FII deaths and serious harm

Fabricated or Induced Illness in England: Examining mortality and serious harm

Andy Bilson, Alessandro Talia

British Journal of Social Work, Sept 2025

https://doi.org/10.1093/bjsw/bcaf089

This paper critically examines the actual incidence of mortality and serious harm attributed to Fabricated or Induced Illness (FII) in England, challenging the high-risk statistics often cited in official guidance.

Study Scope and Methodology

The study analysed 1,766 Serious Case Reviews (SCRs) published in England between 2010 and 2021 and found just 10, and one practice review, where FII or its synonyms (like Munchausen's Syndrome by Proxy) were mentioned. SCRs are mandatory when a child dies and abuse/neglect is suspected, or when a child suffers serious harm. This analysis, supplemented by a literature review, aimed to identify confirmed cases of death or serious harm directly caused by FII.

Key Findings: Mortality

The research found no reported deaths of children in England due to FII within the 12-year period covered by the Serious Case Reviews (2010–2021). The literature review covering the same period also identified no UK-based deaths from FII.

This finding directly contradicts previous statutory guidance (in force 2008–2022) which suggested that up to 10% of children subjected to FII die, and that FII is associated with "high mortality and morbidity." The authors note that these historical high mortality rates were based on older, often challenged research, including figures potentially inflated by the influence of the discredited "Meadow’s Law."

Key Findings: Serious Harm and Systemic Failures

Out of 11 SCRs where FII was mentioned:

• FII Ruled Out or Equivocal: In the majority of cases, FII was explicitly ruled out, unsubstantiated, or the evidence was equivocal.

• Serious Harm Cases: Only four cases involved FII as an established factor in serious harm (plus one non-statutory practice review). In these cases, the harm often stemmed from:

  • Over-medicalization: Children suffered unnecessary, invasive procedures, surgery, and medication (including developing opiate addiction) due to parental reporting and an over-reliance by professionals on the parent's account.

  • Missed Opportunities: In several instances, the focus on FII or the absence of effective multi-agency practice led to missed opportunities to protect the child from physical maltreatment, neglect, or suicide risk (e.g., in the Child F case).

  • Distraction from Systemic Issues: One SCR (Child A) found that the FII investigation distracted professionals from understanding the underlying issues and identifying medical harm caused by a cluster of misdiagnoses within a single pediatric department.

Conclusion and Implications

The study highlights that the long-term harm to children and families is often caused not by FII itself, but by the traumatic consequences of misidentification and the resulting investigations.

The authors conclude that the current guidance, which suggests FII is highly prevalent and associated with high mortality, needs to be re-evaluated. The evidence suggests that a stronger focus on standard medical practices and multi-agency collaboration—including rigorous investigation of symptoms, objective assessment, and reducing over-reliance on parental reporting—would provide better protection for children than the current system, which focuses heavily on searching for parental culpability.