8.34 Parenting Capacity and Mental Health Issues

For the purposes of safeguarding children, the mental health or mental illness of the parent should be considered in the context of the impact of the illness on the care provided to the child.

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, especially with regard to enduring and / or severe parental mental ill health, the parent's condition 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 Children's Social Care using the Making a Referral Procedure.

The following parental risk factors may justify a referral to Children's Social Care for an assessment of the child's needs:

• Previous history of parental mental health especially if severe and / or enduring condition;
• Predisposition to, or severe post natal illness;
• Delusional thinking involving the child;
• Self-harming behaviour and suicide attempts (including attempts that involve the child);
• Altered states of consciousness e.g. splitting / dissociation, misuse of drugs, alcohol, 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;
• Mental illness combined with domestic violence and/or relationship difficulties (trio of vulnerabilities);
• Unsupported and/or isolated mentally ill parents;
• Parental inability to anticipate needs of the child.

The following factors may lead to the conclusion that a child might have suffered or is at risk of suffering Significant Harm:

• A child acting as a young carer for a parent or a sibling;
• Impact has been observed on child's growth, development, behaviour and/or mental / physical health, including alcohol/substance misuse and self- harming behaviour;
• The parent / carer's needs or illnesses taking precedence over the child's needs;
• Insufficient alternative care for the child within extended family to prevent harm.

If a child has suffered or is at risk of suffering 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.

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 - see Information Sharing and Confidentiality.

Care programme meetings about parents who have mental health difficulties must include consideration of any needs or risk factors for the children concerned. Children's Social Care along with other relevant agencies should be involved in planning discharge arrangements.

Where a parent,/ carer, of a child is deemed to be a danger to self or others by agency professionals, a referral must be made to  Children's Social Care, who should be invited to any relevant planning meetings.

Strategy Discussions and Child Protection Conferences must include any psychiatrist, community psychiatric nurse, psychologist and adult mental health social worker involved with the parent / carer.

Children's Social Care 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. (See Visits by a Child to High Secure Hospitals and Prisons Procedure). Psychiatric hospitals should have written policies drawn up in consultation with Children's Social Care 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.