This is a guest post by Keith Cooper, who is a senior staff writer for The Doctor magazine. Keith kindly agreed to write a post at our request when we saw his extraordinary writing about a family court case, and realised that a huge amount of work must have gone into both the writing of the piece and into obtaining the necessary permissions to publish it at all.
Last month, The Doctor magazine published Born of Injustice,a piece based on papers we obtained from a family court. It raises serious questions about the treatment of Carrie Adams*, a mother with mental ill health whose baby had been removed at birth for nine months, questions we couldn’t have raised without sight of those papers.
In short, it reveals that the mother had been denied three times a bed on a psychiatric mother and baby unit where she could have been kept together with her daughter, Evie*. There was evidence of prejudice against her because of her mental ill health and that a physical cause for her confusion, one day after a caesarean-section delivery, was assumed to be of psychiatric origin without a physical cause being ruled out.
It was the second of a two-part series and the result of almost a year’s research. This aided our successful application for court papers. As a publication of the British Medical Association, our work on this story was motivated by doctors’ desire to push for better help for anyone with mental ill health.
Our research included: some six hours of interviews and scores of emails with the mother over several months; further interviews with her friends; e-mail exchanges with one of her doctors; interviews with senior perinatal psychiatrists (the doctors specialising in the care of mothers and mothers-to-be with mental ill health). None of the independent specialists were surprised by the details of the case. Other women faced similar situations ‘painfully often’, one said, despite their best efforts to intervene.
There were more interviews with psychologists, with charities which offer peer support to mothers while they’re waiting for NHS care, and with other mothers whose children had been removed (such as ‘Ms R’, from the recent Parliamentary and Health Service Ombudsman report.)
When writing the first part of the series, Separated at Birth,we were very aware of the restrictions of reporting a case involving the family courts. These meant that we were not allowed sight of the papers in Dr Adams’ case. In the absence of those details we did further research into the public policy context around the time when Evie was removed for explanations it might offer for what had happened to this family.
Here, we found plenty of evidence which we realised would be useful for the public interest arguments we would later have to make in our application to the courts for access to the papers. We looked at: press cuttings, interviewed academics, read their papers (notably the work of Lancaster University’s Professor Karen Broadhurst and colleagues who had access to hundreds of case files for their Nuffield Foundation-funded research); court rulings, such as those made public by Bristol family court judge Stephen Wildblood QC. We looked at how the family courts and council-run social services were faring under austerity and increasing workload (not very well by many, if not all, accounts).
And we looked at the state of NHS services available to mothers and mothers-to-be.
Research by the Maternal Mental Health Alliance showed us that there were no specialist services in many areas in England and Wales. From our own previous investigation we knew that waiting times for psychological therapies were too long in many areas and that patients with more severe or complex ill health were barred from widely available ones, such as IAPT (Increasing Access to Psychological Therapies).
From all this research it seemed obvious that themes evident in the experience of Carrie Adams were common to other cases: those made public by judges, seen by researchers or worked on by doctors involved. Children were being removed from mothers after the NHS was unable to provide services – such as psychological therapies. Social services and courts were also making decisions in care cases under increasingly pressured conditions and sometimes without access to the best specialist advice.
The months of investigation which began with that first interview with Carrie Adams appeared to reveal a wider public interest issue. There looked to be significant gaps in public service provision which could lead to children being removed from mothers unnecessarily.
And so, in April this year, we applied to the relevant family court for an order to release papers relating to Carrie Adams’ proceedings and retained a barrister to represent us. We helped draft the first skeleton argument for the case, drawing on all the research we’d done to date to make what we hoped were compelling public interest arguments in favour of the documents’ release.
In the first of two days in court in July, after hours of talks, we agreed a way forward with all parties and the judge. Over the next few months we helped prepare a second skeleton argument including an outline of measures we would take to safeguard the identities of the mother and child, as well as the authors of any reports we obtained.
On the second day of the hearing, the papers we wanted were released to us by a court order. This stated the agreed measures to protect the identity of the mother, child, professionals, and organisations involved. We also agreed to a request from one party that the judge review our final piece to flag any risks of identification of the mother and child.
Any reporting restrictions are challenging. But giving the judicial arm of the state the chance to review copy? It was a new one on me.
To understand why I agreed to it, is to put yourself in the position of a journalist in a family court, a largely unfamiliar territory for us. We’re used to turning up to criminal and other courts with a notepad and pen and face relatively rare battles against bids to restrict reporting. We face prison if we get it wrong.
We were asking the mother to return to the court which removed her baby. Each point of contention between parties takes time to resolve, so you choose your battles. Even those you think you might win, given the time.
Our aim was to get hold of the papers, get answers for the mother, ones we could share in the public interest. On balance, at the time, it didn’t feel like a point worth contesting. In the end, it wasn’t an issue. All acknowledged the public interest arguments. It all felt weirdly congenial.
It took weeks to review the papers and write up the piece, in which we constructed a timeline and what I believe was a balanced and fair narrative of the how Carrie Adams came to be separated from her first child for nine months of her life.
Anyone involved in family court cases will know that those papers contained some incredibly personal intimate details. I hadn’t realised how much trust Dr Adams had placed in me to tell her story with respect for her privacy. It felt like a heavy and difficult burden to bear and balance. On the one side is the weight of a responsibility to tell a fair story. On the other, the need to report respectfully on a mother who had been through so much already.
I feel we achieved this. There is no doubt – and the mother doesn’t deny – that she had severe and complex mental ill health during pregnancy. She acknowledged that she needed help. She was desperate for it to the extent of admitting to suicidal thoughts in an attempt to get it. Professor Broadhurst’s research tells us that other mothers resort to similar ‘desperate acts’.
But Carrie Adams was an NHS junior doctor. She’d had faith in public service to help her.
What our months of investigation and court action helped show was how the pressures, flaws and poor provision in services contributed significantly towards Dr Adams being separated from her baby, as it has done for many other mothers, and just as perinatal psychiatrists, academics and judges had warned, and continue to warn.
Without access to these previously private court papers, we would never have been able to report this. Without all the months of research we might not have had the public interest case to convince the courts to release them. And without the backing and resources of a large, understanding and supportive institution, the British Medical Association, this story would certainly not have been possible.
It started out with us listening to one mother recounting the awfulness of being separated from her baby, when she had expected support. It has ended, we hope, with a series of stories to convince others, the public, politicians and officials, to fix the flaws and ease the pressures in public services which we have identified. So far fewer women experience such awfulness.
*Not their real names.
Feature pic : courtesy of Abhijit Chendvankar on Flickr (via Creative Commons Licence). Thanks!