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2.2.15 Mental Ill Health of Parent or Carer

RELEVANT GUIDANCE

Mental Health Crisis Care Concordate: Improving Outcomes for People Experiencing Mental Health Crisis

AMENDMENT

This chapter was updated in October 2014. A link was added to the Mental Health Crisis Care Concordate: Improving Outcomes For People Experiencing Mental Health Crisis.


Contents

  1. Definition
  2. Care Programme Approach
  3. Recognition
  4. Importance of Working in Partnership
  5. Children's Visits to Hospital Patients


1. Definition

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.


2. Care Programme Approach

Any professional working with a person with mental health problems must establish if there are any children living in her/his household. All initial CPA assessments must include the compilation of a Genogram (family tree) that as a minimum identifies any children or young people (under 18) for whom the service user has parental responsibility or caring responsibilities or who live in the same household or visit regularly.

All CPA assessments and reviews must consider the impact of mental illness on children and young people and where required, a referral must be made to social care in respect of the children / young people.

Where a CPA assessment or review identifies children or young people living in the same household or receiving regular care from a service user, then the service user must be:

  • Informed of potential further support that can be offered by health visitors and school health professionals. Consent must be sought to notify the family health visitor or school health professional. Where consent is obtained, the family heath visitor or school health professional should be informed that a parent / carer in the household is living with a severe or enduring mental illness which has resulted in a referral to a specialist mental health service. Where consent is refused, the service user’s rational for refusing consent must be explored and documented in their clinical case record and on their electronic record however the professional still has a responsibility to refer to Specialist Children's Services / Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) if there is likelihood of Significant Harm to the child whose welfare is paramount;
  • Provided with access to useful information and resources about the impact of parental mental illness through use of resources such as Young Minds and Children of Parents with a Mental Illness (COPMI).

All assessment, CPA monitoring, review and discharge planning documentation and procedures should include documentation of staff consideration of whether a service user is likely to have or to resume contact with their own child or other children in their network of family and friends.

Where a service user has or may resume contact with children, this should trigger an assessment of whether there are any actual or potential risks to the children including delusional beliefs involving the children. Such an assessment should include as many available sources of information as possible including compliance with treatment. Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) and other relevant agencies must be involved in planning discharge arrangements.


3. Recognition

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. It is important to note that many people who suffer from mental illness or poor mental health may only be receiving care from a general practitioner. Involvement of general practitioners in planning for children of these patients is essential.

In some cases, especially with regard to enduring and / or severe parental mental ill health or where there is associated family disharmony / break-up, the parent’s condition will affect the safety, health, development and social and emotional well-being.

The following parental risk factors may justify a referral to Children Social Services / Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) for an assessment of the child’s needs:

  • Previous history of parental mental health especially if severe and / or enduring condition;
  • Predisposition to, or severe post natal illness;
  • Delusional thinking involving the child;
  • Self-harming behaviour and suicide attempts (including attempts that involve the child);
  • Altered states of consciousness, 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;
  • Disorder designated ‘untreatable’ either totally or within time scales compatible with the child’s best interests;
  • Mental illness combined with domestic abuse and/or relationship difficulties;
  • Unsupported and/or isolated mentally ill parents;
  • Parental inability to anticipate needs of the child;
  • Neglect of self and vulnerability to exploitation.

Children most likely to suffer Significant Harm are those who feature within parental delusions and children who become targets for parental aggression or rejection, or who are neglected as a result of parental mental illness.

A referral must be made to Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) if a service user expresses delusional beliefs involving a child (under 18) and/or if service user might harm a child as part of a suicide plan.

A consultant psychiatrist must be directly involved in all clinical decision making for service users (with severe and/enduring mental illness) who may pose a risk to children in accordance with guidance from the National Patient Safety Agency (NPSA).

The following factors associated with the child may justify a referral to Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) for an 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);
  • 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;
  • Impact has been observed on child’s growth, development, behaviour and/or mental / physical health, including alcohol/substance misuse and self- harming behaviour.

Pre-birth

Pre-birth procedures must be considered when it is known that someone with mental health problems is expecting to become a parent / have another child. Consideration must be given to the ability of the parents to obtain adequate antenatal care and subsequently provide good care for the baby. If referral to Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) is justified, it must be undertaken as soon as concerns are identified, to enable early assessment and support.


4. Importance of Working in Partnership

Those working with adults with mental health problems and /or children of these adults must be familiar with Practice Guidance for Professionals When Working with Parents with Mental Health Problems (on Kent Safeguarding Children Board website) and the need for assessment, liaison and appropriate sharing of information. National guidance can be found in the “Think child, think parent, think family: a guide to parental mental health and child welfare”.

All practitioners within Adult Mental Health Services have a duty to ensure that their clients are assessed in the context of their family responsibilities always taking into account that the welfare of children is paramount. They should consider the:

  • Impact of their client’s mental health difficulties on their ability to meet their children’s physical and emotional needs;
  • Impact of treatment, hospital admission or any other intervention from the Mental Health Services on their client’s dependent children;
  • Implications for children in cases where adults have refused co-operation or have withdrawn from treatment;
  • Physical safety of the client’s children in the case of violent, aggressive or unpredictable behaviour.

When an adult, who is also a parent / carer, is deemed or others by agency professionals, including Adults’ Social Care, to be a danger to her/himself or others a consultation must be held with Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway). Consideration must be given for an invite to any relevant planning meetings. This should not prevent a referral being made in emergency (for more information refer to Royal College of Psychiatry’ document ‘Patients as Parents' (2002).

Mental health professionals assessing actual or suspected abusers should ensure that any report produced, particularly for another agency or child protection conference, makes a clear statement of assessment of risk to any child with whom the abuser has contact regardless of diagnosis or treatability.

Strategy Discussions and Child Protection Conferences must include any health professional (psychiatrist, nurse, psychologist, therapist or Adult Mental Health Services (AMHS) – social worker) involved with the parent / carer.


5. Children's Visits to Hospital Patients

Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) may be requested to assess whether it is in the best interests of a child to visit a parent or family member in a psychiatric hospital (see Children Visiting Psychiatric Wards and Facilities Procedure) for procedures regarding high secure hospitals (Broadmoor, Ashworth and Rampton).

Psychiatric hospitals should have written policies, drawn up in consultation with Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) about visits by children to patients, which should only take place following a decision (regularly reviewed) that such a visit would be in that child’s best interests.

Where there are child welfare concerns regarding visits to patients detained under the Mental Health Act, the Trust may ask Specialist Children’s Services (Kent)/Children’s Social Care Services (Medway) to assess whether it is in the child’s best interests.

End