On the Friday afternoon before a bank holiday weekend, of all times, the Health Service Executive announced that a further 151 young people known to the HSE have died over the past ten years. These are in addition to the previous announcement that 37 children and young people died while in the actual care of the HSE, making a total of 188 in ten years. Of these 151, they claim that 102 died of ‘unnatural causes’ including, in some cases, murder (Irish Times report). According to the HSE children known to the HSE are defined as follows in compiling these statistics:

Children who were known to social services and for whom there was a child protection concern referred to the social work department. This group refers to children who would have had ongoing contact with child protection services (an open case) at the time of their death and also children who died up to two years after their case had been closed (i.e. no further involvement was deemed necessary by social workers at that time). Within this group there would be a number of different circumstances arising such as youth homelessness and children under supervision orders but living in their own home.

and

Young adults between 18 and 21 years of age who had previously been In Care but who were no longer In Care at the time of their death in so far as their death can be established (for example if the young person was no longer engaging with aftercare services, had moved to another jurisdiction etc the HSE may not have not have details).

These quite shocking figures raise an important and potentially disturbing question as to the level of care that is really provided to young people who are in the physical custody of or known to the HSE?

We know that for years there has been a deficit of appropriate housing for young people in this State; indeed, for many years young people ostensibly within the care of the State have in fact been put up in Bed & Breakfast accommodation from which they are ejected in the morning, left to wander the streets all day, and to which they may then return in the evening. By any standards, this is not adequate from a care perspective. Inevitably these young people tend to be adolescents as opposed to younger children, but even when younger children are in foster or other care there can be serious difficulties of effective care often (although not always) emerging from an abject failure of the part of the State to properly resource the care of younger people who, for whatever reason, become reliant on the State in the short or longer term. Some of these children and young people who died will not have been within the physical custody of the State but will have come into contact with the HSE and other state services—questions begin then to arise as to whether at least some of those who died from unnatural causes, were known to the HSE and were not within the care of the State in fact ought to have been.

Deaths in the care of the State raise clear questions and place clear obligations on the State. Under Article 2 of the European Convention on Human Rights there is a positive obligation on the State to carry out an effective investigation in to every case of death in State custody. Failure to do so is a breach of the right to life of the individual deceased. In a press release on Friday evening the HSE confirmed that it intends to work with the Independent Review Group established to investigate these deaths. Whether or not that investigation is effective and adequate from an ECHR perspective at least will depend to a great extent on its independence, openness, access to files and information, and capacity to make recommendations regarding criminal prosecutions if and where appropriate. At this point we must simply wait for any required legislation to be introduced (hopefully before the Dáil breaks for the summer?) and for the investigation to take its course. However, the reason for the delay in this investigation seems at least partially to be that until March 2010 there were no national guidelines for the notification of deaths (natural and unnatural) of children in care and those known to child protection services. This in itself is exceptionally problematic and potentially points towards a disregard for the life of these children and for ensuring accountability and transparency in the event of their sad deaths that may engage the State unfavourably with Article 2.

Quite apart from the legal questions of Article 2 however (and these will undoubtedly be considered by the investigation itself), the more fundamental difficulty here remains the failure by the State to truly and adequately provide care to those who need it, whether those individuals are children, people with disabilities, the elderly, poor people or persons who otherwise experience economic and social exclusion. One can not, perhaps, expect a State to prevent the deaths of all children within its care or who we know need its support, but one can expect the State to (a) know with some precision how many of these children and young people have died; (b) have a clear and uniform reporting mechanism in relation to these deaths; (c) investigate these deaths especially where the deceased was within the physical custody of the State; and (d) demonstrate effective care. One might be forgiven for thinking that in all of these contexts our State has failed these children.