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A whole systems approach to supporting parents with mental health difficulties and their children

Keeping the Family in Mind Councillor and Trustees Seminar 7th Feb 2008. A whole systems approach to supporting parents with mental health difficulties and their children. Why is it important to Keep the Family in Mind?.

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A whole systems approach to supporting parents with mental health difficulties and their children

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  1. Keeping the Family in Mind Councillor and Trustees Seminar 7th Feb 2008 A whole systems approach to supporting parents with mental health difficulties and their children

  2. Why is it important to Keep the Family in Mind? • Between 30% and 50% of mental health service users are primary carers of children u18 yrs (Gopfert, Seeman and Webster 2004) • Serious psychiatric disorder is a significant factor in fatal child abuse (National study of SCRs 2003 - 5, Barton 2008) • Mental illness is the biggest indirect cause of maternal deaths • Parental mental illness can have an adverse effect on child mental health and development (Falkov 1998) • “More effort has gone into the damage children suffer as a result of poor parenting than has been put into studying those who overcome the disadvantages of their upbringing” (Booth and Booth 1997)

  3. Impact of Stigma, Social Exclusion, and Discrimination • Parents 1 of the 4 groups most likely to face barriers in accessing MH services & support • The ‘inverse care law’ • Parental competence ‘may be more properly seen as a feature or parent’s social networks rather than as an individual attribute’ (Booth & Booth 1997) • Impossibility of parenting without social networks - “It takes a tribe to raise a child” • Women are afraid to come forward for help, particularly black women. (Darton et al 1994) • 80% black women with children in care referred for MH, compared to 20% of white mothers (Barn 1990) • Impact of poverty and low income • Pressures on parents increase significantly where there are more children

  4. Background to the Liverpool FAMILY Collaborative • National guidance (SCIE/NICE) • Local practice and innovation • Opportunity and resources • Shifts in policy emphasis eg ‘Think Family’ • Imperative based on need • The term ‘what works’ - more helpful to this group when used as a question than a prescription • Discrepancy between policy and strategy (what should happen) and practice (what does happen)

  5. Successful whole systems change Service task should be the focus of learning and change Emphasis on the connectedness of parts Beginning by listening Approaching with humility – from ‘not knowing’ Start with questions Keys to success • Leadership and ownership • Public learning • Valuing difference and diversity • Meeting differently • Follow-through and sticking with it

  6. Stage 1 • To generate a shared understanding of ‘care pathways’ across child and adult service systems for parents with mental health difficulties and their children • Care pathways mean in this case the journey and experiences commonly followed by parents and their children when accessing relevant services

  7. Summary of Findings (1) • Evidence of effective joint-working and collaboration • Many examples of innovative practice • No current strategic plans highlighting the needs of the whole family. • Service deficits - no discrete provision currently commissioned • Little provision for affected families with children under 12 months • Scant local prevalence data • No routine monitoring of need • Existing data suggests prevalence rates in line with national figures • The needs of young carers are well profiled in both adult and children’s plans

  8. Summary Findings (2) • innovative joint assessment and care planning protocols have been developed. • Referral pathways exist, but lack transparency • Language, assessment criteria and information-sharing protocols are main barriers. • Parents and children also reported poor co-ordination between agencies and services • Thresholds for support are based on risk, differing criteria • No ‘family’ threshold • High levels of support and mature partnership working • Strong foundation for future plans to improve provision for local families.

  9. What were the recommendations? • Implementation & dissemination • Commissioning and strategy • Influence new strategy - eg parenting • CAF/CPA pilot • Family thresholds - what would these look like? • Data collection and notification systems • Training and awareness • Identification and recognition • New pathways - eg via provider panels • Implement the National Parental Mental Health guidelines

  10. Using collaboratives to improve systems and services • ‘To achieve better outcomes for children & families by continuing to development family focussed policies, services and systems…..’ • Whole systems • Bottom up & top down • Collaborative is inclusive and permissive, involving practitioners and encouraging initiative: egs include; increase in work between CAMHS & CMHTs; children family support team & AMH support team; identification of cases of shared interest; • Things were happening anyway (Keeping the Family in Mind) …..but the collaborative has knitted it all together..

  11. So what have been some of the changes and outcomes so far? • ownership at SMTs for children’s services and AMHS; • induction training for all staff in MHT; • notifcation system to HVs re U5s; • young carers assessments & training; • protocols between AMHS & local authority re access to universal C & F services (initially for YC s); • family rooms (>7 plus protocols & training re access, usage and monitoring); • resources & booklets re talking to children; the 10 messages; anti-stigma campaign; • CPA leaflets; • audit of CPA; • advanced statements; • audit of ‘shared’ families

  12. The ‘Jelly Baby’ Logo • Kite-Mark illustrating family orientated services • e.g. family rooms, child friendly literature • Logo designed by a young carer

  13. Questions to Councillors and Trustees • What can you do to Keep the Family in Mind? • What support do you need to enable you to do it, and who/what could give it to you?

  14. References & further info from: Clare Mahoney North West Development Centre CSIP clare.mahoney@csip.org.uk 0794 115 6255 Louise Wardale Keeping the Family in Mind,Barnardos Louise.wardale@barnardos.org.uk 0151 708 7323

  15. Web-site addresses • Parental Mental Health and Child Welfare Network - multi-agency, practice development & information-sharing http://www.pmhcwn.org.uk/ • SCIE/NICE systematic review re parental mental health needs http://www.scie.org.uk/work/children/index.asp#jointworking • CSIP Social inclusion and supporting families with mental health difficulties (Action16) http://www.socialinclusion.org.uk/work_areas/index.php?subid=17 • Barnardos http://www.barnardos.org.uk

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