5.25 Enduring and/or Severe Parental Mental Illness
‘Mental Health Crisis Care Concordat’ February 2014; This document outlines new developments for services to people of all ages in relation to acute mental health problems.
This chapter was updated in September 2014 to add links to ‘Mental Health Crisis Care Concordat’ February 2014; and Children and Young People’s Health outcomes forum July 2012 - see above.
The majority of parents who suffer significant mental ill-health are able to care for and safeguard their child(ren) and / or unborn child.
In some cases, enduring and/or severe parental mental ill health will seriously affect the safety, health and development of children. Where professionals believe that this may be the case a referral must be made to Surrey Children's Services.
The following parental risk factors justify a referral to Surrey Children's Services for an assessment of whether a child has suffered or is likely to suffer significant harm (including, for example impairment suffered from seeing or hearing the ill-treatment of another):
- Previous history of mental health problems;
- Predisposition to or severe post natal illness;
- Delusional thinking involving the child;
- Self-harming behaviour and suicide attempts;
- Altered states of consciousness e.g. splitting / dissociation, misuse of drugs, alcohol or 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 the child;
- Disorder designated 'untreatable' either totally or within time scales compatible with the child's best interests;
- Domestic violence and/or relationship difficulties;
- Unsupported and/or isolated parents.
The following factors may also lead to the conclusion that a child may have suffered or is likely to suffer significant harm:
- A child acting as a young carer for a parent or a sibling;
- Impact on child's growth, development, behaviour and/or mental/physical health, including alcohol/substance misuse and self- harming behaviour;
- The parent/carer needs or illnesses taking precedence over the child's needs;
- Insufficient alternative care for the child within extended family.
If a child has suffered or is likely to suffer significant harm as the result of commission or omission on the part of the parent/ carer, then the welfare of the child must be paramount.
Importance of Working in Partnership
Adult and child mental health professionals, child care social workers, health visitors and midwives, school nurses and education services must share information in order to be able to assess risks.
Care programme meetings about parents who have mental health difficulties must include consideration of any needs or risk factors for the children concerned. Relevant Surrey Children's Services teams along with other agencies should be involved in planning discharge arrangements.
Surrey 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 or. r high security hospitals (Broadmoor, Ashworth and Rampton) - see Children Visiting Psychiatric Wards and Special Hospitals Procedure.
In summary, psychiatric hospitals should have written policies drawn up in consultation with Surrey Children's Services regarding visiting of patients by children, which should only take place following a decision (regularly reviewed) that such a visit would be in the child's best interests.
Where there are child welfare concerns regarding visits to patients detained under the Mental Health Act, the trust should ask the Surrey Children's Services Assessment Team to assess whether it is in the child's best interests.