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6.12 Children of Parents with a Mental Health Problem

AMENDMENT

This chapter was updated in March 2016 and the changes can be viewed in red text.


Contents

  1. Definition
  2. Recognition
  3. Response


1. Introduction

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.

Parental mental illness does not necessarily have an adverse impact on a child's developmental needs, but it is essential to always assess its implications for each child in the family. Many children whose parents have mental ill health may be seen as children with additional needs requiring professional support, and in these circumstances the need for a common assessment should be considered. Professionals from both Children's Services and Adult Mental Health Services must share information and collaborate in any assessments undertaken to ensure that everyone is working in partnership with the children and the parents/carers.


2. 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.

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 seriously affect the safety, health and development of children. Practitioners must also take into consideration that the absence of a formal diagnosis does not mean there is an absence of risk.  If a psychiatrist cannot make a diagnosis to treat their condition with therapeutic interventions (e.g. medication) that does not mean there is no danger for the child, and in some cases the danger is greater.

The following parental risk factors may justify a referral to Children's Services 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
  • Self-harming behaviour and suicide attempts (including attempts that involve the child)
  • if a parent expresses delusional beliefs involving their child and/or if a parent may harm their child as part of a suicide plan
  • Altered states of consciousness e.g. splitting / dissociation, 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
  • Disorders designated 'untreatable' either totally or within time scales compatible with the child's best interests
  • Mental illness combined with domestic violence and/or relationship difficulties
  • Unsupported and/or isolated mentally ill parents
  • Parental inability to anticipate needs of the child

The following child related factors may justify a referral to Children's Services 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
  • A child missing school regularly as (s)he is being kept home as a companion for a parent / carer
  • Child's physical and emotional needs neglected (may be associated with parental depression)
  • Impact has been observed on child's growth, development, behaviour and/or mental / physical health, including alcohol/substance misuse and self- harming behaviour
  • 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


3. Response

Early Help

In families where parental mental ill health is present, professionals should be aware of the potential need for early help to ensure assistance is provided at the earliest opportunity as soon as problems emerge at any point in a child’s life. This entails agencies working together to identify children and families in need of support, undertaking assessment of need for early help and providing targeted early interventions services to address assessed needs (Working Together to Safeguard Children 2015).

Importance of working in partnership

Adult and child mental health professionals, children's social workers, health visitors and midwives, school nurses and education services must share information in order to be able to assess risks.

Discharge planning arrangements and any associated meetings about parents who have mental health difficulties must include consideration of any needs or risk factors for the children concerned. Children's Services along with other relevant agencies should be involved in planning discharge arrangements by Adult Mental Health Services professionals.

Where an adult, who is also a parent / carer, is deemed to be a danger to self or others by agency professionals, including Adult Care Services, a referral must be made to Children's Services, who must be invited to any relevant planning meetings (see Referrals Procedure).

Where an adult is assessed as high or very high risk of harm by a MAPPA Level 2 (local risk management panel - LRMP) or Level 3 Multi Agency Meeting, the key worker should work closely with the Multi Agency Public Protection Plan and partnership agencies should ensure that the Lead Social Worker is kept fully informed of risk of harm factors. If the parent / carer has a child under the age of 5, the Health Visitor must be informed as a safeguarding measure. If the child is of school age then the school nurse must be notified.

Relevant Adult Mental Health professionals involved with parents/carers must be invited to Strategy Discussions and Child Protection Conferences by Children's Services. The Adult Mental Health professionals must ensure that priority is given to attending and participating in Strategy Discussions and Child Protection Conferences.

Children's Services 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 also reference to High Secure hospitals (See Children Visiting Psychiatric Wards and Facilities Procedure, Visiting Patients in the Special Hospitals: Ashworth, Broadmoor and Rampton.

  • Adult mental health and learning disability units/departments in mental health services should have in place a policy about visiting of patients by children, which for inpatients, should be consistent with the 'Guidance on the Visiting of Psychiatric Patients by Children' (HSC 1999/222: LAC (99)32). Local Authority [Circular LAC (2000)18] refers to who can accompany a child on a visit to a named patient. It is issued as statutory guidance under section 7 of the Local Authority Social Services Act 1970;

See also:

Where there are child welfare concerns regarding visits to patients detained under the Mental Health Act 1983, the Trust may ask Children's Services to assess whether it is in the child's best interest.

Young Carers

Professionals should also consider the needs of young carers (children and young people under the age of 18) providing care for a parent with mental ill health difficulties. Young carers should be assessed to determine the appropriateness of their caring role and the impact on their wellbeing taking into consideration the young person’s wishes and feelings (Working Together 2015).

The Care Act (2015) identifies the need for those caring for an adult (aged 18 and over) to receive more support to help with caring and their wellbeing with support from local councils, national services and local networks.

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