Mental health problems are proportionately common in the overall population, 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.
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.
Many adults who suffer from mental health problems also have substance 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.
National Serious Case 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. Where all three concerns are present they have been described as the 'toxic trio', which practitioners should be alert to, and seek regular supervision whether the practitioner working with the child or the practitioner working with the parents, and consider in any assessments, information sharing or referrals to appropriate services.
A child who has suffered, or is likely to suffer Significant Harm or whose well-being is affected by parental mental illness could be a child:
Whose parent(s) present with command hallucinations (these are hallucinations that the person has to act out on, a voice that tells them that their child is the devil/evil);
Whose parent(s) have suicidal beliefs that include the child;
Whose parent(s) have lack of insight into their mental health;
Whose parent(s) do not engage with services or treatment;
Who is included in his/her parent(s) obsessive compulsive behaviours;
Where both parents have mental health problems;
Individual risk or stress factors, on their own, do not necessarily have a serious effect on an adult's parenting capacity or their children's mental health. However, some parents with mental health problems will face multiple adversities. Risk factors are also cumulative: the presence of more than one increases the likelihood that the problems experienced and impact on the child and parent will be more serious.
It is when three or more environmental and/or personal factors occur in combination that a negative impact on child and/or parental mental health is much more likely. For example, the presence of drug or alcohol dependency and domestic violence, in addition to mental health problems with little or no family or community support, would indicate an increased likelihood of risk of harm to the child and to parents' mental health and wellbeing.
Risks can also change over time and create acute problems - for example, going into hospital can represent a significant crisis in terms of family life. Everyday routines are disrupted, other adults are overstretched and both parents and children often feel worried and powerless. An effective intervention needs to consider the outcomes for the whole family.
Risks to health and well-being will also vary from person to person - for example, people with the same mental health problem can experience very different symptoms and behave in different ways. Therefore, relying on a diagnosis is not sufficient to assess levels of risk. This requires an assessment of every individual's level of impairment and the impact on the family. A review of individuals' interactions with their social environment noted that inequality and poverty were significant stressors in families with mental health problems. Many studies have found that the stress of poverty - often due to parents with mental health problems being unable to work - are profound and can affect the health and wellbeing of both parents and their children. Similarly, a lack of community supports also impacts upon families and children. A study of black children's experiences of caring found an additional burden of care where there was a lack of culturally appropriate services.
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:
Where it is believed that a child of a parent with mental health problems may have suffered, or is likely to suffer significant harm, a referral to Children's social care should be made in accordance with the Referrals Procedure. If there are concerns, it may be the case 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 an Early Help Assessment taking place.
It is essential that staff working in adult mental health services and Children's social care work together collaboratively with a 'whole family' ethos to ensure the safety of the child and management of the adult's mental health.Joint work will include mental health and social work professionals providing and sharing all information with regard to:
Children's social care must assess the individual needs of each child and within this incorporate information provided by mental health workers.
Mental health professionals should be invited to and must attend to provide information to any meeting concerning the implications of the parent/carer's mental health difficulty on the child including Child Protection Conferences and Child in Need 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 in Need 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 or the organisation safeguarding lead, when necessary.
Contingency Planning. 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.
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 Children's social care.
Professionals need to consider carefully the implications for children when closing their involvement with a parent(s) 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, Children's Social Care and other relevant services should always use 'respectful uncertainty' and not readily accept parent / carer's assertions that their mental health problems are not affecting the care they provide to their children. Where there is any doubt in these situations, services should always err on the side of caution.
Confidentiality is important in developing trust between parents with mental health problems and practitioners in agencies working with them, however, the child should always remain the 'central focus' and practitioners must always act in the best interest of the child and not prioritise their therapeutic relationship with the adult.
An acquired brain injury (ABI) is brain damage caused by events after birth rather than as part of a genetic or congenital disorder. ABI can result in cognitive, physical, emotional or behavioural impairments that can lead to temporary or permanent changes in functioning.
Impairment can result from:
ABI does not include damage to the brain resulting from neurodegenerative disorders.
Only valid for 48hrs