Munchausen Syndrome by Proxy

HL Deb 02 March 2004 vol 658 cc548-50

3 p.m.

Lord Clement-Jones

asked Her Majesty's Government:

Whether they will review the scientific validity of Munchausen syndrome by proxy and factitious or induced illness and the protocols by which these conditions are diagnosed.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, the Government have not initiated a review of the scientific validity of Munchausen syndrome by proxy and factitious or induced illness or the protocols by which these conditions are diagnosed. Our inter-agency guidance was published only in 2002, alongside the report of the Royal College of Paediatrics and Child Health. It sets out clear procedures for all agencies to follow and evidence-based decisions should be taken at each stage of the process by a multi-agency, multi-professional team.

Lord Clement-Jones

My Lords, I very much regret the Minister's reply. We of course welcome the review of the care and criminal cases now being conducted, but the underlying cause of many of those injustices is a diagnosis of Munchausen syndrome by proxy. That has tragically deprived many parents of their children and led to parents being gaoled. Will the Government consider the more fundamental issue of whether that diagnosis—which is still given credence in both Department of Health and Department for Education and Skills documents—is fundamentally flawed?

Lord Warner

My Lords, I draw the noble Lord's attention to paragraph 1.3 of the Department of Health's 2002 guidance, which I mentioned in my Answer. That will enlighten him on the fact that fabricating or inducing illness in children is referred to by a large number of names and that a variety of terms are used to describe circumstances and clinical conditions relating to child abuse. We are trying to deal with the key issue, which is safeguarding vulnerable children.

Lord Walton of Detchant

My Lords, as the Minister will agree, this is an exceptionally difficult and sensitive issue. There have even been suggestions in press reports that Munchausen syndrome by proxy does not exist. I well recall, from my personal practice many years ago, that a child of four was referred to my neurological department in Newcastle, having been admitted to a hospital in Cumbria on six occasions for unexplained attacks of coma. It was only when he was able to tell us that, when he was noisy or naughty, his mother attached a tube to the gas pipe, put it in his mouth and turned on the gas until he had calmed down, that we realised that that was a case of Munchausen disease by proxy.

Regrettably, there are such cases, and their recognition depends on the most careful assessment by paediatricians and others. It is important to recognise that it exists and that the protection of children is one of the most crucial aspects of the problem.

Lord Warner

My Lords, I am grateful to the noble Lord for his extremely authoritative remarks on the matter, to which we should all pay careful attention. As I said, the key is not what term we use to describe a wide range of different types of child abuse, but how we protect children. Paragraph 1.4 of the Department of Health's 2002 guidance makes that absolutely clear.

Earl Howe

My Lords, is the Minister aware that whether or not Munchausen syndrome by proxy exists, the guidelines issued by the Department of Health two years ago contain almost no reference to the serious risk of misdiagnosing that condition and the grave consequences that can ensue—as evidenced by recent criminal cases? In view of that, is it not now appropriate for the Department of Health to review those guidelines?

Lord Warner

My Lords, the key point is how we protect our vulnerable children through the child protection procedures. The whole basis of those procedures is that we bring the evidence and information from a wide variety of professionals together into a case conference to discuss and produce the most appropriate response. The noble Earl raises a separate set of issues, but that does not undermine the basic fact that multi-agency, multi-disciplinary work is the key to success in child protection.

Baroness Masham of Ilton

My Lords, is Munchausen syndrome, with or without proxy, classified as a personality disorder? What is the best means of treating it? Is it not important that a review is carried out on the whole subject?

Lord Warner

My Lords, I am happy to look into whether it appears in international classifications, but I repeat that this area of factitious and induced illnesses among children covers a wide range of circumstances. Concentrating on the term "Munchausen syndrome by proxy" distracts us from the important issue of protecting children.

Lord Blackwell

My Lords, does the Minister accept that, although the welfare of children must obviously come first, there is widespread concern in the country at large about the ability of designated experts to take decisions that affect children and parents, with little power for ordinary people to appeal in a sensible manner? Will he consider introducing an appeal process that involves lay people taking a view on what has been diagnosed?

Lord Warner

My Lords, I can speak from my personal experience of running a large social services department. As I said, the key is bringing the information together on a multi-agency basis in a case conference. That can often involve a lot of information about parents involved in those cases. The care proceedings always go through the courts, so that there is judicial involvement before children are removed from their parents.

Baroness Finlay of Llandaff

My Lords, are the Government considering a new term to define that kind of child abuse, given the difficult position in which paediatricians find themselves when trying to protect abused children, when the people on whom they depend for a history are the very people who have probably perpetrated the abuse? A total of 451 cases have been described in 154 different psycho-social and medical journals recently, published in more than nine different languages. So this is a worldwide problem. Another term might be more helpful to define such child abuse in future, because of the difficult position for paediatricians.

Lord Warner

My Lords, the term that I was using was fabricated and induced illnesses; and I stand by that term.