In 2009, The Social Care Institute for Excellence introduced guidelines for practitioners to support families in which parents have mental health problems. Here, Scie presents a case study demonstrating how the guidance could be successfully applied
Cait, 18, from Liverpool, became one of thousands of children across the country having to cope with a parent with mental health problems when her mother had a nervous breakdown and was hospitalised when Cait was just 13.
Cait says: “We lived in a flat and my mum wanted to go outside and jump over the balcony, so I would sit and talk to her to try and distract her from the voices in her head. Sometimes she wouldn’t go to sleep until 4am, but I would stay up because I was too awake to go back to sleep. This made me tired and I’d often be late for school.
The school counsellor thought I was acting out to get attention, which admittedly I was but not for the reasons that she thought.
“When my mum had the nervous breakdown and she went to hospital, not one person had the decency to come and tell me what was going on or ask my opinion. Just because I’m young doesn’t mean I don’t know anything about my mum – I know her complete medical history and I know what tablets she’s on now.”
When Cait’s mum left hospital they were visited by a member of Mersey Care NHS Trust crisis team.
“She asked me what it was like to be a young carer and I said ‘what do you mean? I’m just here because it’s my mum’.
“That’s when I was put in touch with Barnardo’s Action with Young Carers.”
Commentary (by Scie)
Cait’s situation is typical of the cases that could benefit from Scie’s guidelines, which call for professionals to “Think child, think parent, think family” when supporting parents with mental health problems and their families. Liverpool is one of six implementation sites for the Scie guidelines, and staff at the local Barnardo’s Action with Young Carers were able to support Cait and her mother by putting the recommendations from the guidelines into practice.
These “think family” guidelines were based on research showing parents with mental health problems and their families are one of the four groups most likely to be excluded from health and social care provision (Social Exclusion Unit 2004). Research and government reports have highlighted the extent of the problem:
● An estimated one-third to two-thirds of children whose parents have mental health problems will experience difficulties themselves (Office of the Deputy Prime Minister 2004).
● Of the 175,000 young carers identified in the 2001 census, 29% – or just over 50,000 – are estimated to care for a family member with mental health problems (Dearden and Becker 2004).
● Parental mental health is a significant factor for children entering the care system. Children’s social workers estimate that 50-90% of parents on their caseload have mental health problems, alcohol or substance misuse issues (Office of the Deputy Prime Minister 2004).
Changing this requires a new way of working, and the Scie “think family” guide uses evidence-based practice to identify what needs to change.
The referral to Barnardo’s was a key moment in Cait’s life, and an example of how a multi-agency approach works in practice to make a positive difference for the whole family. It is just one example of how Barnardo’s in Liverpool is working with the local authority, Mersey Care Trust, and Scie to implement the guidelines.
Louise Wardale from Barnardo’s in Liverpool says: “Situations like Cait’s often arise because we have adult services that support adults, and children’s services that support children. Quite often, unless there’s a bridge working across these services, children get missed.”
Bridging this gap is vital to the success of the ‘think family’ guidelines, and Cait’s story highlights this. Louise Wardale continues: “When her mum’s health became so poor, it really affected Cait. Even though she shared this information with her school, her school didn’t work with Adult Mental Health to think about what their different roles were.”
Children’s services in Liverpool have since been working to improve their screening systems, as recommended by Scie.
“We are helping our schools to look for signs that a young person might be undertaking caring responsibilities such as very poor attendance, their parents or carer not engaging in the life of the school, or that young person coming to school distressed,” says Colette O’Brien, interim assistant executive director for care and learning services at Liverpool Council.
“We can then look at referring them to services designed to meet their needs. This means that young people like Cait can get the right level of support exactly where it’s needed, and there is ‘no wrong door’ for a family – just because they engage with one particular service the support doesn’t stop there, they can be signposted on to continue receiving appropriate intervention.”
Jane Weller, senior improvement officer for carers at Liverpool Council, is working to identify where the gaps are, ensuring families don’t get missed.
She says: “What the Scie guide has enabled the local authority to do is to take leadership around the ‘think family’ issue, and particularly around the care pathway. This means we are able to identify parents with mental ill health and their children at each stage of the pathway – from screening to assessment – and that the care plans are developed taking the needs of the whole family into consideration.”
For Cait the day she was put in touch with Barnardo’s was a life-changing moment she will never forget: “I would love to say thank you to the lady who put me in touch with Barnardo’s for giving me all these opportunities. She’s given me my life back.”
Key Scie guidance messages from the Think Family guidelines
● 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 the “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.
● The Social Care Institute for Excellence improves care services by sharing knowledge about what works. Scie is an independent charity that works across the UK to capture analyse and disseminate innovative approaches in social work