I wrote on Monday about the many desperate parents who have approached me after losing their children to social services. One thing that they all have in common is shock at how quickly the system seems to decide against them, and at how doggedly it sticks to that view despite all evidence to the contrary. Some parents find that minor issues are magnified until the conclusions reached are out of all proportion. The opposite also seems to hold true: some children come to terrible harm because the system systematically underestimates the risk to them.
Why does this happen? Eileen Munro, a reader in social policy at the London School of Economics and the author of Effective Child Protection, says that “child protection work inevitably involves uncertainty, ambiguity and fallibility”. She believes that it is human nature to form a view based on first impressions, and stick to it. “This has a devastating impact in child protection work,” she says, “in that professionals hold on to their beliefs about a family despite new evidence that challenges them. It can be equally harmful whether they are over or underestimating the degree of the risk to the child. They may continue to believe parents are doing well, even though there are successive reports of the child's being distressed or injured. Innocent parents wrongly judged abusive can face the frightening experience of being unable to shake the professionals' conviction, however much counter-evidence they produce.”
The risk of groupthink makes it all the more important that decisions are transparent and open to review. We all know of the tragic deaths of children such as Victoria Climbié, who with hindsight should have been saved. We know much less about the tragedies of children wrongly separated from their families, because of the secrecy of the system.
There are several types of allegation that are almost impossible for parents to disprove. One is “emotional abuse”. You can see why the category exists. Ill-treatment comes in many forms, not all of which leave visible scars. But in that nebulous phrase lurks the potential for injustice. In the past ten years there has been a 50per cent increase in the number of parents or carers accused of “emotional abuse”. It now accounts for 21 per cent of all children registered as needing protection, up from 14 per cent in 1997. Yet the term has no strict definition in British law.
Emotional abuse is not “neglect”: that is a separate category. The Department of Health defines it as “persistent emotional ill-treatment ... [that] may involve conveying to children that they are worthless or inadequate ... and may feature age or developmentally inappropriate expectations being placed on children ... Some level of emotional abuse is involved in all types of illtreatment of a child, though it may occur alone.”
Local authorities interpret this in different ways. In Nottingham, emotional abuse is “an ingrained pattern of interaction ... which it is essential to observe and understand over time”. In Enfield it includes “swearing”, “conditional love” or “discriminatory remarks”. I have heard anecdotally of councils, including West Sussex and Cambridge, that almost never use the term. There are no statistics to confirm this. But it seems that child protection is as much of a postcode lottery as cancer screening.
Expert medical evidence is also notoriously difficult to disprove, even where there is no circumstantial evidence. Lord Justice Judge (who was named as the next Lord Chief Justice yesterday) has warned against an “over-dogmatic” approach in the criminal courts, when we are “still at the frontiers of knowledge”. But it is less clear how family judges should treat syndromes such as Munchausen's syndrome by proxy (MSbP).
Since the discrediting of Professor Sir Roy Meadow, who first defined it, Munchausen's has been relabelled as “fabricated or induced illness”. This is a perverse disorder in which an adult invents or deliberately creates a child's illness to draw attention to himself or herself. Even the experts agree that Munchausen's is rare, likely to affect no more than 50 people a year. But campaigners fear that far more people are being accused of it. For the traits of the Munchausen mother are broad enough to cast suspicion on many whose children are genuinely ill. They include a reluctance to leave the sick child's side, familiarity with medical terms and, most devastating, the denial of accus-ations of abuse.
Two years ago, a group of MPs with falsely accused constituents asked the Government how many people nationally were accused of having MSbP. The Government replied that it did not collect such data - even though Department of Health guidelines tell charity workers, nursery nurses, teachers and even pharmacists to look out for the condition.
Last year, social workers in Hexham told a pregnant student at Edinburgh University that she was in danger of developing MSbP when her baby was born, so they were thinking of removing the baby at birth. The student, Fran Lyon, had developed self-harming and eating disorders seven years earlier, after being raped. But these are disorders from which she has fully recovered. The psychiatrist who treated her as a teenager states that she poses no harm to her child. So does another psychiatrist, who knows Lyon through her charity work. The only person who seems to have entertained the idea that she could develop MSbP is a paediatrician who has never met her. But social workers have given his evidence more weight. Lyon fled to Europe last year, unable to trust her own country, and is now in a legal limbo.
To err is human. To refuse to acknowledge that is inhumane. No professional can be right all the time, particularly in this fraught territory. That is why wholesale reforms are needed - as I will explain tomorrow.