7.2 Children At Risk Where A Parent Has A Mental Health Problem
In September 2014, a new link has been added to Mental Health Crisis Care Concordat – Improving Outcomes For People Experiencing Mental Health Crisis.
1.The mental health of a parent or carer does not necessarily have an adverse impact on a child but it is essential to assess the implications for the child. If any agency has concerns that a child is at risk of harm because of the impact of the parent/carer’s mental health they should check to see if the child is subject to a Child Protection Plan – see Recording that a Child is the Subject of a Child Protection Plan Procedure.
2. Children are at greatest risk when:
- The child features within parental delusions;
- The child becomes the focus of the parent’s aggression.
In these circumstances the child should be considered at immediate risk of harm and a referral made to Children’s Social Care Services in accordance with the Referrals Procedure.
3. Where it is believed that a child of a parent with mental health problems may be suffering or likely to suffer Significant Harm, a Strategy Discussion/Meeting should be held and consideration should be given to undertaking a Section 47 Enquiry.
4. In circumstances whereby a parent/carer has mental health problems it is likely there are a number of professionals involved from different services. It is important that these professionals work together within enquiries and assessments to identify any links between the parent’s mental health, their parenting, and the impact on the child. Any assessment should include an understanding of the needs of the family and children and an identification of the services required to meet these needs.
5. To determine how a parent/carer’s mental problem may impact on their parenting ability and the child’s development the following questions need to be considered within an assessment:
- Is there a child or young person living in or visiting the household regularly? If so, does the child/young person take on roles and responsibilities within the home that provide physical or emotional care or support that is inappropriate, excessive or harmful to their health, education or overall development?
- Does the parent/carer neglect their own and their child’s physical and emotional needs?
- Does the mental health problem result in chaotic structures within the home with regard to meal and bedtimes, etc?
- Does the parent/carer’s mental health have implications for the child within school, attending health appointments etc?
- Is there a lack of the recognition of safety for the child?
- Does the parent/carer have an appropriate understanding of their mental health problem and its impact on their parenting capacity and on their child?
- Are there repeated incidents of hospitalisation for the parent/carer or other occasions of separation from the child?
- Does the parent/carer misuse alcohol or other substances?
- Does the parent/carer feel the child is responsible in some way for their mental health problem?
- Is the child included within any delusions of the parent/carer?
- Does the parent/carer’s mental health problem result in them rejecting or being unavailable to the child?
- Does the child witness acts of violence or is the child subject to violence?
- Does the wider family understand the mental health problem of the parent/carer, and the impact of this on the parent/carer’s ability to meet the child’s needs?
- Is the wider family able and willing to support the parent so that the child’s needs are met and inappropriate, excessive or harmful caring activities are prevented or removed?
- Does culture, ethnicity, religion or any other factor relating to the family have implications on their understanding of mental health problems and the potential impact on the child?
- How the family functions, including conflict, potential family break up etc.
6. Adult mental health services – including those providing general adult and community, forensic, psychotherapy, alcohol and substance misuse and learning disability services – have a responsibility in safeguarding children when they become aware of, or identify, a child suffering or likely to suffer Significant Harm. This may be as a result of a service’s direct work with those who may be mentally ill, a parent, a parent-to-be, or a non-related abuser, or in response to a request for the assessment of an adult perceived to represent a potential or actual risk to a child or young person. Adult mental health staff need to be especially aware of the risk of neglect, emotional abuse and domestic abuse to children. Staff should be able to consider the needs of any child in the family of their patient or client and to refer to other services or support for the family as necessary and appropriate, in line with local child protection procedures. Consultation, supervision and training resources should be available and accessible in each service. In order to safeguard children of patients, mental health practitioners should routinely record details of patients’ responsibilities in relation to children, and consider the support needs of patients who are parents and of their children, in all aspects of their work, using the Care Programme Approach. Mental health practitioners should refer to Royal College of Psychiatrists policy documents, including:
- Parents as Patients: supporting the needs of patients who are parents and their children; and
- SCIE Guide 30 Think child, think parent, think family: a guide to parental mental health and child welfare.
7. Close collaboration and liaison between adult mental health services and children’s social care services are essential in the interests of children. It is similarly important that adult mental health liaise with other health providers, such as health visitors and general practitioners. This may require sharing information to safeguard and promote the welfare of children or to protect a child from Significant Harm. The expertise of substance misuse services and learning disability services may also be required. The assessment of parents with significant learning difficulties, a disability, or sensory and communication difficulties, may require the expertise of a specialist psychiatrist or clinical psychologist from a learning disability service or adult mental health service.
8. Joint work will include mental health workers providing all information with regard to:
- Treatment plans;
- Likely duration of any mental health problem;
- Effects of any mental health problem and medication on the carer’s general functioning and parenting ability.
9. Child protection workers must assess the individual needs of each child and within this incorporate information provided by mental health workers.
10. Mental health professionals must attend and provide information to any meeting concerning the implications of the parent/carer’s mental health difficulty on the child. These will include:
11. All plans for a child including Child Protection Plans will identify the roles and responsibilities of mental health and other professionals. The plan will also identify the process of communication and liaison between professionals. All professionals should work in accordance with their own agency procedures / guidelines and seek advice and guidance from line management when necessary.
12. Child care and mental health professionals should always consider the future management of a change in circumstances for a parent/carer and the child and how concerns will be identified and communicated. This may include:
- Relapse in the parent/carer’s mental health;
- Failure to maintain medication;
- Change in family dynamics/relationships.
13. Professionals need to consider carefully the implications for children when closing their involvement with parents with a mental health problem. Consideration should be given to informing the appropriate Children’s Social Care Services team in order that the implications for the child are assessed.