Intended for healthcare professionals

Head To Head

Has child protection become a form of madness? Yes

BMJ 2011; 342 doi: (Published 18 May 2011) Cite this as: BMJ 2011;342:d3040
  1. Alain Gregoire, clinical director for mental health and learning disability,
  2. Simonetta Agnello Hornby, family law solicitor
  1. 1South Central Strategic Health Authority, Southampton, UK
  2. 2London, UK
  1. Correspondence to: A Gregoire alaingregoire{at}

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 …

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