2.12 Children of parents with mental health problems
The term ‘mental health problem’ 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.
‘Mental health problems can affect the way you think, feel and behave. They affect around one in four people in Britain, and range from common mental health problems, such as depression and anxiety, to more rare problems such as schizophrenia and bipolar disorder. A mental health problem can feel just as bad, or worse, as any other physical illness – only you cannot see it.’
The status of an individual’s mental health is not always 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 mental health problems may 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’ or trilogy of risk, which practitioners should be alert to and consider in any assessments.
Additionally, it is important that professionals are focused on the welfare of the child and other children living in the household.
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:
- who features within parental delusions
- who is involved in his/her parent’s obsessional compulsive behaviours
- who becomes a target for parental aggression or rejection
- who has caring responsibilities inappropriate to his/her age and should be assessed as a young carer
- who may witness disturbing behaviour arising from the mental illness
- who is neglected physically and/or emotionally by an unwell parent
- who does not live with the unwell parent, but has contact (e.g. formal unsupervised contact sessions or the parent sees the child in visits to the home or on overnight stays)
- who is at risk of severe injury, profound neglect or death
- who is an unborn child of a pregnant woman with any previous major mental illness, during which her behaviour or capacity to parent would have been a concern (also see Pre-Birth procedure).
To determine how a parent/carer’s mental health problem may impact on their parenting ability and the child’s development the following questions need to be considered within an assessment:
- Does the child take on roles and responsibilities within the home that are inappropriate?
- Does the parent/carer neglect their own and their child’s physical and emotional needs?
- Does the parent/carer’s mental health problem affect the development of a secure attachment with the child?
- Does the mental health problem result in chaotic structures within the home with regard to meal and bedtimes, etc?
- Does the parent/carer’s mental health have implications for the child within school, attending health appointments etc?
- Is there a lack of the recognition of safety for the child?
- Does the parent/carer have an appropriate understanding of their mental health problem and its impact on their parenting capacity and on their child?
- Are there repeated incidents of hospitalisation for the parent/carer or other occasions of separation from the child?
- Does the parent/carer misuse alcohol or other substances?
- Does the parent/carer feel the child is responsible in some way for their mental health problem?
- Is the child included within any delusions of the parent/carer?
- Does the parent express any intention to harm the child or fear of doing so? This should always be taken seriously and its meaning rigorously explored;
- Does the parent/carer’s mental health problem result in them rejecting or being unavailable to the child?
- Does the child witness acts of violence or is the child subject to violence?
- Does the wider family understand the mental health problem of the parent/carer, and the impact of this on the parent/carer’s ability to meet the child’s needs?
- Is the wider family able and willing to support the parent so that the child’s needs are met?
- Does culture, ethnicity, religion or any other factor relating to the family have implications on their understanding of mental health problems and the potential impact on the child?
- How does the family function, including conflict, potential family break up etc?
Protection and action to be taken
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 by using the framework for assessment or Early Help (EH) Assessment taking place.
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.
It is essential that staff working in adult mental health services and children’s social care work together collaboratively to ensure the safety of the child and management of the adult’s mental health. Further guidance on this can be found in local protocols between mental health services and children’s social care.
Joint work will include mental health workers providing all information with regard to:
- treatment plans
- effects of any mental health problem and medication on the carer’s general functioning and parenting ability.
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 must be invited to and should 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 should 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.
Review conferences and the core group should be aware of the fact that a mental health problem can fluctuate over time. Its impact on the parent’s capacity to care for the child must be reviewed regularly, and this should be specifically considered at each core group and review conference.
Not all children who are cared for by a parent who has a mental health problem will experience difficulties – adverse effects are less likely when appropriate supervised treatment is provided, and when the mental health problem is mild, lasts a short time, is not associated with family disharmony and does not result in the family breaking up. Children may also be protected from harm when the other parent, or another family member, can respond to the child’s needs, and when the child or young person has the support of friends and other caring adults.
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 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 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, practitioners must always act in the best interest of the child and not prioritise their therapeutic relationship with the adult.
- Children's Needs - Parenting Capacity
- Mental Health and Growing Up (Royal College of Psychiatrists)
- Learning from Serious Case Reviews (NSPCC)