Mental Health Protocol launch, Conwy & Denbighshire LSCB Conference March 2013

1. Supporting Children, Supporting
Parents: A North Wales Multi-
agency Protocol

2. Scope of the protocol
Mental illness/disorder
An adult who following assessment is diagnosed with one
or more of the following:
• Schizophrenia or other enduring or transient psychosis
• Bipolar disorder
• Severe affective disorder
• Severe eating disorder
• Dementia or other related organic state(s)
• Personality disorder
(based on ICD 10 diagnostic categories

3. Substance Misuse
• An adult with problematic substance
misuse who following assessment, is
deemed to have a dependency on one or
more substances

4. Reason for the Protocol
• 1st version ratified by Conwy and Denbighshire
LSCB in December 2008 in response to the
outcome of a serious case review in
Denbighshire
• In November 2006 Child CS and Child AS who
lived in Denbighshire were killed by their father
PS
• PS had a well documented history of mental
illness and received extensive services for a
number of years
• He was described by family and professionals as
a “loving and doting father”

5. SCR (now Child Practice Reviews)
Children Act 2004, Section 32(2)
Where abuse or neglect of a child is known or suspected and:
• A child dies or;
• Sustains a life threatening injury or serious impairment of
health or development, including serious sexual abuse or;
• A child has committed suicide or;
• A child has been killed by a parent with a mental illness
The LSCB for the area must undertake a Serious Case Review

6. SCR (now Child Practice Reviews)
Purpose to:
• Establish whether there are lessons to be learnt about
the way professionals and agencies work together to
safeguard children.
• Establish how lessons will be acted upon and what is
expected to change as a result, and as a consequence,
• Improve inter-agency working and better safeguard
children and;
• Identify examples of good practice

7. Conclusions of the SCR
The children’s deaths were neither predictable nor
preventable and PS did not pose a risk to his
children until just before he killed them
Practice issues
• Very little contact between Adult and Children’s Services
• Adult professionals were clear about child protection
procedures but there was little consideration of the
children’s general needs by professionals working with
the family

8. Practice Issues cont.
• A Protocol for joint working existed but not
generally known about
• The Protocol was flawed in some areas
• Some recording and general practice
issues were identified

9. Recommendations
• Introduce the dimensions of the
Assessment Framework into assessments
by the Community Mental Health Team
• Re-draft the existing North Wales Multi-
Agency Protocol and ensure its use
• Joint training for Adult Mental Health and
Children’s Services
• Strengthen links between the LSCB and
the Adult Mental Health Partnership

10. Purpose of the protocol
• To safeguard and protect children
• To support co-ordinated responses from
Children and Family Services, Mental
Health, Substance Misuse Teams and
Primary Care services
• To facilitate the early identification by adult
services of those children who may be at
risk of harm

11. Purpose of the Protocol (cont)
• To support joint assessments of families where
there are child care concerns and where the
parent has significant problems in relation to
mental illness and/or substance misuse
• To facilitate the consideration of the trans-
generational impact of an adult with a severe
mental illness/substance misuse and any
impediments it may present to parenting ability
and/or the child’s development
• To support effective and well-coordinated
service delivery to these families

12. Additions to the protocol – new
sections
• Making a referral to Children’s Services from
Adult Mental Health/Substance Misuse Services
• Children’s Services response to those referrals
• Children’s Services referrals to Adult Mental
Health/Substance Misuse Services
• Adult Mental Health/Substance Misuse Services
response
• Holistic Assessment Tool for use by Adult
Mental Health and Substance Misuse Services

13. Statistics
• Estimated one third to two thirds of children
whose parents have mental health problems will
experience difficulties themselves (ODPM 2004)
• Of the 175,000 young carers identified in the
2001 census, 29% (50,000) are estimated to
care for a family member with mental health
problems (Dearden &Becker 2004)
• Parental mental health is a significant factor for
children entering the care system. Childcare
SWs estimate that 50-90% of parents on their
caseload have mental health, alcohol or
substance misuse issues (ODPM 2004)

14. Impact of parental mental health on
parenting
Many parents with mental health issues are able to provide good
enough parenting but:
• Links between mental illness and adverse outcomes for children is
well established (Royal College of Psychiatrists 2002)
• Failure to meet a child’s basic needs can have a significant impact
on the child’s health, welfare and development
• Adverse consequences are cumulative, leading to a wide range of
developmental, emotional and behavioural problems
• Stigma around mental illness and fear that children may be taken
away can prevent parents from asking for help
• Children caring for parents and/or other siblings
• Reider and Duncan (1999) reviewed 35 child death cases and found
43% of parents had active mental health issues at the time the child
died

15. Factors affecting parenting capacity
Crisis points where children may be more
vulnerable include:
• Domestic abuse
• Relationship breakdown/changes to family
structure
• Debt
• Failure to comply with medication
• Hostile environment
• Substance misuse

16. Impact of substance misuse on
parenting capacity
• Between 250,000 and 350,000 children of
problem drug users in the UK
• Can cause serious harm to children from
conception to adulthood
• May have mental health issues in tandem
• Impact of poverty, vulnerable to abuse/neglect,
poor socialisation, health/educational needs not
met, exposure to criminal behaviour and children
as young carers
• See ‘Hidden Harm’ (ACMD, 2003) and ‘Hidden
Harm, 3 years on (ACMD, 2007)

17. Case Study
Agencies involved included:
GP, HV, Children’s Services, Adult
Mental health, Children’s Centre,
Housing, Police

18. Case study – lessons learnt
• The challenge of working with parents who are hostile or
difficult to engage – there is a place for professional’s
meetings
• The need to listen to the child
• The importance of thorough multi-agency assessments
• The need to recognise key risk factors – domestic
violence, mental health issues and substance misuse
• Professional confidence to challenge medical
assessments and outcomes
Executive Summary of the Serious Case Review in respect
of Child U (published 28th February 2013 by Manchester
Safeguarding Children Board)

19. Keeping Children Safe
• Know the AWCPP’s and when to use them
• Know this protocol and work to it
• Mental health practitioners – routinely assess
impact of mental health on parenting capacity
• Good communication and joint planning with
Children’s Services
• Contribute to the assessment framework
assessments led by Children’s Services
• Attend CP conferences and meetings to offer
professional assessments of parenting, not as
advocates for the parents

20. What next in Conwy and
Denbighshire?
How do we improve working together?
• Creating understanding
• Being responsive
• Being more flexible
• Improving communication and information sharing
• Being visible and available
• Removing suspicion and developing trust
• Multi-agency consultation and holistic assessments
• Developing true partnerships

21. Questions?