NEVER HAVE THE powers-that-be collected more information. But never has it been so difficult to find out what they know. It took months of questioning by an MP on the Public Accounts Committee to expose the foreign prisoner debacle; Whitehall twisted and ducked. Now another committee of MPs is being fobbed off in answer to a question that could prove to be of similar importance. The question may not sound like much. It is how many people are being accused by social workers of having the psychiatric disorder Munchausen syndrome by proxy (MSbP).
The MPs in the all-party group have an unusual link: each has constituents who were wrongly accused of having Munchausen’s. It is legitimate for them to wonder whether these individual cases might form part of a systemic pattern of overzealousness on the part of the authorities, a concern that was being expressed in Parliament as long ago as 2001. But Beverley Hughes, the Minister for Children, is not prepared to answer their question. “We don’t collect the data,” she told them at their recent meeting. She may come to think better of that statement.
MSbP, also called factitious illness, is a perverse disorder in which an adult invents or deliberately creates a child’s illness to draw attention to themselves. Even the experts agree that it is extremely rare, affecting about 50 people a year in Britain. But campaigners fear that far more people are being accused of it because of steady definitional creep. Psychologists in the mid-1990s established a set of traits of the Munchausen mother that are broad enough to cast suspicion on many whose children are genuinely ill. The signs include attentive mothering, a reluctance to leave the sick child’s side, familiarity with medical terms and, most devastating, the denial of accusations of abuse. There, but for the grace of God.
You may think that is just so Nineties, That if there really was overzealous diagnosing of MSbP, it must have ended with the high-profile release from jail of women such as Angela Cannings. Not necessarily. Two months ago Mr Justice McFarlane castigated social workers who had removed a nine-year-old girl from her parents after her mother had sought help for the girl’s modest behavioural difficulties. Social workers decided that the mother had Munchausen’s after a nurse rang them to say that she had taken the child to hospital with stomach pains and was asking to see a doctor when the nurse found nothing wrong. Within hours, and without consulting the doctor, social workers were seeking an emergency order to take her into care. Despite no doctor ever suggesting fabricated illness, they kept the girl from her parents for 14 months. This judgment is only public because Mr Justice McFarlane chose to make it so: we cannot know how many other cases there are.
Which is precisely why MPs are asking questions. Among other things, they are concerned that the 2002 Department of Health guidelines for social services may encourage professionals to spot the disorder where it doesn’t exist. Charity workers, nursery nurses, teachers and pharmacists are all told to look out for and help to identify it. The dreadful risks of a false positive are barely mentioned. What used to be treated as a rare condition, diagnosed by a paediatrician and a psychiatrist, looks dangerously like becoming a way of relabelling sick children as abused.
“A significant number of (abusive) parents,” say the guidelines, “are likely to report having experienced genuine medical problems. They may or may not have been substantiated by medical investigations.” Come again? Their children may “present a rosy picture to the outside world”, “have been seriously ill” or have a medical history that started early in life. This is a charter for Little Hitlers and busybodies.
Innocent parents are in a double-bind. If they deny the accusations, they may be seen as a danger to the child who will be taken away from them. If they “admit” that the child is not ill, she or he stands less chance of being treated. The worst of both worlds came to Donna Reid, of Los Angeles, in 1997, when social workers said she was exaggerating her son’s asthma. He was taken from her and died six weeks later in care, of an asthma attack. The foster mother complained that she hadn’t been told how bad his asthma was.
Have we learnt nothing? Three weeks ago the High Court ruled that the General Medical Council should re-examine the complaint by a mother from Braintree about two paediatricians. The doctors believed that her daughter was not genuinely ill, but was feeling low because of her mother’s excessive anxiety.During a long battle to keep her out of care, another doctor finally diagnosed chronic fatigue syndrome in the girl. We know about this case only because the parents fought all the way to the High Court.
A simple answer to a simple question would be of enormous help here. If Whitehall does not know how many cases there are, it should ask each social services department. The excuse is that it is expensive to go through individual case files. But accurate data could at one stroke show either that there is no problem — if there are fewer than 50 cases a year — or indicate where the problem really lies. It is quite possible, for example, that an analysis by region would show clusters of cases — clusters that could indicate overzealous clinicians and social workers. They are the only people who have an interest in keeping this secret.
While the information vacuum persists, there is a huge undercurrent of claims and counter-claims. Attempts are already being made to rubbish the MPs as naive. I have spoken to four of them. They are not. And they have a duty to their constituents. Those are real people, people who were hunted down as monsters for seeking help for children. We should not permit the authorities the protection of obfuscation. This is a democracy, and all we need is the answer to one simple question.
