Parental mental health and child welfare: A guide for adult and children's health and social care services

Improving access to services

Problems with current practice

Families with a parent with mental health problems often fall through the service net because:

• staff do not ask the right questions early on
• there are ambiguities with regard to the roles and responsibilities of different professionals
• there is a lack of signposting information – it is often the people who use services themselves who collect information and inform staff of other services and resources
• parents with a mental health problem may be reluctant to identify themselves because they fear losing parental responsibility for their children and because of the stigma associated with mental health and social services; children are also reluctant to raise concerns as they fear being separated from their family.

In a successful service:

• all families are routinely screened to identify which adults with mental health problems are also parents in adult services, and which parents in children's services have mental health problems
• given a parent's permission, staff make contact with all other relevant agencies to assess, plan and deliver a coordinated care package for the whole family
• families with a parent with a mental health problem are routinely signposted or referred to other appropriate services
• staff develop supportive relationships with adults who use services to allay people's fears and reduce the stigma surrounding services.

Recommendations for change

Staff need to:

• Ask the right questions to identify families with a parent with a mental health problem. During the screening process, they should also explore the impact of any mental health problem on parenting and the child, and then put parents in touch with the right services. In children's services, staff will need effective ways of screening for and assessing parental mental health, including a tried and tested screening tool that identifies potential mental health problems. In adult services, staff will need to find out whether the adult is a parent or has childcare responsibilities and to record this. All staff may need training and support to understand why it is important to ask for this information and how to change their practice. See Resources - screening tools.
• Develop a working knowledge and confidence in how other services operate, what they have to offer and how to refer to them. Staff need to be able to reassure parents that services will meet their needs, provide written information about a service and, when necessary, be able to challenge other services and advocate on their behalf. This applies to staff in all settings. For example, enabling children's centres, schools, Family Intervention Projects (FIPs) and GPs to navigate the local care pathway for mental health and children's services would provide a valuable mechanism to join up healthcare planning with family, parenting and children's services.
• Reassure parents that identifying a need for support is a way of avoiding rather than precipitating child protection measures.
• Involve parents and children as much as possible in the screening process, explaining that the process is important for making sure families get the support they need. This should be the start of developing a supportive and therapeutic relationship.
• Be proactive in developing good working relationships with their counterparts in other agencies, so as to facilitate joint working and shared case management.

Organisations need to:

• Develop new systems and tools in collaboration with parents and children (or customise existing ones) to routinely collect information about families where a parent has a mental health problem and record the data for future use. This information is essential for individual case assessment and care management. It is also crucial in building up a picture of the potential population for use by commissioners and managers of adult mental health and children's services. See Resources: screening tools.
• Provide training for their staff in talking with children, young people and adults to support the use of new screening tools as well as training to clarify roles and responsibilities in terms of collecting this information and acting on it. This applies to all staff in all agencies.
• Produce written and other formats of information about their services and include provision of translated materials and culturally sensitive information. This needs to include information about:
  • adult mental health problems and the range of treatment and support available
  • the connections between adult mental health problems and parenting, and what has been helpful for families
  • how agencies work together to support individuals and families
  • services for young carers, as well as general information for all carers that explains what a carer's assessment is and what support is available
  • clear signposting to other services, including those providing parenting support and parenting education, and relationship support
  • local and national advocacy services.
• Develop a communications strategy to tackle the stigma and fears that parents and children have about approaching and receiving services. It should be a priority to enable families to get the support they need as soon as possible and the focus should be on promoting good mental health and wellbeing for all family members. This strategy needs to span universal, targeted/specialist and secondary services and reach families at all levels of need. It is best coordinated by Children's Trusts working with local commissioners of adult mental health services.

Managers need to:

• Develop a 'whole family' perspective and along with all other staff improve their knowledge and understanding of the interrelated nature of mental health difficulties, parenting and child development, and reflect this learning in decision-making.
• Provide advice and guidance, both informally and through more formal systems, to help frontline staff work across agencies and signpost and refer families to appropriate services.
• Use management information systems/case management data and staff supervision and appraisal to ensure that referral, assessment and screening take place, that staff know how to use appropriate screening tools for adult mental health and are using them effectively. They also need to ensure that information-sharing is of high quality.