The latest guidance on treating parents with mental health problems suggests a whole family approach is the surest way to improve care and end stigma

Services for parents with enduring mental health needs must move away from focusing entirely or almost exclusively on the clinical treatment of the adult.

Outlined in the new parental mental health and child welfare guidance document from the Social Care Institute for Excellence, recommendations for both children’s and mental health service providers point to a broader perspective and set of actions that consider the individual needs of the parent and children, as well as the whole family.

The guidance echoes the Social Exclusion Unit’s findings several years ago that parents with mental health problems and their families are one of the groups most likely to be excluded from health and social care provision. Therefore stigma is a barrier for families in need of support, and something agencies need to overcome early.

“It is vital that agencies think together about tackling the fears that parents and children have with regard to approaching and receiving services,” says Marie Diggins, practice development manager at SCIE and one of the principal authors of the guidance.

She adds: “These can include anxieties about compulsory hospitalisation, children going into care or, conversely, a complete lack of care.

“All of the providers who might be involved with families need to work hard on [formulating] communication strategies and signposting exercises that really tackle these stigmas and get support in as soon as possible.”

Only when families feel confident enough that services and practitioners are in a position to look beyond the parent’s mental health problems - considering the adult in the context of their family relationships and all the resources that can help them with inclusion - will managers and commissioners be able to properly understand the population on their doorstep.

“There is no routine or reliable screening in mental health or children’s services about which adults are parents or which children have parents with mental health problems,” says Ms Diggins. “Professionals cannot encourage people to get help or provide holistic support to families if they don’t fully understand their situation.”

“This is about a culture shift,” she continues, “and the starting point for that is identifying who these adults and children are. Organisations need to give their practitioners the systems and tools to help them ask the right questions and incorporate a family perspective.

“Commissioners and managers in health and social care can then consider and plan services that promote the needs of these families and increase their resilience.”

Case study: guidance in practice at Mersey care trust

Carol Bernard is service director for adult mental health at Mersey Care trust. The trust and local partners are working with SCIE to run one of six practice implementation sites for the new guidance. Experiences and outcomes from the sites will be shared nationally.

“Exploring innovation through strong working relationships with social care, children’s services and organisations like Barnardo’s is key to success,” she says.

Ms Bernard continues: “Because of different traditions of emphasis and perspective, creating a clear care pathway that is agreed and understood by mental health and children’s services will present a challenge. This can be overcome by empowering all staff to feel comfortable in conversation both with parents with mental health problems and their children and, without detracting from work in their primary specialty, to identify unmet need and to be very clear about how they refer that to another part of the service that responds promptly and positively.

“Joint training and working between frontline practitioners from across the services will encourage a whole family approach that sees agencies consult with each other on changes to care, while looking to plan treatment that doesn’t disrupt childcare arrangements,” she says.

Think child, think parent, think family

To meet the needs of families with a parent with a mental health problem, changes are recommended along the entire care pathway:

Screening New systems for routine identification of parents with mental health problems

Assessment Processes to take account of the whole family

Care planning Plans for each family member and the family as a whole that increase resilience, reduce stress factors and respond to risks

Care provisionCommissioning for the full spectrum of needs of parents, children and families

Care review Involve children and carers in reviews of individual and family goals

Strategic approach Multi-agency service review, senior level commitment to policy and practice change, workforce development

FIND OUT MORE

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

www.scie.org.uk/publications/guides/guide30/index.asp

Mersey Care trust

www.merseycare.nhs.uk