Professor Colin Pritchard, Senior Lectures Jill Davy & Richard Williams, Centre for Social Work & Social Policy, Bournemouth University Who Kill Children? Re-thinking the Neglect-Abuse Continuum in the search for improved Protection of Children. Identifying the Psychiatric- Criminological- Child Protection Interface

Preamble: Challenging the Neglect to Abuse continuum We should not be afraid of making judgements because being thought `judgmental. The continuum of neglect into abuse, & at the extreme a dead child, the `tip-of-the- iceberg of neglect, & deaths became indicators of Child Protection effectiveness but who actually kill children? Re-analysing previous research we re-think the neglect to abuse continuum, placing the problem in a socio-economic context, recognising child Neglect is poverty- related but poverty is Not related to violent deaths. Serious violence very rare & people who kill children, are `special & not predominately neglecting. Assailants problems Mainly `psychological/ criminological rather than socio- economic, though poverty makes a situation worse. The Brandon (Serious Case Review) Report 2009 validates the re-analysis!!! More accurate assessment in identifying `potential assailants would improve agency collaboration if the psychiatric-criminological interface was better understood & given greater weighting in risk assessment.

Statistical Rarity of UK Extreme Violence Rates per million [pm] 2006 (WHO & Home Office Crime Stats 2008) Homicides All Age Rates pm E& W Males % % % : Female % % % : USA Male % % % : USA % % % : Assume all England & Wales murders (114) peak age criminality to randomly find 1 murder need 1: 27,2315 men. Based on Wessex 10yr study to find 1 Child murderer Male [19-42years] 1: 659,298 & Women [20-34 years] 1: 527,188. Most violent Western country, USA, 1 murderer in 11, yrs men `Violence against person 1,000,000 in Eng & Wales but only 44,000 needed medical attention i.e 4.4% or 0.07% general population. Prison Population, 82,000 27% Serious Violent Crime & Sex =0.18% of general population. Serious Violence statistically Rare

Good News: Combined Homicide & 33% Undetermined Deaths (? Under-reported abuse) in 22 Western countries ? rates per million and % change Country Babies (<1) Babies & Infants (0-4) & Ranks v v [3-1] USA change +34% +21%. [12-2 ]New Zealand % change +116% +39%. [10=-3] Scotland % change +46% +38%. [4=-4=] Germany % change -39% -37%. [4=-15=]Eng & W % change -76% -74%. [21-21] Spain % change -37% -40%. [7-22] Ireland change -95% -99%.

Relative Poverty (Income Inequalities top 20% v bottom 20%) & ALL CAUSES of DEATH of Child (0-14) in 20 Western World Countries: Implications [ see Handout] Countries DEATHS pm & Rank Rank Income Inequality 1] USA 6839pm times 2] Portugal 5208pm times 3. UK 5141pm times 4 Australia 4924pm times 5. New Zealand 5880pm times 6. Italy 4318pm times 17. Sweden 2900pm times 18. Norway 3273pm times 19. Finland 3233pm times 20. Japan 2862pm times

Correlating `Poverty, & Baby (<1) ACD & Violent Deaths in 20 Western World countries All Causes of Death (<1) & Income Inequality Baby [<1] Rho= p <0.001 highly significant Possible or Actual Child-Abuse-Related Deaths Ill-Defined-Signs & Symptoms Rho= p <0.025 significant. Accident & Adverse Events Rho= p <0.05 sig Homicides Rho= Not significant Homicide & 33% Undetermined Rho = Not significant. Poverty NOT statistically linked to Violent Deaths!?!?!?!

Who Kill Children ? Initial 2year cohort study of mainly, Police Records plus SSD data & Regional Suicide register (4% sample UK population ) 1]Male Child Sex Abuser Types: 2year cohort n=374) i] Sex Only (50%) no other crimes but against children. ii] Multi-Criminal-Child-Sex Abusers (36%) more non-sex-crimes than sex offences. iii] Violent-Multi-Criminal-Child-Sex-Abuser (VMCCSA) (14%), i.e with serious previous violence, ABH or GBH. 2]Decade of Child Homicide ASSAILANTS in 4% UK sample Child Protection- Psychiatric Inter-face Within-Family (82%) Mentally-ill-Mothers (MIM) 30%, Mentally-ill-Fathers (MIF) 15%; `Step-Fathers Previous Violence (SFPV) 15%, Mother CPP (MCPP) 22% (but 15% jointly charged S.father). Extra-Family Assailants: 18% [Male] VMCCSA. Flawed Interpretation Concerned about mental health stigma, instead of focusing upon Frequency & Commonality of Offender focused on Dangerousness.

New `Realistic Analysis: Commonality of Assailants. Joint Charged CPR Mothers; Court decided Not main killer. Numbers- Common Sense approach to Statistics Category Nos in General Decade of Ratio of Assailants Population: Assailants. Rates p.a. to Population General Population Men [19-42] 8.57mill pm 1: 659,298 Women [20-34] mill pm 1: 527,188 Wessex Mentally Ill 22,165 Fathers 4 30pm 1: 3,355 Mothers 8 92pm 1: 1,093 Wessex Mother CPP pm 1: 362 Wessex Previous Violence S/Fathers pm 1: 425 VMCCSA pm 1: 20 Combined pm 1: 200

The Practice Question in Mental Health & Child Protection (NB Brandon Report 2009 Validates re-analysis?) Psychiatrist ask re psychosis- `personality disorder pnts Whats happening with children? Social Workers should Is there a mental health problem and a history of violence? If these questions had been asked Wessex child homicides halved. Wessex Results Validated by Brandon Report (2009) on Serious Case Reviews 40 Intensive cases 53% Domestic violence & 63% mentally ill parents!?!?!? Brandons focus Process Not CONTENT Challenge notion that Neglect & Abuse are a Continuum- Child homicide assailants problems Essentially Psychological/ psychiatric-Criminal not primarily socio-economic. Current Risk Assessment Protocols fail to give sufficient weighting to Psychiatric & Previous violence- the Commonality of killers – We AVOID getting information on `Fathers?? Issue is INTER-GENERATIONAL POVERTY = NEGLECT, rather than ABUSE, should be recognised as the Dominant Problem. Instead `Worst-Case-Scenario, leads to costly & unhelpful bureaucracy & loss of focus on protecting and reducing neglect of children. Naught is good or ill but as thinking (The Media) makes it so Policy Should be Evidenced Not Media Driven

References ( National Sources online: WHO (2008) Annual Statistics. Office National Statistics (2010); Home Office (2008) Crime Statistics) Brandon Report (2009)Understanding Serious Case Reviews & their Impact. Dept CSF (Education) Falkov A (1996) Fatal Child Abuse & Parenting Psychiatric Disorders. Part 8. London, Dept Health. Pritchard C (2004) The Child Abusers: Research & Controversy. Open Uni Press. Pritchard C & King E (2005) Comparison of Child-Sex-Abuse-related & Mental-Disorder-Related Suicide in Six-year cohort of regional suicides: The importance of the Child Protection-Psychiatric Interface.British Journal Social Work. 34, Pritchard C & Sayer T (2007) Exploring potential `Extra-familial Child Homicide Assailants in the UK and estimating their Homicide rate: Perception of Risk & the need for Debate. British Journal Social Work. 36 in press. Pritchard C & Williams R (2009) Does Social Work Make a Difference? A Controlled study of Former Looked-After-Children and Excluded-from-School Adolescents Now Men Aged 16-24: Subsequent Offences, Being Victims of Crime and Suicide. Journal of Social Work 9, Pritchard C & Williams R. (2010) Comparing possible child-abuse-related-deaths in England & Wales with the major developed countries British Journal of Social Work. 40, Wilkinson R & Pickett K (2009) Spirit Level.Why more equal societies almost always do better. London, Allen Penguin.MUST Williams R & Pritchard C (2006) Breaking the cycle of educational disadvantaged. Open Uni press