Children of Parents with Mental Illness (Parenting Capacity)
Scope of this chapter
This chapter will use the term parental “mental illness” to mean that a parent has a diagnosable mental health condition such as:
- Depression;
- Anxiety disorder;
- Bipolar disorder;
- Personality disorder;
- Schizophrenia or schizo affective type disorder;
- Dual Diagnosis.
This guidance is for all practitioners (paid or unpaid) who work with children (including the unborn child), those who work with adults who are parents/carers and who therefore hold responsibility for safeguarding and promoting the welfare of children. It is intended to be read alongside the Children and Young People (Jersey) Law 2022, the commensurate Statutory Guidance 2024 and the Jersey Children’s First Framework (JCF). Practitioners must follow the Statutory Guidance on sharing information (which follows Data Protection (Jersey) Law 2018) and follow the SPB Child Protection Procedures and the SPB Children and Young People Safeguarding Referrals Procedure.
Amendment
This chapter was amended in April 2024 to align with the Children and Young People Jersey Law 2022, commensurate Statutory Guidance, the Jersey Children’s First Framework and The Continuum of Children’s Needs. Reviewed in total, links refreshed to updated Chapters in SPB Jersey. Updated with thanks to the London Safeguarding Partnership Board.
Parental mental illness does not necessarily have an adverse impact on a child's wellbeing, health and developmental needs (NSPCC 2021), but it is essential to always assess its implications for each child in the family. Parents with mental illness may need support to meet the needs of their children. Many children whose parents have mental ill health may be seen as children with additional needs requiring professional support, and in these circumstances, the need for an Assessment following the Jersey Children’s First (JCF) Framework should be considered.
Where a parent has enduring and / or severe mental ill-health, children in the household are more likely to suffer significant harm. This could be through physical, sexual or emotional abuse, and / or neglect (see SPB Jersey Recognising Abuse, Neglect and Exploitation).
Significant harm is defined as a situation where a child is likely to suffer a degree of harm which is such that it requires statutory intervention into the life of the child (including the unborn child) and their family, (see SPB Jersey Child Protection Procedures and Children and Young People Safeguarding Referrals Procedure).
The term ‘mental illness’ does not have a clear definition and does not necessarily imply that there is always cause for concern. The state of a person’s mental health is usually not static and can vary according to several factors, correspondingly their capacity to parent safely may also be variable, and therefore, an understanding of the factors which may increase risk is important (see Section 3, Risks).
Some adults who suffer from mental health problems also have additional stressors such as:
- Social exclusion;
- Domestic abuse (see SPB Jersey Domestic Abuse - Safeguarding Children and Young People (Including the Unborn Child));
- Problematic Substance Use (see Parents who are Problematic Users of Substances (including Alcohol) - Parenting Capacity);
- Have grown up in care (see SPB Jersey Children Living Away from Home);
- Financial problems, compounded by an inability to work due to mental ill health;
- Living in poverty, or in substandard accommodation.
If a parent/carer is facing several challenges at once, it can be very hard for them to provide their children with safe and loving care, particularly if they aren't getting the support they need (Cleaver, Unell and Aldgate, 2011; Gatsou et al, 2017; Grove, Reupert and Maybery, 2015; Hogg, 2013; Wolpert et al, 2015 cited in NSPCC 2021). Where there may be several agencies and services, for both adults and children, who are working with a family.
Local and National Serious Case Reviews and Domestic Homicide Reviews identify parental mental illness, domestic abuse and problematic substance use as a significant combination of factors when found together. The combination of these indicators raise the concern for children (including the unborn) and young people, (Cleaver, Unell and Aldgate, 2011 cited in NSPCC 2021).
Mental illness can vary in severity and impact differently on people’s day to day lives. This depends on parents’ individual circumstances and additional stressors may arise because of their condition, contribute to the condition developing, or make it worse.
Along with mental health problems parents experience all of life’s other challenges, for example divorce, separation, unemployment, housing problems. Where coping with lots of challenges at once can make it difficult for parents to provide their children with the care that they need.
Children are likely to suffer significant harm and their wellbeing, health and development and welfare requires safeguarding, where they:
- Feature within parental delusions;
- Are involved in their parent’s obsessional compulsive behaviours;
- Becomes a target for parental aggression or rejection;
- Have caring responsibilities inappropriate to their age;
- May witness disturbing behaviour arising from the mental illness (e.g. self-harm, suicide, uninhibited behaviour, violence, homicide);
- Are neglected physically and / or emotionally by an unwell parent;
- Do not live with their unwell parent but have contact (e.g. formal unsupervised contact sessions or the parent sees the child in visits to the home or on overnight stays);
- Are at risk of severe injury, abuse, exploitation, neglect or death (dependant on their age and capacity).
Or they could be an unborn child:
- Of a pregnant woman with any previous major mental disorder, including disorders of schizophrenic, any affective or schizo-affective type; also, severe personality disorders involving known risk of harm to self and / or others.
Parental mental health problems may affect children differently, this is dependent on the severity of their ill health and on the age, developmental stage and dependency the child on their parent.
Some parents with mental health problems struggle to control their mood and emotions, this can lead to them being unavailable to their children emotionally. They can struggle to:
- Recognise and respond to emotions;
- Recognise and respond to their child’s physical needs;
- Set safe and appropriate boundaries;
- Manage their child’s behaviour and engage socially with their children.
Babies and young children rely on their parents to care for their physical and emotional needs, they need warm, nurturing and responsive care to enable them to grow and develop. Parental mental ill health in pregnancy and in the first years of a child’s life can have a lifelong impact and early intervention is key.
The following indicators may impact on parenting capacity and increase concerns that a
child may be suffering or likely to suffer, significant harm can be:
- A history of mental health illness with an impact on the sufferer's functioning;
- Unmanaged mental illness with an impact on the sufferer's functioning;
- Maladaptive coping strategies;
- Problematic use of drugs, alcohol, or medication;
- Severe eating disorders;
- Self-harming and suicidal behaviour;
- A lack of insight into illness and impact on child;
- Non-compliance with treatment;
- Poor engagement with services;
- Previous or current compulsory admissions to mental health hospital;
- A disorder deemed long term 'untreatable', or untreatable within time scales compatible with child's best interests;
- A mental illness combined with domestic abuse and / or relationship difficulties;
- A mental illness combined with isolation and / or poor support networks;
- A mental illness combined with criminal offending (forensic);
- A non-identification of the mental illness by practitioners for example untreated depression and post-natal depression can lead to significant attachment problems;
- A previous referrals to children's social care for other children; or
- A combination of these factors which lead to accumulated levels of risk.
Please see the Continuum of Children’s Needs - as guidance to help practitioners identify a child’s level of need and how to respond appropriately.
When assessing risk practitioners should consider the following indicators around the effect of the parent/carer’s mental illness on their parenting capacity:
- Do they neglect their own and their child’s physical and emotional health needs;
- Does it affect the development of a secure attachment with the child;
- Does it result in chaotic structures within the home regarding meal and bedtimes;
- Does it have implications for the child within school, attending health appointments;
- Is there a lack of the recognition of safety for the child;
- Does the parent/carer have an appropriate understanding of their mental health problem and its impact on their parenting capacity and on their child;
- Are there repeated incidents of hospitalisation for the parent/carer or other occasions of separation from the child;
- Does the parent/carer feel the child is responsible in some way for their mental health problem;
- Does the parent/carer’s mental health problem result in them rejecting or being unavailable to the child;
- Does the child witness acts of violence or is the child subject to violence;
- Does the wider family understand the mental health problem of the parent/carer, and the impact of this on the parent/carer’s ability to meet the child’s needs;
- Is the wider family able and willing to support the parent so that the child’s needs are met;
- Does culture, ethnicity, religion or any other factor relating to the family have implications on their understanding of mental health problems and the potential impact on the child;
- Does the family functions, including conflict, potential family break up have an impact.
Where child(ren) (including the unborn child) or young person is recognised to have wellbeing need any professional can start a JCF Early Help Assessment with consent from the family.
Where a parent with mental illness appears to have difficulty meeting their child/ren's heath and development needs, or are unable to protect their welfare practitioners must:
- Where there is immediate risk of harm, call the police on 999;
- Follow the SPB Child Protection Procedures, the SPB Children and Young People Safeguarding Referrals Procedure;
- Refer to the Children and Families Hub;
- In parallel refer an adult or young person with their consent to supportive domestic abuse services, if domestic abuse is a feature of concern for the adult or child (see SPB Jersey Domestic Abuse - Safeguarding Children and Young People (Including the Unborn Child));
- Where a child may have been physically or emotionally abused, suffered neglect or sexual abuse (see Recognising Abuse, Neglect and Exploitation), consideration must be given to following the Child Protection Medical Pathway and/or the Child Sexual Abuse Pathway;
- Where a parent is also an adult who may be at risk of significant harm practitioners must raise a safeguarding concern with referral to the Single Point of Referral (see SPB Jersey Multi-Agency Adult Procedures).
It is essential to take a child centred approach where the best interests of the child must be a primary consideration.
Parents and carers should be viewed as partners (where this does not prejudice the welfare of their children). Parents with Mental Ill Health are often aware of what their children may need whilst they are unwell.
Children who live with parents with mental ill health should be viewed as experts in their lives, where they will often be acutely aware when their parent/carer is becoming unwell. Any assessment must capture and respect the voice of the child, (See SPB Respecting the voice of the child).
Practitioners should consider the needs of all children as part of their JCF Assessment (see SPB Jersey Assessment).
Practitioners working in Adult Services must have suitable training in Safeguarding to enable them to identify those parents where there children may be at risk of poorer wellbeing, health and developmental outcomes or those who will require intervention to ensure they do not come to harm, (SPB Jersey Training accessed here).
On identification of children (including the unborn child), make appropriate referral to the Children and Families HUB.
Following principles of working together, where adult mental health services and children's social care are both involved with a family, multi-agency Assessments must be carried out to assess the support parents need and the risk of harm to the child/ren, in line with SPB Jersey Referral and Assessment Procedure.
Where the child has identified health and development needs or where there is a need for statutory intervention, adult mental health services and adult social care, and any specialist adult service specific to the adult’s needs, should be included in Strategy Discussion/Meetings, Child Protection Conferences and associated meetings, (see SPB Jersey Article 42 Enquiries, Child Protection Conferences, Child Protection Plans).
It is essential that staff working in adult mental health services and Children’s Services work collaboratively to ensure the safety of the child and management of the adult’s mental health.
Joint work will include mental health workers providing proportionate information regarding:
• Treatment plans;
• Likely duration of any mental health problem (where known);
• Effects of any mental health problem and medication on the carer’s general functioning and parenting ability.
Children’s Services must assess the individual needs of each child and consider the information provided by mental health workers.
Mental Health Inpatient services should have written policies regarding the welfare of children and particularly those children visiting parents/carers and wider family members.
Clear and reliable channels of communication are required and mental health professionals must be invited to and attend meetings. To provide information on the parent/carer’s mental health and provide their expert information on the implications this may have for the child. Children’s Social Workers conversely must be invited to and attend meetings related to the management of the parent’s mental health.
All plans for a child including Child Protection Plans will identify the roles and responsibilities of mental health and other professionals. The plan will also identify the process of communication and liaison between professionals. All professionals should work in accordance with their own agency procedures / guidelines and seek advice and guidance from line management or the organisation safeguarding lead, when necessary.
Consistent language should be used to describe mental illness with clear and fully understood terminology to avoid misunderstandings.
Children’s Social Care and Adult Mental Health should always consider the future management of a change in circumstances for a parent/carer and the child and how concerns will be identified and communicated.
Mental health services should always use ‘respectful uncertainty’ and not readily accept parent / carer’s assertions that their mental health problems are not affecting the care they provide to their children. Where there is any doubt in these situations, services should always err on the side of caution. If a parent/carer disengages from mental health services or is non-compliant with Treatment and the professional judgment is that there is on-going risk to the child in these circumstances, then the children should be referred to the Children and Families HUB.
Professionals need to carefully consider the implications for children when closing their involvement with parents with a mental illness. Consideration should be given to informing the appropriate Children’s Services team in order that the implications for the child are assessed.
Confidentiality is important in developing trust between parents with mental illness and practitioners in agencies working with them. However, practitioners must always act in the best interest of the child and not prioritise their therapeutic relationship with the adult over the needs of the child.
Practitioners should have access to regular single agency safeguarding supervision. Agencies should also consider multi-agency reflective supervision where cases are complex, stuck or drifting.
Professional challenge should be welcomed and partnership working depends on resolving
professional difference and conflict as soon as possible. Where staff experience professional differences, they must follow the SPB Resolving Professional Difference/Escalation Policy.
Last Updated: April 1, 2024
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