Case No. LV20C00210

. She is left however coping with distress, hyperarousal, feelings of anxiety, depression, isolation, somatisation and relationship problems. Her sensitivity means she also likes food, sex, and the senses, so when channelled into more positive or acceptable experiences she experiences a release.”I find it difficult to penetrate the logic of this paragraph. I sense that Dr Hansen is endeavouring to filter into her report some of the more positive aspects of M’s personality. It is important that these positives are identified and acknowledged. 37.I formed the impression that Dr Hansen had found M to be a complex personality. She has given M the opportunity to talk with her at great length and garnered information which is important in enabling the professionals better to understand her. It may also, as has been suggested, be a useful foundation for therapy in the future. Ultimately, Dr Hansen identified that M would require extensive therapeutic input. As I have recorded above (see para. 19), the need for M to engage in challenging ‘her own narrative’ must, in Dr Hansen’s view, be the ‘first to be addressed’. There has been some debate as to the extent of the therapy that M has received. It would appear, that it is now agreed that she has attended 12 sessions. The number of sessions, however, is entirely irrelevant. What is significant, is that M has not even begun to confront the dissonance between her perception of the world and the perceptions of others, most importantly, her own children. 38.Dr Hansen considered that M might benefit from Cognitive Analytic Therapy (CAT): Assessment and information of early life and presenting difficulties. The objective of this would be to create a collaborative formulation which might enable her to ‘contain her narrative of life’ and to reconsider repeating patterns and her own feelings. Dr Hansen told me that the length of therapy for such intervention varies but she was clear that M would need the maximum available. This may be in the region of 32 sessions. Additionally, Dr Hansen identified significant trauma in M’s own childhood. In her evidence to me, M was asked about her childhood and her own experience of parenting. She effectively closed down that line of questioning immediately but, in the few sentences she did speak, the pain generated by the issue was almost palpable and the intensity of her reaction notably greater than to any other subject that was raised with her. Dr Hansen had foreshadowed this in her oral evidence and in her report. She considered that these experiences indicated significant trauma which in and of itself, required additional specialist support and treatment. In particular, Dr Hansen considered Eye Movement Desensitisation Reprocessing (EMDR): Management of trauma, with a development of effective resilience. She made this observation in her report, which requires to be emphasised: “The trauma intervention, such as EMDR needs to account fully for the potential for dissociative symptoms. Failure to do so could lead to trauma therapy, such as EMDR, failing to be effective if dissociative symptoms are not prepared for at the outset or mismanaged during treatment. Consequently, the identified EMDR therapist should assess the dissociative symptoms present with so that this can be managed effectively if required. Essentially the therapist needs to prepare for and accommodate such difficulties. Preparation for the management of any dissociative symptoms should include the treatment of these by the EMDR therapist before moving onto the other aspects of EMDR therapy. [M] may be able to access this via CMHT through a referral from her GP. In terms of length of treatment, this would be determined based upon how she engaged, the number of sessions available to her and her capacity to use the sessions productively.”39.Though Dr Hansen considered this trauma therapy to be a separate piece of work, she was prepared to contemplate a degree of overlap, if a therapist could be found (and funded) who possessed the expertise and experience with both therapeutic models. I found Dr Hansen to be gentle and kindly disposed towards M. I felt that she was doing her best to help her and encourage her commitment to the therapeutic process. Dr Hansen concluded that the programme of work she outlined would ‘at best’ take a period of 12 months from its start. Whilst I accept that timeframe, I feel bound to comment that as Dr Hansen outlined what was contemplated and the therapeutic distance M still has to travel, I felt that there was a degree of optimism underpinning her time estimates. Perhaps, more importantly, I could find no real indicator from Dr Hansen’s evidence suggesting that M would engage constructively in the therapy. Intrinsic to this therapy is unambiguous confrontation with M’s false or delusional view of the world. To date, she has recoiled entirely from such confrontation. 40.Dr Weir’s prognosis was uncompromisingly bleak. I had some sympathy for Mr Browne’s questions of him which intimated that Dr Weir’s view was a counsel of despair. Dr Weir told me that most people with personality disorders of the type that he identified in M, ‘die with those disorders intact’. Change or therapeutic progress, he described as occurring at glacial pace (my expression, not his). Certainly, he was contemplating many years of therapeutic intervention. Insofar as there is a conflict of view in respect of prognosis and treatment between Dr Weir and Dr Hansen, I cannot resolve it, nor for reasons that I will explain below do I consider it necessary to do so.41.It may seem inconsistent with much of what I have set out above to say that I have no doubt at all, that M loves her children very much. Even though, she has repeatedly blamed A’s complaint for the situation the family now finds itself in, she nonetheless describes A as ‘her princess’. She has told me expressly, that she loves her greatly. I do not regard this as manipulative, on the contrary, I see it as entirely genuine. To understand the apparent contradiction requires a careful understanding of what Dr Weir and Dr Hansen have analysed. M’s psychological functioning causes her to have a distorted perspective on the world in which her genuine and instinctive emotions coexist in parallel with her own carefully constructed and ultimately false narrative. For M, that which is real and that which coexists in consequence of her paranoia, can be accommodated at the same time. The two run separately and entirely disjointedly. The tension that creates causes M distress.42.In cross examination, M was repeatedly confronted with occasions on which she has been an aggressor. Whilst she expresses some platitudinous acknowledgment of blame, these wilt under the heat of her unsparing and occasionally, vituperative criticisms of others. In truth she struggles to see any perspective on the world other than her own. It is inevitable and healthy for children to challenge their parents, but challenge causes unsupportable stress for M and, in my judgement, having listened carefully to her, this triggers the construction of a narrative which she finds it easier to live with. When confronted by A’s assertion of her own teenage autonomy, M perceives this negatively as opposition in which she is obliged to ‘pull rank’, to use her phrase. At similar times in their respective development and for similar reasons, this has caused M to resort to violence against both Q and A. I sensed that this is driven by fear and a need to control and is not simply malicious in the way that it may sometimes have been perceived to be. Thus, M has convinced herself that Q and A both have mental health problems. This is an easier option than confronting her own mental health issues which, on some level, I sense she recognises will expose her to considerable pain and, as Dr Hansen has identified, the reawakening of past trauma. 43.Since the birth of S, M has argued for and submitted herself to repeated residential assessments, in which every aspect of her own and her baby’s life, has been monitored. This has not merely involved 24-hour scrutiny by assessors but has, for over 18 months, included video surveillance. Assessment of this nature and intensity over such a period of time, is, at least to my mind, dehumanising. It is corrosive of personal privacy. All this has occurred in a time of pandemic which carries further restrictions of its own. The fact that M has been prepared to put herself through such a process, reflects both her courage and resolve to reunite her family. She has readily sacrificed her own liberty and freedom. This requires to be acknowledged unambiguously. 44.Whilst M may have created turmoil and distress to many within the unit by what I find to have been her verbally aggressive, intimidating behaviour, it must also be emphasised, that for the vast majority of the time, she has provided warm, nurturing care to her son. She is an intelligent woman. On a conceptual level, she has an educated understanding of the principles of good childcare. Her son has always been clean, appropriately dressed, properly fed, and bathed with love and affection. She has provided him with good, nurturing care and as I have been told, ‘lots of eye contact and cuddles’. At contact sessions (family time), her relationship with T has also been similarly warm and affectionate. There is no doubt amongst any of the professionals, that T loves his mother, although he has become increasingly unsettled by the artificial constraints of their relationship. A has also attended those contact sessions. I have been told that her motivation reflects her protective instinct towards T, rather than a genuine desire to meet with her mother. 45.I listened carefully to M’s evidence, but in it, I could not find any meaningful or sincere acknowledgment of her own responsibility for what has happened to her family. Her response remains to hit out, verbally, at others. Despite all this, she has cooperated with Dr Hansen’s marathon 19 hours of interviews and attended 12 therapy sessions. This leaves me with a clear impression that, at least on an intellectual level, she is highly motivated to care for her children. My assessment of her resonated with Dr Weir’s view that she is ‘reluctant to take ownership of her problems’ and ‘has a tendency to blame others for her difficulties’. As Dr Weir makes clear, this reluctance to ‘take ownership of her problems and tendency to blame others for her difficulties’, renders her prospects of making ‘meaningful change in the medium term… extremely limited’. 46.I have highlighted the privations of this protracted assessment process from M’s perspective. Residential assessments most commonly involve parents and very young babies and for relatively short periods. It is important to emphasise, with even greater force, the impact on S. S has been continuously observed by professionals for the whole of his life, barring short periods in foster care. Latterly, and for the past few months, he has been in M’s care at her home on a supervised basis and then returned at the end of the day to his foster carer. Happily, the foster carer has been the same person throughout. 47.The present arrangements are monitored by a company named ‘247 Supervision’. Extensive logs of their daily observations have been filed. The logs are impressively detailed. On the 23rd April 2022, M was plainly recognising that S was becoming unsettled. M said that it was ‘not fair’, she described S’ routine as ‘up the wall’. M said it is ‘just messing with his head’. All this strikes me as both accurate and sadly inevitable, having regard to what has been referred to by Mr Browne as ‘the hot house’ of the environment in which he has spent most of his first two years of life. What is surprising, at least to my mind, is that it has not been articulated as unequivocally and more volubly by the professionals. Again, I confess that I am utterly perplexed as to how it was thought acceptable to continue these arrangements for as long as has occurred. I simply cannot reconcile them with S’s welfare interests. 48.M, notwithstanding her own complex and distorted view of the world, is right to identify the harm that these protracted residential arrangements have caused to her son. It is entirely illustrative of what Dr Weir and Dr Hansen have said, that alongside this insight into S’s needs, exists M’s own powerful and ultimately overwhelming personal distress. In a pattern which has been observed over many years, M manifests this distress by lashing out at others. She criticises the foster carer who she contends gives S ‘what he wants’. This was in response to an occasion on which S was plainly fractious and crying. M observed to the supervisor ‘all of my kids have mental problems, so do I’ … ‘the social worker and everyone set me up’… ‘on 3 occasions, they have taken him with no reason or with no Judge saying it’. 49.Later that day (23rd April 2022), M said: “Sometimes I think it’s easier if he goes, he is going here there and everywhere and as a mum you don’t want them put through it. I think, take him. Not nice, but I want what’s best for him. This is messing him up.”50.In the early evening on the same day, M was plainly becoming stressed. She told the assessor: ‘I have not got in a routine with baby, but I need to clean this house. This is getting on top of me, they are trying to put more pressure on me’. A little later she is recorded saying ‘I am putting him back on baby milk, it’s got all of his vitamins in. I am just winging it and no one best clean my house and no one needs to open my curtains; it’s nobody’s business’. After feeding S, M went upstairs with him to bathe him and staff are recorded as sitting on the stairs when M returned downstairs. S is recorded to have closed the living room door. M told me, in her evidence, that he is always closing the doors. The logs record the following: “[M] said, look at him closing the door again… I worry, serial killers do stuff like that. I’m not saying he is a serial killer, but I do worry”. “[M] then told a long-winded story about her friend, whose dad was a Judge, he was stabbed by someone who had mental issues and had an obsession with closing doors”In the context in the history of this case, I find these remarks disturbing. They resonate with her views that Q and A have mental health problems. I note that M was stressed, and that S had been challenging at the time she made these remarks. Again, that resonates with the accounts of Q and A that I have analysed above. 51.All this requires to be factored into an accurate understanding of the nature of the risk to S. It is important that I highlight that notwithstanding the advice and guidance M has been given about the dangers of co-sleeping and the fact that there was a serious incident earlier in the assessment process which put S in danger, M again, recently had to be reminded not to fall asleep with her baby. On the 23rd April 2022, M had to be prompted three times before putting S in his cot. Reading the logs, I am sympathetic to M’s distress. M had been trying to get S to sleep and she was plainly tired herself. She did not want to risk waking her son to put him in the cot, but her judgement was compromised. I accept, as Mr Browne points out, that at approaching two years of age, S is no longer at quite the same level of risk were he to fall. That is, of course, not the same as being risk free in a situation which was avoidable. 52.Finally, it is important that I address M’s physical health. M suffers from a condition known as extra-cranial arteriovenous malformations (AVM). She was assessed by Dr Stephen Mullin, Consultant Clinical Neuropsychologist. He reported that there was no intracranial component and therefore no risk of any central neurological problem. He considered that M had been ‘remarkably stoic’ about her condition. He found M to be highly articulate, friendly and entirely appropriate throughout the interview. She answered all questions put to her ‘eloquently and well and provided accurate information about the nature of her medical condition… good recall of information and demonstrated no impairment to reasoning’. This meeting was the polar opposite to the combative encounter with Dr Weir. Mr Browne leans on it to advance the proposition that those who deal with the mother sensitively and creatively may secure her open cooperation, rather than the responses that have been charted above. Whilst I respect the point made, I am left with the clear view, on the preponderant evidence, that M is entirely capable of being charming when she wishes to be so and especially, when her own ‘false narrative’ is not being challenged. Dr Mullin considered that there was no organic means by which AVM could affect M’s personality or psychological functioning. But, he did emphasise that it is a ‘serious physical health condition’ and the ‘knowledge of having such a condition’ as well as ‘the accompanying pain and discomfort’, may well be highly stressful. 53.The Local Authority’s care plan for S contemplates placement with a view to adoption. Counsel have not addressed me on the applicable law. It was not necessary for them to do so. The law in this area is settled, though always challenging to apply, given the collision of such fundamental rights and responsibilities. What is contemplated is the deracination of a child from his mother and family. Wherever it is possible, and consistent with their identified welfare needs, children are entitled to be brought up within their birth families (Re KD [1988] AC 806; Re W [1993] 2FLR 625). Care plans for adoption have been described variously as "very extreme" and only to be made when "necessary" for the protection of the child… when all other options have been discounted and “when all else fails” and when “nothing else will do”. A plan contemplating adoption is properly characterised as ‘a last resort’: (Re B [2013] UKSC 33; Re P (a child) [2013] EWCA Civ 963; Re G (a child) [2013] EWCA Civ 965).54.Despite her intelligence, eloquence and resilience, M’s own experience of life has left her with significant psychological difficulties. On an intellectual level, she articulates a willingness to participate in what is, on any view, a gruelling therapeutic regime. The first objective of such therapy is to challenge M’s distorted or delusional perspectives on the world. There is no evidence that process has begun. It is sadly all too clear that the timescales for M’s therapeutic journey simply cannot be reconciled with S’s pressing need for and entitlement to secure, loving, and settled family life. At two years of age, and in his circumstances, this can only be achieved within the framework of an adoption. In the not-too-distant future, A will most likely move on to college or university. T has a real prospect of being cared for by his father. Long-term foster care for S would therefore not involve a placement with his half-siblings. It would also not provide him with the security that adoption so frequently achieves for children placed at this age. 55.There are many aspects of M’s care which have, properly, been commented upon in very positive terms. She has good practical caring skills and has been able to provide her son with a feast of good eye contact and cuddles. It will be painful for her to read but nonetheless important for her to know, that this serves to equip S well for the future and to enhance the prospects of a successful adoptive placement. Accordingly, I endorse the Local Authority’s care plan, recording that it is also supported by the Guardian. 56.The Guardian has suggested that the Local Authority might consider an open adoption in this case. However, she recognises this is to be subjugated to the need to avoid delay. Ultimately, she considered that the objective should simply be to find a placement that is most suited to S’s needs. I agree. 57.By way of postscript, I should add that it has not been possible to track down why it is that this case has drifted in the way that it has for as long as it has. No advocate or any other professional has sought to defend the lamentable delay, nor, in my view, could they. I have asked for a report from Children’s Legal Services and from Cafcass setting out how they consider this has occurred and how it might best be prevented in the future.