5.25 Enduring and/or Severe Parental Mental Illness
This chapter was updated in July 2020 .
Some children grow up with parent(s) and or carers who have diagnosable mental health problems. Some of these mental health problems may be mild and or short-lived, whilst others may be severe and enduring which include: depression, anxiety disorders, schizophrenia, personality disorders and bi-polar disorder. Some parents/ carers may also have long-term alcohol and or substance dependency and or a combined mental health problem and alcohol and substance dependency.
Children living in households where parents/ carers have mental health problems does not mean that they will experience abuse and or neglect. The majority of parents/carers who suffer significant mental ill-health are able to care for and safeguard their child (child (ren) and / or unborn child and are able to give their child (ren) safe and loving care.
However, sometimes parental/carers mental health problems may occur alongside other stressful life events such as: divorce and separation, unemployment, financial hardship, poor housing and lack of social support. These stressful life events may cause or make the problems worse. The combination of these problems can make it very difficult for some parents/carers to provide their children with the care and support that they need. In some cases, enduring and/or severe parental mental ill health may seriously affect the safety, health and development of children. Where professionals believe that this may be the case, a referral must be made to Surrey Children's Services.
The NSPCC lists the potential impact on children when living with parents with mental health problems. These include:
- increased risk of developing behaviour problems such as physical aggression by the time they reach school age
- risk of developing mental health difficulties
- taking on a caring role, providing emotional and social support, basic household chores and more intimate tasks such as nursing or bathing their parents
- demands of caring may lead to fewer opportunities to have fun and build friendships, disruption of education, educational underachievement and reduced life chances
- constant worry about their parents' or carers' health and wellbeing and denial of their own needs and feelings
- distress if faced with frightening situations such as a parent's suicide attempt, overdose or volatile behaviour
- a lower standard of living or financial hardship if their parent's illness makes it difficult for them to work
- embarrassment or shame over their parents' or carers' condition, limiting their friendships and social interaction due to the social stigma attached to mental illness
- bullying and social isolation
- separation from parents or carers by Children's Services or the parent's hospitalisation
- in the most serious cases, children may suffer abuse or neglect from a parent or carer with a mental health problem.
The following factors may also lead to the conclusion that a child may have suffered or is likely to suffer significant harm:
- Impact on child's growth, development, behaviour and/or mental or physical health, including alcohol/substance misuse and self- harming behaviour;
- The parent/carer’s needs or illnesses taking precedence over the child's needs;
- Becomes a target for parental aggression or rejection;
- Has caring responsibilities inappropriate to his / her age and should be assessed as a young carer;
- May witness disturbing behaviour arising from the mental illness;
- Is neglected physically and / or emotionally by an unwell parent;
- Does not live with the unwell parent, but has contact (e.g. formal unsupervised contact sessions or the parent sees the child in visits to the home or on overnight stays);
- Is at risk of severe injury, profound neglect or death;
- Is an unborn child of a pregnant woman with any previous major mental illness.
Actions to Take
A referral to Children's Social Care should be made where it is believed that a child of a parent with mental health problems may have suffered or is likely to suffer significant harm.
Professionals are also advised refer to the Effective Family Resilience Surrey document for further guidance.
Importance of Working in Partnership
All professionals involved with the parent/carer and/or child/ren must share information in order to be able to assess risks. This may include, but is not limited to; mental health professionals, social workers, midwives. health visitors, school nurses, GPs and education staff.
Care Programme Approach meetings about parents who have mental health difficulties must include consideration of any needs or risk factors for the children concerned. Relevant Surrey Children's Services teams along with other agencies should be involved in planning discharge arrangements.
Surrey Children's Services may be requested to assess whether it is in the best interests of a child to visit a parent or family member in a psychiatric hospital or high security hospitals (Broadmoor, Ashworth and Rampton) - see Children Visiting Psychiatric Wards and Special Hospitals Procedure.
Where there are child welfare concerns regarding visits to patients detained under the Mental Health Act, the Mental Health organisation should undertake a risk assessment in consultation with the Family Social Worker to ensure the visit will be in the child's best interests.
Further information/ References
- NSPCC, Parental mental health: How to help children living with parents with mental health problems
- Think child, think parent, think family: a guide to parental mental health and child welfare
- Stress and resilience factors in parents with mental health problems and their children