The toxic trio: what social workers need to know

    Working with domestic abuse, substance use and mental ill health

    Photo: antic/fotolia

    This article comprises of excerpts taken from a Community Care Inform guide about the toxic trio, written by Jennifer Holly, project manager at AVA. The full guide covers the impact on children of living with multiple parental difficulties, indicators a child is living with these difficulties, and questions to ask parents. Subscribers can read the guide on Inform Children and Inform Adults.

    What is the ‘toxic trio’?

    The past few years have seen an increased awareness of the frequency with which domestic and sexual violence, substance use and mental health problems co-exist, particularly in the context of safeguarding children and young people. Various terms have been coined to describe the concurrent experience of these three issues: the ‘toxic trio’, ‘the trilogy of risk’, and people with multiple and complex needs. There is concern that terms such as the ‘toxic trio’ are problematic because they can lead to the parents – most often the mother who is frequently the victim of abuse herself – being deemed toxic or seen as the main source of risk, and therefore they don’t hold the perpetrator of domestic abuse to account for their behaviour.

    The use of the term ‘multiple and complex needs’ is not necessarily any less stigmatising – it is yet another label applied to a person or family and one that is used to exclude some from services. Furthermore, any combination of needs may be complex, not just substance use and mental health problems. As such, supporting families affected by these three issues involves exactly that – talking explicitly about domestic abuse, substance use and mental ill-health and helping them to address the impact that these issues are having on them and their family.

    Living with mental health problems, using alcohol or drugs, or experiencing domestic abuse does not automatically mean a parent/carer is unable to safeguard their child(ren) from serious harm. Furthermore, adequate support can reduce (although not necessarily eradicate) the risk of children experiencing long-term negative effects of growing up with such problems. This means children can outgrow their troubled childhood. This is particularly true where only one issue affects the family.

    Major concerns arise when more than one of these problems is present, as is often the case. It is the ‘multiplicative’ impact of combinations of factors that have been found to increase the risk of harm to children, with family disharmony and domestic violence posing the greatest risk to children’s immediate safety and long-term wellbeing (Brandon et al, 2010).

    So, identifying all three issues and how they impact on the adults and children present in any family is vital. Furthermore, professionals need an in-depth understanding of how the issues interlink – particularly in terms of what domestic abuse is and how victims may end up using substances as a way of coping with their experiences – to ensure the interventions that are put in place are as effective as possible in promoting the safety and wellbeing of all members of a household.

    Gathering and analysing information

    A key message that has emerged from serious case reviews is that practitioners need to gather and analyse more information; they “must be encouraged to be curious, and to think critically and systematically” to understand how the difficulties affecting families interact (Brandon et al, 2008, p98). Unless professionals are sufficiently curious, questions will go unasked and important information will not be gathered.

    Each family member should be spoken to individually about what is happening in the household. This is particularly important given the tendency to focus on mothers in families where a child or children are at risk of harm. It has been noted that fathers can be more difficult to engage with, either because they refuse to talk to social workers, are absent from the home when professionals visit, or do not live in the home with the child (Farmer, 2006 cited in Cleaver et al, 2011). However, every effort must be made to engage with fathers, even more so in cases of domestic abuse where usually the father/male carer is the perpetrator and poses a high level of risk to the family.

    Children should be spoken to away from their parents wherever possible as they may not feel able to talk about what is happening in the family in front of them. This is particularly true if they fear negative consequences for their parents/carers or themselves, eg if they disclose that one parent/carer is abusive towards the other or towards the children. Very often, children and young people don’t want to get their parents into trouble, and also fear the family being separated as a result of disclosing.

    In a similar vein, in cases that involve domestic abuse, both parents/carers should be spoken to, and spoken to separately. It is unlikely that a victim of domestic abuse will feel able to speak freely in front of the perpetrator, and perpetrators will often use such ‘forums’ to further manipulate and control the victim.


    Brandon, M; Bailey, S and Belderson, P (2010)
    Building on the learning from serious case reviews: a two-year analysis of child protection database notifications 2007-2009: research brief
    Department for Education

    Brandon, M; Belderson, P; Warren, C; Howe, D; Gardner, R; Dodsworth, J and Black, J (2008)
    Analysing child deaths and serious injury through abuse and neglect: what can we learn? A biennial analysis of serious case reviews 2003–2005
    Department for Children, Schools and Families

    Cleaver, H; Unell, I and Aldgate, J (2011)
    Children’s Needs – Parenting Capacity. Child abuse: Parental mental illness, learning disability, substance misuse, and domestic violence (2nd edition)

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    3 Responses to The toxic trio: what social workers need to know

    1. Paul Bywaters March 5, 2018 at 3:05 pm #

      There is a further issue that our research ( has shown is all too often ignored in the focus on these three significant issues. That is the way that all three are inextricably linked to financial poverty and insecurity. This was mentioned as an issue the much quoted Cleaver et al research review but subsequently disappeared from most discussions. Not only does poverty and insecurity increase the likelihood of mental ill health and disputes and violence between adults and children in households, but may increase the paradoxical likelihood of adults using substances inappropriately as a response to stress. At the same time, all of these factors increase the likelihood of a family being in poverty and their difficulties in escaping from it. Practice should always address the way the material circumstances of families underpin, influence and inform relationships and behaviours and seek to ameliorate such difficulties. There is clear evidence that families in work and out of work are frequently not receiving all the help they are entitled to.

    2. Planet Autism March 7, 2018 at 9:00 pm #

      “Toxic Trio” Nice way to describe parents and yet more of the parent-blame culture.

      Perhaps if people with mental health struggles were given the right support at the right time they wouldn’t escalate into substance abuse and abusive behaviours.

      And as most mental health starts in childhood, there is ample opportunity to resolve it then. By not doing so, they grow into adults with mental ill-health and become parents.

      Then they are blamed and accused.

      Some people should never become parents, that much is true. But for most, they just needed help and support. With the useless, under-resourced and pitiful mental health services in this country, it should never come to it that people with struggles become parents whilst they are still struggling. They should have been helped the first time their difficulties arose.

    3. Crispin March 8, 2018 at 11:46 am #

      I think Paul the point that financial poverty and insecurity is always linked to “the Toxic Trio,” this is potential unwise it also risks marginalising a segment of the community who are at risk and ignoring others. There are both domestic homicides reviews and serious case reviews where domestic abuse, substance misuse and parental mental health have been prevalent without financial poverty.
      Financial poverty should be seen as an exacerbating factor along side, bereavement, acrimonious separation and criminality (Sidebotham etal 2016 p77). In the area where I work Operation Encompass was rolled out by police and local authority. More affluent schools did not see the point since they did not believe their child would be living in homes where domestic abuse was present. Within a very short period of the introduction of the program those same schools realised it had been a hidden secret.
      Yes. Toxic Trio: parent mental health, substance misuse and domestic abuse might be exacerbated by poverty. However the children living in the more affluent homes can also be victims of neglect, physical abuse, and emotional abuse.
      The point Paul makes the importance of poverty on family should not be lost as important and should maybe be considered instead with the development of ACE (Adverse Childhood Experiences) into professional, agency tools and the effect on the population now and in the future.