In recent weeks, the Royal College of Paediatrics and Child Health (RCPCH) has come under fire for refusing to withdraw its guidance on Fabricated or Induced Illness (FII). The calls to withdraw the guidance came from a group of researchers and non-governmental organisations who said the guidance has a ‘discriminatory impact’ on disabled parents and can lead to ‘traumatic experiences’ among disabled children and their families.
Indeed, research from Cerebra and the University of Leeds found that disabled parents appear to be four times more likely to face FII allegations than non-disabled parents, and these allegations often causes devastating and life-long trauma to those accused and to their children.
Cerebra says false Fabricated or Induced Illness allegations are an ‘extreme form of parent carer blame’, and the RCPCH’s refusal to withdraw its guidance could have “tragic consequences” for families and children.
The RCPCH defines FII as ‘a clinical situation in which a child is, or very likely to be, harmed due to parent(s) behaviour and action, carried out in order to convince doctors that the child’s state of physical and/or mental health and neurodevelopment is impaired (or more impaired than it actually is).’ In other words, FII is when a parent or carers exaggerates (fabricates) or deliberately causes (induces) symptoms of illness in a child.
However, the British Association of Social Workers (BASW) says the RCPCH’s definition of Fabricated or Induced Illness is ‘very broad’ and is therefore likely to cover a ‘wide range of situations’. They also note there is a common misconception that FII is the same as Factitious Disorder Imposed on Another (FDIOA), which is an extremely rare psychiatric diagnosis and used to be more commonly known as Munchausen Syndrome by Proxy (MSbP).
Ultimately, BASW says FII is not in itself a diagnosis and it is more about professionals suspecting a parent is creating or exaggerating their child’s difficulties, with no identifiable evidence to substantiate their existence.
It is difficult to estimate how widespread FII is, but the latest BASW guidance states it is “extremely rare.” For this reason, Dr Fiona Gullon-Scott, a Consultant Clinical Psychologist and co-author of the guidance, says it is “far more likely that a child has a complex condition than it being a case of FII.” Despite this, the prevalence of FII referrals made to social care has soared in recent years, which has caused concern for families and children at the centre of false accusations.
Fabricated or Induced Illness accusations can have a devastating impact on families. Indeed, the Cerebra report on FII said family trauma was a ‘major finding of the research’, with the impact often being lifelong. Yet these allegations are not uncommon, with parents in at least 74% of English children’s services authorities experiencing FII allegations.
One parent interviewed for the research said she is ‘haunted’ by the memory of watching her daughter in pain after hospital doctors prevented her from giving her medication following an FII accusation. The doctor disagreed with previous medical instructions, alleging that she was “killing” her child and that if she didn’t stop the medication, she’d “go to social services, and get her taken [away]”.
The mother was then forced to stand by and watch her daughter apparently in pain. “She would give us this look, begging me to help her, and I couldn’t. We had to just sit there and watch,” she said.
Another participant involved in the research said: “As a parent and a human being, being accused of such a heinous form of child abuse has undoubtedly left long-standing, emotional/psychological scars which will remain until the day I die. Just hearing and seeing the words MSBP/FII reignites the trauma and injustice of it all.”
According to research, many parents and carers feel they have nowhere to turn to for support following an FII accusation. This led Chrissa Wadlow, who tackled a false FII accusation after she requested an EHCP for her daughter, to set up a SEND consultancy group for parent facing allegations and/or seeking SEND support.
Sunshine Support: why one mother created a SEND consultancy group for those affected by FII allegationsI experienced a wrongful accusation of Fabricated or Induced Illness when I asked for an Education Health and Care Plan (EHCP) for my daughter, who was so distressed and dysregulated that she had become a danger to herself. Years before I had begged for help; my daughter is Autistic with the PDA profile and also has a diagnosis of ADHD. After jumping through every hoop and getting nowhere, I eventually hired a solicitor to help me obtain an EHC needs assessment for my daughter. The process was laborious and littered with unlawful delays. My daughter became more and more traumatised by her mainstream school that was not suitable for her, and eventually, she disengaged due to the danger that her brain perceived she was in when she was there. The EHC assessment process is legally meant to take 20 weeks, ours took over a year due to (what I can only call) a side-show created by our local authority that involved social care. “It must be Mum… She’s making it up”My daughter is bright and intelligent; she masks and fawns beautifully to ensure those around her don’t spot just how much she struggles – a very typical profile of an Autistic teenager with the PDA profile whose brain is working overtime to assess risk around them, and inadvertently perceives danger due to extreme anxiety and hyper-vigilance. Because of this, the professionals around us did not believe what she was experiencing and how this was impacting my daughter and the rest of our family. Our family was breaking down, we struggled to work, struggled to sleep and our younger children were being exposed to extreme domestic violence (DV). Only this wasn’t the sort of DV we see in the news, this was child-to-parent-abuse and often sibling-on-sibling abuse. There doesn’t seem to be a service that understands this; and so, we were forced into the ‘child protection social care team’ who could not fathom what was going on with our family. Not only were they unskilled in neurodivergence, but they filled the gaps in their knowledge with assumptions. Their formula led them to “It must be Mum… She’s making it up”. Yet there was no evidence of this, and they could not quantify my motive. Meanwhile my daughter’s mental health was deteriorating at pace. “Social care and wrongful FII accusations destroyed my family”Months of spontaneous visits, judgment and interrogation ensued along with a catalogue of unlawful practice, mis-sharing of information, bullying, threats and general malpractice amongst social workers (they were later found guilty of this malpractice by the Ombudsman). We found ourselves at a ‘hearing’ in front of a panel of education, health, care and police professionals who had never met us before and did not fully understanding why we were there, but we later found out this was called a ‘Child Protection Conference’. Our designated workers were all mysteriously absent. We were told to be quiet and that we would have a short opportunity to defend ourselves at the very end to those who didn’t know us, giving their viewpoint on our parenting abilities. Claims were made, no evidence was shared. I was repeatedly told to be quiet whenever I spoke and I was humiliated, lied about and ridiculed by those in the room. A very long story short, our child was placed on a Child Protection plan on the basis of ‘Emotional Harm’. No recommendations for parental improvements were given, because there was no evidence of emotional harm or parental wrongdoing. It was traumatising to say the least. During this short period of three months, we were subjected to more spontaneous visits and hypervigilance from every doctor or professional we came into contact with. We became ‘those parents who abuse’, without any evidence at all. We engaged a specialist independent social worker to undertake an independent assessment. She was a neurodivergent specialist and far more thorough than the council. We went back to the Child Protection Review where it was decided we were not harming our daughter; it had been a huge misunderstanding, and the original social worker had now left the council. We had a verbal apology from the chair of the panel. No support was given to us during this horrific time. No support was forthcoming afterwards. We were dropped from social care without a care in the world. We ended up fighting for our daughter’s educational provision through the High Court where we won, after many years and several SENDIST tribunals. We ‘won’, but there was no justice. It cost almost £200,000 in legal and medical fees, and more importantly, it fractured our relationship with our child. Social care had embedded such a damaging narrative along the way, it was almost impossible to recover from. How Sunshine Support is making a differenceSocial care and wrongful FII accusations destroyed my family, but I am determined we didn’t suffer like this in vain. I am on a mission to ensure that my story becomes a rare one, which is why I set up Sunshine Support. Since our inception in 2017, we have helped hundreds of thousands of children all over the UK and across the world with all matters relating to SEND. We launched the world’s first ever FII Awareness week in 2021, and have continued to support research and improving awareness and practice in this area ever since. |
Chrissa’s story illustrates how traumatising Fabricated or Induced Illness allegations can be for families and the children at the centre of the accusation. She has urged the RCPCH to update its guidance and the NHS to update its description of FII which Chrissa says is currently incorrect. She urges professionals to take heed of BASW’s 2021 FII practice guidance which has “an enormous focus on neurodivergence”, with many who have used it reporting “brilliant outcomes”.
The BASW recommendations are simple – social work practitioners are urged to exercise ‘professional curiosity’ when a referral is made and be aware that:
owledge of the condition are involved.
BASW says social workers also need to accept the potential for interprofessional differences about Fabricated or Induced Illness and they should use reflective supervision to support their own learning and confidence in handling of FII referrals.
In the same vein, Chrissa wants to see a “culture change” among practicing professionals to ensure that families are spared the trauma of FII allegations that so many others have endured.
“The increase in wrongful Fabricated or Induced Illness accusations comes from a kickback from the councils when parents request expensive provisions; they openly admit it’s cheaper to put a child into foster care than a specialist provision,” she said. “The other issue stems from a huge lack of education within neurodivergence and emerging new findings within neuroscience and education; this of course can be blamed on lack of funding, but there is a huge amount of wasted resource on wrongful FII allegations and an even bigger overspend on fighting parents in tribunals through the SENDIST (£99 million was spent last year throughout England and almost 100% of cases were won by parents).”
“There needs to be a culture change. It needs to be from the top down, and this new reluctance to improve from the RCPCH is a huge blow for the families affected by this poor practice.”
