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 ability 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.
A child at risk of 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 (see Young Carers);
- 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;
- Where it is believed that a child of a parent with mental health problems may be at risk of significant harm, a Strategy Discussion/Meeting should be held and consideration should be given to undertaking a Section 47 Enquiry.
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:
- 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 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/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 the family functions, including conflict, potential family break up etc.
It is essential that staff working in adult mental health and child care work together within the application of child protection procedures to ensure the safety of the child and management of the adult's mental health.
Joint work will include mental health workers providing all information with regard to:
- Outcomes of current risk assessments;
- Treatment plans;
- Likely duration of any mental health problem;
- Effects of any mental health problem and medication on the carer's general functioning and parenting ability.
Child protection workers must assess the individual needs of each child and within this incorporate information provided by mental health workers.
Mental health professionals must attend and provide information to any meeting concerning the implications of the parent/carer's mental health difficulty on the child. Child care professionals must be invited to 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 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 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.
Professionals need to be mindful of the risk of over optimism or disguised compliance, where some parents repeatedly appear to make small positive improvements, only to revert to previous patterns of behaviour which adversely impact on the child. Analysis of family history and chronology of events is important for professionals to understand the long term impact on the child.
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 Services team in order that the implications for the child are assessed.