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 1 st 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 28 th 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?