POWYS LOCAL HEALTH BOARD

Working with Parents Who are Experiencing Problems of Mental Illness or Learning Disabilities Policy

Rev
/
Date
/ Purpose of Issue/Description of Change / Planned reviewdate
PLHB WCH 0022 / Nov 2007 / Working with parents who are experiencing problems of mental illness or learning disabilities / February 2011
Responsible Officer / Approved by / Date
Pauline Galluccio
Head of Safeguarding children’s service / Powys LHB CP Forum
Mental Health directorate
Women and children’s directorate
Consultation with Powys Child in need multi agency group
Powys LSCB policy sub group
Governance and Risk Management Committee / Nov 2007
May 2007
July 2007
Feb 2008

Contents Page

1. Introduction 2

2. Aims2

3. Scope2

4. Identifying the needs of children, their parents

or carers, or pregnant women with mental health

problems or learning disabilities. 3

5. Decision making flowchart 4

6. Guidance for referral and assessment for

pregnant women with mental health problems 5

7. Guidance for referral to Adult Mental Health

Services 5

8. Guidance for referral to Social Services,

Children’s Team 6

9. The Family Focused Pathway for Dependent

Children of People Referred to Mental Health

Services 6

10. Visiting of Psychiatric patients by children 6

11. Reference documents 7

12.Appendix A. Guidelines: factors to consider when thinking about child’s welfare when working with parents/carers who have mental health difficulties. 8

1. Introduction

These guidelines apply to all health staff whenever there are concerns about the well-being or safety of children whose parents or carers have mental health problems or learning disabilities specifically where these difficulties are impacting, or are likely to impact on their ability to meet the needs of their children. These guidelines alsoapply to pregnant women who have mental health problems or where their partners are known to have mental health problems.

2. Aims

2.1. To increase understanding of the impact of an adult’s mental health problems or learning disabilities on children’s lives.

2.2. To assist staff in identifying children in need.

2.3. To ensure the provision of co-ordinated services to families where the parents, carers or pregnant women have mental health problems or learning disabilities.

2.4. To ensure effective co-operation and collaborative decision making between and within agencies.

3. Scope

3.1.This policy is for all staff who come into contact with children, their parents and families in their everyday work, including practitioners who do not have a specific role in relation to child protection.

3.2 Parents, carers and pregnant women with mental health problems or learning disabilities have the right to be supported in fulfilling their parental roles and responsibilities

3.3. A multi agency approach to assessment and service provision is in the best interests of children and their parents and/or carers.

3.4 Risk is reduced when information is shared effectively across agencies and there is effective multi agency and multi disciplinary working

4. Identifying the needs of children, their parents or carers, or pregnant women with mental health problems or learning disabilities.

4.1. The birth of a child changes relationships and often brings new pressures to any parents or family. Professionals need to be sensitive and responsive to the changing needs of parents or carers.

4.2. Parents, carers or pregnant women may have difficulties which impact on their ability to meet the needs of their children or new baby. These children may be in need of assessment for services provided by a range of agencies.

4.3. The flowchart and guidelines in Appendix A are designed to guide health professionals with their decision making about how to best meet the needs of children and adults in families experiencing mental health problems or learning disabilities.

4.4.Staff should ensure that any decisions and agreed course of actions are discussed with a line manager and are fully documented in the case records

4.5. Where there is an immediate danger to the parent, carer, pregnant women, children or others, the Police must be contacted.

4.6The All Wales Child Protection procedures document in detail the action that should be taken in case of child protection concerns.

4.7 The Policy and Procedures for the Protection of Vulnerable Adults from Abuse document in detail the action that should be taken where there are concerns about a vulnerable adult in the household.

5. Decision making flowchart

6. Guidance for referral and assessment for pregnant women with mental health problems

6.1.All agencies are responsible for identifying pregnant women with mental health problems or learning disabilities who may be in need of additional services and support. Pregnant women with a history of mental health problems are particularly vulnerable to breakdown during the later stages of pregnancy and following the birth of their baby.

6.2. When an agency identifies a pregnant woman experiencing mental health problems an assessment must be undertaken to determine what services she requires. This must include gathering relevant information from their Midwife, Health Visitor, GP, Adult Mental Health Services, and any other agencies that may be involved, to ensure that the full background is obtained about any existing or previous diagnosis, treatment or illness.

6.3. Where the need for referral to other agencies is unclear, this must be discussed with a line manager. If a referral is not made this must be clearly documented, signed and dated.

6.4. If there are any child protection concerns or if there are other children within the household who are on the Child protection Register, then the All Wales Child Protection Procedures must be followed.

7. Guidance for referral to Adult Mental Health Services

7.1.A referral for an initial assessment to Adult Mental Health Services should always be made if there are concerns about the person’smental health. Any identified risks which seem to be mental health related should be identified and discussed with mental health services as soon as possible. Where possible these concerns should be discussed with the client. A referral should be discussed with your line manager.

7.2. Initial referrals for assessments of adults caring for children when they are not known to the Community Mental Health Team should normally be made to the family GP who will refer on to the Community Mental Health Team as appropriate.

7.3. Mental health problems may also be associated with high risk behaviour or alcohol / substance misuse. Therefore these factors need to be taken into consideration when undertaking the assessment. A discussion with or referral to PDAC may be necessary with the client’s permission

7.3. Factors which may indicate a referral to Adult Mental Health Services include:

  • Previous or current treatment for mental health problems by the GP
  • Previous or current history of assessment and treatment by Adult Mental Health Services.
  • History or current concerns regarding self harm, self neglect, depression, anxiety, thinking or behaviour.
  • Fluctuations in mood and activity e.g. excessive crying, inappropriate expression of anger, overactivity, increased suspicion
  • Expression of concerns from family, friends or their children

8. Guidance for referral to Social Services, Children’s Team

A referral for an initial assessment to Powys Children’s services should always be made if a parent, carer or pregnant woman is considered to have significant mental health problems. A referral should be discussed with a line manager. Staff should ensure that decisions and agreed course of actions are fully documented.

9. Powys Family Focused Pathway for Dependent Children of People Referred to Mental Health Services

This has been developed in collaboration between mental health and children’s services across Powys Local Health Board and Powys County Council. It is intended that the pathway be used by all mental health professionals in Powys during the assessment process following referral to the services. The Pathway emphasizes the inherent strengths and importance of working in partnership with other professionals and agencies to ensure the highest standards are met. The aim of the pathway is to ensure a standard approach to the management of issues concerning dependent children or young people whose parents or carers (including foster carers) are referred to the mental health service.(ref Powys LHB policy on children of parents referred to mental health services or admitted to inpatient psychiatric facilities: Family Focused Pathway For Dependent Children of People Referred to Mental Health Services

10. Visiting of Psychiatric patients by children

For any patients admitted as in patients to mental health facilities, dependant children must be considered as part of the initial assessment and if there are any concerns regarding the safety or welfare of the child appropriate professionals/ services should be contacted and invited to attend any planning meetings.

Staff should be aware of the possible risk to children visiting mental health facilities either from their own parents/ carers or from other patients. The initial assessment should identify any risk that a patient may pose to children visiting the unit and appropriate measures put in place.

11. Reference documents

  • All Wales Child Protection Procedures
  • Children Act 1989
  • Children Act 2004
  • Data Protection Act 1999.
  • Framework for the Assessment of Children in Need and their families. National Assembly of Wales. 2002
  • Human Rights Act 1998
  • Powys LHB policy on children of parents referred to mental health services or admitted to inpatient
  • Southwark ACPC 2005 Joint Service protocol to meet the needs of children and unborn children whose parents or carers have mental health problems.
  • Mental Health Act 1983.DOH. Crown Copywright
  • Psychiatric facilities:Family Focused Pathway For Dependent Children of People Referred to Mental Health Services
  • Working Together to Safeguard Children. DOH. 2002

Appendix A

Guidelines: factors to consider when thinking about child/ren’s welfare when working with parents/carers who have mental health difficulties.

Mental illness 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.

It may be that the parent/ carer has a pre-planned care plan e.g. for pregnancy which will need to be considered.

Those who have a role in working with these parents/carers must ensure that both the expertise of adult mental health workers and childcare workers is used to inform any assessment regarding the welfare of the children. The following guidelines may be useful in assessing the impact on the child and their family.

CHILDREN’S DEVELOPMENTAL NEEDS

  1. In assessing whether the developmental needs of children are being met, the following areas should be considered.
  • Does the parent/carer anticipate the child’s need for food, clothing, sleep, play and safety?
  • Does the parent/carer respond to the child’s initiatives, offer warm interactions and respond appropriately to distress?
  • Does the parent/carer refer to the child positively, or describe them with warmth.
  • Does the parent/carer set age-appropriate boundaries to the child’s behaviour?
  • Does the parent/carer expect to “look after” the child, rather than the child being expected to “look after” the parent?
  • Does the parent/carer offer a consistent and continuing relationship with the child over time?
  • Does the parent/carer manage any periods of separation taking into account the needs of the individual child?
  • As the child develops, is he or she supported in relationships with the world outside the immediate household?
  • Is the child at risk of significant harm?
  • Does the child attend school regularly (if relevant)?
  • Is the child’s health and development that which is expected for that individual child?

PARENTING CAPACITY

  1. The signs of parents/carers mental health difficulties.
  • Does the parent/carer display inappropriate behaviour in front of the child?
  • Does the parent/carer appear to be hearing/responding to voices?
  • Is the parent/carer experiencing any sleep or appetite disturbance?
  • Is the parent/carer’s self-care adequate?
  • Is the parent/carer able to leave the house?
  • Does the parent/carer leave the house impulsively?
  • Is the parent/carer taking prescribed medication in relation to mental health needs?
  • Does the parent/carer leave the children without making adequate arrangements for their care?
  • Does the parent/carer display episodes or severe withdrawal or irritability?
  • Does the parent/carer display unusual and/or bizarre beliefs about the child?

FAMILY AND ENVIRONMENTAL FACTORS

  1. Family Social Network and Support System
  • Is there another parent/carer who can provide compensatory care when needed?
  • Are close relatives including spouse/partner aware of any mental health issues?
  • Do they have the capacity to be supportive to the parents and/or the children and is their support accepted?
  • Is the parent/carer accepting of help and treatment offered from professional/voluntary agencies involved?
  • Is there parental/partnership conflict/family violence?
  1. Accommodation and Home Environment
  • Is the home environment adequate for children – e.g. clean, warm, safe with enough food?
  • Are parents/carers ensuring that rent and bills are paid for?
  • Does the family have a settled home base?
  • Is the parent/carer using alcohol and/or drugs as well as prescribed medication?
  1. What is the parents’ perception of the situation?
  • Does the parent/carer acknowledge any mental health problems?
  • Is the parent/carer able to think about and meet their child’s need?

PLHB WCH 0022. Policy for Children of parents with mental health problems and learning disabilities. Author: Head of Safeguarding Children. Approved: Governance and Risk Management Committee February 2008. Review February 2011. Page 1 of 11