In 1999 I gave evidence to an NHS Government Inquiry - the Griffiths Inquiry - into alleged malpractice by Professor David Southall who was employed by the North Staffordshire NHS Trust.

When the Griffiths Report came out I was named as a professional who had given evidence in relation to the erroneous thinking and methodology of Munchausen’s Syndrome by Proxy.

The Griffiths Report included a paragraph on the concept of Munchausen’s Syndrome by Proxy (‘MSBP’) and its potential for errors of judgement.

This was how I come to be conversant with the evolution of the MSBP guidelines.

Background

My first letter of concern about the dubious influence of warped MSBP theorising, dressed up as a beguiling, rare medical disorder, had been published two years earlier (The Psychologist, 1997).

I feared that this type of thinking, and the methods and draconian actions which flowed from it, could rapidly work their way through the system causing untold damage. Unless the flawed thinking was stopped in its tracks, it was a concern that it could become a basis for accepted practise.

The core problem in this sector is simply put.

There are many innocent explanations for conditions which might be labelled as MSBP - later referred to as FII (feigned or induced illness) and interwoven into thinking about Shaken Baby Syndrome (SBS). In addition, a score of bona-fide medical disorders are known to give rise to similar symptoms as well as adverse reactions to various medical interventions. All in all, MSBP is a diagnosis to be used sparingly with great care.

The Editor of The Therapist contacted me after reading my letter. As Professor Meadow had also written a piece in that Journal, she also asked me to write an article. It came out in 1998. In parallel with these efforts, which included numerous letters, more articles and a 1997 New Zealand TV3 Medical Documentary, I made diplomatic attempts to alert the Civil Service and Ministers to my concerns.

It was in this context that I was asked to give evidence at the Griffiths Inquiry.

Mr Clark’s Remit: The Griffiths Report

At that time, MSBP was very much a newcomer of uncertain provenance on the medical scene. But it had already attracted an enthusiastic following. This fell within the ambit of the North Staffordshire Inquiry.

At paragraph 12.4 of his report, Professor Griffiths dealt with concerns arising from the diagnosis and prosecution of parents alleged to be suffering from MSBP:

“In order to assist in the correct identification of children who have either had illnesses induced or fabricated by their carer, the Review recommends that the Department of Health should convene an Expert and multidisciplinary panel which reviews methods of identification, including the use of covert video surveillance, within the framework of the Government’s interagency guidance for child protection “Working Together to Safeguard Children” (1999). Guidelines would aid professionals in their identification of this type of abuse and would suggest good practice in multi-disciplinary and multi-agency management of such cases”

The Griffiths thinking was clear: the immediate, gateway concern was the ‘correct identification’ of cases and a ‘review’ of the ‘methods of identification’.

The report’s thrust was the development of proper diagnostic criteria to counter an inflow of extreme and unfounded diagnoses, based on equivocal ephemera which were typically indicative of alternative and innocent explanations.

As subsequent events show, this prudent remit was seized upon as an opportunity to develop a ‘medical theology’. Under Mr Clark’s chairmanship, the Griffiths Report was to become the platform for the reverse assumption and a false premise: that MSBP was a robust medical construct, commonplace, justifying radical intervention, which could be confidently inferred from ambivalent trivia.

In a brief discussion with Professor Griffiths I asked if he thought I should be on the Panel (which was to become Mr Clark’s Working Party). He said he did. I then called Lord Hunt’s office and they asked me to send my CV.

Early Omissions

Some months later, with no sign of a Working Party, and no response to me personally, I was asked to speak at a conference on this issue at Durham University.

Prior to the conference, I needed to find figures for allegations of MBSP for my paper (‘Adding Insult to Injury: False MSBP and Acquired Autism’). Given the recent profile of MSBP, it was likely that the figures would have risen considerably. I contacted the Department of Health as I felt this would surely be one of the first steps in the recommended review of `methods of identification’. I was surprised to find that they did not keep figures on MSBP allegations.

When I asked about the Working Party I was told to contact Bruce Clark. He was in overall charge. When I spoke to his office and asked if the Working Party had produced such figures, or indeed, if there even was a Working Party, I heard some laughter in the background as the person I spoke to asked those in the office.

I was then told to contact Jenny Gray.

Packing the Committee

Jenny Gray’s involvement came as a shock.

I knew that Jenny Gray had previously been in the Social Services Department in Great Ormond Street.

To my certain knowledge Jenny Gray had assisted the now-disgraced David Southall into taking at least one child under the false guise of MSBP. There had been no concerns about the family prior to that time, and, for the record, I mention that this case is one of many complaints still going forward to the GMC against David Southall. The child, with a known serious medical condition, was that night placed in an experiment and brain-damaged. The case is in the public domain. From that point in time, it would appear that Jenny Gray rapidly climbed the promotional ladder in the Department of Health within the arena of MSBP. She has since been the person to meet groups such as the National Autistic Society when they raised concerns with Ministers.

I later discovered that the Working Party convened and overseen by Bruce Clark:

- did not include a dissenting voice on the MSBP hypothesis

- did include individuals who worked closely with David Southall

To go ahead, this latter group included those who still continue to work closely with David Southall and Roy Meadow’s MSBP/FII/SBS agendas – despite public exposure of their illogical and destructive methodologies so dogmatically presented in the Criminal Courts.

Moving the Goalposts

In due course Mr Clark’s Working Party produced guidelines which embedded the MSBP thinking into the system. Compounding the damage, the Royal College of Paediatrics and Child Health produced their own Guidelines which echoed the DoH Guidelines. The Royal College was, presumably, influenced by the Government document and perhaps minded to protect the reputations of both Professors Meadow and Southall who were paediatricians (the former a former President).

There was no reference in either document to undertaking the preliminary work which the Para 12.4 recommendations had been all about – to ensure correct identification.

I submitted a long formal document during the consultation phase (mentioned in the Sunday Observer, `Ministers knew about Child Harm Theory’; Jamie Doward, January 2004).

This submission, receipt of which was not acknowledged, began by arguing that the Civil Service document started from the wrong premise; the submission went into great detail about the problems inherent in almost every paragraph.

The underlying problem was that the Clark Guidelines were only concerned with validating dubious methodologies after a person was suspected - and not with the crucial preliminary consideration envisaged by the Griffiths’ Report:

should that person have been suspected in the first place?

Ensuring a correct identification was a crucial preliminary before Guidelines and policy were built - potentially not just on shifting sand, but on quicksand.

The proper concern was: What were the theoretical bases to that suspicion? Were the theories robust? Were there considered alternative differential diagnoses?

Given the power of rumour and the seriousness of cutting parents off from their children, and children from their parents, and maybe even imprisoning parents on suspicion or rumour (The Psychologist 1997) I considered that the standard of proof had to be set very high.

At the time I interpreted the DoH Guidelines - and I still do - as a cynical exercise to install the thinking of now-discredited individuals (whose thinking was already under serious clouds) into family policy. It was a particular concern that the vehicle for this doubtful enterprise was misuse of a very serious investigation – the Griffiths Inquiry – into the liabilities of this same thinking.

Mr Clark’s Working Party departed from the recommendations of the Griffiths’ Inquiry.

His Working Party was used not as a forum for serious discussion into the actualities of assessment but as a manifesto for MSBP.

A Unilateral Venture: Expanding the Department

Only those within the Working Party were privy to its inner dealings. I am, however, familiar with evidence of Jan Loxley-Blount. She had initially contacted me after hearing a piece on Woman’s Hour where I spoke about the dangers in the use of this theory. Her account of the same events suggests that information regarded as inconsistent with the MSBP hypothesis was discarded or overlooked by the Clark Working Party.

I refer to Ms Loxley Blount’s paper, “The Role of Government Edicts in False Allegations of Child Abuse” for the 2004 UCAFFA Conference. The paper, extracted below (Footnote 1) makes the corroborative point that, even at the 11th hour, the Ministers and Civil Servants with secondary responsibility in this area:

- seem to have remained unaware that there were serious questions about MSBP

- had not seen the voluminous evidence contradicting the assumptions of their Chair

The Guidelines finally issued (Working Together to Safeguard Children: Fabricated and Induced Illness) permitted, and indeed encouraged, the making of these dangerous diagnoses on almost any grounds; and recommended rapid referral by medical practitioners when suspicion arose. These serious interventions were on the basis of a belief-system mispresented as a robust scientific and medical theory.

The Guidelines also ensured that workers involved after the `referral` would believe they were acting on a reliable medical diagnosis which could not be challenged. From then on, alternative explanations would be ignored, and protestations of innocence warped into forms of ‘denial’.

Medical practitioners originally involved with the case would assume that the checks-and-balances would be dealt with afterwards by the social workers. Everyone involved laboured under the delusion that someone else would carry out, or had carried out, the necessary evaluation. As matters have unfolded, it transpires that medical practitioners could make the initial damning referral, or revise their previous sensible opinions, merely on the basis of an unqualified worker spreading a rumour based on this same erroneous thinking.

Social Consequences: The Scale of the Problem

Since the introduction of the Clark guidelines, the warped MSBP thinking has performed much as one would expect. It has snaked right through the system.

It has encouraged workers and professionals at all levels to think in a medieval manner and misconstrue what is in front of them. It has fostered a misplaced belief that the road to their suspicions is paved with robust science and indisputable medical evidence. It has fostered a misplaced belief that they are protecting children.

The anecdotal figure for the number of parents whose children are wrongfully removed by virtue of the MSBP / FII guidelines is generally agreed to run well into the thousands.

The costs to the State for the interventions, the Court cases, and the care of removed children has run into multiple millions.

The modern-day Barons Von Munchausen are Professors Meadow and Southall and the enablers such as Bruce Clark. It is a well documented area, save that the concerns which are well-known were ‘paved over’ by a Working Party supposedly established to investigate them.

Intellectual Consequences: The Wrong Mindset

Workers are encouraged to act in a punitive manner toward parents, wrongly believing in the theories now cemented into the system. Under this dubious mindset, every denial is seen as proof of guilt; every action, gesture or even facial expression can be ‘morphed’ to provide evidence of bad parenting or deliberate intention to harm children. Black becomes white.

No effort is made to change these approaches, which can lead to appalling outcomes for families. Every complaint, and every programme, article, or wrongly- convicted person freed is misapplied to embed the thinking more deeply. Unpalatable evidence is reformatted as proof of the dangerousness of `these plausible people and their advocates` (The Therapist 1998).

Caught up in the shroud of psycho-analytic mystery is the idea that child abusers are highly plausible people who look perfectly normal. When applied without proper checks-and-balances, as it is, this idea becomes a licence to pursue cases on the grounds of lack of evidence. To case-workers reared in this belief, the only `way out` is an admission of abuse.

Practical Consequences: the Aftermath of MSBP

Real illnesses and disorders are missed or ignored; what is seen misinterpreted as abuse. The MSBP / FII/ SBS assumption is used as a launching point to either take parents to Court to remove their children, or to engage them in misdirected “therapeutic exercises”. Rather than caseworkers becoming more aware of the practical problems and real needs in relation to children’s early illnesses, the opposite seems to have happened.

Ordinary parents are routinely accused of causing their children’s difficulties.

Social services have no real understanding of autism and Asperger’s Syndrome. During a period in our history when there is an increase of bona-fide neuro-developmental impairments, children with these disorders are instead put on the At Risk Register or taken into ‘care’. Once in care, these same children continue to suffer from the original problems previously considered factitious and blamed on their parents. Guidelines increasingly encourage social workers to see autism - and think attachment disorder.

The interpretative change can be clearly seen in changes in descriptions of children in adoption `magazines` for prospective parents. Children with these medical conditions or related health conditions can be:

1. Removed from their parents under an official misapprehension

Such children are given to foster and adoptive parents, resulting in further harm as the children’s health and educational needs are not met.

In some cases, the foster and adoptive parents are in turn blamed for the pre-existing conditions which do not go away, despite removal from parents

2. Used as a ‘stick’ to blame the parents who are allowed to keep the children

Parents falling into this category live intolerable existences under a cloud of suspicion, terrified into thinking their children could be taken, even in the dead of night. They face case conferences and core-group meetings. These meetings are frequently attended by people who have no knowledge either of their child or of their condition, yet who will be encouraged to keep them on the At Risk Register on the basis of the reports of others, similarly blinded.

Tactics to split the parents are routine.

Fathers are made to suspect their wives and vice versa. Parents are told that if they continue to support their spouse, they too represent a danger to their children as they are `colluding` in the abuse. Many parents have succumbed to extreme pressure. Their testimony, induced by duress, is then produced as solid proof of abuse.

Some of these children and some of these parents are seriously ill, and indeed dying, because of these malpractices (Private Eye 26th April 2005). (Footnote 2)

A Slipshod Experiment in Social Engineering?

The concept of Child Protection could hardly have departed further from its intended goal.

If the mantra of `the interests of the child come first’ is to have weight, investigations leading to Government Guidelines and policy should be seriously undertaken.

The Clark MSBP Working Party demonstrates that not only were the investigations not a serious venture – the investigations were not undertaken at all.

25.4.05 Lisa Blakemore-Brown,
Psychologist,
B.Sc.MSc.C.Psychol.A.F.B.Ps.S

Footnote 1

“Draft guidelines on the identification of parents and carers supposedly guilty of inventing or inducing their children’s illnesses were released in 2001. They read like the gospel according to Saint Roy and Saint David. Following my initial contact with Earl Howe and the subsequent meeting between Earl Howe, Nick Lyell, Charles Pragnell, Lisa Blakemore Brown and me there was a sense of needing a political focus to bring the question of false allegation of Child Abuse to the attention of Parliament.

My husband and I then met with Lord Clement Jones who then met with Earl Howe. These two front bench Health Spokespersons of the two major opposition parties alighted on the idea of a Lords Debate on False Accusation of Child Abuse to be opened by Earl Howe and summed up by Lord Clement Jones. The debate was eventually set for 17 October 2001 which was very timely as it was a few weeks before the closing date for evidence and comment concerning the draft FII guidelines.
In the run up to the Lords debate there was a flurry of activity. Earl Howe met Lord Hunt of Kings Heath of the Department of Health who would reply to the debate for the Government. Lord Hunt was flanked by key civil servants. Earl Howe presented Lord Hunt with a compelling dossier of case histories and other information questioning or disproving the hypotheses of Meadow and Southall and suggesting that the proposed guidelines on FII were entirely inappropriate.

He came away with the impression that this was the first time that key civil servants had heard anything contrary to the Meadow/Southall view. Earlier in that same summer I had written to Beverley Hughes and to Harriet Harman requesting a meeting to discuss MSBP. I had known and worked with Harriet on the issue of after school and holiday provision. My letter was ignored until after Earl Howe’s meeting with Lord Hunt.

Suddenly I was summoned to the Department of Health. I took Lisa Blakemore Brown and my husband with me. We met with two of the same civil servants who had flanked Lord Hunt at his meeting with Earl Howe. They were fascinated by what we were saying and cancelled their next meeting to spend longer with us. I concentrated on the role of voluntary organisations whose propaganda leaflets were causing much confusion by citing as symptoms of supposed Child Abuse many things which could equally be symptoms of Autism, Asperger’s Syndrome, ADD/ ADHD, Dyslexia, Dyspraxia, CFS/ME and a whole host of other childhood illnesses or disabilities. The civil servants were effusive in their thanks and pressed us to contribute written comments on the FII guidelines. We submitted a thick lever arch file of compelling evidence from parents and professionals, together with conference speeches, academic theses etc. Other key professionals including Dr Paul Shattock OBE of Sunderland submitted their separate evidence.

In the 17 October debate, when Lord Hunt replied for the Government we were all pleasantly surprised. He offered to meet Lady Mar and Lord Astor. He promised that speeches made in the debate and documents submitted would be taken into account when the draft guidelines were reviewed prior to publication. How wrong could we be?”

Jan Loxley to UCAFAA Conference London November 2004.
“The Role of Government Edicts in False Accusations of Child Abuse.”

Foot Note 2

ASPERGER SYNDROME
Anti-social services

It is hard to envisage more ignorant or unsympathetic treatment by the “caring professions” than that meted out to the Storey family of Rayleigh, Essex.

Debbie Storey, 41, has Asperger’s Syndrome (AS), as do her sons Ben, 16, and Sam, 12. AS is a form of autism where sufferers often have high IQs but lack social and communication skills. This can be seen in apparently “odd” behaviour.

Last year Ben and Sam were nearly taken into care because a therapist who had been visiting the Storey home decided – without being qualified to do so – that the children were being psychologically abused. Nothing could have been further from the truth. But a confidential report prepared for Essex social services concluded that Mr and Mrs Storey were “consciously or unconsciously using their children to meet their own needs.” They were summoned to a child protection conference and the boys were put on the “at risk” register for emotional abuse and neglect.

In what was subsequently found to be only one of a series of failures by the authorities, no input was sought from any expert on autism to throw more light on the condition of Mrs Storey and her sons. Lisa Blakemore-Brown, a psychologist and expert on Asperger’s, was so horrified by what was happening to the family she even gate-crashed a case conference to act as a family advocate. She found the intimidation of the family “absolutely unbelievable and unacceptable”.

After a mammoth battle with Essex county council involving lawyers and various experts, Ben and Sam Storey were eventually removed from the “at risk” register last September. But the year-long ordeal took an enormous toll on everyone, especially Mrs Storey. In emails she revealed the depth of anxiety and desperation she felt throughout the period. In March last year, for example, she wrote: “They are ripping my family to pieces and there isn’t anyone who can intervene at a higher level and stop the damage this is doing to the children.

“Ben is really unwell with all the flu symptoms again that flare up when he is under immense stress….but thanks to the core group (those monitoring the children) we’re too afraid to take him to a GP who has blatant disregard for experts and is totally ignorant to the needs of a family dealing with autism….This is spiralling out of control and I’m rapidly going with it.”

But it was not just her mental health that was suffering. According to Debbie’s mother Rosemary, Debbie had been fatigued and feeling unwell for some time but was too fearful to go to the doctor lest this was interpreted as more “attention seeking behaviour” that could harm her chances of keeping the children.

She had complained of increased back pain in the middle of last year and in November was referred to the Royal Orthopaedic hospital for spine and hip investigations. No cause for the pain could be found. Instead, according to Rosemary, questions were asked about whether Asperger’s could have affected Debbie’s perception of pain.

Later in November the pain was so bad it was frequently causing Debbie to vomit. A GP at her practice prescribed slow-release morphine to ease the pain, but another GP took her off it. At one stage she was in such pain she dialled 999 and was taken to casualty at Southend Hospital. After two painkilling injections she was sent home. But she was then readmitted to hospital by her GP when blood tests revealed worryingly low levels of haemoglobin. Again she was discharged.

It was only in March of this year that, on mother Rosemary’s suggestion, Debbie was seen by the consultant who was treating her brother for a rare renal cancer. It turned out that Debbie’s “perception” of pain was all too horribly real. She too was diagnosed with rare renal cancer, only hers had spread to other parts of her body.

While her husband Michael now cares for Ben and Sam, Debbie is being nursed by her parents and awaiting an operation to remove a kidney on 4 May.

Because she is so seriously ill, an advocate from Mencap has written to the respective health authorities, the Southend Hospital NHS trust and Castle Point Health Trust, to question and complain about her treatment. But Lisa Blakemore-Brown has no doubt that the labels attached in ignorance to Debbie and her family over the years mean she has not received the kind of treatment and care she needed when she needed it. “What has happened to Debbie and her family should not be ignored. We have seen over the last seven years more and more cases of parents being wrongly blamed and their real needs ignored. In this case a completely unqualified person set a rumour running that then permeated the entire health, education and social work systems, blinding the professionals. This resulted in no support for the children, no recognition of their condition – and a mother fighting for her life.”

PRIVATE EYE Issue No: 1131 29 April – 12 May 2005