Report Abuse Report Abuse

1.5.5 Adult Mental Health and Child Protection

RELATED GUIDANCE

Mental Health (parents/children) Children in the Youth Justice System: Mental Health Crisis Care - Concordat - Improving Outcomes for People Experiencing Mental Health Crisis

RELATED CHAPTERS

Strategy Discussions Procedure

Assessment Protocol

Section 47 Enquiries Procedure

Recording that a Child is the subject of a Child Protection Plan Procedure

Implementation of the Child Protection Plan - Lead Social Worker and Core Group Responsibilities Procedure

Child Protection Review Conferences Procedure

AMENDMENT

This chapter was updated in September 2014, Mental Health (parents/children) Children in the Youth Justice System: Mental Health Crisis Care - Concordat - Improving Outcomes for People Experiencing Mental Health Crisis was added to the Related Guidance section.


Contents

  1. Introduction
  2. Legal and Policy Framework
  3. Principles
  4. Lessons from Serious Case Reviews
  5. Importance of Inter-Agency Working
  6. Assessing the Impact of Parental Mental Ill Health
  7. Process
  8. Local Practice and Initiatives
  9. Conclusion
  10. Key Texts


1. Introduction

This guidance addresses the issues of inter-agency working in relation to adult mental health and how this can impact on child protection. It is important that everyone has a working understanding of individual's roles within the whole process. This guidance was updated in 2009 and reflects the work undertaken nationally by the Social Exclusion Task Force in 2007 and 2008 on the Families at Risk Review. This review concentrated on families with multiple and complex problems, and one of these problems was poor mental health The "Think Family" approach that flowed from this review is being promoted actively by this LSCB. When this guidance refers to "parents" it generally also includes carers and is not used in the legal sense of parent "with Parental Responsibility".

We all have a responsibility to safeguard the welfare of children and young people. Remember 'Think Parent - Think Child - Think Family'.

National documents and papers were considered and their principles encompassed in our work, especially 'Working Together to Safeguard Children', 'Crossing Bridges' and the Families at Risk Review documents. (References to all documents mentioned in the text are contained in the Key Texts section at the end of this paper).


2. Legal and Policy Framework

Children's Social Care Services has access to legal advice from their respective legal departments. Children can be protected by the use of the Children Act 1989 or occasionally by the use of Mental Health Act 1983. This would remove the mentally ill adult who poses a risk to the child from the home, rather than removing the child.

Working Together to Safeguard Children (2015) includes the statement:

"A wide range of health professionals have a critical role to play in safeguarding and promoting the welfare of children including: GPs, primary care professionals, paediatricians, nurses, health visitors, midwives, school nurses, those working in maternity, child and adolescent mental health, adult mental health, alcohol and drug services, unscheduled and emergency care settings and secondary and tertiary care."

Where Child and Adolescent Mental Health Services are involved in a family and adults are also known to the Adult Mental Health Services, close collaboration should take place between both services.

The National Service Framework for Mental Health (1999) provides a framework, which can assist in better provision for patients who are parents. For example, it provides all mental health practitioners with opportunities to:

  • Promote mental health and engage in earlier intervention/prevention (Standard one). Knowing which patients are parents will enable appropriate steps to be taken for the patient as parent and for her/his children;
  • Improve links with Primary Care where the bulk of maternal depression/anxiety will present and where closer collaboration with the range of community-based children's services can occur;
  • Support carers (Standard six). This should be interpreted as applicable to all carers: those who care for individuals experiencing mental illness; young carers who look after a mentally ill parent/carer and those who are themselves experiencing mental ill health and who also care for dependent children.

The Framework for Assessment of Need in Children and Families (2000) provides an approach to assist Children's Social Care Services to undertake systematic assessments of the needs of the child and parental capacity to meet those needs. It recognises the role of social adversity and mental illness as stress which could affect parenting. It emphasises the importance of collaboration between services and agencies at all stages of the assessment and in intervention. It will therefore help to identify gaps in provision and provide opportunities for establishing better links between childcare and mental health services.


3. Principles

The majority of parents who suffer mental ill-health are able to care for and safeguard their children and/or unborn child. Some parents, however, will be unable to meet the needs and ensure the safety of their children.

The welfare of the child must be paramount. Where professionals suspect a child and/or unborn child has suffered or is at risk of suffering Significant Harm as the result of commission or omission on the part of the parent/carer, the referral process must be followed. An appropriate child protection referral should not be delayed, for example, because a diagnosis has not yet been made in relation to the adult (please see Referrals to Children’s Social Care Procedure). In addition all agencies should be pro-active in identifying those children and young people who have not yet reached the threshold for child protection referral but who would quickly do so if not offered additional support early on.

All professionals should find out about availability of local services to ensure a range of systems to support families. These include:

  • Services for adults with mental health problems who have responsibilities for children;
  • Services for parents with mental health problems and for children, including young carers;
  • Specific services for black and ethnic minority peoples' mental health;
  • Services for other culturally diverse groups, people from abroad, and asylum seekers.

All agencies need to provide their services in ways that respond sensitively to the views of parents, children and young people, including young carers. The Social Care Institute for Excellence (SCIE) has produced national guidance for adult and children's mental health and social care services, entitled Working with parents with mental health problems and their children (Think child, think parent, think family: a guide to parental mental health and child welfare).

For themselves, parents want:

  • More understanding and less stigma and discrimination in relation to mental health problems;
  • Support in looking after their children;
  • Practical support and services;
  • Good quality services to meet the needs of their children;
  • Parent support groups;
  • Child-centred provision for children to visit them in hospital;
  • Ongoing support from services beyond periods of crisis;
  • Continuity in key-worker support;
  • Freedom from fear that children will inevitably be removed from them.

For their children, parents want:

  • Opportunities for children to talk about any fears, confusion and guilt;
  • Opportunities for children to meet adults they can trust, and to participate in;
  • Activities where they can meet other children;
  • Provision of explanation and discussion about the events and circumstances;
  • Surrounding the parental mental health problems;
  • Continuity of care and minimal disruption of routines during a crisis (including hospitalisation of parent/carer).

Children and young people want:

  • Age-appropriate information about the illness and prognosis;
  • Someone to talk to - not necessarily formal counselling;
  • A chance to make and see friends.

Children and young people taking on a caring role want:

  • Practical and domestic help recognition of their role in the family;
  • A contact person in the event of a crisis regarding a parent.
(These findings were originally listed by Falkov in 1998 but were also echoed by the parents and children who contributed to the SCIE Practice Survey in 2006/8. This survey was part of the background work to prepare the guidance).


4. Lessons from Serious Case Reviews

Serious Case Reviews are carried out when abuse and Neglect are known or suspected factors when a child dies (or is seriously injured or harmed) and there are lessons to be learned about inter-agency working to protect children. An overview analysis of these reviews is undertaken every two years to draw out themes and trends. The last such review: Learning Lessons from Serious Case Reviews was published by DCSF in 2010 and covered 2009 to 2010. It covered 147 cases. There are also other relevant research reviews, including and the Ofsted Report, Improving Safeguarding Practice, 2008 adds to this body of evidence. There is a great deal of consistency between these reports which suggest that the same sorts of family problems are emerging in the most risky situations for children and that the same sorts of mistakes are being made by professionals and systems in response. One of the key findings is adult mental health services, and other agencies working with families, not sharing key information about family circumstances early enough.

Some of the key findings of the 47 cases studied in detail from the DCSF review published in 2008 are:

  • Domestic violence was present in 66% of cases;
  • Substance misuse was present in 57% of cases;
  • Mental ill health was present in 55% of cases;
  • All three issues were present in 34% of cases.
All practitioners should be encouraged to be curious and to think critically and systematically about families.


5. Importance of Inter-Agency Working

Adult mental health professionals and childcare social workers, school nurses, health visitors and midwives and education services and other agencies as appropriate must share information in order to be able to assess risks. This includes the sharing of information around a parent's past experience of psychiatric services, not just about current involvement. Children's workers need to seek out such information and adult mental health workers need to see it as their role to provide this information when requested. Please see Information Sharing and Confidentiality Procedure for more information. If more than one adult service is involved, then both should work closely together, e.g. if both parents known to services, or if they are known to drug or alcohol services, forensic or personality disorder services as well as an adult psychiatry service. They should also gather relevant information from any police, housing or probation workers involved. Some Adults at Risk may also be subject to the local multi-agency policy and procedures for the protection of Adults at Risk from abuse. Details of these procedures are available on the websites of the three local authorities.

Care Programme Approach (CPA) meetings about mentally ill parents must include consideration of needs and risk factors for the children concerned. In all such cases Children's Social Care Services must be involved in planning discharge arrangements.

Child Protection Strategy meetings and Child Protection Conferences must include any psychiatrist, community psychiatric nurse, psychologist and adult mental health social worker involved with the parent/carer.

Children's Social Care may be requested to assess whether it is in the best interests of a child to visit a parent or family member in a local mental health unit or special hospital.

Please see Children's Visits to Special Hospitals/Psychiatric Units Procedure for more information.


6. Assessing the Impact of Parental Mental Ill Health

When a parent receives mental health services in the community or is hospitalised, it is crucial to identify which patients are parents and include the following as part of the assessment.

  • Is the patient a parent?
  • Is the patient the main carer?
  • Does the patient have contact with children?
  • How many? How old? Gender? Names?
  • Where are the children? Who looks after them? Who is responsible for them? (basic safety issues)
  • Who is living in the household?
  • How are the children? Does anyone have concerns? e.g. parent, partner, health visitor, GP, school (parental consent required);
  • Are there other services or agencies involved?
  • Does the disorder influence or impair the patient's ability to look after the child(ren)?
  • In what way?
  • Who assists with childcare (e.g. if parent unwell)?

Are there practical arrangements or sources of support, which could assist the patient and the children? For example, extended family, grandparents etc. identify their views on the treatment plan/medical diagnosis

Talk to the patient's children - they will be aware of most of their parent's symptoms, the way parents behave when unwell (in relapse) and warning signs or any difficulties their family is experiencing

(The above questions are specifically important for Approved Mental Health Practitioners (AMHP's) (formerly known as Approved Social Workers) when considering the possibility of compulsory admission of a parent/carer).

In May 2009, NPSA issued a Rapid Response Report/RRR to all Mental Health organisations asking them to make changes to how their staff consider and act on any risks to the children of adult service users.

All NHS Trusts need to be compliant with the principles of this NPSA report regarding safe discharge of mentally ill patients and encompassing in the discharge plan's and CPA's any risks for the children.

Assessment needs to follow the Framework for Assessment of Children in Need as for any social assessment of a child. This includes a holistic assessment of the child's developmental needs as follows:

  • Health and physical development;
  • Education and cognitive development;
  • Emotional and behavioural development;
  • Family and peer relationships;
  • Self-care and competence;
  • Identity;
  • Social presentation.

Particular issues relating to adult mental health problems are:

Child's own development and mental health

  • The child's understanding and response to the mental illness.

Parenthood and the parent-child relationship

  • Extent and nature of care provided by the ill parent;
  • The child's involvement in and exposure to parental symptoms;
  • Quality of parental/family relationships and effects of any changes or separations;
  • Previous child/parent relationship.

Adult Mental Illness and its impact on Parenting Capacity

  • Mental state of the parent;
  • Effect of symptoms and treatment on parenting capacity;
  • Quality of social supports;
  • Childhood experiences of parents/carers;
  • Stresses involved in becoming a parent;
  • Relationship with and mental health of partner or other significant family members.

Assessing the impact of the mental illness on parenting capacity. Children may not be exposed to or involved with specific symptoms, yet parenting can still be altered. The presence of mental illness can reduce and/or change a parent's responsiveness toward their child. For example, a parent may become less emotionally involved, less interested, less decisive or more irritable with the child. This will affect the quality of the parent-child relationship, parenting capacity and the child's well-being.

When assessing the impact of parental illness on children, differentiate between:

  • The nature of the child's experiences associated with their exposure to parental symptoms;
  • How the parent's actual parenting has changed due to the illness;
  • The quality of parenting skills when well.

NB. This information may not always be available.

Consideration should be given to the protective factors as well as stressors and should include:

  • Actual symptoms and child's involvement in and exposure to parental symptoms;
  • Pattern of the illness including nature, severity, duration and timing; first or recurrent episode, chronicity;
  • Compliance with treatment/use of help/acceptance of support;
  • Religious/cultural beliefs;
  • Previous psychiatric and forensic history;
  • Whether the symptoms and behaviours can be improved in any way;
  • Previous history of violence, self-harm, suicide attempts;
  • Dual diagnosis e.g. mental illness and Personality Disorder or mental illness and learning difficulties;
  • Mental illness combined with misuse of drugs or alcohol;
  • Delusions involving the child;
  • The especially worrying combination of mental illness of a parent and domestic violence;

Changes in family structure or functioning/Young Carers

Where mothers or expectant mothers are admitted to a psychiatric unit, then the Nurse in charge of the ward should automatically contact the Safeguarding Nurse advisor at Leicester Partnership Trust to organise between them who should contact the relevant community health professionals (midwife, GP, health visitor, school nurse) to inform them of the admission.

Children may take on more responsibilities and/or caring roles within the family when a parent is mentally ill. This includes practical tasks such as chores, caring for siblings, shopping and emotional concerns like worrying about the ill parent. Hospitalisation of a parent may lead to changes in roles and/or living circumstances for the family. The impact on children following admission to hospital of a single, socially isolated parent will have quite different implications compared to hospitalisation of a mentally ill adult in a family where good quality alternative carers are available. The specific needs and safety of the children must be assessed directly and not assumed. Please note the Laming requirements of a pre-discharge meeting to discuss these.

Be aware that young carers can receive help from both local and health authorities. They are entitled to an assessment of their ability to care under section 1(1) of the Carers (Recognition and Services) Act 1995 and the local authority must take that assessment into account in deciding what community care services to provide for the parent. In addition, consideration must be given as to whether a young carer is a child in need or in need of protection and whether the child's welfare or development might suffer if support is not provided to the child or family.

Recognise that treating symptoms in isolation is not sufficient. Difficulties in parent-child relationships have been shown to persist well beyond the period of parental mental illness. Addressing the social context of parents and children is essential. In particular, practitioners should not assume that resolution of the episode of illness would also mean an automatic return of good quality and appropriate parenting nor should they assume that children will accept their parent back easily into the family home. In situations where there are serious concerns about parental inability to meet a child's needs when unwell, professionals will need to reassess the adequacy of parenting and the parent-child relationship once psychiatric symptoms have resolved. Good links between children's and adult services, across agencies, are therefore essential.

Be aware of the dilemmas, which can arise in terms of the times required for a parent to recover and the continuing uncertainty this generates for children, carers and professionals. Ways need to be found to support children while parents are being rehabilitated. However, there will be situations where the likely duration of parental rehabilitation will pose unacceptable delays and risks to children's development. Alternative care arrangements may be necessary and, in conjunction with the local authority, permanent fostering and adoption will need to be considered.

Find out about availability of local services to ensure a range of systems to support families -for adults with mental health problems who have responsibilities for children, for parents with mental health problems and for children including young carers. The LAMP website covers services relating to mental health issues in Leicester, Leicestershire and Rutland

High Risk Indicators

Childcare professionals should be consulted where there evidence of:

  • Psychotic beliefs particularly if involving the child;
  • Persistent negative views expressed about a child, including rejection;
  • Ongoing emotional unavailability, unresponsiveness and neglect, including lack of praise and encouragement, lack of comfort and love and lack of age-appropriate stimulation;
  • Inability to recognise a child's needs and to maintain appropriate;
  • Parent-child boundaries;
  • Ongoing use of a child to meet a parent's own needs;
  • Distorted, confusing or misleading communications with a child including involvement of the child in the parent's symptoms or abnormal thinking. For example, delusions targeting the child, incorporation into a parent's obsessional cleaning/contamination rituals, or a child kept at home due to excessive parental anxiety or agoraphobia;
  • Ongoing hostility, irritability and criticism of the child or adolescent, inconsistent and/or inappropriate expectations of child;
  • Serious neglect of the child;
  • Any history of domestic violence (please see Domestic Abuse/Violence Procedure for more information) (In addition, a local Multi Agency Risk Assessment Conference or MARAC may be called for those victims of domestic violence who are at the highest risk of homicide or serious harm;
  • A history of issues with regard to safeguarding adults (for local Safeguarding Adults at Risk Procedures see the website for the relevant local authority for these procedures);
  • Any history of substance misuse by parent(s), visiting family members or friends or carers (please see Parental Drug and Alcohol Misuse Procedure for further information);
  • Any history of significant personality disorder in a parent/carer.

Other Negative Indicators

The following factors suggest riskier situations. They do not predict abuse in individual families. When more than one of these factors below are present the risk is increased.

  • Combinations of depression, substance dependence and personality disorders at various points in time are the most frequently reported psychiatric conditions affecting parents who abuse their children;
  • Mental illness or another mental disorder combined with a background of domestic violence;
  • Both parents have a mental disorder or a lone parent with limited support has a mental disorder;
  • Poor compliance with treatment;
  • Lack of insight into the disorder and its likely impact on the child;
  • Self-harming behaviour and suicide attempts;
  • Parental learning difficulties and mental illness.

Examples of mental illness and its impact are:

  • Severe post natal depression, which is likely to pose a greater risk to children;
  • Psychotic illness including puerperal psychosis. The risks to children increase if the mentally ill parent has delusional ideas involving the children e.g. if the parent thinks the child is the devil or if a severely depressed parent feels that the child should be protected from the evils of this world by killing the child;
  • Parents with obsessive compulsive disorders may involve their children dangerously in their rituals (e.g. by scrubbing the child constantly) and they may also become very irritable and short-tempered with a child who naturally interrupts their rituals;
  • Adults experiencing episodes of manic behaviour are more likely to be extremely irritable and short tempered with children during these episodes.

Particular attention should be paid to concerns about personality disorder.

NICE guidance was published in January 2009 on:

  • Anti-social personality disorder and;
  • Borderline Personality Disorder.

A parent with a personality disorder may have very limited ability to cope with the symptoms of relatively moderate mental health problems (e.g. mild anxiety or depression). Such parents will find it much harder to priorities their children's needs than some other parents with severe mental illnesses but without serious personality disorders. Parents with personality disorders may also be less likely to comply with treatment and may be antagonistic to Social Care and Health Professionals. The challenge for professionals is then to keep their focus firmly on the child's welfare and safety.

People with emotionally unstable personality disorder or sociopathic personality disorder present particularly strong risks to children for different reasons. Emotionally unstable personality disorder means that a person will be at risk of poor attachment, poor containment of their emotions, and lack ability to maintain appropriate boundaries. They can be very chaotic especially with relationships. They are liable to deliberate self-harming behaviour such as cutting or overdoses. They often have an inability to empathise with others' needs. Another form of personality disorder is sociopathy and this also poses strong risks to children. Sociopathic or dissocial personalities find it extremely difficult to understand other’s needs, and often have histories of aggressive or criminal behaviour. They can be charming, but have no true feeling for others, and lie, abuse drugs or alcohol, and can manipulate Adults at Risk or children for their own ends.

The Personality Disorder Service at Francis Dixon Lodge, Leicestershire Partnership Trust, can advise or offer an assessment. Referral forms for this service and for the associated day service (Jasmine Centre) can be obtained by phoning 0116 225 6800. Self-referrals are also considered.

A small number of those with personality disorders may be subject to Multi Agency Public Protection Arrangements (MAPPA). These arrangements support the assessment and management of the most serious sexual and violent offenders. (For local MAPPA information and contact details see MAPPA Website (GOV.UK). See also Children using Abusive Behaviour Procedure). A further form of personality disorder may be associated with parents who fabricate or induce illness in their children. There are specific LSCB procedures when this is suspected (see Fabricated and Induced Illness Procedure).

Positive Indicators/Protectors

The following may reduce the likelihood of suffering significant harm:

  • Older age of the child at the time of the onset of their parent's illness (due to less opportunity for exposure to difficulties and a greater range of potential coping resources);
  • The more sociable child who is able to form positive relationships (easier temperament);
  • A more able child;
  • A parent who has discrete episodes of mental illness with a good return of parenting skills and abilities between episodes;
  • Alternative support from adults with whom child has positive, trusting relationship;
  • Success outside of the home, e.g. at school or in sport;
  • Professionals can improve children's chances of avoiding significant harm by strengthening these protectors.


7. Process

Those working in all agencies should be aware of the designated and named professionals for child protection who can provide advice.

Remind all patients taking medication about the need to store potentially lethal substances safely and securely if children are likely to visit the household. If English is not their first language, ensure information is understood by the patient in his/her own language.

Talk with patients about their role as parents, associated stressors, ways in which psychiatric symptoms and parenting responsibilities affect each other and their perception of their children's health, welfare and safety.

Include partners in any assessment of a mentally ill parent's circumstances. A partner is important as a potential source of:

  • Alternative care and support;
  • Additional burden because they may also show evidence of mental illness;
  • Direct harm for children if the partner has maltreated children and mental illness prevents a parent from adequately protecting children;
  • Indirect harm for children, for example if domestic violence is witnessed. A woman who is unable adequately to protect herself will find it difficult to ensure her children are adequately protected.

Talking to the child

To meet children's needs when a parent is hospitalised for mental health reasons, all professionals looking after a parent and those caring for the children should:

Be open and honest. Children will have an awareness of changes especially the absence of their parent/carer. They may have observed all that went on or overheard conversations whilst in another room or whilst being hurriedly taken to neighbours, friends or family. Pretending nothing has happened may be especially confusing. They need to be kept informed.

Provide explanation. A truthful statement/description appropriate to the child's age should be provided. The use of clear language, which the child can understand, is important. The ill parent could be described as sad, confused, upset, needing a rest, stressed, mixed up inside, etc. Describing what happens while parent is in hospital - talking, being looked after, medication etc is also helpful. For a child with special educational needs who use alternative and additional communication systems, Key Workers from their educational setting should be consulted.

Emphasise that the child is not to blame. They should be told this.

Negotiate with the child and parents/carers how and how much the child should share with their friends and others about their parent's mental health problems and hospitalisation. Rehearse with the child, how they might deal with hurtful responses from their friends and classmates.

Support opportunities for contact when this is in the interests of the child (see Child Visits to Special Hospitals Procedure for further information). Other ways of maintaining contact include the use of phone calls, letters and pictures where appropriate. Be aware of the importance of promoting the development of good quality attachment between children and their parents or caregivers and of the adverse, lifelong implications for children when these early attachments are disrupted. However, the needs of the child must be the paramount consideration in any decision about any form of contact.

Recognise changes in behaviour patterns and discuss with relevant professionals in children's services. Children will worry, have fears/anxieties, be confused, which can be shown in a wide range of observable behaviours and hidden distress. These could include disrupted sleep or routines, uncharacteristic quietness/inaccessibility, poor appetite, poor hygiene, clinginess, bed wetting, demanding or disruptive behaviour, anger, irritability, tearfulness, stomach aches, nightmares and refusal to attend school. This is especially important for children with communication difficulties who may have little or no expressive language. Always consult a Key Worker from their educational setting for advice about appropriate communication.

Alert school and teachers that the child may need extra support, attention and praise. It is important that communication is ongoing and takes into consideration the issue of bullying due to the parent's ill health.

Additional Issues to consider for specific Roles or Agencies Refer to Mother and Baby Policy, Visits of minors to Psychiatric Wards Policy and The Care Programme Approach (Leicester Partnership, NHS Trust). (See Key Texts at the end of this paper for references).

Role of Child and Adolescent Mental Health Service Child and Adolescent Mental Health Services should:

  • Ensure that the mental health of parents of referred children is routinely considered in assessment and intervention;
  • Ensure that appropriate arrangements are made for treatment of a parent's mental ill health;
  • Consider the role of the child's disorder in the mental health of parent;
  • Be responsive to calls and referrals from colleagues in adult services. This should include establishing opportunities for collaboration during and beyond a crisis e.g. routine discussion about the needs of patients who are parents, consultation and joint work;
  • Be prepared to work flexibly so that assistance can be provided to children and families or to mental health staff during a parent hospitalisation or via attendance at a parent's CPA meeting.

Role of Forensic Services Forensic mental health risk assessment of the adult (s) is provided by the Forensic Mental Health Service, Leicestershire Partnership NHS Trust, for those who have committed serious offences or are deemed at high risk of harming children.

Referral to forensic services should only be made in situations where:

  • A child protection conference has reached the view that there is sufficient risk of continuing significant harm that a child should be made subject to a child protection plan (the former wording was that a child should be placed on the Child Protection Register) or would be if not looked after;
  • Psychological assessment of an adult directly involved in the case of the child is seen as necessary to inform decisions and assist in the development of appropriate child protection plans;
  • Where the subject agrees to a referral.

Where there are current Forensic Mental Health Services provided to an adult, it is required that all professionals involved with a family will provide information to child protection conferences and assist in assessing risk.

Service Contact Point:

Service Manager
Forensic Mental Health Services
Leicestershire Partnership NHS Trust
Herscel Prins Unit,
Glenfield Hospital Site, Groby Road
Leicester, LE3 9PQ

Tel: (0116) 295 3000

Mental Health Professionals attending Child Protection Conferences and Core Groups and Strategy Meetings.

Professionals attending such meetings should familiarise themselves beforehand with the appropriate sections of this manual: Initial Child Protection Conferences, Core Groups, Review Child Protection Conferences and Strategy Meetings.

For more information see:


8. Local Practice and Initiatives

Maternal and Neonatal Mental Health

Some family health visitors and a number of other relevant professionals have been trained in the maternal and neonatal mental health approach. This training enables professionals to identify newborn babies at risk of developing mental health problems and attachment disorders and then offers a range of preventive or treatment responses. This is especially beneficial where mothers are suffering from postnatal depression. Graded responses are organised with psychiatric referral for the most severely depressed mothers and regular listening sessions and simple bonding exercises for less severely depressed mothers.

Some local practitioners have been trained in using Video Interactive Guidance with mothers and babies to promote better attachment and bonding.

Mother and Baby beds in local psychiatric units There are currently three beds in Aston Ward at the Bradgate Unit, Glenfield General Hospital designated for mothers (with babies under one year) needing inpatient psychiatric care in the local area.

Working with Adult Survivors of Childhood Sexual Abuse

Amongst people attending psychiatric clinics records of people with experience of child sexual abuse are significant. Such experiences may have an impact on parenting. There might also be child protection implications for other children if the alleged perpetrator still has care of or close contact with other children or young people. The Leicestershire Partnership Trust has produced Guidelines for working with Adult Survivors of Child Sexual Abuse (October 2006). Reference should be made to the guidelines in any case where a patient discloses such a history. Some of these adults may still be experiencing sexual "abuse" and may need to be considered under the local Safeguarding Adults at Risk Procedures (See the website for the relevant local authority for these procedures)

Early Help Assessment and the Lead Professional (LP) Role.

In Leicester City and Rutland, Early Help Assessment is used; in Leicestershire it has changed to Early Help Assessment Services. For more information see Early Help Assessment Procedure

The Early Help Assessment is:

  • A "framework for helping practitioners assess children's needs for services earlier and more effectively, develop a common understanding of those needs and agree a process for working together to meet those needs"

    and
  • "A shared assessment tool used across agencies in England" providing "A common method of assessment across all children's services and across all local areas".

It aims to help early identification of risks, needs and strengths, leading to co-ordinated provision of services, involving a lead professional where appropriate, and sharing information to avoid duplication of assessments. This also reduces the need for children or their families to re-tell their story to different practitioners.

The Lead Professional (LP) is the person responsible for co-coordinating the actions identified in the assessment process and being a single point of contact for children with additional needs being supported by more than one practitioner.

This national approach is currently being rolled out locally by Bridges and there is a related local Needs Led Identifier tool that lists likely protectors and risks for children and young people. Among the risk factors listed are ones about parental mental health problems.


9. Conclusion

This guidance concerns the specific Child Protection Issues relating to adults with mental health problems who have significant contact with children and young people. In particular, the guidance has concentrated on assessing the impact of parental mental health problems on children. Remember 'Think Parent - Think Child - Think Family'.

As in all areas of child protection good communication is vital between professions and agencies ensuring that what is communicated is clear in its message and the implications for the child's protection are clearly understood by all involved.

This guidance as with other LSCB guidelines and policies are applied across all agencies and should provide a common and safe framework for everyone to work within ensuring that the needs of the child are paramount and remove any perceived barrier to inter-agency working and the exchange of vital information in whatever form that information is held.

The guidance not only points out the importance of information sharing but strongly recommends joint working between agencies and professions to provide, as comprehensively as possible, risk assessments and combine child protection plans and adult care plans or care packages, to meet the needs of the whole family.

Often a barrier to joint working is the issue of confidentiality and who owns information. Where an issue of child protection is involved it is valid and lawful to share any relevant information in order to protect the child.

Staff involved in child protection issues may experience dilemmas on how best to manage information. Staff should discuss information with other team members and all areas should have access to a named child protection professional. Each agency should identify and disseminate this information.

Where a disagreement exists between agencies and professionals on what action to take please refer to Resolving Practitioner Disagreements and Escalation of Concerns Procedure.


10. Key Texts

Relevant National Legislation and Government Guidance in relation to children

  • Children Act 1989;
  • Working Together to Safeguard Children (Department for Education 2015);
  • The Framework for the Assessment of children in need and their families (Department of Health 2000);
  • Reaching Out: Think Family. Analysis and Themes from the Families at Risk Review, Social Exclusion Task Force, Cabinet Office, June 2007;
  • Think Family- Improving the life chances of families at risk. Social Exclusion task Force, Cabinet Office, January 2008;
  • Local Authority Circular (99) 32 Guidance on the visiting of Psychiatric Patients by Children;
  • Guidance to Local Authority Social Services Department on Visits by Children to Special Hospitals;
  • Improving Safeguarding Practice- Study of Serious Case Reviews 2001 to 2003;
  • Analysing Child Death and Serious Injury through abuse and neglect: what can we learn- Serious Case Reviews 2003 to 2005 DCSF 2008; 2007 - 2009 (2009); 2009-2010 (2010);
  • Safeguarding children: Third Joint Chief Inspectors' Report on arrangements to safeguard children, Ofsted 2008;

Relevant National Legislation and Government Guidance in relation to Adults with Mental Health Problems

  • The Mental Health Act 1983/ The Mental Health Act 2007 and associated Code of Practice and Memorandum (The latest Revised Code of Practice was published in 2008);
  • The Care Programme Approach (CPA) and Refocusing the Care Programme Approach, Policy and Practice Guidance, March 2008;
  • Section 17A, Regulation 6-, community treatment order, of the Mental Act 1983, updated by the Mental Health Act 2007;
  • Mental Health (patients in the community) Act 1995;
  • Mental Capacity Act 2005;
  • Health Service Circular 1999/222;
  • Carers (Recognition and Services) Act 1995;
  • National Service framework for Mental Health (Department of Health 1999);
  • Crossing Bridges, Training resources for working with mentally ill parents (Department of Health 1998) (Pavilion Publishing);
  • Working Together Part 8 Reports - Fatal Child Abuse and Parental Psychiatric Disorders - Dr Adrian Falkov (Department of Health 1995) ACP Series, Report 1;
  • Children's Needs - Parenting Capacity The impact of parental mental illness, problem alcohol, drug use and domestic violence on children's development - H.Cleaver, I.Unell & J.Aldgate - HMSO 1999;
  • NICE Guidance on Ante and Postnatal depression 2007;
  • NICE Guidance on Antisocial personality disorder, January 2009;
  • NICE Guidance on Borderline Personality Disorder (BPD) January 2009;

Local Protocols & Practice

  • The Care Programme Approach - Collaborative Practice in Action;
  • Lamp Directory;
  • Maternal and Neonatal Mental Health-Nursing Policy and Procedure for the Admission of Mothers and Babies-Leicestershire Partnership (NHS) Trust;
    • Reviewed June 2002;
    • For review June 2003.
  • Children's Visits to Special Hospitals/Psychiatric Units Procedure;
  • Leicestershire and Rutland CCG Policy Document. Clinical Guidelines for Management o0f Post Natal Mental Illness (2006);
  • Local Early Help Assessment Protocols and see Early Help Assessment Procedure of local LSCB procedures, Early prevention through to referrals to Children's Social Care Services;
  • Safeguarding Adults Procedures (see separate websites for local authorities, Leicester, Leicestershire or Rutland in relation to local multi-agency policy and procedures for the protection of Adults at Risk from abuse).

    See also MAPPA Guidance (GOV.UK).

Books, Articles etc

Reder P, Duncan S + Gray M.
Beyond Blame - Child Abuse Tragedies Revisited
(1993) Routledge

Weir A and Douglas A (Ed)
Child Protection and Adult Mental Health - Conflict of Interest?
(1999)

Reder P + Lucey C (Ed)
Assessment of Parenting - psychological Contributions
(1995) Routledge

Reder P + Duncan S
Lost Innocents - A follow up study of fatal child abuse
(1991) Routledge

Sheppard M
Child and Family Work (1997)
The link between child abuse and maternal depression.

Family Minded - supporting children in families affected by mental illness by Jane Evans and Rebecca Fowler, Barnardos 2008

Children of a Parent with a Mental Illness: Perspectives on need. Maybery, Ling, Szakas and Reupert. Australian e-Journal for the Advancement of Mental Health, Vol4, Issue2 (2005)

Family Talk- Tips and Information for Families where a parent has a mental health problem or disorder. 

A Checklist for Professionals coming into contact with children of parents with mental health problems. Working in partnership with Psychiatrists and Parents - Partners in Care.

Social Care Institute for Excellence (2003) Families that have alcohol and mental health Problems: A template for partnership working.

Social Care Institute for excellence (2003) Alcohol, Drugs and Mental Health Problems: working with families.

Research paper 9: Working Together to Support Disabled Parents

There are also some useful guidelines and practice aids in the Crossing Bridges pack for talking to children and working with parents with mental health problems.

E.g:

  • Handout 54 - Answering children's questions;
  • Handout 55 - Talking with Families, Role play;
  • Chapter 8 of the reader Preventive Approaches;
  • Appendix IV - What's wrong with mum? Appendix VI - Children have feelings.

Resources for practitioners and other stakeholders working with families affected by parental mental health problems

The resources listed below represent some of the key tools, information and research available on this subject.

Support Network

This network began in 2004 to promote joint working between social care and health staff working with parents with mental health problems or their children. Membership is free, join via the website.

Information & research

Poverty Parenting and Social Exclusion

SCIE e-learning resource, bringing to life key aspects of poverty, parenting and social exclusion with particular reference to children and families.

Parental Mental Health Problems: Key Messages from Research, Policy and Practice Tunnard J (Research in Practice)

Supporting Disabled Parents and Parents with Additional Support Needs (SCIE Knowledge Review)

This SCIE briefing focuses on factors contributing to either stress or resilience in families where one or both parents have mental health problems. It considers the position of parents and children focusing upon issues of stress or resilience arising from individual and 'informal' sources. By Lester Parrott, Gaby Jacobs and Diane Roberts. March 2008.

Working with families with alcohol, drug and mental health problems.

This report focuses on the policies and practices that can promote integrated services to families. By Patricia Kearney, Enid Levin and Gwen Rosen. June 2003.

Promoting children's mental health in early years and school settings (2001)

Parents in Hospital: How mental health services can best promote family contact when a parent is in hospital. Barnardos, June 2007.

Developing Local Protocols

Social Care Institute for Excellence

This report shows how to develop inter agency protocols to support families in which parents have additional needs related to physical and/or sensory impairments, learning disabilities, mental health, drug and alcohol-related problems or serious illnesses. Jenny Morris and Michele Wates. March 2008.

Training resources for practitioners

Being Seen and Heard DVD

A training package providing practical and creative suggestions about working with children and parents. It contains clips of children, young people and their parents talking about their experiences of mental illness and how professional can work effectively with them. A CD-ROM of additional resources is enclosed.

Resources for children & young people

Young Carers website - useful information on mental health conditions

It's about you too! Leaflet

This short guide is for children who have a parent with a mental illness

Need to Know Leaflet

This short guide is for young people who have a parent with a mental illness (aimed at 11-14 age group).

Resources for parents

How to parent in a crisis (Mind, 2004)

This excellent booklet aims to help parents to avoid reaching crisis point. It identifies problems and suggests strategies.

Making Time to Talk leaflet (explaining mental illness to your child, from NSF Scotland)

Alcohol: 'Information for parents' leaflet for alcoholic parents produced by the National Association for Children of Alcoholics (NACOA)

Parents Using Drugs website - as above, this also offers resources to parents, including key messages from children about how to support them.

End