PROFESSOR COLETTE MCAULEY CHAIR OF SOCIAL WORK UNIVERSITY OF BRADFORD

Professor Colette McAuley
Chair of Social Work University of Bradford

        Praxis All Ireland Conference Dundalk
                     27 March 2015

   Parental mental illness-prevalence
   Parental mental illness, parenting capacity
    and child abuse/neglect
   Factors associated with better child outcomes
   The impact of parental mental illness on
    children’s development
   Inter-agency and interdisciplinary
    collaboration and the challenges
   What children and young people want from
    services

It is estimated that
 between 30-68% adults with a mental illness in the UK have
   dependent children
 there are between 50,000 to 200,000 children and young
   people in the UK caring for a parent with a severe mental
   illness (Mental Health Foundation 2010)
Moreover
 many studies report the rates of mental illness for mothers
   only
 there is much less evidence regarding fathers and male carers
 hence prevalence amongst parents generally is likely to be
   underestimated; there is little knowledge about the impact of
   fathers’ mental health on child development; the number of
   children living with both parents with mental illness is likely
   to be greater

   Mental health difficulties can impact on a person’s
    daily functioning in a number of different ways
   In some cases, it can influence a person’s ability to
    parent their child
   Some (but not all) parents may need support to meet
    their child’s needs
   In extreme cases, it can contribute to a parent
    abusing/neglecting their child or putting their
    children in a situation where they are abused by
    someone else
   The majority of parents who experience mental
    illness do not neglect or harm their children simply as
    a consequence of the disorder

   Children are more vulnerable to abuse and
    neglect when parental mental illness coexists
    with other problems such as substance misuse,
    domestic violence or childhood abuse
   The impact of parental problems such as mental
    illness, substance misuse, domestic violence and
    learning disability on children’s welfare has been
    repeatedly highlighted in English child protection
    research studies (DH 1995) and Serious Case
    Reviews (Rose and Barnes 2008; Brandon et al
    2009; 2010; 2012)
   This is consistent with findings from Ireland, the
    US and Australia.

   The issue of co-occurrence and its
    association with child abuse/neglect has been
    particularly highlighted in more recent
    research from both the UK and Australia
   The impact of such parental problems on
    children’s development has become a core
    element of SW training in the UK and beyond
   Understanding of child development itself
    been been highlighted in Serious Case
    Reviews as a key area for improvement in
    professional training

We have considerable research evidence on the factors
which are associated with better child outcomes:
Parent/family factors
 when the parental mental health difficulty is mild in
  nature and short in duration
 parents are more aware of the mental health difficulty
  and more willing to seek support/treatment
 there is a secure and reliable family base
 they are living in a two parent family
Worse outcomes are associated with living in one-
parent families or when both parents are dealing with
mental health difficulties

Child factors
 children are older at onset
 children have strong coping strategies and
  are able to adapt to stress
 children who develop an understanding of
  their parent’s mental health difficulties as
  something outside their representation of the
  parent as an attachment figure

Societal factors
 Availability of other support/attachment
  figures
 Higher socio-economic status
 Having access to preventative services eg
  after school care, child and adolescent
  services and preventative programmes

   Likely to be multiple risk and protective factors
    influencing whether a child is at risk
   An accumulation of risk factors can produce a
    negative outcome
   Children are at greater risk if their parent has a
    mental health difficulty in conjunction with low
    socio-economic status, a substance abuse
    problem, domestic violence and/or intellectual
    disability
   Whilst not every child living with these family
    problems is at risk, practitioners need to be
    aware of the different factors and their interplay
    and consider carefully when undertaking an
    assessment of needs

   Recent research has collated what we know
    about the child’s needs at different
    developmental stages
   Alongside this, they have considered the
    impact of parental behaviours such as
    parental mental illness on their capacity to
    meet the child’s needs at each stage
   Any assessment would also consider the
    wider family and environmental context
   Some examples:

Parents may be less attentive to the
baby’s health needs and unable to
complete basic care or keep routine
          health checks

 The baby’s cognitive development may
be affected because interaction between
      mother and baby is reduced

   A consistent lack of warmth and
negative responses may result in the
  infant/child becoming insecurely
               attached

 The relationship between parents
 and babies may be affected if the
parents’ behaviour is inconsistent or
  they are emotionally unavailable

Children may have an increased risk
 of heath problems due to missed
          school medicals
Children may not attend school or on
 time or schooling may be disrupted
      due to unplanned moves
 Children may have a more negative
 self-image and/or suffer from low
            self-esteem
 Children may be fearful and anxious
   about their parents’ behaviour
and/or display behavioural problems
Inconsistent and unexpected parental
  behaviour may cause attachment
              problems.
Children may be expected to assume
     too much responsibility for
       themselves and siblings

Adolescents may have to cope with
     puberty without support

  Parents may be unable to attend
school events or encourage learning
              at home

Adolescents may exhibit behaviour
     problems and emotional
          disturbances

Adolescents may feel responsible for
 their parent’s difficulties and suffer
           low self-esteem

Young people’s friendships may be
  restricted due to their parents’
       unreliable behaviour.

 In general terms, following assessment the aim is
  to provide effective interventions to support
  children and their families
 The level of support/intervention will vary with
  the level of need and risk
 Range of interventions where there is concern
  about risk of maltreatment-parent-focused,
  parent and child-focused and family-focused
 Child-focused interventions to mitigate
  impairment
Further reading:
McAuley et al (2006; forthcoming) and Ward and
Davies (2012)

  Importance of collaboration between adult mental
   health services and child protection services to
   provide effective services when the parent’s mental
   health is affecting the child’s development
 Likely to lead to improved quality and continuity of
   care, better access to services, reduced stress for
   workers and cost-savings for organisations
 Barriers highlighted include-
1.   the way services are organised-often in separate
     management and organisational structures
2.   lack of clarity in professional roles/expectations
3.   Inadequate information/knowledge
4.   Issues around effective communication

   the complexity and unpredictability inherent
    in mental illness
   issues around confidentiality
   balancing the needs of the child/ren and
    those of the parent(s)
   variation in procedures, policies, guidelines
    and structures across agencies

Positive developments reported through:
 creating multidisciplinary teams
 embedding specialist practitioners in other services
 establishing ‘champions’ within teams to provide information,
  promote collaboration and identify obstacles
 offering interdisciplinary training especially at post-qualifying
  level
 providing inter-agency training -highly valued and effective in
  terms of impact and cost

However, developing such collaborations takes time and the
building of trust
 proposals to change delivery arrangements or cut budgets could
  unintentionally undermine valuable progress
 important to consider the impact of changes on
  developing/established collaborations

   children may have very close relationships with parents,
    have a great sense of love and loyalty to them, even when
    they are abusive or neglectful
   often torn between feeling love and loyalty and feeling
    hurt, angry, embarrassed or resentful
   children often have a much greater awareness of the
    problems than parents realise
   they worry particularly when they fear for their parents’
    safety e.g. are at risk of self-harm
   children’s sadness and isolation can be perpetuated by the
    stigma and secrecy that surrounds parental mental illness
   in some cases, children may feel depressed or experience
    bullying or need protection due to neglect or abuse.
        Source: Gorin, S. (2004) Understanding What Children Say. London: NCB.

I’m frightened to leave her in case she goes into a fit or something.
When we were little…she got really down and started taking
overdoses and that really scared us…When she’s really down she
says ‘I’m going to take an overdose’…I’m frightened to leave her.
               Newton and Becker 1996:25

It’s not just the caring that affects you…in fact we’re a very close
family and we all pull together. What really gets you is the worry of
it all, having a parent who is ill and seeing them in such a state…
               Frank 1995:42

They (local youths) used to bully, they used to bully us. Well, they
used to bully me. And hit, and punch me and everything…well, like
(they would say) ‘you look after your mum and dad, ha ha’, all that.
And they would go ‘At least I haven’t got a mental dad’ or
something.
               Aldridge and Becker 2003:81

   Some children will find it very hard to talk to
    anyone about their problems
   Reasons-fear of the consequences of telling,
    fear of not being believed, not feeling anyone
    could help, sense of shame and stigma
   They want someone they can trust, who will
    listen, provide reassurance and confidentiality
   They will seek informal support as main
    means of accessing help-wider family,
    siblings, friends or pets

   Children do not always know where to go for
    help-advertise where young people gather
   Often favour contacting helplines initially to
    obtain control, remain anonymous and are
    available outside office hours when crises
    may occur-ensure information provided on
    wider support available

They appreciate professionals who:
 avoid jargon
 listen or talk directly to them
 ask them for their views
 provide age-appropriate information (verbal
  and written) which explains what is going on
  in their family
Often they want:
 some time from problems in home and
 chance to get to know other children in
  similar situations

Aldgate, J. et al (2006) The Developing World of the Child. London:
Jessica Kingsley Publishers.
Brandon et al (2012) New Lessons from Serious Case Reviews: A Two
Year Report for 2009-2011. London: Department for Education.
Bromfield, L., Lamont, A., Parker, R., & Horsfall, B. (2010). Parenting
and child abuse & neglect in families with multiple and complex
problems. Child Abuse Prevention Issues, 33
Cleaver, H. et al (2011) Children’s Needs-Parenting Capacity. Child
Abuse: Parental Mental Illness, Learning Disability, Substance Misuse
and Domestic Violence. Second Edition. London: The Stationery Office
Davies, C. and Ward,H. (2012) Safeguarding Children Across Services:
Messages from Research. London: Jessica Kingsley Publishers.
DH (1995) Child Protection: Messages From Research. London: HMSO.
.

Department of Health, Department for Education and
Employment and Home Office (2000) Framework for the
Assessment of Children in Need and their Families. London:
The Stationery Office.
Gorin, S. Understanding What Children Say: Children’s
Experiences of Domestic Violence, Parental Substance
Misuse and Parental Health Problems. London: National
Children’s Bureau.
McAuley, C. et al (2006) Enhancing the Well-Being of
Children Through Effective Interventions: International
Evidence for Practice. London: Jessica Kingsley Publishers.
McAuley, C. et al (forthcoming) A Review of International
Literature on Child Protection. Dublin: Irish Research
Council/Department of Children and Youth Affairs
Rose and Barnes (2008) Improving Safeguarding Practice.
London: DCSF.