Think child, think parent, think family: a guide to parental mental health and child welfare
Problems with current practice
Children and young people are not often involved in care planning and review. However, they need to be directly involved because they are direct beneficiaries of the care package, and also key to implementation plans.
In a successful service:
- Long-term assessments, involving continuous monitoring and review, enable services to respond to changes in family circumstances.
- Parents with mental health problems develop continuous, responsive relationships with trusted professionals, so that they and their children feel empowered to discuss any difficulties without feeling that they are being judged.
- Staff (inpatient nurses, community mental health staff, children's social care staff, foster carers etc.) work with families to make sure arrangements for the children's care, including any 'contact' arrangements, are put in place when a parent is hospitalised and that support is in place for the parent and child on discharge.
- Carers and young carers are involved in the care plan review for the person they care for.
Recommendations for change
Staff need to:
- Seek parents' permission and as far as possible involve children and young carers in the parent's care plan review process. This is important because young people can provide a valuable and unique perspective on what has been happening with their parent, how it is has been for them and what they think has worked well. They can then also comment on how any changes in the care plan might affect them.
- Aim to review the carer's plan as close as possible to the review of the adult's care plan. This will ensure the care plans work better together and reflect both individual and family goals. It will also ensure that any changes to the care plan that affect the carer are also addressed in their own care plan.
- Ensure care plan reviews consider change in family circumstances over time. For example, if important life events such as the birth of another child, a child studying for GCSEs, or the six-week summer holidays are coming up, then this needs to be explored and any contingency or extra support included in the plans if necessary.
In terms of hospital admission and reviewing care, staff need to:
- Ensure that the care plans for the parent and child are reviewed when a parent is hospitalised or receiving respite and again before they are discharged.
- Prioritise and address any financial and housing issues arising from hospitalisation (e.g. interruptions in welfare benefits, assistance with child care to avoid a parent or carer having to take unpaid leave to look after the children during this time).
- Contact or help parents to contact their children's school to make them aware of the temporary changes in the family to maintain family life during a time of crisis and ease the path of return when the parent returns home.
- On discharge from hospital or during periods of 'hospital leave' ensure that enough time is given to put any identified support in place for the parent and child as 'coming back together' for families can be a very stressful time with high expectations.
- If children and families or other essential support services are involved in the parent and children's care then it is imperative that the doctor and ward staff in charge of the parent's inpatient care involve named agencies in discharging planning or give adequate notice of discharge arrangements.