1.4.16 Mental Health of Parent or Carer
See also guidance for adult mental health professionals on the National Reporting and Learning Service website.
- 1. Introduction
- 2. Recognition and Referral
- 3. Importance of Working in Partnership
- 4. Responsibilities of Adult Mental Health Staff When Working With Adults Who Have Parental Responsibilities
- 5. Responsibilities of Children's Social Care Staff
For the purposes of safeguarding children the mental health or mental illness of the parent or carer should be considered in the context of the impact of the illness on the care provided to the child.
While mental illness can be compatible with good parenting, some parents with a severe mental illness are at risk of harming their children. Very serious risks may arise if their illness incorporates delusional beliefs about the child, and/or the potential for the parent to harm the child as part of a suicide plan. Staff in adult mental health services caring for a parent must always consider the child’s needs and the potential for physical and psychological harm as primary task of the Care Programme Approach (CPA) and as part of multi agency risk assessment processes. Risks should be considered for service users who are not parents but are in contact with children e.g. service users with child siblings or grandchildren. Concerns about patient confidentially should never delay acting as soon as a problem, suspicion or concern about children becomes apparent. (NPSA Alert (2009) Rapid Response Report NPSA/2009/RRR003: Preventing harm to children from parents with mental health needs). See NHS website.
2. Recognition and Referral
The majority of parents who suffer significant mental ill-health are able to care for and safeguard their child/ren and/or unborn child, but it is essential always to assess the implications for each child in the family.
In some cases, the parent's condition may seriously affect the safety, health and development of children particularly when subjected to known stressors or alcohol/substance misuse.
A referral should be made to children’s social care as soon as a problem, suspicion or concern about a child becomes apparent, or if the child’s own needs are not being met.
A referral must be made:
- If service users express delusional beliefs or any psychotic ideation involving their child; and/or
- If service users might harm their child as part of a suicide plan.
When considering whether a child is at risk the following parental risk factors may justify a referral to Children's Social Care for an assessment of the child's needs:
- Previous history of parental mental health, especially if severe and/or enduring, e.g. previous diagnosis of Bipolar disorder or Schizoaffective disorder are a significant risk of relapse due to birth hormones;
- Predisposition to, or experience of, severe post natal illness;
- Self-harming behaviour and suicide attempts;
- Altered states of consciousness e.g. dissociation, misuse of drugs, alcohol, medication;
- Obsessional compulsive behaviours involving the child;
- Non-compliance with treatment, reluctance or difficulty in engaging with necessary services, lack of insight into illness or impact on child;
- Disorders designated 'untreatable' either totally or within time scales compatible with the child's best interests;
- Mental health problems combined with domestic abuse and/or relationship difficulties;
- Unsupported and/or isolated parents with mental health problems;
- Parental inability to anticipate needs of the child.
The following child related factors may justify an Early Help Assessment of the child's needs:
- A child acting as a young carer for a parent or a sibling;
- Child having restricted social and recreational activities;
- Child's physical and emotional needs neglected (may be associated with parental depression);
- Impact has been observed on child's growth, development, behaviour and/or mental /physical health, including alcohol/substance misuse, attachment issues and self- harming behaviours;
- The parent / carer's needs or illnesses taking precedence over the child's needs;
- Insufficient alternative care for the child within extended family to prevent harm.
3. Importance of Working in Partnership
Meeting the needs of parents with mental health problems and their families raises practical, professional and organisational challenges for services. SCIE’s guide, Think child, think parent, think family (2009, revised 2011) (see SCIE website) addresses these challenges, and recommends ways to overcome them.
Adult and child mental health professionals, children's social workers, health visitors and midwives, school nurses and education services must work together and share information to meet the needs of families and to be able to assess risks.
The whole-family approach is important. Parents with mental health problems and their children often have complex needs. Families won’t always need health and social care services, but those that do often struggle to get accessible and effective support that addresses children’s needs and also recognises the parental responsibilities of many adults with mental health problems.
The Early Help Assessment can facilitate this way of working and be used to consider the needs of both parents and children when assessing and planning care.
Where an adult, who is also a parent / carer, is deemed to be a danger to self or others by agency professionals, including Adult Social Care, a referral must be made to Children's Social Care, who must also be invited to any relevant planning meetings.
4. Responsibilities of Adult Mental Health Staff When Working With Adults Who Have Parental Responsibilities
Any mental health worker who becomes concerned about the welfare of a child should make a referral to Children Social Care (see Referral and Assessment Procedure).
The needs of children should be explicitly considered within the risk assessment and Care Programme Approach (CPA) assessment and planning process. Where there are concerns about service users’ ability to care for their children due to their mental state, and following referral, Children's Social Care should be invited to attend CPA meetings.
The needs of children should be considered from an early stage in the planning.
Adult mental health workers should record all incidents and actions taken in relation to child care concerns in their on-going recording, including any decisions and their rationale. If recordings cannot be shared with the service user because of child protection concerns, these matters should be recorded on RIO but marked as third party information. Advice should be sought from a team manager if in doubt.
Mental Health units should have policies drawn up in consultation with Children's Social Care about visiting of service users by children, which will be based on an assessment that such a visit would be in the child's best interests.
Where there are child welfare concerns regarding visits to patients, the Adult Mental health services may ask Children's Social Care to assess whether it is in the child's best interests.
5. Responsibilities of Children's Social Care Staff
A referral may be received regarding concerns of parental mental ill-health expressed by the referrer or arising during a Child and Family Single Assessment, but there is no information about involvement of Adult Mental Health Services. As part of the routine checks, the assessment team should establish whether the client is known to Adult Mental Health Services. This information is available through 01908 605650.
Out of normal working hours, information may be available from 01908 395599.
Strategy Discussions and Child Protection Conferences must include information from any mental health professional involved with the parent e.g. in patient or MKCHS psychiatrist, community psychiatric nurse, psychologist and adult mental health social worker involved with the parent / carer.