Archive

Case study
The names of service users have been changed

SITUATION: Marianne Lawton, 27, has been known to a number of social services and education departments for several years. It was thought that she had factitious illness disorder (formerly known as Munchausen's syndrome by proxy). Her son, Miles, 12, was a schedule one offender, having sexually assaulted three young girls two years ago. As such, Miles is also a registered sex offender. Marianne and Miles were resident in three separate local authorities in 12 months. Each time the differing authority came close to issuing care proceedings, Marianne and Miles abandoned their home and left the area.

PROBLEM: They have now turned up in another authority, with Marianne insisting that Miles has a number of illnesses. These are being investigated but cannot successfully be concluded, as Marianne constantly thwarts attempts by professionals to spend time with Miles alone. Marianne has demanded expensive educational and residential resources and has recruited solicitors to fight her corner - while at home the risks of neglect and emotional harm have risen. Marianne often leaves Miles with others (including a 17-year-old male and a friend with a four-year-old son) to look after him. Recently, Miles took an overdose of tablets which had resulted in hospital treatment. He has been placed on the child protection register and a plan has been drawn up that requires Marianne to agree to a 52-week educational placement. She is unconvinced.

Practice panel Warrington Council, social services and housing department
Barbara Costello - specialist mental health nurse, youth offending team ; Sue Buffel - social worker, over 12's team ; Anne Woods - housing manager ; Carolyn Connor - team manager, over 12's team and leaving care ;  Lisa Jamieson - team manager, fostering and adoption

Panel responses
Barbara Costello
It is likely that Miles was transferred from another youth offending team (Yot), where he may still have been on a supervision order for sexual assault against a minor. In this case, social services may request that the Yot health officer remain involved to assist in the risk assessment, the information-gathering process and provide consultation and advice about any psychological or health issues that may present.

A risk assessment should be completed after a joint home visit with Miles's social worker and the gathering of information from health, youth justice and social services. 

Given the details available, it seems likely that an assessment will conclude that Miles was at high risk of reoffending, while his mother seems unable to offer consistent supervision which means that he is a risk to the community and he is at risk himself.

A local risk management meeting could be called by police, inviting all agencies involved with Miles and his family. This would be an opportunity to present the findings of the risk assessment and share information with all parties, highlighting areas of concern and providing an action plan that would assist in reducing risk.

After Miles took an overdose, the health officer from the Yot should have attended the children's ward and complete a mental state examination to assess the risk of suicide.

The local child and adolescent mental health service (Camhs), which would be aware of the health officer's involvement with Miles, may request that the officer complete the assessment.

Copies of the assessment could then be sent to Camhs and social services and, if Miles presented with complex needs, consultation could take place with the named nurse for child protection with the NHS trust.

Throughout the process of assessment and risk management, the health officer could provide social services with support and advice as communication between agencies should be open and free-flowing at all times.

Sue Buffel
Attempts should be made to work with Marianne. But this may prove difficult due to her negative view of social services and education. Progress will almost certainly be held up because all correspondence will be sent back and forth to Marianne's solicitor.

An initial assessment would uncover more detail about decisions taken by Marianne to leave Miles in the care of others. It does not seem safe to leave Miles, given all his attendant difficulties, in the care of a 17-year-old young man. It is also worrying that she should leave him with a friend who has a young son, who may well be of a similar age to those children abused by Miles. Is Marianne's friend aware of Miles's history? Even so, it is unlikely that the friend would be able to manage the risk Miles posed or be experienced enough to supervise Miles to a level to protect the son and ensure that Miles was not a (or at) risk in the community.

A request could be made for a specialist fostering placement and Marianne could be offered respite in order to assist with the level of supervision felt necessary by social services. Marianne, of course, may decline this offer, feeling that no one can understand Miles or manage his behaviour. 

In cases such as these it is essential that all correspondence should be copied to other professionals, and regular meetings held to ensure everyone remained focused on the tasks.    

A child protection agreement could be drawn up to minimise the risk to Miles and others, but again, of course, Marianne may well refuse to sign such an agreement.

An interim care order or emergency placement order could be discussed but the legal department may consider that social services do not have enough evidence to secure either. Indeed, planned legal action may well have been the trigger for Marianne moving authority and may thus be counter-productive.

Throughout this time I would want to work closely with education to identify a suitable placement. I would attend regular risk panel meetings and present Miles's case at the resources panel meeting in order to secure funding for the proposed 52-week placement.

User view

This is a complex and potentially dangerous situation, writes Mark Houston. As Miles is a risk to himself and others, the local authority is legally obliged to intervene. Miles's emotional deterioration reinforces the need for intervention.

To find out what Miles thinks, how he feels and how he perceives the situation, it is essential professionals speak to him away from Marianne.

Because of the complexities, support from mental health services may be necessary. Until the roots of Miles's difficulties are understood, delivering the right support could be almost impossible. Social workers need to be clear with Marianne about why they want to speak to Miles alone.

Marianne has clear difficulties in parenting so, although the local authority should always respect her views and opinions, it may be wrong to go along with her wishes. In making decisions about Miles's future, the priority must be to consider what is best for Miles. If the professional decision conflicts with Marianne's opinions and a satisfactory agreement cannot be reached, care proceedings may be necessary to give the council parental responsibility.

Such intervention needs to be carried through sensitively - Marianne must feel that the authorities are working with her rather than against her. Causing bad feelings is likely to exacerbate the situation and ultimately have further adverse effects on Miles's emotional well-being. It is hence vital that discussions take place between the professionals and Marianne, so that she understands what is happening and why the local authority has taken the decisions it has. It is equally important to involve Miles in such discussions for the same reasons.

Having an education where Miles is in the right environment with the correct specialist support would help to tackle the underlying roots of his difficulties and allow him to develop.

Threats from Marianne of legal action should not influence the professionals' decisions - the sole factor that should influence any decisions is Miles's welfare.

If Miles goes into a 52-week placement, contact with Marianne should still be allowed, but under supervision. It is important that Miles has some social contact as being too segregated is likely to result in further problems of social exclusion in adulthood. But, given the nature of Miles's criminal convictions, social contact would have to be carefully planned. Miles may benefit more from mixing with older children, who could act as role models.

Mark Houston is a care leaver