Child protection versus parental mental health services

In the absence of a national strategy, Julie Griffiths looks at the problems impacting on the co-operation between children’s social workers and adult mental health professionals

A young mother stabbed her five-year-old child during a psychotic episode following a lack of communication between adult mental health and children’s services professionals in Birmingham. A 2009 serious case review concluded there was uncertainty over the roles and responsibilities of the different social workers involved, particularly between the adult mental health social worker and the child’s social worker, and pointed out agencies were failing to communicate and co-ordinate their approaches.

Another example was highlighted in a SCR in Sunderland last year. It looked into the case of an injured baby, who had been assaulted by his father, and found insufficient attention had been paid to the father’s mental illness and the effect it had on his children. There was a need to keep “child-focused in the face of adult difficulties”, said the review.

The topic has been debated on Community Care’s CareSpace forum with one contributor claiming mental health social workers had no understanding of child protection: “They have a similar view of social workers as their clients – that we are out to get them – and end up advocating for their client and undermining child protection. It happens so often it’s frightening.”

Another complains of adult mental health practitioners insisting that a suggestion of removing children would have a detrimental effect on their client’s mental health.

“Children are not therapeutic tools,” the contributor states.

Debbie Lyons, a Southampton social worker in child and adolescent mental health services (Camhs), believes the problem is largely due to a lack of good personal links between adults’ and children’s services.

“People change jobs a lot and it’s hard to keep a named contact,” she says. “It’s also a difference of approach. Adult mental health has a focus on the individual but in children’s services we are working with children as part of a family and have a very strong focus on family therapy.”

An adult mental health social worker from a London borough, who wishes to remain anonymous, says there is also a silo mentality in social work teams and – worse – a fundamental lack of understanding about what different social workers do.

Given that generic training no longer takes place, perhaps this is unsurprising. She says back-biting among social workers is common because there remains an expectation that a fellow social worker should be more of an ally.

“We think social workers should be more understanding and that makes it more frustrating when they’re not,” says the mental health professional. “We have a perception about what other social workers do and it’s usually not the reality. I’ve gone into teams where they turn on me and say your team doesn’t do this or that.”

Yet, many children’s social workers, particularly those in child protection, need mental health social workers to understand complicated areas such as learning disabilities, according to the charity Mencap.

Maureen Piggott, director of Mencap Northern Ireland, says half of parents with learning disabilities who come into contact with social services lose their children. “Parents with learning disabilities are being asked to prove that they are good parents to higher standards than others,” Piggott says. “They may demonstrate competence in a different way – their verbal skills may not be as good, for example – and it requires a different way of engagement. But there is insufficient awareness of that.”

Patricia Kearney, head of family and children’s services at the Social Care Institute for Excellence, says there is a “double whammy” in the gap between health and social care as well as the divide between adults’ and children’s services. “Social workers are not just in different departments; they’re in different organisations,” says Kearney. This makes communication challenging because phrases may not mean the same thing in different organisations, yet the presumption is that they do, she says.

Bridging the gap requires a whole-system approach with buy-in at the top level, says Kearney: “It’s not enough to rely on the charisma of a social worker. You can be as collaborative as you like in your approach but there needs to be structural change.”

Some councils are moving to merge their adults’ and children’s departments. But this may be for cost reasons rather than to improve co-ordination.

Kearney says joint training days can help strengthen understanding of different roles. Another option is to set up a system where a named contact acts as a liaison point for adult mental health and children’s social workers, helping to talk through problems or queries from both sides and make referrals.

Point of contact reduces misunderstandings

Children and families social worker Sonia Isaza has always had good experiences of working with adult mental health.

Working in the duty and assessment team in Camden, London, she can call on the expertise of a mental health consultant. The aide, a social worker based at a mental health facility, liaises with both children’s services and adult mental health when a referral is made or information is sought.

Isaza says the Camden system works well. “The difficulty is that usually you don’t know who to talk to or how they work. The mental health consultant bridges the gap for us. When I have needed an emergency assessment, she’s told me who to call and how to get the message across.”

Isaza says this point of contact reduces misunderstanding between social work teams who often work in different ways. It has helped to avoid miscommunication when one team has priorities unknown to those on another, she adds.

“Sometimes it is confusing to know how adult mental health works and what they are doing, but the consultant understands how we work and how they work. She’ll explain to us what mental health can do and are willing to do. And she’ll tell them of our concerns about the children.”

Tips for joint working

● Know where other services are based and what they do. Build a relationship to help information-sharing and joint-working on cases.

● Review whether thresholds for both adult mental health and children’s services take into account the needs of children and parents.

● Reassure parents that identifying a need for support is a way to avoid rather than trigger child protection measures.

● Ensure there is access to both children’s and adults’ services when it is needed and make sure staff know who makes what decision.

● Ensure screening systems in adult mental health and children’s services identify and record information about adults with mental health problems who are also parents.

● Consider allocating an individual budget to provide flexibility to care packages.

● Increase children’s understanding of a parent´s mental health problem.

● Offer leadership and guidance to help social workers overcome barriers and change practice.

Source: Scie: Think Child, Think Parent, Think Family Guidance

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This article headlined Never the twain shall meet? in Community Care 07 April 2011