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 unborn, child / children. Mental health support may be provided through a range of services including primary health, psychological support services, charitable organisations such as Mind and secondary care services.

The majority of parents who suffer mental illness are able to care for and safeguard their child(ren) and / or unborn child. However, some children of parents with mental illness may be seen as children with additional need who require support.

There is a risk to children where a parent has an enduring and/or severe mental illness, that they may be more likely to suffer significant harm. This could be in relation to all categories of abuse.

Where 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, in relation to their mental illness then the welfare of the child must be paramount.

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.

When a parent is under the age of 18 they may also need a referral to children’s services for support in their own right

When social workers or other partner agencies believe that there is parental mental illness that has not been previously recognised consultation with the GP should be considered for referral for ongoing mental health support.

The following factors indicate a child who may be at higher risk of suffering significant harm:

• An unborn child or baby of parents with severe and enduring mental health problems.
• A child where there is evidenced impact on their growth, development, behaviour and/or mental health as a result of parental mental illness.
• A past history of social care involvement.
• A child who features within parental delusions.
• A child who is involved in their parent's obsessional compulsive behaviours;
• A child who becomes a target for parental aggression or rejection;
• A child who may witness disturbing behaviour arising from the mental illness (e.g. self-harm, suicide, uninhibited behaviour, violence, homicide);
• A child who is neglected physically and / or emotionally by an unwell parent;
• A child where the parent has both mental health and substance misuse problems.
• A child 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);
• A child who has caring responsibilities inappropriate to their age - Young Carer Procedure  

The following parental risk factors may impact upon parenting capacity and increase concerns which may require a referral to Children's Social Care for an assessment of the child's needs:

• Mental health problems combined with domestic abuse and / or relationship difficulties
• Disorder deemed long term 'untreatable', or untreatable within time scales compatible with child's best interests;
• Previous or current compulsory admissions to mental health hospital;
• Poor engagement with services;
• Non-compliance with treatment;
• Lack of insight into illness and impact on child, or insight not applied;
• Self-harming and suicidal behaviour;
• Severe eating disorders;
• Misuse of drugs, alcohol, or medication;
• Maladaptive coping strategies;
• Unmanaged mental health problems with an impact on the sufferer's functioning;
• History of mental illness with an impact on the sufferer's functioning;
• 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 LA children's social care for other children.
• Parent / carers with physical health care needs which are impacting on their emotional and mental health which may in turn impact their parenting capacity
• Parents / carers who utilize prescribed / non-prescribed medications and the potential impact of this on parenting capacity

It may be necessary to seek consultation with specialist mental health practitioners in some circumstances regarding parents experiencing mental health difficulties. This is in order to gain an understanding of the nature, degree and context of their behaviours and potential impact on parenting capacity for example:

• Parental OCD where thoughts to harm a child are being verbalised –guidance should be sought about the presentation and likelihood of harm in line with national guidance and safety plans initiated 
• If a child is involved in their parent's obsessional compulsive behaviours
• Eating disordered parents 

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

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.

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.

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.