Mental Illness in a Parent or Carer
This procedure is to be used when considering the likelihood and severity of the impact of an adult's mental ill health on a child. It involves the practitioner using their professional judgement to balance the risk and protective factors for the child.
1.1 Research indicates that 10–15% of children in the UK live with a parent who has a mental disorder.
1.2 A wide range of mental ill health can affect parents/carers of children and their families. This includes depression, anxiety and psychotic illnesses such as Schizophrenia or Bipolar Disorder.
1.3 Mental health issues can cause changes/difficulties with the way people think, feel or behave. Parental/carer mental ill health can, in some circumstances, lead to an inability to look after the child’s physical and emotional wellbeing. This is often for a short temporary period however for some individuals it can be more prolonged.
1.4 It is important to identify that:-
A mental illness is a clinically diagnosable disorder that interferes with an individual’s cognitive, emotional or social abilities. Diagnosis is generally made according to a classification system (ICD 10). It is estimated that mental illness will affect 1 in 4 of us at some time in our lives.
Mental health problems are typically less severe and of shorter duration than mental illness and may include mental ill health temporarily experienced as a reaction to life stressors.
1.5 Parental/carer mental illness does not necessarily have an adverse impact on a child’s development. Just as there is a range in severity of illness, so there is a range of potential impact on families. The consequent likelihood of harm being suffered by a child will range from a minimal effect to significant one. Research has shown that the adverse effects on children and young people are less likely when parental/carer mental disorders are mild, last only a short time, are not associated with family disharmony and do not result in the family breaking up. Where a parent/carer, has an enduring and / or severe mental illness children in the household are more at risk of, or experiencing significant harm.
1.6 Children may be protected from harm when the other parent/carer or a family member can respond to the child’s needs, and the child has the support of friends and other caring adults.
1.7 It is essential to assess the implications of parental/carer’s ill health for each child in the family. This would also include assessment of the impact on the family members of the social, physical ill health or substance use, difficulties that a parent/carer with mental illness may also be experiencing.
1.8 Offering treatment for mental ill health and appropriate additional support in addition to building resilience for families usually means that mental illness can be managed effectively and as a result parents/carers are able to care successfully for their children.
2.1 Young carers are children who are caring for a parent, sibling or other relative/person. There is growing evidence pointing to the adverse impact on the health, future employment opportunities and social and leisure activities of those providing unpaid care, particularly in young carers. The 2011 Census indicated there are 181,000 children and young people under 18 in the UK providing some care to family, friends or neighbours.
2.2 Additional information around Young Carers can be found here: Specific Issues Affecting Young Carers
3.3 Obsessive Compulsive Disorders
3.4 Bipolar disorder
3.6 Personality Disorders
3.6.1 Personality Disorders are a type of mental health problem where your attitudes, beliefs and behaviours cause you longstanding problems in your life. Your experience of personality disorder is unique to you. However, you may often experience difficulties in how you think about yourself and others. You may find it difficult to change these unwanted patterns.
3.6.2 Symptoms can include:-
3.6.3 A diagnosis of personality disorder can only be made by a mental health professional, such as a psychiatrist – not by a GP.
4. Parental mental ill health holds specific risks for children of particular age groups which include:
4.1 Babies up to 1 year old
4.2 Young children
If you have concerns regarding a client experiencing Mental Health concerns please consider the PAMIC tool below to support your decision making.
5.1 The PAMIC flowchart and PAMIC check, support’s assessment, It is a tool which can be used by anyone involved in providing services to children or to adults who are parents/carers of a child. It is to be used when considering the likelihood and severity of the impact of an adult’s mental ill health on a child: it is not intended to replace professional judgement. Consideration needs to be given not only to the nature of risk but also the protective factors for the child:
6. PAMIC Check
6.1 Risk of Significant Harm - If any of the following factors are present they are highly likely to have a direct impact on the safety and well-being of the child. Follow Tees Safeguarding Child Protection Procedures:
6.2 Moderate Risk of Harm - Where, for example, factors such as the following are present, although not of the severity of the above they can potentially impact on parenting and result in concern for the child’s care. Make a referral to Children’s Social Care for an assessment.
6.3 Low Risk of Harm - Where, for example, factors such as the following are present they require an assessment of the child’s needs to influence planning of the child’s care an Early Help Assessment should be completed.
*Alternatively negotiate with a children’s services worker e.g. Health Visitor/School Nurse to complete.
6.4 Not considered at risk – No obvious impact on the child’s health and well-being are evident. Liaise with key others where appropriate and consent to do so is obtained. As events may change keep under review?
7.1 Information Sharing
7.1.1 Good information sharing is a crucial element of successful inter-agency working, allowing professionals to make informed decisions, thus improving outcomes for patients/clients. Sharing of information is lawful where:
7.2 Disclosure with Consent
7.2.1 Individuals can give their consent to personal information about them being disclosed to third parties, but it must be explained why this information is needed and who it will be disclosed to. If the information is sensitive in nature, for example relating to a person’s mental health, such consent would need to be in writing and placed on their case file. Verbal consent should be recorded in the case notes.
7.2.2 A young person aged 16 years or over is capable to giving consent on their own behalf; children under 16 years can only give consent if it is thought that they fully understand the issues and are able to make an informed decision. If not, the decision must be made by the person who holds Parental Responsibility for them.
7.2.3 Where an adult is deemed incapable of giving consent to disclosure, consent should be sought, where possible, from a person who has the legal authority to act on that person’s behalf.
7.2.4 If it is not possible to obtain consent to disclosure, information can be disclosed without consent under the circumstances listed.
7.3 Disclosure without Consent
7.3.1 Where consent has not been given, or it is thought that to seek consent from a parent or carer may place the child at further risk, professionals should consider whether it is lawful for them to disclose the information without consent.
7.3.2 Clearly, it would be lawful to disclose information in order to safeguard a child’s welfare, but professionals must consider the proportionality of disclosure against non-disclosure: is the duty of confidentiality overridden by the need to safeguard the child? Where information is disclosed, it should only be relevant information and only disclosed to those professionals who need to know.
7.3.3 Professionals should consider the purpose of disclosure and remind those with whom information is shared that it is only to be used for that specified purpose and should otherwise remain confidential.
7.3.4 Further guidance on information sharing with regard to safeguarding children is contained in Information Sharing for Practitioners and What to do if you are Worried a Child is being Abused
8. Useful Guidance Pathway Tools, Contacts and Websites:
8.1 Practice guidance produced by Social Care Institute for Excellence (2009) Think child, think parent, think family. London: SCIE