Runaway children: whose problem?BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7087.1064 (Published 12 April 1997) Cite this as: BMJ 1997;314:1064
A history of running away should be taken seriously: it may indicate abuse
- F Lawrenson, Community paediatriciana
- a Child Health Department, Leeds Community and Mental Health Services, St Mary's Hospital, Leeds LS12 3QE
Surprisingly little is known about the extent or importance of running away, particularly in Britain. The police collect the only routine statistics, which are probably an underestimate because of variations in data collection and because parents may not report children who are thought to be safe or who have been abused or thrown out. The total number of reported runaways was 43 000 in 1990, a rough incidence of six runaways per 1000 children per year.1 By combining the police information with that from a school population study2 and projects involving young people living on the streets and in safe houses,3 it is possible to distinguish two main groups.
The population survey showed that episodes of running away are quite common. One in seven children aged under 16 say that they have run away overnight, giving a rough incidence of 12 runaways per 1000 children per year. Most are one off episodes, and these children do not go far and generally go alone. They are more likely to come from poor backgrounds and reconstituted families and to have previously played truant from school. However, some of these children are very young (11% were under 11 years), and the fact that half of children running away slept rough suggests that this is not undertaken lightly or for fun. Not enough is known about why these children run away; it may be temporary rebellion, exploration, or unhappiness. Some are not reported missing, and some children establish a pattern of repeating what may be an unpleasant experience, so it is important to consider why a child should do this.
There is some overlap between these cases and children in the second group, who establish a pattern of running from their families as an escape from abuse and rejection. This becomes entrenched if they move into substitute care, particularly if there have been frequent placements. These frequent runaways are overrepresented in the police statistics, in which 30% of children overall have run away from care (particularly residential).
The sequence seems to be abuse or rejection followed by gradual dissociation from families, schooling, and social support. This detachment seems to be inherent and is probably related to previous experiences as much as being in care, and as such it is difficult to redress. Not all chronic running away is from substitute care, indicating that protecting adolescents living with their families can be difficult. The incidence in Britain resembles that in North America, where high rates of previous abuse, up to 75%, are reported.4 In such cases, running away should be considered as a failure of child protection, as these children report years of ill treatment before choosing to escape.5
Running away may have positive aspects, especially in escaping abuse, but chronic running can easily drift into homelessness with its associated morbidity and vulnerability.6 Access to services becomes difficult, although successful schemes are described.7 Not much is known about the health or needs of young homeless people in Britain, but in the United States this group has more physical and mental health problems related to accidents, poor nutrition, untreated infections, drug and alcohol misuse, and sexually transmitted diseases.8
The links between childhood abuse, running away, street life, and prostitution in Britain were discussed in a recent report.9The Home Office statistics for offences related to prostitution show an increase in both convictions and cautions for children aged under 16 in 1993 (162 and 664 respectively), and this included the successful prosecution of three 12 year olds. It has to be asked whether prosecuting the children rather than the perpetrators is appropriate.
The true incidence of prostitution in runaway or homeless children (that is, of sexual abuse) is not known. It is not readily disclosed, but recent figures suggest an incidence of up to 20%.3 Many of these girls are from residential care and are vulnerable to abuse. During the screening of 210 adolescent girls (mean age 14 years) from residential care in a genitourinary clinic 10 years ago, it was noted that 22% had engaged in prostitution and 31% had had two or more sexual partners in the preceding four weeks.10
Running away should not be viewed as a normal childhood milestone, and as a means of coping or escape it is not a good option for an abused teenager. There are issues of protection for children at home and also difficulties in meeting the needs of frequent runaways, but is it possible to offer more? Accessible services such as street work projects should help, but there are only 25 refuge places for children aged under 16 in the whole of Britain, all in the voluntary sector.2 The Children Act aimed to enable more of this provision, but it has failed so far. A history of running away should be taken seriously and abuse considered if there are several episodes. There is a need to provide more coordinated and effective services to reduce the morbidity for these children. Who should take on this responsibility?