become sort of defined and boxed into or even boxed in into sort of, you know, this participation thing or actually that's so fundamental, isn't it? And what you said there is it's the service response, but also opening up the space, you're allowing the space for agency for the capability of the person to act, yeah, and to share voice. It's a really useful thing that you're picking up because I do agree, it can easily become something of cliche, but also it can be dealt with in a very, very concrete way. So, you know, lots of good arrangements can be made, you know, people ask children about their experience, I'm sure, you know, much more carefully subsequent to all of this than they did before. But the point I'm trying to make in describing Victoria's situation is that if somebody had asked her, they might have heard something relevant, but I'm not sure that they necessarily would have done. She was very good at saying what she thought she had to say to survive in relation to her aunt, which would be to say what the system needy should be told from the answer point of view. So, I think she really lost her sense of the kind of mind of her own for much of the time that she was in England. So, that I think that when we talk about voice, it's as if if you just open out and try to be responsive to, then you're going to find out the truth, but that really leaves out all the things which it's actually difficult to know about in oneself and what it was difficult for Victoria to know about. I close in my language, it leaves out the unconscious, and if you leave that out, you're leaving an awful lot out. So, you've got to be thinking not just about what can be explicit and said and demonstrated, but what is the whole picture telling you if you actually observe a child, not just ask them things, but spend time, observe how they relate to themselves and to other people. That's when you'll get the understanding of where they really are inside themselves, but that takes time and a lot of skill. That's really clearly, as really clearly said, and would that be your prescription for the social workers? Well, I would love it if there were workers who could really specialise in that, because social work is a very, very broad profession, and people train and they might do many, many different kinds of social work. So, I think it would be really highly desirable that there should be a strand within social work where people would learn to observe children in a much more detailed way than you could offer in a general social work training. Something more for particularly to have available in dealing with the children who are then not going to be safely brought up in their own families, all the looked after children. Well, it's interesting. You say that at a time of national reforms and these new lead child protection practitioner roles where the requirement is that they have five years post-qualified. So, you said they're land swaps. Well, it's more experience, that's jolly good, but at one the right experience and time to pick up these more subtle skills, really. Well, we really appreciate you joining for the conversation, Margaret, and I'm going to touch base with Rich and see how he is, because he. Please do. Was it? That's fine. Okay. Okay, Margaret, nice to meet you. Bye-bye. All right, then Rich. Well, thanks very much to Margaret. Yeah, much appreciate for coming on and speaking to us. Yeah, yeah. And, yeah, we will. Yeah, when the heat wave is over, over and there we've got like Bastid's talk for longer, we'll have her back. And that would be great. And, yeah, let's. Well, we'll see you all next time. Yeah. See you later. See you later. Bye. [Music]