Children of Parents with Mental Health Problems

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Children of Parents with Mental Health Problems

AMENDMENT

In May 2021, additional links were added in Further Information.

Definition
Harm/Worries
Warning Signs
Strengths and Safety
Issues
Further Information
Local Documents

1. Definition

Mental health problems are relatively common, the term does not in itself have one clear definition, and therefore the existence of mental health problems should not be taken as a risk factor without contextual information.

The state of a person's mental health is usually not static and can vary according to several factors, correspondingly their capacity to parent safely may also be variable, and therefore, an understanding of the factors which may increase risk is an important part of any assessment.

Some adults who suffer from severe mental health problems also have drug and/or alcohol misuse problems, which is described as Dual Diagnosis and there may be several agencies and services, for both adults and children, who are working with the family.

Child Safeguarding Practice Reviews and Domestic Homicide Reviews have identified domestic abuse, parental mental ill health and drug and alcohol misuse as significant factors in families where children have died or been seriously harmed.

2. Harm/Worries

Many parents will have mental health issues and be able to look after their children and keep them safe, especially if they have a good network of support around them. However, parents who have mental health problems may experience symptoms that get in the way of them being able to look after their child or keep them safe. When parents are unwell, this can increase the chance of children being neglected, for example children may miss school, go unwashed, miss meals or they may miss out on affection. Children of parents with mental health issues may take on a caring role and help to look after their parents or other children in the house which can lead to them missing out on time with friends and other opportunities.

Some parents who have obsessive compulsive behaviours may involve their child in these. Other parents with mental ill health may struggle to accept their child or to spend time with them, or they may show a lot of anger towards their child. This can lead to children feeling rejected and unloved. Children may also see a parent who is unwell behaving in frightening ways, e.g. harming themselves.

Although a child may not live with a parent who has mental health issues, they may have family time with a parent who is unwell, e.g. visits to that parent's house or overnight stays, and the impact of this on the child needs to be considered.

Pregnant women with mental ill health may also act in ways that could be harmful to their unborn child, e.g. misusing drink or drugs to try to feel better.

Sometimes, parents may become so unwell that this can get in the way of them being able to keep their child safe, for instance a parent who experiences delusions about their child, e.g. hearing voices telling them to harm their child. In the most severe cases, children may be at risk of serious injury, severe neglect or even death.

Where there are worries about a parent's mental health, the impact of this on the child needs to be understood.

The Harm / Worry Matrix can be used to analyse harm or worries in relation to parents'/ carer's mental health, by focusing on the detail of the behavior that was harmful or worrying, how often this behavior has happened (timespan), how bad the behavior is (severity) and how the harmful or worrying behavior has affected the child (impact).

When considering the impact of parental mental health on the child, the child is best placed to say how this affects them however practitioners who do not have direct contact with the child may also base their worries on information shared by the parent or by speaking to other people in the child and parents' network who know them well about what their worries are.

Questions to explore the impact of parent's mental health on the child include:

What does the worry about the parent's mental health look like? What is the worrying behaviour that has been happening? How often has this worrying behaviour happened?
How long have there been worries about the parent's mental health? What did it look like when we first had worries? How has this changed over time and how is this affecting the children now? (are things getting better or worse over time?)
What has been the worst thing that has happened to the child whilst they have been in the care of their parents when the parent has been unwell? How do we know?
What kind of things are the children seeing or hearing due to their parent being unwell and how is this affecting the children?
What would the children say worries them the most about the way that their parent behaves?
How much does the parent's mental ill health get in the way of routines for the children, what they are able to do and who they are able to spend time with?
How is the parent's mental ill health affecting their relationship with their child?
Who are the people that parents spend time with that professionals worry could harm the children? What is it about these people that makes professionals feel worried?
When parents are unwell, who looks after the children? How much do the children do to look after themselves, their parents or other children in the house?
How do the parents make sense of their mental ill health (e.g. based on their culture or beliefs) and what is the impact of this on the child?

3. Warning Signs

To understand how a parent or carer's mental ill health may affect their ability to look after their child or keep them safe, practitioners need to be aware of the signs that a parent's mental health is deteriorating. The following indicators may suggest that this is the case and should be explored in any assessment so that plans can be put in place to make life better for the child:

Children are taking on a caring role in the house, e.g. looking after themselves, their brothers or sisters or their parents;
Children's and / or parents'' needs are not being met, e.g. they are not washing as often, they may be going without food, the children may be missing school or health appointments, parents may struggle to spend time with their children etc;
A poor relationship between the parent and the child, e.g. children may feel rejected as their parent is not spending enough time with them or parents who have mental health problems may act more harshly towards their children. Children's behaviour can become more difficult to manage as a result of this;
Children may be poorly supervised. A parent who is struggling with their mental health may find it difficult to always know where their child is or who they are with and this may increase the risk of the child being harmed, e.g. through accidents or by others taking advantage of the child;
Some parents with mental health issues may lack any insight into how their condition is affecting them or their ability to care for their child, which can make it harder to support the family;
Some parents with mental ill health may spend periods of time in hospital or away from the family home and this can affect their relationship with their child;
Parents may turn to drink or drugs to help them to manage their feelings, which can get in the way of them being able to look after their child well or keep them safe;
Some parents may blame their child for their poor mental health, or children may be part of a parent's delusions, e.g. a parent who hears voices telling them to harm their child;
Some parents who are unwell may be more likely to become violent and children may be caught up in this or become frightened by it;
Relationships with the wider family and friends (the family network) may become strained which can lead to arguments or family breakdown.

4. Strengths and Safety

Where practitioners have worries about how a parent or carer's mental health affects how they care for their child or keep them safe, a referral to First Contact in line with the Referrals Procedure should be made and the practitioners from adult mental health services or other relevant agencies should work in collaboration with Children's Social Care to make sure that that the child is kept safe and the adult's mental health needs are supported.

If there are concerns, it may be that the child and family will find early help services supportive and an assessment of the needs of the child should take place at an early stage, for example through the Child & Family Assessment.

Joint work between mental health services and Children's Social Care will include mental health workers providing information about:

Treatment plans and how parents are managing any treatment;
Likely duration of any mental health problem;
How the parent or carer's mental health issue or medication may affect their ability to look after their child and keep them safe.

Children's Social Care must assess the individual needs of each child and include information provided by mental health workers as part of their assessment.

Any assessment of the worries and impact of a parent / carer's mental ill health on their child should also include questions about what works well in relation to the worries (strengths and safety), who the important people are around the parent and the child and how it is that they help.

Questions to explore strengths and safety include:

What would the children say are the things that they love most about their parents? What would the parents say that they love most about the children?
Who would the children say that they are closest to? Who do they think are the best people around their parents? What do they like about these people and what do they do to help?
Who are the people that the children feel safest with? What do these people do that helps the kids to feel safe?
Have there been times that the parent felt so low or anxious that they wanted to stay in bed all day, but they decided that they needed to do something different because they did not want the children to miss out? What did they do instead? Who helped?
Have there been times where parents could have argued and fought with each other but they did not want to frighten the children, so they did something else? What did they do instead?
When do the parents and the children get along best? What is it that the parent is doing differently when this happens? How does their child respond?
When has the parent been most in control of their feelings? What was different about that time? Who was around at that time and what did they do that was helpful? What else helped them to stay in control of their feelings?
Who are the people that parents are least likely to lose control of their feelings around? What is it about these people that means they are helpful people for the parents to be around?
What are all of the ways that the parents have tried to manage their mental health difficulties? What has worked the best for them? What difference has this made to the children?
What are all of the ways that the parents try to make sure that the children do not miss out or go without due to them feeling unwell? Who can they count on to help out?
How do the parents try to make sure that their children can't come across their medication? Where do they store things?

Children who have a network of supportive adults around them who look out for them and can step in to help when parents are struggling tend to do better than children who are isolated so the family's naturally occurring network of support (family, friends, neighbours) should always be explored as part of any assessment and the network should help to create plans so that children are kept safe and well now and in the future. This work can be started through the Child & Family assessment and it should form the basis of assessments and planning in Children's Social Care.

Mental health professionals should be invited to and must attend to provide information to any meeting about the impact of the parent/carer's mental health on the child including Child Protection Conferences and Team Around the Family (TAF) meetings. Children's Social Care professionals should be invited to and must attend Care Programme Approach (CPA) and other meetings related to the management of the parent's mental health.

All plans for a child including Child Protection Plans and Child and Family Plans should identify the roles and responsibilities of mental health and other professionals where this is needed. The plan will also make clear how the family and professionals will keep in touch with each other. All professionals should work in accordance with their own agency procedures / guidelines and seek advice and guidance from line management or the safeguarding lead, when necessary.

5. Issues

Safety Planning: Children's services 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.

If a parent/carer disengages from mental health services, or is non-compliant with Treatment and the professional judgment is that there is on-going risk to the child in these circumstances, this should be referred to First Contact.

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 team in order that the implications for the child are assessed.

Mental health services should always use 'respectful uncertainty' and consider disguised compliance and not readily accept parent / carer's assertions that their mental health problems are not affecting the care they provide to their children. Statements made by the parents and carers should be verified through further assessment.

Any professionals, carers, volunteers, families and friends who are in contact with a parent with mental health problems must ask themselves "What is it like for a child in this environment?".

Confidentiality is important in developing trust between parents with mental health problems and practitioners in agencies working with them, however, practitioners must always act in the best interest of the child and not prioritise their therapeutic relationship with the adult.