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The Child Protection System in England

Written evidence submitted by the Association for Improvements in the Maternity Services (AIMS)

1. WHAT WE DO AIMS is an experienced pressure and support group, run entirely by volunteers, which has existed for 50 years. We give evidence to Select Committees and government, are stakeholders in many NICE consultations on medical care, work with the Confidential Enquiries into Maternal and Infant Deaths, and so on. We have links with a number of similar organizations in other countries, and also are active members of ENCA (European Network of Childbirth Associations)

2. HOW WE BECAME INVOLVED We run a national help line for the UK, offering support and information to callers and those who contact us by email and post. The changing pattern in these calls often alerts us to new problems before they appear in the medical press or elsewhere. It was in this way that we became aware of an increasing number of calls from parents asking for help when threatened with removal of babies or young children by social services after the previous government set a crude target to ‘increase adoption numbers’. (The original brief at the Cabinet Office committee had been to look at ‘adoptions and permanence’ for children in care) This target was reinforced by annual local authority inspections from OFSTED, and there were potentially large rewards attached. For example, Doncaster received over half a million pounds and Essex a million and a quarter for doing so well on their target. We dealt with distressed parents in both areas. Both local authorities were later downgraded to the lowest possible OFSTED rating for quality of children’s services: possibly the concentration on the high-reward adoption target had distorted their pattern of essential care for children.

We believe that the emphasis on adoption has distorted the pattern of care, and has increased parents’ fears and distrust of social services and healthcare professionals and has actually prevented the development of help and support for families in need. Because babies and young children became prime targets, this has had adverse effects on maternity and infant care.

It is not that we are opposed to adoption, when appropriate, (indeed, one of my own children is adopted and we are now besotted grandparents) and is an essential part of the pattern of care for children who genuinely can no longer remain with their birth parents. Adoption targeting is, however, only one of many problems within the system.

3. PUBLIC IMAGE OF SOCIAL WORK The Munro Review of Child Protection (April 2011) refers to the "considerable evidence that the child protection system and social workers are portrayed very negatively in the media" and that there is a need to "help the public get a better understanding". We can only say that this public image has been repeatedly borne out by our own observations and the hundreds of accounts we have received from families, as well as those from newer organizations which have been formed by parents in response to their experiences. Newspaper accounts of families’ bad experiences are invariably confirmed by extensive email correspondence from those with similar stories. Having worked in a local authority child care department in the days when there were properly trained child care officers, I find our case files deeply shocking. It is often even worse than media stories portray. And it is not just a few hard cases; it is widespread. The House of Commons Select Committee on Children, Schools and Families, in its report on Training of Social Workers found social work training not fit for purpose, and agreed with the points we had made in our evidence to them. However, the problem is not quality and training of social workers alone. Even when we observed families’ interactions with social workers who behaved pleasantly and professionally, they too were trapped in the same rigid computerised process, which actually prevented wider understanding and constructive solutions for real problems which some families had. In this we agree with Munro’s recommendations for change. But her recommendations do not go far enough.

4. CONFIDENTIALITY Because we offer confidentiality to parents (a service no longer available in the NHS, charities in receipt of official grants, and many other support groups like Women’s Aid), we are trusted by those who contact us, and receive a great deal of information which, sadly, is often no longer shared with professional health carers by parents who fear referral to social services. We often have long-term contact with the families who come to us; we have met some of them and visited their homes and met their children, we have been present during social workers’ visits, have attended case conferences and review meetings, and (since we are accepted as advocates) have seen much official paper work, so we do not know only the parents’ side of the story.

5. MISLEADING REPORTS ON FAMILIES We have observed contacts, and have seen how different descriptions in official reports may be from what actually occurs. These were not just errors or perceptions by individual social workers (of which we saw many examples) Minutes of meetings we attended at social service offices attended by many people in every case misrepresented what had happened. When we asked clients about this, they replied that it was "normal", and always happened. This implies not just individual, but institutional dishonesty. Many examples from other support groups confirm this picture. It will take more than public relations image building to change this picture in the eyes of the public.

We believe that tape recordings, with copies for families, should be made of all social work interviews and meetings, or that families should be told that they can record for themselves (currently this is frowned on or forbidden, and parents are powerless to refute false evidence given to family courts) In one of our cases a mother videoed her constructive and affectionate contacts with her children at a Contact Centre, which belied social work reports. The judge refused to look at it.

6. VIEWS OF CHILDREN In some cases we have been privileged to talk with the older children, and learn how devastated they have been by the whole process – particularly when they have been separated temporarily from a sibling or half-sibling. This major bereavement, which often has serious long term effects on their behaviour and school work, has received little understanding or recognition. In most of our work involving babies and younger children, we observe body language, which can speak volumes, but seems to be one in which social workers are not trained. In some cases we can speak for the children who as yet have no voice – the unborn, the infants and the youngest children.

7. WHERE IS THE EVIDENCE OF BENEFIT? Most of our work has been on maternity care, and we are used to reading and assessing evidence, and looking at a range of outcomes, whether adverse or beneficial. What was immediately deeply shocking to us was the lack of research on effects of social work intervention. There were virtually no randomised trials – the gold standard of research. Yet local authorities were using often poorly trained and sometimes unqualified social workers to intervene in the lives of thousands of families, and to set in train a series of expensive interventions with no evidence on outcomes. No expensive medical intervention would be allowed this level of expenditure at the taxpayers’ expensive without evidence that benefit outweighed harm. The only harm which was widely emphasised and publicised, was the concern for children not removed in time to prevent a tragedy – e.g. Victoria Climbie, Baby P, and so on. Everyone was drawn into the net – social workers, midwives, health visitors, GPs, teachers, council house repair workers, charities receiving grants. All had only one aim in practice: to "cover their backs" by not missing a case, resulting in many unnecessary referrals – and we see the adverse effects in our calls and postbag every day.

Since we study sociological as well as medical research, we are well aware of difficulties in researching "grey" areas. But it can be done, as we shall show,(see para. 18) and it is not only unethical NOT to seek answers before sundering or harming thousands of families, it is indefensibly wasteful of public money.

8. THE NEED TO MEASURE OUTCOMES It seemed that there was not just lack of knowledge; it is as if there was an unspoken agreement not to seek or record adverse effects. The adverse effects of ‘false positives’ in medical tests and screening were very familiar to us. However, in child protection it seemed that an unlimited number of children and their families could be damaged by false positive identification and intervention, and no one asked How many? What ratio is acceptable to society? What are the outcomes for families?

9. VOICES OF CHILDREN - AND PARENTS TOO There has rightly been emphasis in recent years on voices of children in the process (though a number of children have bitterly complained to us that their messages are only accepted if they are saying what the social worker and CAFCASS officer want to hear. One older sibling decided to tape record her interview with a social worker, which showed repeated attempts to persuade her to make hostile comments about her mother, her sole carer since birth). There is room for infinite distortion in the process of transmitting those voices through the courts, and children do not see what is eventually written and said. Parents do – and frequently challenge, and produce proof, that there are many distortions and inaccuracies. But they have the lowest status in the process. They must have been found wanting as parents, the proof being that social services are involved with their family. Even when they are trying to transmit important messages about safety of their children, or their essential health needs, their voices are ignored. (AIMS submission to House of Commons Select Committee on Children, Schools and Families on Looked After Children) Parents are disempowered in order that the State can take power, and "children’s voices" are used as an excuse to exclude theirs. Yet the Sure Start research has shown that it is empowering parents which proved to be the most effective tool for improving parenting. (F. Williams & H. Churchill Empowering Parents in Sure Start Local Programmes HMSO 2006)

10. EARLY EVIDENCE OF HARM We were so concerned at the picture which was emerging, that in 2007, after analysing our first 50 cases, we wrote to Chief Medical Officer in England on the Adverse Effects on Public Health of Child Protection. (attached) We were seeing long term trauma to families who had been investigated even briefly, babies taken into care being denied breast milk despite its many proven benefits, women now afraid to report domestic violence or pregnancies resulting from rape for fear of being reported to social services and losing their children, concealment of postnatal mental illness for the same reason despite the fact that postnatal suicide was the largest single cause of deaths associated with childbirth, increased marital breakdowns after such intervention, and so on.

11. STRESS DAMAGES THE UNBORN CHILD All these problems continue and even more worrying data has emerged. Severe stress in pregnancy which causes anxiety has been shown to have independent long term adverse effects on the health and behaviour of the child after birth, and these effects continue into adulthood. (V. Glover, T. O’Connor Effects of antenatal stress and anxiety: implications for development and psychiatry Br Journ Psychiatry 2002 180: 389-391) We are, of course, used to working with mothers whose pregnancy is stressful for many reasons, but the stress for both parents in cases where social service referral is threatened or actual during pregnancy is as bad as, and often worse than, anything we have worked with before, and is, of course, prolonged into the postnatal period.

12. SCREENING FOR POTENTIALLY HARMFUL PARENTS All pregnant women are now routinely screened for supposed "risk factors" to their unborn child, and positive identification is likely to result in referral to social services, or the threat thereof, despite the fact that there are no studies as to whether this improves outcomes for the pregnancy, the birth process, or long or short term on the child and it is known such screening will create many false-positive cases. Yet research now shows that the anxiety created in the mother is almost certainly doing more harm to the unborn child than that which the mother may be at risk of causing later. An alternative approach would be to provide supportive and caring services for all pregnant women suffering any outside cause of stress, and not to add any further cause for anxiety. This is one of many examples where child "protection" aimed at identifying parents as potential abusers (the ‘witch-hunting approach’, as our clients call it) rather than offering truly supportive services, is doing more harm than good, and is damaging children even before birth permanently and seriously to a greater degree than the mother might do.

13 LACK OF KNOWLEDGE OF MATERNITY CARE Even experienced social workers know little about pregnancy, childbirth, breastfeeding and the sensitive time and needs of parents in the postnatal period. (AIMS written evidence to Select Committee on Children Schools and Families on Training of Social Workers) We have had many examples where their ignorance has been damaging (eg a nervous mother near term with her first child traumatised by the social worker who told her the pregnancy could be outside the uterus; if true, she would have made medical history). Yet they blithely intervene with prescriptions for what the mother must do to show she is compliant and satisfy their criteria if she is to keep her baby. They have even issued dangerous medical instructions and advice in several cases. The problem is compounded by the fact that while local authority Safeguarding Teams include a nurse, they do not include a midwife, and we have had cases where the nurse’s ignorance of maternity care, and assumption that she knew things which she did not, led the team seriously astray.

14. LACK OF TRUE SUPPORT FOR PARENTS AND FAMILIES On many occasions we have seen cases where families in genuine need of help are longing for truly supportive services, but they do not exist. We have seen too many cases where a simple request for what we see as legitimate help has led to parents who had openly asked for constructive help had been tramlined into the only pattern of response which now seems to exist – the punitive and damaging labelling of parents as inadequate or dangerous, and threatened or actual removal of all or some children We have seen a number of similar cases highlighted in the press, and this risk is now well known in communities, and serves as a warning to others. Whilst the Munro Review recommends an increase in supportive work – increasing the size of the carrot – the stick is to be moved just a little further into the background. We believe this change does not go far enough.

15. HEALTH VISITORS Because of their enhanced role in child protection, Health Visitors are now widely known as "the health police" and increasingly mistrusted. We know, from our many calls on the subject, how often they are actually deterring families from consulting them about real problems, and how they increasing distrust of official services. The Munro Review calls for expansion of the service. We believe that restoring trust and confidence in their work will be a long and difficult process. They too have unquestioningly accepted recruitment into a rigid, damaging system, which as professionals they should have looked at more critically. And midwives are now going the same way.

16. RISKS FOR FAMILIES WITH DISABILITIES These unmet needs are particularly apparent in families who have a parent, or one or more children with chronic disabilities. Because they become unpopular with local authorities for demanding expensive services or educational facilities which are in short supply, and they also are in frequent contact with health services where they also have often to act as patient or child advocates, they may be at particular risk of damaging and unwarranted social services intervention. In their cases, threat or use of child protection procedures is a means of exerting power, gaining control, and ensuring compliance.

17. SOCIAL SERVICES AS A MEANS OF CONTROL We are seeing an increasing number of cases where referral to social services is seen as a means of controlling or silencing pregnant women or parents who are seen as asking for services an individual health worker or teacher does not want to provide, which may be legitimate but inconvenient (e.g. women who want home births, or to avoid repeat caesarean sections), or who refuse recommended treatment – invariably for good reason. Social workers and some midwives and doctors seem to be unaware that coerced consent is not legally valid. Also we, and other consumer groups, have seen a number of cases where child protection referral has been used maliciously in an attempt to silence parents who have made a justified complaint about a midwife, doctor, health visitor or teacher. The adverse effects of this have been so severe in a number of families, that we, one of the most experienced organizations in the country in dealing with health care complaints at every level, are very wary indeed of advising clients to complain once any social services intervention is remotely possible, or to complain on their behalf ourselves, despite the fact that some involve serious issues of public safety.

18. A DIFFERENT WAY Fortunately, on the other side of the Atlantic, effective and impressive research has taken place. At last someone was using the gold standard to study outcomes: a large scale randomised trial. In Minnesota, after exclusion of cases where children appeared to be at immediate and serious risk, over 5,000 families referred for social work investigation were randomly allocated to either the standard process – like ours – of seeking out damaging and dangerous parenting, or to an Alternative Approach, which was supporting the families and trying to obtain help they needed. The families were followed up for an average of three and a half years. An Executive Summary of the Minnesota Alternative Response Evaluation by L Anthony Loman and Gary L Siegel and is available at http://www.iarstl.org/papers/FinalFRAReportExecSum.pdf and the full report is available at http://www.iarstl.org/papers/ARFinalEvaluationReport.pdf. (There are a number of publications on this work) The study was repeated in Missouri, with similar positive results, and this Alternative Approach has now been adopted in a number of other states in the USA. The most important finding was that the Alternative Approach did not damage child safety; there was evidence that it actually improved. There were less likely to be new maltreatment reports, though children were less likely to be removed. Both families and social workers liked this approach, and social workers were more popular. Moreover although initial outlay may be greater, it did not prove more expensive.

19. REDUCTION IN HARM, INCREASE IN BENEFITS Harms and benefits to children and families are outlined on pp 66-68 of the full report, which is published by the Institute of Applied Research in St Louis Missouri. What struck us immediately was the similarity of adverse effects from the current approach to those we had seen in our own cases, which now amounted to hundreds. Anecdotal evidence however, does not impress policy makers, but well-designed, large scale, trials with long-term follow up, cannot be ignored.

a) The percentage of families who felt more able to care for their children had declined with the standard approach, but increased in the supportive Alternative social work. This exactly fitted the picture of the many parents who told us that they were less confident in coping with their children than they had been before they had had even short-lived contacts with child protection processes.

b) Economic stress had also increased in families subject to standard social work – again confirming parents’ accounts to us.

c) Children in families who had traditional social work had had more serious illness than before social workers intervened, now had increased days off school from illness, complained more often of being unwell, had more trouble than before in learning at school, were more likely to refuse to go to school, were more likely to seem depressed, were slightly more likely to be difficult to control and more likely to engage in delinquent behaviour.

d) Children in families who had Alternative social work had less serious illness than before, fewer had trouble learning at school and they got on better with other students, and were less likely to engage in delinquent behaviour and were slightly less likely to be difficult to control. Rates of missing school through sickness, school refusal, and acting depressed were unchanged, and complaints about being unwell had increased. As the authors point out in their summary table on p 68, "the direction of the change was persistent across items, always a little worse for the children in the control group and a little better among children in the pilot.

20. CONCLUSION: DOING HARM TRYING TO DO GOOD This confirms the picture we have seen over and over again in our families, and from accounts reported by other consumer support groups. The official approach has been to identify bad and dangerous parents (though some will always be missed under any system) and to remove their children at the earliest possible age, when adoption has the greatest chance of success, or to "re-educate" parents. The standards as to what is acceptable parenting – which in our experience vary from social worker to social worker, area to area, and of course over time – are not publicly discussed, and the public for the most part have no idea what is being done in their name. Those who make the observations and judgements are woefully undertrained and under-equipped for this task. We know that many previously normal, affectionate parents and their children have been deeply damaged by the current investigative process, and far more seriously than the Loman and Siegel studies show. As for families who already had problems and needed constructive help, they did not receive it, and all emerged worse than before. Children removed as babies and adopted will, we hope, be flourishing, but there are likely to be future problems for them and their adoptive parents when they seek out their origins.

Further Written evidence submitted by Association for Improvements in the Maternity Services

ADVERSE EFFECTS OF CHILD PROTECTION ON PUBLIC HEALTH

You may recall that we sent you our analysis of our first 50 or so child protection cases when you first started looking at problems with medical expert witnesses. We read your most helpful document on supply and training of expert witnesses with interest, and responded to the questionnaire, and have seen your brief summary of responses. We are now preparing our second round of comments as NICE stakeholders on diagnosis of child abuse (greatly concerned, incidentally, at the truncated definition of the amended scope).

Medical opinions, however, are but a part of the system which impacts on children and parents. We are now so concerned at the adverse effects of child protection procedures in the UK that we felt we had to write to you. As a group which runs a national help line, we are seeing how serious, long-lasting and widespread the adverse effects of these expensive interventions are. Since, as advocates, and occasional Family Court witnesses, we see many case and court files, we know how questionable and inaccurate the allegations, interpretation and documentation from which many investigations spring are. Sometimes it is unclear where the trail began, and a surprising number seem to start after justified consumer complaints have been made about health care or other staff.

When instructions went out to all staff in contact with children to report concerns about risk, this seems to have been done with little prior thought, without consultation, and without provision for training. The result was the post-Climbie cover-your-back syndrome: "when in the slightest doubt, report to social services." We see a huge variety of standards, misunderstandings, prejudices, ill-informed interpretation of risk factors, cultural incompetence and even racism, in the initiation of cases from health visitors, teachers, midwives, nurses, doctors and others. Quite apart from the damage to families, each one of these reports pre-empts resources and often leads to substantial, and unnecessary, cost. Ironically, the basic, simple help or real support families would like, is unavailable because resources are lacking, that is not the focus of social work activity, and anyway nowadays many parents are afraid to ask because any contact with social services is too risky. .

Community information grapevines work, and effectively circulate information about what people see as the growing risk of being investigated or labelled as a dangerous parent after contact with medical care. The risk is not merely perceived: it is real, and the consequences are devastating. Damage to the whole family structure (sometimes the extended family network and its support structure), to parental confidence and self-esteem, to children’s sense of security and safety, and their sense of security that their parents can and will protect them - these are very serious adverse effects. Often we find it is the most sensitive parents, to whom family life means everything, who are most damaged. We also have many concerns about damage we have seen to authority of black parents vis-a-vis their children, many of whom are already coping with multiple racial prejudice problems. As we have pointed out to NICE as stakeholders in their consultation of diagnosis of child abuse, such potential for harm must now be considered, and it is long overdue. The sheer cultural incompetence of many social workers has to be seen to be believed.

The following list is not exhaustive, but gives examples of typical problems. We make no claim for their being representative of the whole picture of child protection activities, of course, since we deal only with those who come to us for help. However, the problems we are finding seem to be echoed by other groups.

1. FEAR OF ACCESSING MEDICAL CARE Nowadays parents call us and ask for advice when their children have accidents, because they are afraid to go to A & E, and they know we run a totally confidential service. We cannot give such advice as we are not qualified to do so. We have been in existence for well over 40 years and can recall no such requests until about four years ago. There is now no health professional, or official help line, parents feel they can safely ask for help. All agencies, including NHS direct, will report anything they regard as suspicious. Innocent parents, who have had one brush with the system, or social services investigation, or whose friends, relatives or neighbours have, now find the risk of avoiding treatment preferable to the risk of damage to the whole family of going for help.

2. DISTRUST OF HEALTH VISITORS Mothers are opting out of seeing health visitors, and are advising friends not to see them, after they, or someone they know, has had a similar encounter. Those who feel obliged to do so, tell them as little as possible. One incident and they tell us "I’ve made sure everyone in the village knows not to trust her." In some areas, however, merely opting out of seeing a health visitor (maybe because they don’t like her, or find her advice or manner unhelpful) is cause for referral to social services in itself - thereby confirming the increasingly common perception of them as the "health police". Those who do see the health visitor are highly circumspect about the information they give.

3. ADVERSE EFFECTS OF MEDICAL INVESTIGATIONS Small babies with a tiny bruise are automatically given whole-body X-rays at an early stage. ("Those who don’t cruise, rarely bruise." - "rarely" being interpreted as "never"). The likely cause has sometimes proved to be equipment such as a baby-carrier or push-chair. Sometimes a boisterous older sibling - a toddler - is suspected but this cannot be proved. The parents, not unreasonably, are now continually worried about the future possibility of leukaemia. As these whole-body X-rays are now so common, (there should be a database of such exposures) the likelihood of this in some children must be increasing.

4. CONCEALMENT OF POSTNATAL MENTAL ILLNESS As at least two studies have shown, mothers are lying in response to the questions on the Edinburgh Postnatal Depression Scale and they are concealing post natal mental illness, for fear of social service intervention. We knew this from our help line, long before the research appeared. A formerly useful, validated, screening tool no longer works. This is alarming since suicide is the largest cause of deaths associated with childbirth. We are dealing with seriously ill women, and we know that contact with child protection services only worsens their state but it is as if no-one cares. One immediately suicidal mother was told by her GP "We don’t have to worry now: the baby is safely in care." Everyone concentrates on safety of the baby, though statistically the chances of the mother killing herself are very much greater.

The known serious long-term adverse effects for a child of losing a parent through suicide are not even considered. We seem to be the only remaining group who see mother and baby as a dyad, and think they need to be treated as such. The Confidential Enquiries into Maternal Deaths report cases of suicide which are directly related to women’s fear of social services taking their children - real or imagined, and points out what a large number of children have been orphaned by post-natal suicide. These suicides are, of course, only measured for the first year post-natally, but we have clients at risk, and know of cases, long after that. We have many cases where social services intervention is intensifying and prolonging the very postnatal depression which they are seeing as the reason to take their babies. We have never yet seen a case where the mother found social worker intervention helpful or supportive. In the last fortnight I have worked with two women who I feel are suicide risks (one acute) solely as a result of social service management. As their babies are now over a year old, their deaths would not be included in the statistics, but we are prepared to give evidence to coroners if the worst happens.

There are no Paternal Death statistics. Naturally postnatal mental illness in mothers is our major concern, but we are hearing of more and more cases of fathers tipped into depression by child protection investigations. The intervention itself is frequently toxic to mental health, and greatly damaging to self-esteem, which is particularly important where it is fragile to begin with, or families are already dealing with racism.

5. LOSS OF BREASTFEEDING Many mothers whose babies were precipitately removed, (they, and we, suspect as potential adoption material to meet targets) but had to be returned when a case could not be made, grieve for the loss of breastfeeding, with its long term benefits for mother and child, and for the damage to bonding. If and when children are returned, they are unable to re-establish it. One woman recently told us of the profound difference in feelings towards her two children, the first of which was affected by child protection actions and threat of removal, and the second, which had a happy normal birth. It is a story we have heard from a number of others. Even the threat of intervention or suspicion can cause serious damage in the sensitive postnatal period, and we have vivid descriptions from parents.

In a number of cases mothers have expressed breast milk and begged social workers to give it to the baby, and they have refused. Others have not openly refused but mothers later discovered it was thrown away. One baby (an adoption target) was recorded by a paediatrician as "bottle fed from birth" though all the notes clearly indicated otherwise. More recently some breast feeding mothers have been asked to express milk by social workers (we suspect as a result of European Court human rights decision on one of our UK cases P, C and S v. UK 16 07 02). They dared not refuse since it might lessen the chance of the baby’s return, but firstly this is often very difficult for the inexperienced primigravida, and the continued lactation (and oxytocin levels) added to their distress at the baby’s absence ( a price all lactating mothers pay). It was not a choice those particular mothers would have made. In some cases the stress has caused lactation to fail totally, and the mother is further devastated. This is NOT a case that social workers are "damned if they do and damned if they don’t", but that their ignorance and the way they use (and mis-use) information to strengthen their case often works adversely for both mother and child.

6. INCREASED USED OF ALTERNATIVE PRACTITIONERS After a brush with the system, more families in our files are avoiding orthodox medical care and increasingly turning to alternative practitioners for their own, and their children’s care. Whilst many parents are full of praise for the alternative practitioners they use, we have concerns about lack of paediatric and medical knowledge. I have never forgotten interviewing the mother of a young child who died from diabetes when parents followed such advice. Parents with ongoing medical problems are also foregoing care for themselves because they no longer trust the system.

7. MORE CHOOSE HOME SCHOOLING An increasing number of children in our files are being removed from school and are home educated, sometimes after a fairly minor brush with "protection" services, because the educational system (including nursery education) is now seen as part of the surveillance process, which can be influenced by the whims, prejudices and occasionally hostility of individual teachers. Another child was removed by nursery school because the teacher there was questioned by social workers about the parents and is no longer trusted, so it is at home.

8. MORE SEPARATIONS AND MARITAL BREAKDOWN We have lost count of the number of marriages and partnerships which have broken down as a result of the intense stress caused by child protection investigations of what turned out to be innocent parents. The children now have an absent father and are largely cared for by the traumatised mother. This loss alone is far more damaging to the child than the potential harm of which parents were initially accused.

9. REDUCED PROSPERITY AND WELL BEING We have been surprised to see how often families suffer considerable financial loss and are in reduced circumstances because of intervention. This includes both the poor and the middle class. The stress, and time-consuming nature of trying to fight their corner, takes all their time, and often erodes their health. There is no longer time, or money, to take the children on outings they would once have had, for example. Making photocopies, postage of documents, paying for copies of their records and faxes, and so on, eats into the limited resources of those who have little to spare. Some are prevented from pursuing former careers where local well-circulated, and unproven, suspicions have made them unemployable, yet there is not a shred of evidence that they are unfit.

When social services depart and have closed the files, the family may well have turned in on itself. Sometimes they have felt they could not talk about what is happening to neighbours, friends, or even relatives. Sometimes they fear stigmatisation. Sometimes they are stigmatised. Garbled, distorted stories may have been circulated in schools, clinics, churches, etc. Contact with friends, neighbours, clubs, even relatives, may be reduced sometimes drastically. Their social capital - known to be an important factor in mortality and mortality - has been reduced.

10. LACK OF HELP FOR THOSE IN NEED Parents whose children have behavioural or educational difficulties now feel there is no confidential, trustworthy source of help they can go to. It was sometimes those very difficulties (then undiagnosed) which led to the interventions, but when everyone else goes home, the parents are left to cope with them, often now worse than they were before, but with nowhere they can, or dare, turn to.

Parents who cannot avoid the system, because they have disabled children, find themselves in a continual weary battle to preserve their sanity, their integrity and their self-esteem. There is a lot of black humour in our ’phone calls: we agree they are "the lucky ones" in that their children are so seriously disabled, social services and doctors don’t want to take them (they would be too expensive and risky to keep in care, and are not seen as adoption material) but the perception is that professionals just want to exert power and control everything they do, rather than listening to parents who have found out what works and helping them with basic, simple needs.

Because we run a totally confidential service, and never report anyone to anywhere, we are told a great deal which would be helpful to professionals involved with family care, but which they will never know because now all are required to report suspicions, so none of them is trusted.

11. CONCEALMENT OF RAPE CONCEPTIONS Women whose pregnancies are the result of rape are not mentioning this to anyone, though they are desperately in need of support and sensitive care, for fear of social service interference. We are supporting them as best we can, especially since we saw the disastrous effects after a woman confided in her midwife, who reported to social services in another case.

12. CONCEALMENT OF SEXUAL RISK Parents who have had a brush with the system withdraw from being part of the watchful community group which helps to protect all children. For example, a number of them have told us about sexual activities of quite young fellow pupils at their children’s school (which now seem surprisingly common) or grooming attempts by local paedophiles. Whereas at one time they would have acted, now they keep quiet in case any activity re-awakens interest in them or their children. They are no longer willing to try to protect other people’s children: they have pulled up the drawbridge. In view of the number of cases we have seen where women who reported paedophiles and ended up being disbelieved or vilified themselves (the assumption that these genuinely concerned mothers were making it up for their own ends, in custody battles etc) we do not blame them.

13. CONCEALMENT OF DOMESTIC VIOLENCE Women who are suffering domestic violence are continuing to conceal it for the same reason. Since we have seen cases of babies removed from such women, even after they have left their violent partners and are coping well, we are not surprised.

14. CHILD PROTECTION AS SOCIAL CONTROL Use of child "protection" or threats thereof are increasingly being used to control parents who are seen as unorthodox, or not completely compliant. (The social worker’s ideal "compliant" mother does not seem to be one who would have the personality to insist that other people don’t smoke near her baby. Yet "stroppy" mothers can be advantageous to children, protecting them when they live in difficult social circumstances. Heaven help the disabled child or one with special needs who does not have at least one stroppy parent to fight for him). The message is getting round quickly, and parents are opting out of official sources care even more, or being even more selective on what information they give, and what they conceal.

15. TOXIC PSYCHIATRIC LABELS Your recent report confirmed the picture we have from our cases, that psychiatrists greatly outnumber paediatricians as court experts in Family Court cases. Selected experts are invited by social workers to confirm that the parent who complained about the health visitor, or who has criticised or challenged them must have a "personality disorder"(not uncommon); this has now replaced the rather discredited Factitious and Induced Illness (frustratingly rare) as the method of choice. Judges do not ask the simple question: what is the baseline of this in the community, and are we to remove the children of all such parents? Where is the evidence that this child is, or has been, at risk from this parent?

The result is that many parents and children, even if not separated and found guilty of no harm, have now acquired permanent damaging labels - widely circulated among shared records - which they, and we, suspect are likely to be a permanent source of prejudice, which do not contribute in any constructive way to their care, support, treatment or interaction with services. Since the condition is widely regarded as untreatable, there is no responsibility on the psychiatrist or the NHS to treat, but there is total freedom by lay and medical personal to disregard what the parents say.

There is a substantial literature on the effect on professional attitudes of any label such as "personality disorder", for example, and how it affects attitudes to the patient and hinders diagnosis and prevents treatment. Yet many families are acquiring these labels as a result of totally unjustified intervention in the first place. In many of our cases specific psychiatrists and psychologists seem to have been called in when social workers were unable to find evidence to prove the case they wanted. Despite our strong suggestions to clients that they should obtain copies of the psychological tests carried out on them, so that conclusions may be challenged, and their validity for different cultures assessed, so far no-one has managed to do so. (Incidentally, we are also concerned at the number of cases where these same professionals then go on to recommend to the court that the family needs exclusive private treatment by themselves at a cost of many thousands of pounds.)

As with paediatricians and Munchausen Syndrome by Proxy, experts who are knowledgeable, are seen as unbiased, and will give evidence for the parent are as scarce as hen’s teeth. When a child has some physical problems, there is hope that the truth that the mother was not wrong in believing her child to be ill, will emerge eventually, through advances in medical knowledge, or even at post mortem. With psychiatric opinion of a parent’s state at the time, what hope is there of rebuttal? The MSBP label carries its own unique trail of damage: anything the mother reports to any authority is not believed - or rather is automatically disbelieved, by doctors, teachers, the police etc, and we have seen cases of actual endangerment because of this.

Medical opinions can be wrong. Has everyone forgotten that once all the paediatricians and health visitors were ordering mothers to place their babies face down to sleep? We know a number of older mothers who did not ‘comply’ with that - they just liked to watch their babies’ sleeping faces. And maybe some of their children were saved from cot death as a result.

I could go on. But you can see why we are so concerned. Unless both professionals and the courts understand how common, and how serious, the adverse effects of child protection intervention and investigation can be, how can they balance the risks of action versus leaving well alone?

November 2011

Prepared 15th November 2011