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5.26 Mental Illness of a Parent or Carer

RELATED NATIONAL GUIDANCE

Chapter 1: Assessing need and providing help, Working Together to Safeguard Children 2015

Think Parent - Think Child - Think Family

AMENDMENT

In November 2013, this chapter was updated in line with Working Together 2013 and the Single Assessment Framework.


Contents

  Introduction
  Risk Indicators
  High Risk Indicators
  Action to Safeguard


Introduction

  1. Mental ill health in a parent or carer does not necessarily have an adverse impact on a child, but it is essential always to assess its implications for any children involved in the family. The parent or carer may neglect their own, or their children's physical, emotional and social needs. The child may take on inappropriate caring responsibilities, which may have an adverse effect on his or her development.

  2. Some forms of mental ill health may blunt parent or carers' emotions and feelings or cause them to behave in bizarre or violent ways towards their children or environment. At the extreme a child may be at risk of severe injury, profound neglect, or even death. A study of 100 reviews of child deaths where abuse or neglect had been a factor in the death, showed clear evidence of parental mental ill health in one third of cases. Post-natal depression can also be linked to both behavioural and physiological problems in the infants of such mothers.

  3. All professionals have a responsibility to safeguard the welfare of children and young people. Remember Think Parent - Think Child - Think Family.

  4. 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.


Risk Indicators

  1. Significant history of violence and parental non-compliance with services and treatment are risk factors for children. The adverse effects on children of parental mental illness are less likely when parental problems are mild, last only a short time, are not associated with family disharmony, and do not result in the family breaking up. Children may also be protected from harm when the other parent or a family member can help respond to the child's needs. Children most at risk of 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.


High Risk Indicators

  1. A Referral to Children's Social Care (see Making a Referral to Children's Social Care Procedure) must be made where there evidence of:
    • Delusional beliefs involving any child;
    • Homicidal thinking involving children prior to completing/ attempting suicide or might harm their child as part of a suicide plan.
  2. Children's Social Care should be consulted and a referral must be considered where there is evidence of:
    • Psychotic beliefs particularly if involving the child;
    • Persistent negative views expressed about a child, including rejection ongoing emotional unavailability, unresponsiveness and neglect;
    • 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, aggression, irritability and criticism of the child;
    • Serious neglect of the child;
    • Any history of domestic violence.


Action to Safeguard

  1. When there is a childcare issue of concern, Health, Children's Social Care and non-statutory sectors should ensure that lines of communication are opened and remain open during the process of referral, assessment, planning and reviews.
  2. Joint assessments should be undertaken between agencies to facilitate assessments and safeguard children, when it is recognised and agreed that it is necessary to do so. The mental health professional involved in the assessment would normally be the care co-ordinator for the Care Programme Approach. If not then outcomes must be fed back to the care co-ordinator.
  3. If a parent or carer is admitted to hospital, a notification must be sent to the paediatric liaison nurse or nearest equivalent. If a referral is made between Children's Social Care and Mental Health Services, a check should be made through the information system as to whether the family member is known to the service. If other workers are involved, they should be informed of the Referral.
  4. Where there is difficulty in accessing agency or professional support the Children's Social Care Mental Health Managers, the Safeguarding Lead should consult with each other on how to proceed with a case if they have concerns.
  5. Requests for and provision of information should be followed up in writing within 5 working days, if not made in writing in the first instance.
  6. Where the Children's Social Care and Adult Mental Health Services are involved with an individual or family, a representative from each service should be invited and should attend standard assessment or Strategy Discussions. The standard meetings and conferences are:
  7. The whereabouts and any risks must be considered during any leave including Section 17 leave arrangements.
  8. Those working in all agencies should be aware of the designated and named professionals for child protection who can provide advice.
  9. Close collaboration and liaison between adult mental health services and Children's Social Care are essential in the interests of children. This will require sharing information to safeguard children and promote the welfare of children or to protect a child from Significant Harm. See also Information Sharing and Confidentiality Procedure.
  10. Where Child and Adolescent Mental Health Services (CAMHS)are involved in a family and adults are also known to the Adult Mental Health Services, close collaboration should take place between both services.
  11. Information about the child/children in families must be recorded at assessment or as soon as possible and recorded on CPA documentation/client records.
  12. Assessments, CPA monitoring, reviews, and discharge planning arrangements and procedures should prompt staff to consider if the service user is likely to have or resume contact with their own child or other children in their network of family and friends, even when the children are not living with the service user, and consider any risks posed to those children.
  13. Risks should also be considered for service users who are not parents but are in contact with children e.g. service users with child siblings or grandchildren.
  14. Children may take on caring roles within the family when a parent is mentally ill. This may include additional chores, caring for siblings 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.
  15. Mental Health personnel may also be requested to contribute to Single Assessments led by Children's Social Care.
  16. In addition to the interagency working described above, it is especially important to ensure that Health Visiting and Primary Health Care staff and Children's Social Care are involved in any cases involving mothers being treated for post-natal depression or puerperal psychosis.
  17. Appropriate completion of the Health and Children's Social Care assessment documentation under the CPA should ensure that any childcare issues are highlighted so that a referral to Children's Social Care can be made where appropriate under the Making a Referral to Children's Social Care Procedure. This should be documented and any subsequent childcare responsibilities also documented in the adult's care plan.

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