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Judge credits psychological assessment with calming of “high octane” conflict between parents and care workers

A High Court judge has credited a psychological assessment "almost entirely" for helping repair a deeply polarised relationship between care workers and the parents of a boy with serious disabilities who is subject of an application for a care order.

Relations between the staff looking after the boy and his parents had become so strained that the private care agency had indicated it would no longer be able to offer its services due to the parents’ alleged combative behaviour.

The agency said the parents had insisted on overseeing the training of carers and had demanded the removal of two carers on "unreasonable grounds," amongst other concerns.

The boy ("W") uses a wheelchair, has epilepsy and a swallowing disorder, and requires one-to-one care at all times. W has been known to self-harm and occasionally to hold his breath until he loses consciousness.

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Tensions came to a head when W suffered a hypoxic episode in which his blood oxygen level fell to dangerously low levels.

During the episode, W's parents refused to allow an ambulance to be called immediately, which went against the guidance the carers were following in the boy's care package. When an ambulance arrived, W was found to be well.

Following the event, and in light of other difficulties, the agency withdrew its care.

At an earlier hearing Mr Justice Hayden approved the instruction of a consultant chartered psychologist and psychotherapist, Dr Kate Hellin, to provide a psychological assessment of both parents, in the hope of achieving a better understanding of some of their interactions with the professionals.

In W (A Child), Re [2021] EWHC 2844 (Fam) Mr Justice Hayden said he had not expected the ensuing report to "so comprehensively" capture the dynamic between the two parties.

The judge said: "It is, in my judgement, a landmark report, the analysis of which requires wider dissemination.

"Today, this interim hearing, which it was anticipated would be contested, has resolved, by agreement of the parties."

Dr Hellin did not consider that either parent had any sign of mood-related problems, personality order, or serious mental illness in her assessment.

Her report noted that W's mother, "M", had "considerable psychological resilience" but that a traumatic experience two years prior in which W suffered a brain haemorrhage and bowel intussusception had left her with a heightened level of resting anxiety.

Judge Hayden noted that Dr Hellin said in "clear and unambiguous" terms that the mother's anxiety was rational and that her response to the challenging circumstance she has faced was normal.

According to her assessment, Dr Hellin would expect "a similar response in even the most psychologically robust person".

Dr Hellin was clear that the court would not be best assisted by evaluating the issues in terms of the parent's perceived failures or any mental health difficulties. It required a recognition by the professionals that these were ordinary parents dealing with extraordinary circumstances.

"Rather than looking to change the parents, I recommend a systemic intervention drawn from organisational psychology, psychodynamic psychotherapy, group analysis and systems theory," Dr Hellin wrote in a section highlighted by the judge.

She added: "The intervention would assist all agencies and the parents to understand the dynamic processes that have led to the current difficulties, to step back from mutual blame and recrimination, to establish working practices which will contain and diminish sensitivities and optimise collaboration between the different parts of the system."

F's representatives submitted that the assessment had unlocked the case.

"It is rare for one assessment to change the landscape so comprehensively, but I entirely agree with their submission," Judge Hayden said.

The Judge said that Dr Hellin's analysis resonates clearly with the applicable legal framework in s.31 of the Children Act 1989.

He said that provision in s.31(2)(b)(i) that reads "not being what it would be reasonable to expect a parent to give" is "not to be regarded as an abstract or hypothetical test but must be evaluated by reference to the circumstances the parent is confronting i.e. what would it be reasonable to expect of a parent in these particular circumstances, recognising that in a challenging situation many of us may behave in a way which might not objectively be viewed as reasonable.

"The test is not to be construed in a vacuum nor applied judgementally by reference to some gold standard of parenting which few (if any) could achieve. On the contrary, it contemplates a range of behaviour, incorporating inevitable human frailty. The reasonableness of the care given requires to be evaluated strictly by reference to the particular circumstances and the individual child."

Mr Justice Hayden said: “I would add that a similar dynamic and frequently for the same reasons identified here, arises in the Court of Protection when dealing with incapacitated adults. This is a particularly common situation in the context of young adults in their late teenage years and early twenties, but by no means confined to it.”

According to Judge Hayden, all of the advocates in the case supported the analytical approach of Dr Hellin’s assessment and were keen for it to be made available more widely.

Adam Carey      

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