IN THE MATTER OF [THE CHILDREN ACT 1989]
AND IN THE MATTER OF CM (A CHILD)
B e f o r e :
| WEST SUSSEX COUNTY COUNCIL
| -and -
Charmaine Wilson (instructed by Boots Stark and Goacher) for the 1st Respondent
Neville Stevenson-Watt (instructed by Anthony Morris Solicitors ) for the 2nd Respondent
Linda Taylor (instructed by WMC Legal) for the 3rd Respondent
Hearing dates: 13th 17th 18th and 19th February 2014,
Crown Copyright ©
- Referral to CS. CM seen sitting in M's lap front of car unrestrained. M says she gives in as CM screams in the back. Some time ago CM seen to bite F in crotch, F smacked CM around the head x3; neighbour heard CM screaming "don't hit me"; CM strangled another boy at his birthday party; M had said in Jan 2012 CM was due in hospital for a twisted bowel. Later said she had cured it with Actimel; subsequently M said GP had diagnosed 25% ASD and GP had signed benefit forms, M said CM had ADHD and not ASD; later it wasn't ADHD but insomnia; CM no bedtime routine and appears to rule the house, family always unwell.
a. (i) CM's parents have at times been confused as to the dosage of prescribed medication to be given to CM, e.g whether the dosage of Methylphenidate (Ritalin) should be 20mg or 15 mg
(ii) The parents have increased the dosage of Melatonin ( herbal) given to CM from 2 mg to 4 mg without proper medical approval.
b. CM has displayed extreme behavioural difficulties which following the
parents' description to professionals has led to misdiagnosis of ASD and ADHD
c. The parents have missed some medical appointments for CM
d. The parents have, on occasions, used inappropriate methods of physical and verbal chastisement which, because of a lack of understanding at the time of CM's difficulties and complex needs, may have exacerbated his behavioural and attachment difficulties.
e. The physical state and cleanliness of the family home has been noted to be of an unacceptable and unhygienic nature at times
f. CM has witnessed incidents of domestic abuse between his parents
g. CM's parents have both endured adverse childhood experiences which have rendered them unable adequately to consistently meet CM's complex emotional and behavioural needs.
"It is most likely that the effects of poor parenting upon CM has been subject to emotional abuse, physical abuse and neglect by his parents, who have not adequately engaged with social services in the previous year in order to improve their parenting skills. Furthermore they have repeatedly sought diagnostic assessment from Dr Sue Shah at the Child Development Clinic, Dr Mohammed Twaij Community Paediatrician at the Child Development Centre, and myself......A diagnosis of ADHD cannot be made safely because it relied on a lot of the history given by KM and LM. As a consequence of the child rearing he has experienced..... CM has developed a disorganised attachment style....A diagnosis of Autistic Spectrum Disorder cannot be made at this time."
a. The issues concerning CM's "medicalised" life and the parents' anxieties and beliefs about his difficulties which were clearly discordant, disproportionate and generated by deep anxiety, leading in turn to CM being affected by that anxiety
b. The issues as regards his behaviours and troubled reactions at school which clearly show the extreme feelings and difficulties besetting him in that context, often resulting in aggressive and very violent behaviour
c. The dramatic changes noted in him by the school and others after he was placed with his foster-carers which is very strongly evidenced, as is the anxiety generated as he anticipated contact. In addition, there is clear evidence of his positive response to clear boundaries, structure, certainty and routine.
d. His communication difficulties, his difficulties with his peers, his issues surrounding food and eating and his difficulties coping with change.
a. I am assured that the search for the right family where he would be the youngest child by a long way or placed on his own is not limited by resources. It is acknowledged that at present there are a number of children with similar needs to CM for whom the LA are seeking a specialised placement, and it may be that the search would need to be widened, though I agree that a placement in this area would be to his great advantage. The Social Worker Miss B is confident based on her knowledge of the case that it will be possible to find a suitable foster-family for CM by April.
b. CM has thrived and changed in a very significant way since he has lived away from his parents. He is well-cared for and has settled extremely well into an experienced home where he is given consistent parenting and proper boundaries. He appears to be able to adapt well to changes when he is given clear explanations about what is going to happen. He adapted very well to life with his current carers and that is a good pointer. It is likely that he would adapt to new carers.
c. CM will need a home where his needs are given the highest priority over and above those of his carers, something which he has now enjoyed. He will need attuned and sensitive parenting by people who can offer him consistent support in all areas: his schooling, his social life, interventions with regards to his developmental and any medical needs, and who can accept and implement professional advice when it is needed. It is likely that he will have more chance of achieving his potential according the Guardian if that kind of care is available to him.
d. His proposed statement of Special Educational Needs will be a useful tool and would give his carers a clear picture of how his educational needs will need to met in future. He would need adults who can work closely with his school and import an enhanced understanding of CM into that arena to help him realise his potential.
e. There would be a need for an appropriate level of support from Children's Services tailored to CM's needs and to supporting his carers, and that support would enhance his progress. CM would have the benefit of work to help him make sense of his history and circumstances in the form of life story work which hopefully would give him a clear and understandable idea of his place in the world.
f. He would be likely to receive more consistent, attuned and insightful parenting than he received in the care of his parents. The structure, boundaries and consistency he needs must be a priority for him to ensure that he does not revert to the emotional chaos which previously characterised his life to a great extent.
g. If the parents were able to support him, his experience of them in contact might well be excellent and therefore his own relationship with them might take on a more positive and meaningful character than their care of him provided. There would be less scope for mixed messages to be given to him once finality had been secured.
a. He would lose the chance of being brought up with the love of his parents and his extended family.
b. He would lose the regular warmth and affection he receives during contact and the link with his family would be seriously diluted if I agree to the reduction of contact proposed by the local authority and supported by the Guardian. However if the parents are able to work with professionals and learn about CM's needs and situation, there is some flexibility proposed as the case progresses, though clearly CM's own needs would dictate the path of contact in the future.
c. He would on either scenario lose the good relationship with his current carers. If he were to go into long-term foster-care, there would be a double loss for him of regular contact with his parents and family, and the care he currently receives. Such losses cannot be underestimated.
d. Given CM's challenging behaviour, as well as the vagaries of the option of long-term foster-care, there is a risk that his placement will break down, perhaps more than once. That risk however needs to be balanced against the risk of a breakdown were he to be placed with his parents which on the evidence is the greater risk. The view of the Guardian is that the parents would be extremely anxious about the possibility of breakdown and that in itself would affect their care of CM, and his view is that the risk is higher than the risk which would be run if her were to be placed in long-term foster-care. Were a foster-placement to break down the care plan would allow for planned and supported change. Were a placement back home to fail, that might not be the case. It would be utterly devastating for CM and his parents.
e. A placement in foster-care would not meet his express wish to go home but this is not a full reflection of his ambiguous and complex feelings. . His experiences of parenting at home as evidenced however highlight the difference between love and good parenting and I am satisfied that he did not receive good parenting when he lived with his parents.
a. CM would be at home and loved by his parents with support from their family members, as was previously the case.
b. This would match his wish to go home which he has expressed to Sylvia Duncan and the Guardian. He is nearly 8 years old and that is an important feature, but it is qualified by the nature of his experiences at home and his expressed fears.
c. The parents say that they would parent him differently now. The home is clean now. The question is whether they have made any of the changes in understanding and parenting which led to CM's removal. They say that have, and were that to be the case, it would be right for CM to go back home.
d. The parents' relationship appears to be strong and supportive now on their account, but there have been issues of domestic violence, witnessed by CM in the past which they ascribe to the stresses they were under when Mr M went bankrupt and the business was lost.
a. The parents might struggle as they did previously without their needs being addressed. The evidence of the Guardian and Sylvia Duncan and HB is that he would be at further risk of significant harm if this happened. The view of Miss Duncan which I accept is that his enormous anxieties are met by parental anxiety and not contained – the more anxious he becomes the more aggressive he becomes and the more anxious the parents become the more resistant CM becomes and he lashes out – she described this as a vicious circle. She told me that it was likely that he would regress if returned home. Given his significant progress that would be extremely detrimental to his development. HB confirmed that in her view if he went home "conditions would probably deteriorate again within a short period of time and become unacceptable without professional intervention".
b. There would be a need for an extremely high level of support, possibly daily. The parents say ( I believe that they sincerely mean) that they want any support they are given, but in the past they have found the intervention of the local authority unacceptable and challenging.
c. In addition there would be a need for orders in my judgment given the level of need and risk were that to happen. A vicious circle would arise if a care order were to be made as the local authority would need to be satisfied that such a placement was, under the regulations, appropriate and safe. Their view is that it would not be and therefore CM would not be placed at home. A supervision order would not have the teeth of a care order, and the local authority would not share parental responsibility with the parents in a case where on any analysis the parents have struggled to such a degree and put CM's health security and safety at risk to the point that it is likely that he has been damaged by the experience.
d. There would I accept be a real risk of a placement at home breaking down which would be a devastating outcome for CM and his parents. Any support from their family would have to be not only robust, but at a greater and more attuned level than it was prior to CM being taken into care. There would need in my judgment to be a high level of supervision and engagement with the local authority by the extended family, and they would be required to be vigilant and if necessary report any return to previous damaging behaviours by the parents.
e. The parents would both need to successfully engage in appropriate treatments for themselves whilst caring for CM. To date the mother has accessed one session of hypnotherapy and is signed up for more. She has diagnosed Munchausen Syndrome by Proxy in herself. Of course that is not a valid diagnosis but were that or any similar syndrome with an up-to-date title proven to be the case, it would have the most serious implications for CM's safety in her care if it were to be unaddressed. It is right that there are references to the mother fabricating illness and the chronology reveals the patterns of anxiety and medical referrals which were so detrimental to CM in the past. There would be a significant risk to CM if he were exposed once again to the fruitless medical quest his parents embarked on.
f. The parents are extremely anxious and the underlying reasons for this have not been addressed. The father is not a well or active person and his mobility problems mean that much of the physical care and managing of CM would fall to the mother. In the past she has been overwhelmed by the task of keeping the home clean. As CM grows he will be physically and emotionally challenging. His educational needs will need to be supported skillfully and patiently and his social needs will require tactful and appropriate handling by those caring for him. He will need carers who do not resort to physical punishment and who are able to explain things to CM in a way he understands. In my judgment he needs the care of people who are very resourceful and who accept and understand the need to access support from professionals, things which to date have sadly been largely beyond the parents.
g. Were the standard of parenting CM requires to dip on any front it would be harmful. He requires carers who are constantly available for him and who can weather his storms and outbursts in a detached and appropriate way, without being overridden by their own emotions, without resorting to inappropriate physical or verbal chastisement and without finding themselves emotionally challenged and completely stressed out as these parents have been when he loses control. He needs in my judgment specific and consistent messages and handling so that he feels increasingly safe and contained. CM has put himself and others in danger. It is lucky that so far no one has been seriously injured during one of his outbursts. He needs carers who do not give into his demands to keep the peace and who can help him to understand where he stands and why. Without that, he would be lost to his own overwhelming feelings. Sylvia Duncan states that his aggression is a reaction to his parents' anxieties. If that occurred again when he was in their care there would be a risk to those caught in the emotional storm of huge damage – to CM because he would be back to his most distressing behaviours, and suffering emotional damage and the risk of serious physical harm, and to the parents because they would be so seriously anxious about what was happening and also at risk of physical harm from him.
h. CM's mother has not addressed her underlying difficulties with telling the truth. The importance of accurate reporting in relation to CM is vital. She was convicted in relation to a false allegation of rape when she was 18. I know that this was a long time ago. The press report indicates that her psychological problems and an "intense imagination" were relied upon by her Counsel in mitigation. She said that she was a child who because of her upbringing sought and craved attention. She was seen as high risk and in need of psychiatric help and she was given a non-custodial sentence on condition that she sought help for her mental health problems. I note therefore that the traits still identifiable in the mother have been present for many years.
i. Her family say that she lied as a teenager; there are many examples of her reporting medical issues about herself or about CM and even about Mr M. The father says she exaggerates. M Primary School reported that she made very unusual statements about CM's health and were worried she was prescribing and administering medication herself. She was reported to have told parents that a teacher was dying of a brain tumor and she had visited him in hospital. This is a very long-standing and deep seated problem and of course the implications for CM if she were to resume caring for him are that it might all start again, leaving a trail of confusion as to where the truth lies. Dr Perera reported that on 25th June 2013 he was given unreliable evidence by the mother about the history. He has stated: a diagnosis of ADHD cannot be safely relied on because it relied a lot on the history given by Mrs M. He reported that the parents could not be trusted to meet CM's needs "because of their own psychological and self-reported physical health problems." He was obliged to review and amend his diagnoses because of the unreliable history he had been given and as a result CM does not have medication.
j. CM's parents have been very resistant to advice and intervention in the past though they say that this has changed. It is hard to see how they would cope with the necessary degree of intervention in their lives. They have had issues with JB, whom F describes as "superior" and about whom a complaint about rudeness was made, and with HB, who it is said was supercilious towards them. I make no findings but there is a pattern of them objecting to social workers and work, of not fully engaging and of becoming defensive when challenged. This would make the situation very difficult if not untenable and it is likely that similar difficulties would arise in future.
k. Despite their concessions, I have not yet heard anything which makes me think that they really understand that, as Dr Perera stated, their parenting was having a severe impact on CM's emotional and behavioural difficulties. Without that understanding, or a real understanding and commitment to changing their ways radically, CM would be at risk. They have in the past, due to their anxieties and inability to meet CM's parenting needs appropriately, resorted to medical help for explanations, and intervention by way of medication for CM's problems. He does not need medication. It would be detrimental to him if the parents' issues as regards his medical needs were to re-emerge and in my judgment without further work and real acknowledgment and understanding of this anxious perception and approach to his health that dynamic is at risk of returning
l. CM's identified needs are very great. His emotional needs have not been met and will best be met by consistent, caring, skilled carers who are available to him. Sadly his parents have not been able to meet those needs in the past and whilst I know that they have strived in contact to understand and meet his needs, nevertheless their own unaddressed needs and lack of insight into his means that they are unlikely to make the radical changes he requires to be safely parented at an emotional level. His physical needs have not been met – he was living in conditions which limited his enjoyment of the available space. In addition his physical safety is at risk during one of his outbursts and unless they are properly contained and supported he may harm himself or others. His difficulties compound the risks and he has needed and will need appropriate medical and professional attention and support. This has been a major issue. He is not now medicated but he has been through the medical mill, and any future interventions will need to be absolutely appropriate. He will need help with any eating issues in order to be kept safe and healthy. Any developmental delay will need appropriate input and support. His educational needs and his identified difficulties need attuned and skillful support, as do the social aspects of school life and friendship.
m. Sadly his parents have not been able to understand these needs and nothing that I have heard from them convinces me that they have grown sufficiently in their understanding to allow them to recognise those needs and meet them in the way CM requires. Neither of them have in any real sense addressed their own needs and serious issues and in reality I do not think that they have as yet really understood that such a need exists. They feel that they have done what is needed themselves.
n. The evidence is that this is just not the case despite their genuine beliefs. I find as a matter of fact that the parents are unable to meet CM's complex needs, because they are so overwhelmed by their own deep and unaddressed difficulties that he would be at risk of significant harm were he to be returned to their care. It is overwhelming evidence and the local authority have proved their case.