Think child, think parent, think family: a guide to parental mental health and child welfare

Introduction: The policy context in Northern Ireland

Health and social care policy in Northern Ireland is the remit of the Department of Health, Social Services and Public Safety (DHSSPS). Legislation and policies affecting parental mental health and child welfare therefore differ from those in the rest of the UK, although the acceptance of the need to work with the whole family is a common thread.

Our Children and Young People – Our Pledge (22) is a 10-year strategy for children and young people in Northern Ireland, similar to Every Child Matters, which seeks to ensure all children and young people:

It identifies that not all children have an equal start in life and that targeted support should be available to particular groups to ensure that all young people have the opportunity to fulfil their potential. It proposes a whole-child approach to ensure support in each of these key areas.

Inspection of child protection services & subsequent standards 2006-2008

An inspection of child protection services in Northern Ireland (23) found some gaps at the child protection and adult mental health interface and recommended:

'There is a need, at all levels, for more effective interagency strategies for responding to alcohol and drug misuse, mental health problems and domestic violence and their impact on children and young people.'

The subsequent DHSSPS Standards for Child Protection Services (24) referred to the need for effective arrangements to manage the interface between child protection and adult mental health services.

Impact of the O'Neill inquiry and others into service shortcomings

In Northern Ireland, there have been a number of cases where children have died or been seriously injured, and inquires into the circumstances surrounding these cases identified parental mental health and deficits in communication and joint working between agencies as contributing factors. In 2005, Madeleine O'Neill, who was in receipt of mental health services, took the life of her nine-year-old daughter Lauren, and then killed herself. The Report of the Independent Inquiry Panel in 2007 found that communication between professionals in relation to hospital admissions and transfers, between consultant medical staff, between hospitals, and between professionals and relatives were potential weaknesses in the support offered to Madeleine and her daughter. The report also highlighted that staff failed to recognise the relationship between child protection and mental health.

A 2008 report into another major child protection case again brought into focus deficits in working relationships between mental health services and children's services, suggesting that the way in which these services work together needed to improve.

As a direct result of the O'Neill Inquiry, the DHSSPS funded two project managers to lead a three-year project to pilot the recommendations of SCIE's Guide 30, 'Think child, think parent, think family', as a way to improve across the children's services and mental health interface. This initiative also covered associated departments such as maternity services, A&E, allied health professional services, and psychological therapies in promoting a Think Family culture across Northern Ireland health and social care provision.

SCIE's Guide 30 and At a glance 32 have received formal endorsement from DHSSPS.

Link: O'Neill inquiry

Parenting strategy

The DHSSPS Families Matter strategy (2009) (25) focuses on early intervention, prevention and universal support for families. The implementation of the strategy and supporting initiatives, in conjunction with Care Matters NI, should ensure that families' needs will be addressed across the spectrum of intervention - from universal need to crisis intervention - in order to support parents and address better outcomes for children and families. The strategy does recognise parents with mental health problems as a group who are prone to exclusion from health and social care provision.

Promoting Quality Care: Good Practice Guidance on the Assessment and Management of Risk in Mental Health and Learning Disability Services (26)
This guidance describes the principles of best practice to assist individual mental health and learning disability care professionals, multidisciplinary teams and the organisations within which they work, to make decisions about managing the potential risk that service users may pose to themselves or others, including the staff who care for them, their families, carers or the general public. It provides guidance on assessing risk to children and young people.

Mental health service framework and legislation

The Service Framework for Mental Health & Wellbeing was launched in October 2011 . It makes significant references to SCIE's Think Family guide, and other SCIE resources, as the evidence base for many of the standards. The Framework also explicitly sets out how the family model should be taken into consideration when implementing the standards framework. The Northern Ireland Frameworks 'are unique in including measurable performance targets for each standard' (27). The framework builds upon the 'Strategic framework for adult mental healthservices', which recognises parenting roles in a section on carers and contains a recommendation that 'service users who are parents should be supported in their parenting role' (28)

The existing legislation for mental health is the Mental Health (NI) Order 1986, which is outdated. A single piece of legislation covering mental health and mental capacity is under development and is being considered by the NI Assembly during 2011. It is due for implementation in 2012.

Further reading