Do No Harm – Dr Radha Kothari

DO NO HARM Seminar 11 September 2018, House of Commons


Good afternoon everybody, thank you for being here.

I am a clinical and research psychologist who works with the support not separate coalition as a consultant and researcher. During this time I have read a number of reports written by psychiatrists and psychologists.

These reports are about mothers who are undergoing a period of assessment, undertaken by a range of professionals, which will determine whether they are fit to parent their child. As you can imagine this is no easy task, and it shouldn’t be. Though I am not a mother myself, I am a daughter, and I cannot imagine what my life would have been like if I had been separated from my parents, and likely as a result, my three siblings.

Neither of my parents were born in England. As a result of this, I imagine that if a group of professionals from England had taken a snapshot of my early childhood they would have found it to be quite different to their own. My parents were not only under tremendous pressure due to our financial circumstances, but in addition they were undertaking the incredibly difficult task of holding on to their own culture, while also learning what was expected of them by the very different Westernised society that they lived in.

On one occasion when I was very young my mother was forced to leave me at home alone for a short time, responsible for the care of my two younger sisters. This was not something that happened regularly, and it was something that happened out of necessity, not neglect or bad parenting, just necessity. An elder sibling playing a role in the care of their younger siblings is also not uncommon in either of the countries that they were raised, and the circumstance arose because my parents could not afford childcare. At this time, which was over thirty years ago, services became involved, but this did not lead to separation. Neither did it lead to support.

Perhaps because of my background, as a psychologist I am particularly sensitive to the variety of different factors that might influence any individual that I am working with. What has struck me most about the reports I have read as a part of my work with the coalition, is the lack of consideration that is given to the individual circumstances of each mother that is assessed.

My background makes me acutely sensitive to the lack of understanding of a mother’s ethnic and cultural background. Comments are often made in reports about how a mother does not act during the assessment in a formal enough manner, for example due how they sit, or how they address a professional by his or her first name. This is generally interpreted as the mother not taking on board the seriousness of their situation, or as if they do not care enough. When reading these descriptions of how a mother comes across however, I am aware that this is likely due to their lack of experience or understanding of the Westernised approach to psychology or assessment.

At a most basic level, anyone who is being assessed should understand what the assessment is for and the language that is being used. Often the interpreter being provided is not able to understand or explain this, and is not using the mother’s first language.

The reports that I have read, and the mothers that I have spoken with, show a wide range of examples of this lack of consideration. By this I mean that, in most cases, a mother’s ethnicity and cultural background, her socio-demographic circumstances, any history of mental or physical health difficulties, and disabilities, are rarely given proper consideration. Professionals appear to have a “one-size-fits all” approach to assessment, and history has shown, time and time again, that this is not an approach that results in equality.

The parents that I have spoken with in my work with the coalition, and in my clinical work, have made it clear to me that when services become involved they feel under attack, not in a position of being offered support. It is normal for anyone that feels under attack to experience fear. Fear is a strong emotion. It results in any human being having a physical and psychological response that is often described as the “fight or flight” response. To put it simply, if we feel under threat, we are evolutionarily programed to fight back or run away.

Imagine being a parent that is being threatened with forced separation from your child and imagine the fear that you would be experiencing. In this situation neither fight nor flight is an option. Imagine now the constant anxiety that you would feel as a result of being repeatedly assessed by a range of different professionals that you had never met, and whose roles you did not fully understand. Imagine feeling like you are being constantly watched by social workers, mental health workers, and teachers.

Would this encourage you to work with professionals, to be honest about the difficulties that you are having, or to ask for help? The reality is that a mother feels trapped. If they ask for help they reveal the weaknesses that might lead to their child being taken away. If they tell all the professionals that everything is fine, they are judged as lying, or having no understanding of the effect of any difficulties on their children.

Psychological instability or mental health difficulties are often cited within reports for why a mother should be forcibly separated from their child. It is obviously important not to minimise the effect of parental mental health on a child’s development and wellbeing. However, we currently live in a society where over a quarter of the population will at some point in their life be diagnosable for a mental health disorder. We also know that life events and difficult circumstances impact upon an individual’s mental health.

The parents that I have had contact with are often experiencing incredibly difficult circumstances, whether this be due to poverty, abuse, immigration difficulties, past trauma, or a lack of support. Add to this the intense scrutiny that they are under from services and it is difficult to imagine many people withstanding the pressure while showing themselves to be what professionals deem to be “good parents.” It is also worth noting here that the standards that must be reached for good parenting can vary a great deal from one professional to another.

Initial findings and anecdotal evidence show the devastating and destructive effects of forcibly separating a child from their parents. Adoptions break down, mothers are repeatedly separated from other children that they give birth to, mothers spend their lives worrying about their children, and children grow up wondering about their true heritage which has undeniable effects on their sense of identity. In addition, the ongoing support provided to children who are separated is highly variable, while support for mothers is practically non-existent. But there will always be some situations, however far and few between, where it is in the best interest for a child to be rehomed. So how do we act in the best interests of everyone involved?

I believe that the first step is for professionals to view each case as one of a family, not just a child, and that this is best done by taking the approach of providing support. Support should be provided for all members of a family: parents, children, siblings, and others; who are effected by the simple act of assessment, let alone separation. For effective support to be provided the individual circumstances of each family must be understood, not just simply acknowledged.

In my research with the support not separate coalition we are taking the approach that the people most informed about how families can be best supported is the families themselves. While I do not undervalue the expertise and knowledge of all professionals working with families and conducting much needed research, the families and mothers are the experts in their individual experiences. In line we this we propose to conduct research with mothers, not on mothers.

We aim to explore the circumstances which lead to services becoming involved, the experience of being assessed, and the kind of support that they would find helpful both during and after assessment, whatever the outcome. In addition to giving mothers a voice in the kind of research that is being done, we also hope to increase their knowledge of the current systems. We believe that mothers who have experience of assessment or separation should be empowered to engage with the system by which they are being measured, and confident in providing insight on how these systems could be made more inclusive and less damaging.

Even though it was over thirty years ago, I remember the fear that my mother experienced when services became involved in our lives. My mother was not a bad mother, she was a mother dealing with difficult circumstances. She was an incredible mother, who fought against these difficult circumstances, and protected us from them the best way that she knew how. If services had separated us from our parents, if they had separated us as siblings, the psychological effects on my mental health would, no doubt, have been enormous. I wonder whether I would be here now speaking with you on this important topic, with two doctorates and an incredibly fulfilling life. Without my parents, none of what I have achieved would have been possible.

I strongly believe that we should see the mothers that come into contact with services as who they are, not bad mothers, but actually as mothers who are suffering and enduring against the complex and difficult problems within our society. Mothers who are going through a tough time, not as mothers who cannot be trusted to bring up their children. By providing support not just assessment, by conducting research with mothers, we stand the best chance of avoiding the tragedy of unnecessary separation and getting the best long term outcomes for everyone involved.