Social workers advise on a case involving a mother with mental health problems

Case study

Situation

Nineteen-year-old Alex* has phoned the NSPCC helpline because his mother, a single parent, is showing signs of becoming mentally unwell and paranoid. He has left home because his mother thought Alex was constantly “trying to get her”. He is worried about the safety of his three younger brothers and sisters, aged five to 13, who are still living with his mum.

Problem

The younger children have not been going to school regularly and the domestic situation is deteriorating. Yesterday the mother became angry about unfinished household chores and threatened to “slit the throat” of the eldest child.

Although such threats are not unusual, on this occasion, a few hours later, the mother took a knife and repeated the threat, this time touching the throat of one of Alex’s younger sisters with the blade.

Alex doesn’t know what to do. He has been advised by the NSPCC helpline that he should call the police to ensure the safety of his younger siblings but he is distressed at the thought of being the one responsible for splitting up his family.

*Name has been changed

The social worker view

Patrick Ayre, child safeguarding consultant and former manager of child protection services

This referral suggests cause for concern about the immediate well-being of these children and an urgent protective response is required. However, in a case such as this, it is essential that we hold our nerve and take time to plan our intervention carefully if we are to avoid increasing the danger to the children rather than decreasing it.

We have been told that the children’s mother is “extremely paranoid” and that she has threatened to use a knife, so we must consider the possibility that some of our instinctive responses may cause a surge in her anxiety with the real risk that she may harm the children. A police car drawing up outside, or a knock on the door from a social worker expressing anxiety about the children might lead, at least, to a locked door and a dangerous stand-off.

In these circumstances, a properly constituted, though very quickly convened, interagency strategy discussion is essential. We will need to draw on police, mental health and children’s services expertise to enable us to step one-by-one through a series of “what-if” scenarios in order to determine which is most likely to have positive outcomes in the short and longer term.

Tink Palmer, social work trainer and chief executive of the Marie Collins Foundation

Records need urgent checking for background information regarding the children and the mother.

An immediate strategy discussion needs to be convened and a joint visit to the home by a social worker and child protection police officer should take place with back-up staff on call. If the mother already has a mental health social worker, it may well be appropriate for her to accompany the investigating police officer and social worker.

There are two key risk assessments that need to take place during this initial visit – the immediate safety of the children and mother’s current state of mental health. If the concerns expressed by Alex prove to have foundation, the children will need to be in a safe place while further assessment and treatment of the mother’s mental health issues takes place.

Social workers should check what support the family could receive from extended family members and their suitability to care for the children as an interim arrangement. They need to consider what role Alex can play in caring for his siblings. If the mother requires hospital admittance, the children may be able to stay in the family home with extended family caring for them and support from children’s services.

The family perspective

Honor Rhodes, director of development, Family and Parenting Institute

From a family perspective this must be one of the most difficult issues any family member has to manage. Alex has summoned up the courage to call services about a risk that he knows he cannot deal with. While he is upset about being the person who had to raise the alarm he knows that the situation he describes is exceptionally serious.

Three magic questions should be running through a social worker’s head: Why now? What for? Why worry?. The first is clear, the danger to the younger children is real and present. The ‘What for?’ may well be because the caller knows that his siblings are without protection and that his mother’s behaviour appears to be escalating.

The ‘Why worry?’ asks us to weigh the risks of removing, perhaps for a significant period of time, the mother’s right to be an autonomous parent with that of the state’s fundamental requirement that children are kept safe.

This mother, when an intervention has been made and the children’s safety secured, may be enabled to receive the help that she needs and will, if not immediately, be grateful that she was never allowed to physically harm her children.