Case No. SE20C00603

39.IW is VW’s second child. Her first child is AW (born on 16 September 2016). She was the subject of care proceedings in Guildford in 2016 - 2017, which concluded with AW being placed with her father, CC. In those proceedings, threshold matters included causation of a rib fracture, sustained in late 2016 – early 2017 and ingestion by AW (then pre-mobile) of dihydrocodeine, a medication prescribed for VW, which resulted in AW becoming profoundly unwell. A judgment of Recorder Bugg given on 4 September 2017 concluded that, while it could not be said that the dihydrocodeine was administered deliberately, VW had ‘somehow committed an act that recklessly endangered AW’s life’. No finding was made as to causation of the rib fracture, in view of the accepted possibility that it could have been caused during CPR. 40.Recorder Bugg noted that VW’s own childhood was blighted by neglect and abuse, leading to significant mental health difficulties from her adolescence onwards. Self-harming behaviour began when she was 12 years old. She was diagnosed with borderline personality disorder and ‘has spent periods of time admitted to mental health units and has attempted suicide’. Her self-harming behaviour and mental health issues worsened during her pregnancy with AW, including, as noted by the Recorder:‘an overdose with paracetamol, cutting herself and, in May 2016, an attempt to commit suicide by jumping onto train tracks.’ Following AW’s birth she was admitted to hospital on a number of occasions, with significant episodes of dehydration, vomiting, failure to feed, and failure to thrive. At the same time, VW’s response to AW was of increasing concern, reporting to relatives, for example: ‘I don’t wanna touch her or hold her or even to be in the same room as her. I thought if I ignored it or just kept doing what I had to it would pass but it’s just getting worse. I wish I hadn’t had her and how can I say that I’m meant to love her unconditionally. I shouldn’t feel these things.’ 41.VW was further hospitalised with self-harming behaviour and mental health issues in late 2016, leading to VW and AW being placed in a residential unit.42.In January 2017 AW was repeatedly admitted to hospital and the rib fracture and toxicology testing for dihydrocodeine led to those threshold matters being adjudicated on by the court. Over and above those two issues, findings were sought as follows:“The mother has a borderline personality disorder as a result of which she has self-harmed on a number of occasions”and“The mother has been assessed as a medium to high risk to AW”But those findings were not made. The court did not reject the averments. They just were not dealt with.43.As stated above, these proceedings were issued on 26 March 2020. During the three years between the two sets of proceedings VW was repeatedly admitted to hospital and, on occasions, to periods of detention in hospital under the Mental Health Act 1983. In the proceedings before me she has been assessed by:i)Dr Stein (consultant psychiatrist). He has diagnosed VW with Factitious Disorder.ii)Professor Nathan (consultant psychiatrist). He has opined that VW suffers from a personality disorder with a range of traits, predominantly borderline personality disorder. He records a history of symptoms of anxiety disorder, depressive disorder and PTSD. He notes features of Substance Use Disorder. He considers that there may be possible mild intellectual impairment. He concludes that VW has a condition within the ‘somatic syndrome and related disorders’ category and/or malingering although it is not possible to determine the precise nature of it. iii)Dr Jennings (consultant endocrinologist). He has stated that it is most unlikely VW has Addison’s disease and that the recurrent hypoglycaemia during pregnancy may have been caused by self-administration of insulin.The reports, which I have summarised above, are lengthy and detailed, and my summary of them does not do them justice. Suffice to say that they provide an exhaustive analysis and diagnosis of VW’s physical and mental health problems. That evidence is uncontradicted.44.The threshold document sets out in pitiless detail why it is said that VW poses a risk of serious harm to IW were he to be entrusted to her care. In summary it alleges:A: VW has experienced abusive and neglectful parenting throughout her childhood.B: The resulting mental and emotional instability has resulted in an itinerant unstable lifestyle, and emotional and mental health issues.C: VW has extensive, serious and enduring psychiatric, psychological and emotional difficulties. She suffers from: (a) somatic symptom disorder, (b) factitious disorder, and (c) malingering.D: VW has an extensive history of deliberate self-harm spanning from the age of 12.E: Since the age of 13, VW has frequently and repeatedly been detained in secure accommodation.F: VW hoards medication and conceals sharp implements so she can continue to deliberately self-harm, even whilst under hospital care or detention.G: In December 2020 whilst detained under section 2 of the Mental Health Act 1983, VW floridly self-harmed.H: From her early teenage years VW has abused alcohol and various illicit substances including cocaine, crystal meth, magic mushrooms, ecstasy, and cannabis.I: VW has an extensive history of presenting at numerous hospitals throughout the country with wide-ranging complaints as reflected in nearly 20,000 pages of medical records.J: VW falsifies signs and symptoms in order to mislead and manipulate medics.K: VW is dependant on opioids.L: On repeated occasions during her pregnancy with IW, VW deliberately and surreptitiously self-administered insulin in order to manipulate her blood sugar levels and thereby factitiously induced a state of hypoglycaemia.M:. VW’s psychiatric and psychological difficulties and behaviours are enduring, and by virtue of them, any child placed in her care is at risk of serious physical and emotional harm.N: VW’s first child, AW, was the subject of care proceedings in which it was found that AW’s life-threatening collapse on the 28 January 2017 was consistent with dihydrocodeine poisoning and that the dihydrocodeine present in AW’s system was due to VW, who gave dihydrocodeine to AW.O: VW’s vulnerability and underlying issues have led her to form a series of damaging, controlling, emotionally and, on occasions, physically abusive relationships with men and to place herself at risk.45.In her witness statement of 15 July 2022 VW made extensive, but far from complete, admissions in relation to the contents of the threshold document. Mr Sampson QC described her admissions as “anodyne”. Ms Heaton QC described her admissions as “vacillation”, and said that she had “effectively skirted around or not addressed the central findings sought”. 46.I emphatically reject these descriptions. VW’s admissions were extensive. She admitted a large number of the concrete facts alleged against her. So, for example, she accepted that she had self harmed by cutting herself; by swallowing razor blades; by overdosing even when in hospital; by tying ligatures around her neck; by threatening to jump off bridges or in front of trains; by self harming in relation to food; by abusing cocaine; and by her extraordinarily high number of hospital attendances. She accepted that from a young age she was involved in abusive relationships. She accepted the findings made by Recorder Bugg. She accepted that she cannot care for IW.47.Mr Garrido QC described her admissions as accepting the underlying facts but disputing the professional label. Therefore, while she admits much of the conduct that led the experts to conclude that she suffered from FII, she disputes that diagnosis. In my opinion to have a state trial about professional labelling or nomenclature would be the height of futility.48.In the Stockport case Thorpe J refers to the very considerable emotional and psychological cost to parents in accepting advice that leads to the conclusion of the case without a hearing. I can completely understand VW’s instinctive reluctance to condemn herself as being a sufferer of mordantly described psychiatric conditions. In my opinion it was brave and sufficient for her to make the admissions that she did in relation to concrete facts. Those concrete facts have been analysed by the experts and they have rendered their diagnostic opinions, which are uncontradicted.