Proven Practice: The holistic approach to family mental health

The Social Care Institute for Excellence offers guidance on holistically working with parents with mental health problems

About one in four adults experience a mental health problem during their lifetime, many of whom are parents. Although there has been a shift in services towards placing greater emphasis on supporting adults in their parenting role, challenges including barriers to joint working between adult mental health and children’s services mean there is much yet to be achieved in practice.

Scie’s new guide (Scie Guide 30*) on working with parents with mental health problems and their children urges service providers to “think child, think parent, think family”. It makes recommendations for improving policy and practice and, based on research evidence, suggests ways to improve service planning and delivery. It is aimed at health and social care professionals, but it also provides useful general information for parents and children.

Tools to improve services

To provide a successful service for the families of parents with mental health problems improvements need to be made at every stage of the care pathway.

Screening

At the screening stage, practitioners need to routinely identify families with mental health problems. Families should be involved in the screening process as much as possible and reassured that this identification is a way of avoiding child protection measures. They should also have a working knowledge of and relationship with others services.

At an organisational level, effective services require the development of systems to collect and record data about families; staff training on screening tools and the new responsibilities tied to this data; and a communications strategy to address the stigma and fear about accessing services, including written information about the services.

Managers need to develop a “whole family” overview of services. They need to ensure that the screening is effective and provide advice and guidance to help frontline staff work across agencies and assist families to access appropriate services.

Assessment

The assessment process needs to be shaped to take into account the whole family, including their individual and collective needs. To do this successfully practitioners need to be clear about what information can be shared and with whom, seeking permission from the family for sharing information whenever possible.

The organisation needs to adapt and develop tools to take account of the whole family, including family threshold criteria for access to services which takes into account the individual and combined needs of family members. It must also develop co-operative working practices to improve communication and collaboration internally and with other agencies.

Managers need to develop strong working links across departments and agencies, with agreed strategies for the management of complex cases or when there is a risk of poor outcomes.

Care planning

Practitioners need to develop care plans informed by the “think child, think parent, think family” approach. This will increase resilience within the family by encouraging understanding of the mental health problems among each family member and the group as a whole. Personal budgets should also be considered as a way of supporting family members.

Care provision

The commissioning, funding and management of processes should ensure services meet the full range of parents and family needs. Interventions should:

● Address concerns about child safety.

● Indentify and manage mental health problems.

● Prevent crisis and manage and quickly manage any that occurs.

● Prioritise social inclusion.

● Reflect the priorities of parents and families including recognition of barriers to accessing services.

● Be flexible in response to changing circumstances.

Organisations should:

● Create, implement and review integration protocols stating decision makers and relevant circumstances.

● Involve parents and young people in the development, review and evaluation of services.

● Create services which meet the full spectrum of need of parents.

● Enable joint commissioning across agencies and change funding mechanisms to pool budgets, provide long-term funding and make funds available for evaluation.

● Facilitate the use of personal budgets.

Care plan review

The review of care plans should consider changes to family circumstances. Reviewers should involve children and young carers as much as possible.

Strategic change

A strategic approach is needed to successfully implement these changes to the services for parents with mental health problems and their families. These include:

● Multi agency-led review of services

This would include mapping current services and identifying how successfully they meet the spectrum of need; working in partnership with parents and children at all stages to centre the service around them; and generating family-focused management targets and measurements of outcome.

● Senior level commitment

To embed these practices commitment must be present at the top of the organisation with a “think family strategy” for leaders and managers and local ‘champions’ allocated with specific responsibility for ensuring recommendations are implemented.

● Workforce development

Training and development should include a “think family” perspective with joint training for staff in adult mental health and children and family services and a leadership programme for adult and children’s social wok supervisors and developers.

Going forward

The Scie guide is only the starting point and the organisation will continue to work with partner agencies and families to develop a national implementation and evaluation plan for the next five years, support practice implementation sites, share good practice and produce training and development resources.

Further information SCIE Guide 30: Think child, think parent, think family: a guide to parental mental health and child welfare

S4EO At a glance 09: Working with parents with mental health problems and their children

Practitioners’ messages

● Think child, think parent, think family in order to develop new solutions to improve outcomes for parents with mental health problems and their families.

● Take a multi-agency approach, with senior level commitment to implement a think family strategy.

● Review whether criteria for access to adult mental health and to children´s services take into account the individual and combined needs of children, parents and carers.

● Ensure screening systems in adult mental health and children´s services routinely and reliably identify and record information about adults with mental health problems who are also parents.

● Listen to parents and children – most want support that is flexible, based on a relationship with a key worker and takes account of their practical priorities.

● Build resilience and manage risk – ensure ready access to specialist mental health and children´s safeguarding services when needed and that staff know who makes what decision in what circumstances.

● Be creative – consider allocating an individual budget to provide flexibility and tackle stigma by developing non-traditional ways of providing services.

● Increase every family member´s understanding of a parent´s mental health problem – this can strengthen their ability to cope.

Research abstracts

Author Social Exclusion Task Force

Title Think family: improving the life chances of families at risk

Publisher Cabinet Office. Social Exclusion Task Force, 2008. 29p.

Abstract Parental and wider family problems such as poverty, parental mental health, substance abuse, poor housing, and contact with the criminal justice system can cast a shadow over families that spans whole lifetimes and passes down the generations. These family experiences can limit aspirationc and provide poor models of behaviour that can impact on a child’s development and well-being, with significant costs for public services and the wider community. They damage the ability of children to build up resilience to problems or to benefit from the opportunities they are given. At the moment adults’ services don’t sufficiently take account of the implications for the family when, say, an adult is taken into prison or has mental health problems.

Author Office of the Deputy Prime Minister. Social Exclusion Unit

Title Mental health and social exclusion: Social Exclusion Unit report

Publisher Office of the Deputy Prime Minister. Social Exclusion Unit, 2004. 144p

Abstract This report marks the start of a sustained programme of change to challenge discriminatory attitudes and improve opportunities and outcomes for adults with mental health problems. Government has an important role to play, but the active involvement of the voluntary and community sector employers and, crucially, people with personal experience of mental health problems will be essential to achieve real change. The report features case studies of many successful local projects and the experiences of individuals who have overcome the challenges posed by mental health problems to lead fulfilling lives. These examples demonstrate what can be achieved and the benefits that result for individuals and society.

Author Department of Health, et al

Title Putting people first: a shared vision and commitment to the transformation of adult social care

reference Department of Health, 2007. 5p

Abstract Across government, the shared ambition is to put people first through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity. This ministerial concordat establishes the collaboration between central and local government, the sector’s professional leadership, providers and the regulator. It sets out the shared aims and values which will guide the transformation of adult social care, and recognises that the sector will work across shared agendas with users and carers to transform people’s experience of local support and services.

Author REUPERT Andrea; MAYBERY Darryl

Title Lessons learnt: enhancing workforce capacity to respond to the needs of families affected by parental mental illness (FAPMI).

Publisher International Journal of Mental Health Promotion, 10(4), November 2008, pp.32-40.

Abstract VicChamps was a three-year funded project which aimed to enhance workers’ awareness of and responsiveness to the needs of families affected by parental mental illness. Process interviews with the project facilitators over three years highlight the strategies that were successful as well as the problems encountered in implementing this project. Successful strategies included identification of ‘organisational champions’, building relationships with other agencies, involving consumers in training, tailoring training to specific organisational needs, with ongoing, specialist support and, finally, providing examples of treatment protocols. Issues in programme implementation included developing specialised services, philosophical issues regarding working with families and defining workers’ responsibilities to their clients’ families.

Published in the 23 July 2009 edition of Community Care under the heading ‘A whole family approach to mental health’