(a) An allegation of FII is a very serious allegation to make against a parent and one that should not be made lightly. Before making an allegation of FII a local authority should be rigorous in satisfying itself that the evidence available, if accepted by the court, is capable of establishing to the requisite standard that there has in fact been fabricated or induced illness.
(b) In reaching the decision to allege FII in circumstances where the allegation is of fabrication of signs and symptoms, it will rarely be appropriate for a local authority to rely exclusively upon the report of an independent expert. The local authority should normally also seek the views of health professionals involved in the care of the children. This should be achieved by convening a strategy discussion as recommended by the 2008 DCSF Guidance.
(c) When instructing an expert to prepare a report in a case of suspected FII the letter of instructions should make it clear that the expert is expected to have regard to 'Fabricated or induced illness by Carers (FII): A Practical Guide for Paediatricians' published by the Royal College of Paediatricians and Child Health in October 2009 and should also draw the expert's attention specifically to the guidance on 'Content of the Expert's Report' set out at paragraph 3.3 of the Practice Direction: Experts in Family proceedings Relating to Children.
(d) As stated by Charles J in Re R (Care: Disclosure: Nature of Proceedings), all those involved should consider and review the report of an expert when it is received and, where relevant, raise points with the expert and other parties relating to the performance of the expert's instructions, his or her reasoning, the factual basis of his or her views and the relevance of his or her views to the proceedings.
(e) In any case in which a local authority applies under FPR rule 4.5 to withdraw proceedings it should state whether or not it accepts that the child is a child in need for the purposes of s.17 Children Act 1989. If it does accept that the child is a child in need the application should be accompanied by a schedule outlining the needs that have been identified and detailing the support and services it proposes to make available to that child to meet those identified needs once the proceedings have been concluded.
To underline the messages the local authority were ordered to pay £50,000 towards the costs of each parent. The Judge estimated the total costs of the case at over £400,000 and it involved over 20 lever arch files.
I have recently come across something called 'abnormal illness behaviour'(AIB) (FII lite?) a term apparently coined by Pilowsky (as long ago as 1969) to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. At least one expert uses this term as being synonymous with FII whereas Pilowsky himself focusses on maladaptive illness denial (ie there is an illness which is denied rather than there is not an illness but symptoms are invented) although he advocates these syndromes being grouped together. AIB is not itself a recognised specific diagnosis but refers to a cluster of somatoform disorders and is sometimes used to include FII. It is variously used to cover a symptom, syndrome or dimension. Approach with care!
Two important documents are referred to in the judgment:
Safeguarding Children in whom illness is fabricated or induced
Royal College of Paediatrics & Child Health Guidance on Fabricated Illness
Should we perhaps coin a new term: abnormal or fabricated threshold criteria syndrome?