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X [2021] EWFC 46

First instance judgment of Peel J following a final hearing in care proceedings in which a central issue was the level of risk to the subject child presented by findings of Fabricated or Induced Illness (FII) made within previous proceedings relating to other children 7 years earlier.

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The case concerned a child just under two years old at the date of judgment, following 'glacially slow' proceedings that had taken the whole of her life so far to resolve.

The mother (M) was profoundly deaf and had a number of longstanding mental and physical health conditions. In particular, she had been led by medical professionals to believe, and had reasonably believed, that she had had Addison's disease since 2011. Only after January 2021 did it become clear that this had never been the case, with the consequence that M had presented with Addisonian symptoms over many years, including during multiple crisis admissions to A&E, despite not having the disease and there being no other organic explanation for such symptoms. The judge went on to find that such symptoms had been in part genuinely experienced, in part exaggerated [112].

Previous proceedings in relation to M's five older children between 2012 and 2014 had resulted in their separation from the parents [20-24]. A catalogue of 'damning findings' had been made against M in terms of her conduct and veracity as a witness; inter alia, one child had been exposed to significant FII and M had exaggerated her own ill health. Peel J now considered that, although the findings were made 7 years ago, he must take them fully into account and consider whether and how far M has demonstrated change since [25].

In the intervening period, M had led a chaotic and dysfunctional life characterised by extreme anxiety and stress, abusive relationships and abnormal behaviour in relation to her medical needs [26-32].

However, while pregnant with the subject child, M made genuine and concerted efforts to effect and demonstrate change [33-40]. Proceedings were issued following birth and the child was immediately accommodated under s.20. There was cautious optimism about the future and the LA, supported to some extent by early expert assessments, initially proposed residential assessment. This was opposed by the guardian and rejected by the court [41]. M's presentation then declined from early 2020 with numerous calls to the emergency services and a reversion to previous patterns of behaviour [45-46]. Expert opinion became more pessimistic over time [50-63] and the LA ultimately proposed placement for adoption.

In finding threshold to be met [108-122], the judge found that M continued and would likely continue to experience both Somatic Symptom Disorder (where an individual genuinely experiences symptoms of illness, which have no organic or medical cause, but are brought on psychosomatically by mental health illness) and Factitious Disorder (where an individual deliberately fabricates or exaggerates their own symptoms of illness). This represented a continuation of patterns of behaviour identified within previous proceedings. M's ongoing presentation and the previous findings of FII gave rise to a significant risk that this child would be subject to FII if returned to her care. Further findings were made regarding M's ability to provide basic case, the risk of further dysfunctional relationships, criminal behaviour, poor mental health, and her superficial insight into past concerns.

Applying the settled law relevant to welfare decision-making and placement for adoption [130-140], the judge concluded that 'by some distance' adoption was the required outcome for the child [141-150].

Case summary by Iain Large, Barrister, St John's Chambers

For full case, please see BAILII