BMJ 2011; 342:d3040 doi: 10.1136/bmj.d3040 (Published 18 May 2011)

Cite this as: BMJ 2011;342:d3040

  • Head to Head

Has child protection become a form of madness? Yes

  1. Alain Gregoire, clinical director for mental health and learning disability,
  2. Simonetta Agnello Hornby, family law solicitor

+ Author Affiliations

  1. 1South Central Strategic Health Authority, Southampton, UK
  2. 2London, UK
  1. Correspondence to: A Gregoire

Alain Gregoire and Simonetta Agnello Hornby argue that child protection fails to detect many children in need of help while becoming ever more bureaucratic and unhelpful, while Margaret Spinelli and Louise Howard (doi:10.1136/bmj.d3063) believe that child protection interventions are essential to prevent child abuse

“Madness,” in both popular usage and in its now outmoded professional sense, is characterised by beliefs that are out of touch with reality or contrary to evidence, that are associated with negative emotions and unhelpful behaviours, and that impair functioning. The term is an apt descriptor for our society’s efforts in child protection.

Apart from the dramatic failures that result in inquiries and accusatory headlines, child protection processes fail to detect 90% of the cruelty experienced by children[1] and let down high risk groups such as disabled children.[2] The surprise at the failings and the blind eye turned to the inadequacies reflect an almost delusional belief in the potential of ever more bureaucratic processes to protect our children from harm by detecting maltreatment and stopping it.[3]

We have lost touch with the reality of what matters for children’s wellbeing, well defined by Unicef: “The true measure of a nation’s standing is how well it attends to its children—their health and safety, their material security, their education and socialization, and their sense of being loved, valued, and included in the families and societies into which they are born.”[4] Most children identified as being in need in relation to such issues do not become subject to child protection plans,[5] and they often receive little or no support. Our growing emphasis on child protection for those already neglected or abused has distracted us from taking action on the underlying causes, which are well known. Even worse, we are spending more and more on responding to the social consequences, largely through the criminal justice system, which will do nothing to stem the tide of social problems. Sweden and Finland spend 50% more of their gross domestic product on children and families than we do; we spend 200% more than they do on social problems.[6]

Our emotional responses swing dysfunctionaly between disinterested complacency at child poverty to indignant, punitive outrage when social workers fail to prevent severe abuse. Our society’s behaviour towards children is absurdly paradoxical: pious statements by politicians to stamp out child maltreatment are coupled with the youngest age of criminal responsibility in the developed world (apart from some US states), 10 year olds facing trial in adult courts, and more children in prison than any other western European country.[7] We also imprison the parents of over 160 000 children without providing specific support services or parenting interventions. At an individual level, the preoccupation with child protection may now be driving dysfunctional attitudes and behaviours between the generations, including fear, suspicion, and avoidance.[8]

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Failure of system

The impact of this loss of touch with reality on our functioning is severe. On multiple measures the UK has the worst child wellbeing of all the 21 richest nations in the world (for example, poverty concentrated in families with children, high proportion of low birthweight babies, fifth from bottom in educational wellbeing), and, not surprisingly, our children are the unhappiest.[4] Perhaps the underpinning factor to all the others is that our children have by far the worst family and peer relationships of all the world’s richest nations.

Even if we select only the extreme indicators of wellbeing we are failing to protect our children from risks: our children carry, by a large margin, the worst levels of risks among the world’s 21 richest nations. This includes measures such as involvement in violence; experience of bullying; use of alcohol, tobacco, and illicit drugs; underage and unprotected sex; and teenage pregnancy. Worst of all are the outcomes for the children we claim to have protected by removal into state care. Both objective measures of outcome and children’s experiences reveal that we continue to fail these children to a degree that would justify their removal from our care.[9] [10]

We live in one of the most unequal and divisively class ridden societies in the developed world. Far from breaking intergenerational cycles of disadvantage, we have low and falling levels of social mobility coupled with inequitable education and health. Our poorest, most vulnerable, and most disadvantaged children are the first to become parents themselves.

Despite the current poor prognosis, effective treatment is possible. Firstly we must cease our dependency on the symptomatic relief apparently offered by child protection: those countries with the strongest emphasis on this have the highest death rates from child maltreatment. The lowest rates are found in those countries that invest in families and prevention.[11] We must shift from child to family focused policies and invest in cost effective early (pre-birth) interventions targeted at the most vulnerable families, attending to the emotional and social wellbeing of parents and children.

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Notes

Cite this as:BMJ 2011;342:d3040

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Footnotes

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
  • “Child protection has become a form of madness” will be debated in a Maudsley debate at the Institute of Psychiatry, King’s College London ( on 19 May.
  • Provenance and peer review: Commissioned; not externally peer reviewed.

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References

  1. Sidebotham P, ALSPAC Study Team. Patterns of child abuse in early childhood, a cohort study of the children of the nineties. Child Abuse Rev2000;9:311–32.

[CrossRef]

  1. NSPCC. It doesn’t happen to disabled children. Child protection and disabled children. 2003.
  2. Munro E. The Munro review of child protection. Part one: a systems analysis. 2010.
  3. Unicef. Child poverty in perspective. An overview of child well being in rich countries. 2007.
  4. Department for Education. Children in need census 2009-2010.
  5. New Economics Foundation. Backing the future. Why investing in children is good for us all. 2009.
  6. Barnardos. Locking up or giving up: why custody thresholds for teenagers aged 12, 13 and 14 need to be raised. 2009.
  7. Furedi F, Bristow J. Licensed to hug: how child protection policies are poisoning the relationship between the generations, and damaging the voluntary sector. 2nd ed. Civitas, 2010
  8. Department for Children, Schools and Families. Outcome indicators for children looked after: twelve months to 30 September 2009, England. 2010. .
  9. Ofsted. Children’s care monitor. 2010.
  10. Action for Children. Deprivation and risk: the case for early intervention. 2009