Supporting parental mental health

Gary Hawker from Dorset Primary Care Trust (PCT), UK, discusses the challenges of developing a holistic service to support parental mental health and safeguard children, through the development of a joint protocol between children and mental health social services departments.

In western society mental health problems are widespread. At any one time, up to one in six of us may experience depression, anxiety and phobias.

Nearly a million adults in England are claiming benefits for mental health conditions. Only 24% of adults with long-term problems are in work (Social Exclusion Unit 2004). Not only can the social and economic consequences for children living in a household where there is mental illness be enormous, but the possible impact on their emotional and psychological development should always be considered sensitively.

This is not to say that having a parent with a mental health problem is inherently detrimental. Not at all; some sources raise the question that, for children, there may be positive aspects of their experience (Nicholson et al 2001). Children can be remarkably resilient and more than capable at adapting to parental behaviour as long as the relationship is otherwise robust or other significant people offer support. If a child understands what is happening, even to an extent, the beneficial outcomes for all will improve substantially. Interestingly, many people who have encountered disability in childhood often speak about experiencing life on a deeper level and later choose a career in the caring professions.

Despite general agreement among both mental health and childcare workers that this area of work is of paramount importance, it may lose priority in busy teams. When working with families, a mental health worker may find it difficult to identify problems with childcare or may take behaviour on face value and not enquire further. Likewise, childcare workers may not be able to detect the first signs of mental distress and dismiss their observations as a common emotional response to difficulty. Both specialisms focus on where their experience lies, but this may lead to a potential blind spot when trying to help families where mental health and childcare interventions may lead to problems in assessment.

This can be depicted in the following diagram.

Amber response: Mental health experience + little childcare experience = focus on parental mental health

Green response: Mental health and child care experience = holistic assessment

Red response: Little mental health or child care experience = poor practice

Amber response: Child care; experience + little mental health experience = focus on child's welfare

If organisations are not genuinely proactive 'amber' or even 'red' services can result, where interventions which may seem appropriate and necessary turn out to be problematic in the medium or long term. Families may fall apart or the stigma of being a member of a family where there is mental illness can be exacerbated or ultimately become destructive. Such families deserve a service which is able to take into account the needs of the family as a whole and deliver help on several levels and in ways which are tailored to resolving their particular difficulties.

Like many other trusts, Dorset PCT recognised that its stated policy on families with parental mental health problems needed more clarity and energy. Various sources - including the work carried out by the Social Care Institute for Excellence, the Crossing Bridges Initiative and the Parental Mental Health and Child Welfare Network - were useful influences.

We agreed on a team lead approach which, via the mental health practice development team of which I am a member, has now been applied to other areas of work. The approach is simple and effective. Every mental health team has a team lead in childcare matters and, vice versa, every childcare team has an equivalent team lead for mental health matters. The team lead acts as a conduit of information, a link to the leads network and potentially as an 'expert' resource for the team. The team lead does not do everything related to this area of work but rather ensures a consistent and quality standard of approach. The flowchart (modified from the Camden Model - Kearney et al 2003) shows how it should work in practice. This is not a policy summary but shows how the team leads fulfil their roles.

Conclusion

The overarching conclusion was that the development of an effective, reflective and sustainable service needed time to evolve both the necessary networks and the mechanisms to ensure that learning from practice was maximised.

This model is a valuable foundation to ensuring that families are given the most appropriate service at the appropriate time. The next stage is to allow the networks to grow, monitor the effects from families and learn from their feedback. There is already some evidence of improvements. The number of adverse incidents has fallen, teams are making proactive connections with one another and key staff are being consulted more readily, all of which indicate that the service is gradually moving in the right direction.

References

Falkov A (ed). 1998. Crossing bridges: training resources for working with mentally ill parents and their children: reader - for managers, practitioners and trainers. London: Department of Health.

Kearney P et al. 2003. Families that have alcohol and mental health problems: a template for partnership working. London: Social Care Institute for Excellence.

Nicholson J et al. 2001. Critical issues for parents with mental illness and their families. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services. Administration.

Social Exclusion Unit. 2004. Mental health and social exclusion, Social Exclusion Unit report. London: Office of the Deputy Prime Minister.

First published in Disability, Pregnancy & Parenthood, issue 62, Summer 2008.

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