Working with parental mental ill health

Too often, the children of parents with mental health issues are taken into care because their needs as a family go unnoticed. Louise Hunt looks at how this can be addressed

It has been known for decades that the children of parents with mental health problems are among the largest group taken into care, yet the needs of such families are still not being routinely picked up by social services. This was first acknowledged in policy by the Social Exclusion Unit’s 2004 report Social Exclusion and Mental Health, which led to the Social Care Institute for Excellence (Scie) reviewing existing practice by health and social care services. Five years later, Scie has come to the same conclusion.

The institute’s Think Child, Think Parent, Think Family report calls for adult mental health and children’s social care services to work together to better meet the needs of families. It says: “There are currently many barriers to effective joint working characterised by separate legal frameworks, policy and practice guidanceMost staff seem to be aware of the issues, but state they need more effective leadership and guidance to help them overcome the barriers.”

Barriers

Voluntary organisations that have been advising the government and statutory agencies on how to change practice to tackle this issue agree where the barriers lie.

Louise Wardale, who co-ordinates the Barnardo’s Liverpool project Keeping the Family in Mind believes that fragmented and complex social care systems have contributed to parents’ and children’s needs being lost between services.

“It became obvious that a lot of the issues were because of deficits in adult mental health services that didn’t recognise people with mental health problems as parents and the role their children played in caring for them,” she says.

Strict boundaries

“Social workers are working within really strict boundaries. They don’t feel they have the tools or confidence to pick up on the wider issues of the family.”

Rose de Paeztron, head of strategic development at charity Family Action, which runs the Building Bridges project, a service commissioned by councils to support families where there are mental health problems, agrees. “Adults’ services often don’t get involved because they feel it is not their area of expertise,” she says. “That is one of the legacies of training becoming more specialised.

“With high staff turnovers, it is not always easy to track down counterparts in other teams. It takes a degree of confidence to approach people and there is a fear of being caught out and seen as ignorant.”

Lack of understanding

Keith Ingham, director of children’s health and social services at the Welsh assembly, accepts there can be a lack of understanding among adults’ services of the impact on children of a range of adult problems. “Sometimes there isn’t a full understanding of what can be an extremely complex area. It depends on the presenting issue and focus of the social worker,” he says.

He suggests that barriers can also be caused by conflicts of interests between services. “There are difficulties in dealing with adult and child problems because there is an implicit tension between the two services. For example, social workers working with adults with mental health problems may not always be looking at the risk to the child or where a risk is identified the potential removal of a child may be seen as harmful to the adult’s well-being.”

Scie’s five-year strategy aims to break down these barriers by proposing reforms to assessment, training and management across all services working with parents with mental health problems and their children. Among its key recommendations are assessment processes for adults with mental health problems that routinely take into account the needs of their children, including the development of new screening tools, the introduction of a family threshold and joint training for adult mental health and children’s social care professionals.

Previous attempts

Amanda Edwards, Scie’s deputy chief executive, believes the guidance will make a difference where previous attempts have failed to bring about a properly integrated approach. “The guidance has a clear set of messages,” she says. “We are encouraging senior level commitment and a multi-level approach looking at the range of services that support families.

“We are proposing new ways to tackle this problem. Routine identification, for example, will make sure that people are asking the questions at the right time. We found this was not happening everywhere and it’s an important thing to be doing.

“We are also asking for a review of criteria across services, so we can have a combined family criteria, rather than separate for children’s and adults’ services.”

Jenny Goodall, co-chair of the Association of Directors of Adult Social Services’ mental health network, says, although the guidance does not make policy recommendations, it would be “really helpful” if eventually it was included in national policy. “We may want to think about whether Scie’s recommendations can be part of performance indicatorswe do need to challenge current practice and for everybody to understand how critical this is.”

Local champion

However, De Paeztron warns that there is no magic cure. “This has been an issue for about 40 years,” she says. “It will be really important to have a local champion to oversee the implementation of the recommendations. It doesn’t matter if they are from adults’ or children’s services but that they can see across the issues. They should be thinking about pooled funding and using the voluntary sector because they can often work with parents at an earlier stage.”

Wales is perhaps taking the family support approach a step further. Having identified in its 2007 10-year social care strategy that families with children on the brink of being taken into care were not receiving the consistent support they needed to prevent crises, the government has been looking at ways for adults’ and children’s services to work closer together.

The approach in Wales is to introduce duties on health and social care agencies to provide support for families where parental problems are thought to pose a risk to children. This involves changing existing legislation that will be put into action when an Integrated Family Support Services model is tested from April 2010 in three areas.

Substance misuse

Each area will be required to set up an integrated family support service to work with families where parents’ problems pose a risk to a child. Initially, the model will focus on families where there is substance misuse, but it will be extended to include mental illness and other factors, such as learning disabilities. Individual staff will not take case-holding responsibilities, but will work with the family as a whole.

“We don’t want responsibility to be passed from one service to another, we want collective responsibility to minimise risk to the child,” says Ingham. “This could mean drawing on capacity through family support networks involving a range of statutory and voluntary services that work with at-risk families.” He acknowledges this will require a significant change in the role of social workers.

The IFSS social workers will have specific training in family support and the plan is to create a route for social workers to specialise in this area. “It’s ambitious,” says Ingham. “That’s why we say we are pioneering rather than piloting the model. If it proves successful it will be rolled out across Wales, possibly before the end of the testing period.”

Resource implications

Naturally, the government will be keeping a close eye on the resource implications of providing more third-tier services – those that can support families before crisis point – and whether this results in fewer children being taken into care, and other wider outcomes for families such as school attendance.

Asked whether he thinks the Welsh approach goes further than the Scie guidance in England, he says he does. “It’s setting out in legislation that there will be an absolute duty to provide a service for children at risk,” he says. “This approach is more explicit.”

➔ Proven Practice: Social Care Institute for Excellence on supporting families where families have mental health issues

This article is published in the 6 August 2009 edition of Community Care under the headline “It’s a family affair”