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The green paper Every Child Matters proposed a more integrated approach to the provision of support services for children and families. However, the structures introduced by the Children Bill will have the effect of cutting children's services off from services for adults. New research by the University of Hull suggests this will undermine essential co-ordination between services for families where parents have mental health needs, and there are also concerns about the children's welfare.¹

For these families, co-ordination between mental health services for adults and child protection is crucial. Information collated by these professionals informs assessments of parenting, and close co-operation means risks can be assessed from several perspectives. The need for effective multi-agency work in this field has been emphasised by mental health inquiries into homicide and serious case reviews into child deaths, both of which have highlighted failures of communication between children's and adults' services.

Our survey of 500 health and social care professionals found that child care social workers identified the key problems they encountered with GPs and with adult psychiatrists as co-ordinating work and issues around confidentiality. The difficulties between child care social work and GPs in the field of child protection are well evidenced but remain a source of concern.² This is particularly so when parents have mental health problems, as GPs represent the gateway to specialist services for those with mental health needs.

There has been less research into the relationship between adult psychiatry and child care social work. The Royal College of Psychiatrists' guidelines encourage collaboration but remain vague as to what form links between psychiatrists and social workers should take when there are child protection concerns.³

Clearly, professional groups have differing remits to represent the needs of children or adults in a family. Although child care social workers were more likely to see themselves as advocates for the children in the families they worked with, half those surveyed did consider they had a responsibility to represent the needs of other family members as well. However, almost 60 per cent of child care social workers reported they lacked opportunities to offer "active listening" to mothers with mental health problems. In this, they compared poorly with other professional groups such as mental health social workers and community psychiatric nurses (CPNs), most of whom felt they did have such opportunities in their work.

This view of child care social workers as being unable to offer emotional support was shared by the 11 mothers interviewed, all of whom had severe mental health problems. Not only were child care social workers perceived as difficult to contact and extract information from, they were also seen as judgmental and untrustworthy. One mother described her social worker as: "threatening and patronising... She sees me as backward... It's not just 'cos she's the bairns' social worker, it's her attitude."

In their relationships with child care social workers, mothers were constantly aware of the danger of losing their children to the care system. This awareness made them unwilling to disclose difficulties and ask for help. One woman described her relationship with social services thus: "Social services still say to this day if I end up in hospital, I'd lose the kids. It makes you stay quiet rather than say anything at all. I've been put down as unco-operative."

Two things result from this: first, mothers may not receive support until they reach a crisis, and second, practitioners' ability to assess parenting is limited by a lack of information. Furthermore, mothers who withhold relevant information may well be seen as "difficult" by professionals, and this perception may increase the likelihood of children being taken into care.

Even when the mothers in the study had their children looked after, they continued to have a relationship with their children and to play a key role in their lives. Mothers in this situation still found it hard to discuss with social workers the difficulties they experienced in parenting at a distance. Such difficulties were particularly evident for the mothers of adolescents.


However, mothers were more likely to describe their relationships with community mental health workers in positive terms. Mental health social workers, CPNs and mental health resource centre workers were considered to be more accessible and prepared to listen. Mothers described such practitioners as being "there for them" and emphasised their non-judgmental attitudes.

However, both the professionals and mothers agreed that it was often difficult for mothers with mental health problems to access mental health services because the eligibility criteria were set too high. Many mothers were not considered to fall within the "severe and enduring" group of mental health service users. One commented somewhat bitterly: "I got refused a CPNÉ Sometimes I think if you can cook and clean and keep a nice house and speak a full sentence, that's it." When thresholds for accessing help are set high, there is a danger that professionals may need to inflate risk to secure services. Almost 40 per cent of the practitioners surveyed acknowledged that they sometimes over-emphasised risk in order to gain resources for families.

The research suggests that child care social workers need to develop their capacity for listening and offering parents with mental health needs non-judgmental support. However, it seems likely that their necessary focus on children's needs and their formal powers in relation to child protection will continue to restrict their capacity to offer this emotional support.

The research team concluded that community mental health workers and child care social workers needed to share the task of co-ordinating assessments and services for families where mothers had mental health problems. We propose a shared key- worker role for practitioners from the two services. This would offer mothers the chance to receive accessible non-judgmental support while ensuring that children's welfare was monitored and assessed.

Such a structure might also offer child care social workers a means of accessing the views and expertise of the mental health professionals involved with the family. Community mental health workers could also serve as a communication link to psychiatrists, whom both mothers and social workers participating in the study experienced as rather remote professionals.

If the new structures envisaged in the the green paper are really to be effective, they will have to incorporate mechanisms that link children's services to those for adults. It is increasingly recognised that parents' mental health needs affect children's welfare: service structures must be designed to reflect the extent to which the needs of parents and children interact.

Nicky Stanley is reader in social work at the University of Hull. Tel: 01482 465965, e-mail: N.E.Stanley@hull.ac.uk 

References

¹ N Stanley, B Penhale, D Riordan, R S Barbour and S Holden, Child Protection and Mental Health Services: Interprofessional Responses to the Needs of Mothers, Policy Press, 2003

² C Lupton, N North and P Khan, Working Together or Pulling Apart? The National Health Service and Child Protection Networks, Policy Press, 2001

³ Royal College of Psychiatrists Patients as Parents: Addressing the Needs Including the Safety, of Children whose Parents have Mental Illness (Council Report CR105), RCP, 2002