PG29. Mental Illness (Parenting Capacity)

1.1

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.

1.2

Where a parent has enduring and / or severe mental ill-health, children in the household are more likely to suffer significant harm. This could be through physical, sexual or emotional abuse, and / or neglect. See Recognising Abuse and Neglect Procedure.

Significant harm is defined in Responding to Concerns of Abuse and Neglect Procedure, Concept of significant harm as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

1.3

A child likely to suffer significant harm or whose well-being is affected, 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 Procedure);
• Who may witness disturbing behaviour arising from the mental illness (e.g. self-harm, suicide, uninhibited behaviour, violence, homicide);
• 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;

Or s/he could be an unborn child:

• Of a pregnant woman with any previous major mental disorder, including disorders of schizophrenic, any affective or schizo-affective type; also, severe personality disorders involving known risk of harm to self and / or others.

1.4

The following factors may impact upon parenting capacity and increase concerns that a child may be suffering, or likely to suffer, significant harm:

• History of mental health problems with an impact on the sufferer's functioning;
• Unmanaged mental health problems with an impact on  the sufferer's functioning;
• Maladaptive coping strategies;
• Misuse of drugs, alcohol, or medication;
• Severe eating disorders;
• Self-harming and suicidal behaviour;
• Lack of insight into illness and impact on child, or insight not applied;
• Non-compliance with treatment;
• Poor engagement with services;
• Previous or current compulsory admissions to mental health hospital;
• Disorder deemed long term 'untreatable', or untreatable within time scales compatible with child's best interests;
• Mental health problems combined with domestic abuse and / or relationship difficulties;
• Mental health problems combined with isolation and / or poor support networks;
• Mental health problems combined with criminal offending (forensic);
• Non-identification of the illness by professionals (e.g. untreated post-natal depression can lead to significant attachment problems);
• Previous referrals to local authority children's social care for other children.

1.5

Adult mental health services should have named nurses / doctors / professionals for safeguarding children within their agency and seek advice from them if necessary.

2.1

Adult mental health professionals must identify those service users who are pregnant and those who are parents or who have regular access to children, whether they reside with children or not. Professionals should consider the needs of all children as part of their Care Programme Approach (CPA) assessments.

2.2

When adult mental health services and local authority children's social care are both involved with a family, joint assessments should be carried out to assess the support parents need and the risk of harm to the child/ren, in line with Referral and assessment Procedure (Referral criteria, provides guidance on the difference in local authority children's social care between s47 / assessment). Other agencies / services should be involved as appropriate (e.g. primary care).

2.3

Where appropriate, children should be given an opportunity to contribute to assessments as they often have good insight into the patterns and manifestations of their parent's mental ill-health.

2.4

CPA assessments and meetings for any adult who is a parent must include ongoing monitoring of the needs and risk factors for the children concerned. Local authority children's social care should be invited to contribute if they are involved with a family or where risks and needs have been identified that justify their involvement.

2.5

Mental health professionals must be included in strategy meetings, child protection conferences or associated meetings if a mental health service user is involved.

2.6

Mental health inpatient services should have written policies regarding the welfare of children and particularly the visiting of inpatients by children. See Psychiatric Ward Visits Procedure.

2.7

Local Safeguarding Children Partnerships are responsible for taking full account of the challenges and complexities of work in this area by ensuring that inter-agency / disciplinary protocols are in place to clarify arrangements for co-ordination of assessment, support and collaboration.