Out of the loop

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

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