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1. Introduction

This practice guidance aims to assist all agencies working with children; adults who are parents/carers or with pregnant women and their partners in identifying situations where action is needed to safeguard a child or promote their welfare as a result of an adult’s mental ill health.

The mental health of a parent or carer does not necessarily have an adverse impact on a child, but it is essential to assess the implications for the child. Just as there is a range in severity of illness, there is also a range of potential impact on families. The majority of parents with a history of mental ill health present no risk to their children, however even in cases of low-level concerns; the needs of the children should be paramount.

It is important to recognise other issues that can exacerbate the risk presented by mental health issues. For example; the presence of drug or alcohol dependency and domestic abuse in addition to mental health problems with little or no family or community support would indicate an increased likelihood of risk of harm to the child, and to the parents’ mental health and wellbeing. Relying on a diagnosis is not sufficient to assess levels of risk. This requires an assessment of every individual’s level of impairment and the impact on the family.

It is essential that the diagnosis of a parent/carer’s mental health is not seen as defining the level of risk. Similarly, the absence of a diagnosis does not equate to there being little or no risk. An assessment should consider the impact on the child of behaviour and support services.

2. Key Definitions

‘Parent’ may refer to biological and non-biological parents or carers including grandparents, pregnant women and their partners and any adult who has regular responsibility for the care of a child or young person (this may not necessarily mean that the adult in this context has Parental Responsibility in legal terms).

The term “mental ill health” is used to cover a wide range of conditions, from eating disorders, mild depression and anxiety to psychotic illnesses such as schizophrenia or bipolar disorder.

Information about some of the most common conditions can be accessed here:

https://www.mind.org.uk/information-support/types-of-mental-health-problems

https://www.rcpsych.ac.uk/mental-health/problems-disorders

3. Responding to Concerns

The most effective response to children and families affected by mental ill health comes through all agencies adopting a holistic whole family approach. This is based on coordinating the support provided by adult and children’s services to a single family “at risk” in order to secure better outcomes for the children and adults through the use of targeted, specialised and whole family approaches to addressing family needs.

3.1 Fundamental to this approach is good inter-agency practice characterised by:

  • Routine enquiry
  • Robust inter-agency communication and information sharing
  • Joint assessment of need
  • Joint planning; and action in partnership with the family
  • Early Help Assessment (EHA) processes should support this and, where necessary, Child in Need and Child Protection Assessment and planning processes

In any situation where there is a perceived conflict between the interests of the adult and those of the child, all agencies must treat the child’s needs and safety as paramount.

3.2 Most children with additional needs due to an adult’s mental ill health are considered under the EHA processes and without the intervention of Children’s Social Care.

https://www.peterborough.gov.uk/healthcare/professionals-area/early-help/the-early-help-approach-in-peterborough/

https://www.cambridgeshire.gov.uk/residents/children-and-families/parenting-and-family-support/providing-children-and-family-services-how-we-work/

However, all agencies must be alert to the potential risks to children of parental mental ill health and must consider its impact on the safety and well being of the children and the need for specialist assessment, consulting other agencies as necessary.

If any agency has concerns that a child is at risk of harm because of the impact of the parent/carer’s mental health they should check to see if the child is subject to a Child Protection Plan.

3.3 The Children Effective Support for Children and Families in Peterborough and Cambridgeshire (Thresholds) Document Nov 2018 should be used to assess the level of support or need for specialist referral on a case to case basis.

Full details about Early Help and access to Social Care, including processes and contact details are contained within this.

If an EHA is required, professionals should seek the parent’s/carer’s consent and follow the EHA process.

Professionals should follow their own agency’s safeguarding procedures. They should consult their line manager or agency safeguarding lead if they are uncertain about the need to refer to Children’s Social Care.

Throughout their involvement with the adult and children, professionals must continually review the impact of mental ill health on parenting capacity and the safety and well being of the children.

4. Children are at greatest risk when:

  • The child features within parental delusions.
  • The child becomes the focus of the parent’s aggression.

In these circumstances the child should be considered at immediate risk of harm and a referral made to Children’s Social Care Services in accordance with the Referrals Procedure.

If you have a concern regarding a child or young person and would like to discuss it further, you should consult the Safeguarding Lead or a Safeguarding Professional within your organisation.

If at any time you have reasonable concern that a child or young person has suffered significant harm or may be at immediate risk of suffering significant harm, please contact children’s social care:

Cambridgeshire

Telephone 0345 045 5203

Peterborough

(01733) 864180

Emergency Duty Team

(01733) 234724

 

or contact the Police if you feel the child is at imminent risk.

You should then complete this form to confirm your referral within 24 hours of your telephone call.

Safeguarding-Children-Referral-Form

4.1 Where it is believed that a child of a parent with mental health problems may be suffering or likely to suffer Significant Harm; a Strategy Discussion/Meeting should be held and consideration should be given to undertaking a Section 47 Enquiry.

4.2 In circumstances whereby a parent/carer has mental health problems it is likely there will be a number of professionals involved from different services. It is important that these professionals work together within enquiries and assessments to identify any links between the parent’s mental health, their parenting, and the impact on the child. Any assessment should include an understanding of the needs of the family and children and an identification of the services required to meet these needs (see appendices for contact details within organisations).

5. Implications of Parent/Carer Mental Health Difficulty

Any professional undertaking an assessment needs to consider the following questions to determine how a parent/carer’s mental problem may impact on their parenting ability and the child’s development:

  • Is there a child or young person living in or visiting the household regularly? If so, does the child/young person take on roles and responsibilities within the home that provide physical or emotional care or support that is inappropriate, excessive or harmful to their health, education or overall development?
  • Does the parent/carer neglect their own and their child’s physical and emotional needs?
  • Does the mental health problem result in chaotic structures within the home with regard to meal and bedtimes, etc?
  • Does the parent/carer’s mental health have implications for the child within school and attending health appointments etc?
  • Is there a lack of the recognition of safety for the child?
  • Does the parent/carer have an appropriate understanding of their mental health problem and its impact on their parenting capacity and on their child?
  • Are there repeated incidents of hospitalisation for the parent/carer or other occasions of separation from the child?
  • Does the parent/carer misuse alcohol or other substances?
  • Does the parent/carer feel the child is responsible in some way for their mental health problem?
  • Is the child included within any delusions of the parent/carer?
  • Does the parent/carer’s mental health problem result in them rejecting or being unavailable to the child?
  • Does the child witness acts of violence or is the child subject to violence?
  • Does the wider family understand the mental health problem of the parent/carer, and the impact of this on the parent/carer’s ability to meet the child’s needs?
  • Is the wider family able and willing to support the parent so that the child’s needs are met, and inappropriate, excessive or harmful caring activities are prevented or removed?
  • Does culture, ethnicity, religion or any other factor relating to the family have implications on their understanding of mental health problems and the potential impact on the child?
  • How the family functions, including conflict, potential family break up etc.

6. Guidelines for Joint Working

6.1 Adult mental health services are provided by CPFT. In office hours you can seek advice from a central source (CPFT safeguarding duty team 01733 777961 CPFT Safeguarding Children (NHSMail) CPM-tr.cpftsafeguardingchildren@nhs.net).  Out of hours, please contact CPFT First Response service (FRS). Professional line is 01480 442007

6.2 Adult mental health services – including those providing general adult and community, forensic, psychotherapy, alcohol and substance misuse and learning disability services – have a responsibility in safeguarding children when they become aware of, or identify, a child suffering or likely to suffer Significant Harm.

This may be as a result of a service’s direct work with those who may be mentally ill, a parent, a parent-to-be, or a non-related abuser or in response to a request for the assessment of an adult perceived to represent a potential or actual risk to a child or young person. Adult mental health staff need to be especially aware of the risk of neglect, emotional abuse and domestic abuse to children. Staff should be able to consider the needs of any child in the family of their patient or client and to refer to other services or support for the family as necessary and appropriate, in line with local child protection procedures. Consultation, supervision and training resources should be available and accessible in each service.

In order to safeguard children of patients, mental health practitioners should routinely record details of patients’ responsibilities in relation to children, and consider the support needs of patients who are parents and of their children, in all aspects of their work, using the Care Programme Approach. In CPFT the use of alerts and completed ‘Keeping Children safe Tool’ is promoted in all service users.

6.3 Mental health practitioners should refer to Royal College of Psychiatrists policy documents, including:

Parents as patients – supporting the needs of patients who are parents and their children

Social Care Institute for Excellence Guide 30 Think child, think parent, think family: a guide to parental mental health and child welfare

The Royal College of Psychiatrists  has also  written guidance around ‘Parental mental illness: the impact on children and adolescents: for parents and carers, 2017’ https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/parental-mental-illness-the-impact-on-children-and-adolescents-for-parents-and-carers

6.4 Close collaboration and liaison between adult mental health services and children’s social care services are essential in the interests of children. It is similarly important that adult mental health services liaise with other health providers, such as health visitors and general practitioners.

This may need to start before the birth of the child e.g. where there are concerns around parental mental health and potential impacts on unborn child http://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/pre-birth_assessment/

This may require sharing information to safeguard and promote the welfare of children or to protect a child from Significant Harm. The expertise of substance misuse services and learning disability services may also be required. The assessment of parents with significant learning difficulties, a disability, or sensory and communication difficulties, may require the expertise of a specialist psychiatrist or clinical psychologist from a learning disability service or adult mental health service.

6.5 Joint work will include mental health workers providing all information concerning:

  • Treatment plans.
  • Likely duration of any mental health problem.
  • Effects of any mental health problem and medication on the carer’s general functioning and parenting ability.

6.6 Child protection workers must assess the individual needs of each child and within this incorporate information provided by mental health workers. Within Peterborough this is promoted further by the Family Safeguarding model; this will be further implemented across Cambridgeshire.

6.7 Mental health professionals must attend / provide information to any meeting concerning the implications of the parent/carer’s mental health difficulty on the child. These will include:

  • Strategy Meetings.
  • Initial and Review Child Protection Conferences.
  • Core Groups.

If there are difficulties obtaining mental health involvement please contact CPFT safeguarding duty team 01733 777961 CPFT Safeguarding Children (NHSMail) CPM-tr.cpftsafeguardingchildren@nhs.net  .

6.8 All plans for a child including Child Protection Plans will identify the roles and responsibilities of mental health and other professionals. The plan will also identify the process of communication and liaison between professionals. All professionals should work in accordance with their own agency procedures / guidelines and seek advice and guidance from line management when necessary.

6.9 Effective working together depends on an open approach and honest relationships between agencies. Problem solving and resolution is an integral part of professional co-operation and joint working to safeguard children and young people. Where there are difficulties please access http://www.safeguardingpeterborough.org.uk/childrenboard/professionals/procedures/escalation_policy/

7. Contingency Planning

7.1 Childcare and mental health professionals should always consider the future management of a change in circumstances for a parent/carer and the child and how concerns will be identified and communicated. This may include:

  • Relapse in the parent/carer’s mental health.
  • Failure to maintain medication.
  • Change in family dynamics/relationships.

7.2 Professionals need to carefully consider the implications for children when closing their involvement with parents with a mental health problem. Consideration should be given to informing the appropriate Children’s Social Care Services team in order that the implications for the child are assessed.

7.3 In cases of significant risk, professionals can request a multi agency risk management meeting. Please contact the named nurse via CPFT safeguarding duty team 01733 777961 CPFT Safeguarding Children (NHSMail) CPM-tr.cpftsafeguardingchildren@nhs.net

8. Learning lessons nationally from Serious Case Reviews

https://learning.nspcc.org.uk/research-resources/learning-from-case-reviews/parents-mental-health-problem/   

https://learning.nspcc.org.uk/children-and-families-at-risk/parental-mental-health-problems/

Young Carers Support

A young carer is a young person, under the age of 18, who has a caring responsibility. This is usually for a family member who has a disability, long-term illness, mental illness (including depression, anxieties) or drug/alcohol substance misuse. https://cambridgeshirecin.proceduresonline.com/chapters/p_young_carers.html

Support can be accessed via:

Background information about Diagnosis and Treatments

Mental health diagnosis can not be seen in isolation. We must see the parent who has mental health needs in a holistic way.

However, some practitioners have indicated that they would like more information. The following sites provide reputable information.

Drugs and treatments

https://www.mind.org.uk/information-support/drugs-and-treatments/ 

https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing

Appendix 1  

Key Contacts within Cambridge and Peterborough Partnership

1. Early Help pathways.

Peterborough Early Help Team for advice on how to proceed email earlyhelp@peterborough.gov.uk  or Telephone 01733 863649

Cambridgeshire-  email early.helphub@cambridgeshire.gov.uk  or Telephone on 01480 376 6661

2. Children Social Care Assessment

If there is reasonable concern that a child or young person has suffered significant harm or may be at immediate risk of suffering significant harm contact:

Cambridgeshire Peterborough Emergency Duty Team
0345 045 5203 (01733) 864180 (01733) 234724

or contact the Police if you feel the child is at imminent risk.

Follow all telephone referrals in writing within 24 hours email to ReferralCentre.Children@cambridgeshire.gov.uk

3. Mental Health Professional Concerns

  • Urgent mental health advice/assessment needed contact: professional line 01480 442007 (111 option 2 for patients) 24 hours a day 365 days a year.
  • Non urgent professional enquiries with mental health services, call care co-ordinator for patient if known.
  • Otherwise call CPFT safeguarding team 01733 777961 CPFT Safeguarding Children (NHSMail) CPM-tr.cpftsafeguardingchildren@nhs.net or First Response Service  NHS 111 Option 2
    Telephone:  01480 442 007 (professionals line) firstresponseservice.frs@cpft.nhs.uk  (team email)

 4. Other useful CPFT mental health numbers are :-

5. Police contacts

contact numbers 101 (Integrated Mental Health Team). 0700-20.00hrs

Police Multi-agency Safeguarding Hub 01480 847743

Out of hours contact 01733 234724.

6. Unborn baby pathway

Pre-Birth Protocol http://www.safeguardingcambspeterborough.org.uk/childrenboard/professionals/procedures/pre-birth_assessment/

7. Perinatal mothers presenting with psychosis assess via perinatal team

 Telephone: 0800 952 0060 (Mon to Fri, 9am-5pm) or PerinatalReferrals@cpft.nhs.uk

8. City & South Cambridgeshire Learning Disability Partnership

Comberton Road, Cambridge CB23 2RY Telephone: 01223 743747

9. Mental Health Act assessments /Approved Mental Health Professional office

Telephone: 0345 245 0067

Cambridge Adult Mental Health Team Telephone: 01223 341500

10. Midwifery specialist Named Midwives

Peterborough and Hunts

Karen Hedger: Named Midwife for Safeguarding, Peterborough City Hospital.

Telephone: 01733 673775 / 07802656033 Email: khedger@nhs.net

 Cambridgeshire

Jo Bellamy (Mon-Tuesday) Toni Van Vorst (Wed-Friday)
Tel: 01223 348988 Ext:348988

Email joanna.bellamy@addenbrookes.nhs.uk or secure email for confidential information joanna.bellamy@nhs.net

Tel : 01223 256932  Mobile: 07740753920 Email toni.vanvoorst@addenbrookes.nhs.uk or secure email for confidential information: toni.vanvoorst@nhs.net

11. Out Of Hours Mental Capacity assessments via First Response Service

Tel:  01480 442 007 (Professionals line)

Email: firstresponseservice.frs@cpft.nhs.uk

12. Adult Mental Health Teams see contacts below appendix 2

Appendix  2  CPFT Adult mental health services

Click on blue coloured hyperlink for service details

The pathways that CPFT provides are listed below. For more information on the teams that deliver these pathways please click on the links on the left-hand side of the page.

Pathway Disorder Treatments available Teams supporting the pathway
Affective Disorders
  • Bipolar affective disorder
  • Depression
  • Anxiety
  • Obsessive compulsive disorder
  • Post-traumatic stress disorder
  • Assessment and initial treatment advice
  • Care plan developed with service user
  • Pharmacological interventions and medication management
  • Psychological therapies, mainly CBT, aimed at the specific disorder
  • Support for carers and families
  • Regular care plan reviews
  • Information and support with employment and activities of daily living
  • Advice on health and wellbeing
  • Crisis planning
  • Relapse plan
Community teams:

Early intervention (CAMEO) pathway
  • Psychosis
  • Help, advice, support and signposting
  • Focused specialist interventions including:
  • Cognitive behavioural therapy
  • Relapse prevention
  • Low-dose medication
  • Recovery formulation
  • Help to get back to work, college or develop social life
  • Family work
  • Support groups
  • Structured measures of symptoms and functioning
  • Two-year follow-up – continuous clinical assessment
Community team:

Psychosis
  • Schizophrenia
  • Schizo-affective disorder
  • Psychotic illness
  • Dual diagnosis/psychotic illness
  • Dual diagnosis where psychotic illness is the primary condition
  • Bipolar affective disorder with psychosis
  • Delusional disorder
  • Bipolar affective disorder with psychosis
  • Psychotic depression
  • Assessment and initial treatment advice
  • Care plan developed with service user
  • Pharmacological interventions and medication management
  • Psychological therapies, mainly CBT, aimed at the specific disorder
  • Support for carers and families
  • Behavioural family therapy
  • Regular care plan reviews
  • Information and support with employment and activities of daily living
  • Advice on health and wellbeing
  • Crisis planning
  • Relapse plan
Community teams:

Acute and psychiatric intensive care pathway including crisis resolution and home treatment
  • Adults with severe mental illness/disorder experiencing an acute episode or in crisis.
  • Multi-disciplinary
  • Medical/physical assessment
  • Medication
  • Person-centred approach
  • Ward-based programme of therapeutic activities
  • Psychosocial interventions
  • Aid to daily living support
  • Discharge planning
  • Home treatment and home visits in line with care plans.
Community teams:


In-patient units:

Personality disorders pathway
  • Personality disorder
  • Assessment and treatment advice
  • Help, advice, support and signposting
  • Risk assessment, formulation and management
  • Care plan developed with service user
  • Daily crisis support
  • Medication review and management
  • Psychoeducation
  • Time-limited specialist interventions including:
  • Metallisation-based group therapy
  • MOHO-based goal setting group
  • DBT-based interventions for emotion regulation and distress tolerance
  • Relapse planning
Community team:

Eating disorders
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge-eating disorder
  • Eating disorder not otherwise specified
  • Psychological/psychiatric
  • Medical assessment
  • Nutritional rehabilitation
  • Range of psychological therapies
  • Family counselling
  • Family workshops/couples’ work
  • Carers’ assessment
  • Community psychological therapy programme
  • Carers’ support group
Community teams:


In-patient unit:

The page was last updated on 31 October 2018 by agrosbois.

Appendix 3 Understanding CPFT Front Door Services

1. First Response Service (emergency Front door)

What to do in a mental health crisis https://www.cpft.nhs.uk/about-us/help-in-a-crisis.htm

Call 111 and press option 2 for the First Response Service – a 24-hour service for people in a mental health crisis. This service is for anyone, of any age, who is registered with a GP in Cambridgeshire or Peterborough. Specially-trained mental health staff will speak to you and discuss with you your mental health care needs – instead of you having to go to accident and emergency departments of local acute hospitals.

Professionals number 01480 442007

If living in Wisbech please call 111, select option 1 and then ask the call handler to put you through the First Response Service.

Signs you might be in crisis if:

  • You are thinking of hurting yourself or suicide seems the only option
  • Someone you know has made threats to hurt you or someone else.
  • You are experiencing extreme distress that seems overwhelming.

2. Front Door (non-urgent) Between 9am-5pm, Monday–Friday

  1. CPFT Care Co-ordinator: If you are already receiving support from CPFT services, the first point of contact should be your care co-ordinator or named nurse. Your care plan will contain information on how to contact them. If they are not available, ask to speak to the clinician on duty. Professionals who are unsure what service is used can contact CPFT safeguarding team 01733 777961 or FRS 01480 442007. (out of office hours)
  2. Your GP: If you need immediate help, then please contact your GP.
  3. The Primary Care Mental Health Service promotes early assessment, treatment and/or onward referral in the community. It supports patients to focus on achievable goals and access local community resources.
    The service promotes a patient-centred joint approach to physical and mental health, and support patients to step down from specialist mental health services. Patients’ social care needs are also considered as part of this integrated approach.
    The Primary Care Mental Health Service is for anyone aged between 17-65 years with mental ill health and is based on a person’s needs rather than their diagnosis. Based on need, they may be referred on to different health services, such as specialist mental health services, including the First Response Service.
    The patient sees their GP and a decision is made as to which service would be appropriate for the patient – this could be a referral to the Primary Care Mental Health Service team. Once referred, service staff will contact the patient / service user and either provide telephone advice and signposting or offer a face-to-face assessment.
    Patients will meet Primary Care Mental Health Service staff in their local GP surgery,
    If you would like further information, please contact 01733 748777 or cpm-tr.prismservice@nhs.net.
  4. For parents under 17 years front door to mental health services is via: Single Point of Access, Community CAMH Team; Newtown Centre, Nursery Road, Huntingdon PE29 3RJ. Single Point of Access – CAMHS Telephone: 01480 428115 Fax: 01480 428149. email address:  accesscamhs@nhs.net
  5. For professional advice which about which service is working with a patient or if you feel mental health services would benefit from working more closely with other professionals: Call CPFT safeguarding duty team 01733 777961 CPFT Safeguarding Children (NHSMail) CPM-tr.cpftsafeguardingchildren@nhs.net.

Appendix 4  – Links to other related Local guidance and policy

Cambridgeshire and Peterborough Information Sharing Agreement https://www.cambridgeshire.gov.uk/asset-library/imported-assets/CandP%20ISF%20V2.5%20July%202019.pdf

Pre-Birth Protocol http://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/pre-birth_assessment/

Domestic Violence and Abuse Procedure https://cambridgeshirecin.proceduresonline.com/chapters/p_dom_viol_abuse.html

https://www.safeguardingcambspeterborough.org.uk/children-board/professionals/domestic-violence-and-abuse/

Childrens Social Care Assessment process http://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/child-and-family-assessment/

http://www.safeguardingcambspeterborough.org.uk/wp-content/uploads/2018/03/child-and-family-single-assessment-framework-Cambs.pdf

Working with Uncooperative or Hostile Parents http://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/noncompliant/

Children of Parents who Misuse Substances Procedure http://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/children-of-parents-who-misuse-substances/

Children Visiting Psychiatric Wards and Special Hospitals http://www.safeguardingcambspeterborough.org.uk/children-board/professionals/procedures/children-visiting-psychiatric-wards-and-special-hospitals/

Police and mental health  https://www.app.college.police.uk/app-content/mental-health/

Multi-Agency Parenting Skills Assessment http://www.safeguardingcambspeterborough.org.uk/wp-content/uploads/2018/03/mapsa.pdf 

 

 

Appendix 5

What does research tell us about the needs and experiences of families, in contact with social care, where at least one parent has learning disabilities?

Almost all the information we have about parents with learning disabilities concerns those who are in contact with social care, and it mostly concerns mothers. We know very little about the needs and experiences of families where at least one parent has learning disabilities but who are not in contact with social care; and we currently know very little about the experiences of fathers with learning disabilities, although research is now being undertaken in this area.

Estimates of the total number of parents with learning disabilities in the United Kingdom vary widely, from 23,000 to 250,000. What is clear, however, is that there are increasing numbers of parents with learning disabilities in contact with services. Over the last decade or so, clinical psychologists have reported an increase in requests for assessments, and community learning disability teams have seen an increase in the number of parents with learning disabilities on their caseloads. Most children and family teams have at least one family affected by parental learning disability on their caseloads (Booth and Booth, 2005).

There are also varying estimates of the proportion of parents whose children are removed from their care. It would appear, from a national survey of people with learning disabilities, that about 40% of parents are not living with their children. They are more likely to be living with their children if they are living with other relatives (particularly in the case of mothers), and fathers are more likely to be living with their children than mothers. Six out of ten mothers, who live either on their own or with a partner, are not living with their children aged under 18.

In one local authority area, about a sixth of family court care proceedings concerned children with at least one parent who has learning disabilities and in about 75% of cases children were permanently removed from their family (Booth et al, 2005).

However, analysis of case files across 10 local authority areas found that in less than a fifth of cases involving parents with learning disabilities where their children were removed, most were fostered rather than adopted, and there ‘was no evidence to suggest that parental learning disability in itself was the reason children were removed’ (Cleaver and Nicholson, 2007).

There is anecdotal evidence of local variations in social care practice and court decisions.

Most parents with learning disabilities in contact with social care experience a range of difficulties. Parents with learning disabilities, who are in contact with social care often experience poverty, unemployment, poor housing, difficult neighbourhoods and lack of information (Social Care Institute for Excellence, 2005). While these are factors experienced by most families in contact with children’s social care; parents with learning disabilities have particularly high levels of need, often experiencing severe poverty and inadequate housing (Cleaver and Nicholson, 2007).

Moreover, the lack of information experienced by poor families generally is compounded for parents with learning disabilities by the inaccessibility of most forms of information. Research on parenting support generally, finds that it is very difficult for stressed families to benefit from such support when they face disadvantages such as poverty, poor health and difficult housing situations (Moran et al, 2004). Social care services, therefore, often need to work with other agencies to attempt to, for example, improve a family’s housing situation.

Families affected by parental learning disability are also particularly likely to experience negative attitudes from those with whom they come into contact. For example, small scale studies (e.g. Cooke 2005) and messages from parents with learning disabilities themselves (e.g. CHANGE 2005) indicate that harassment and bullying, and sometimes violence and financial or sexual exploitation can be a major problem for parents with learning disabilities and their children.

Most parents with learning disabilities who receive core assessments from children’s social care also experience other difficulties such as ‘poor mental and physical health, domestic violence, growing up in care, or substance misuse’ (Cleaver and Nicholson, 2007).

Parents with learning disabilities may also have low self-esteem and lack confidence, primarily because of previous experiences of discrimination, abuse and segregation. People with learning disabilities are more likely to have experienced physical, emotional or sexual abuse as children and young adults and will carry the legacies of these experiences into their own parenting experiences.

Some professionals have raised concerns that parents with learning disabilities experience undiagnosed mental health problems including: post-natal depression and argued that it is important to diagnose and respond to such needs (Cotson et al, 2001)

Professionals consulted for this guidance raised their concerns that physical health problems experienced by parents with learning disabilities are also sometimes undiagnosed.

The presence or absence of social support would seem to be more important than the presence or absence of learning disability in terms of the implications for parenting capacity. Social support and stress are negatively correlated amongst mothers with learning disabilities ‘suggesting that the former may buffer the adverse effects of the latter’ (Feldman et al, 2002).

The larger more recent and more helpful the support network reported by mothers with learning disabilities; the better their psychological wellbeing and the greater likelihood of positive parenting experiences (Kroese, et al, 2002).

Learning disability may also mean that a parent has some specific support needs relating to their impairment.

There is no clear relationship between IQ and parenting, unless it is less than 60 (McGaw and Newman, 2005). Although IQ is not a good indicator of parenting capacity, cognitive impairment may mean that a parent has difficulty with reading and writing, remembering and understanding, decision-making and problem-solving, and this will create particular support needs for parenting. Indeed, most parents with these difficulties recognise that they need practical support and help with learning about childcare (Tarleton et al, 2006). Parents who came to a National Gathering of parents with learning disabilities emphasised, for example, that they need information in accessible formats:

“The information given to parents in booklets like ‘Birth to 5’6 is not accessible to parents with learning disabilities. We need information in pictures, plain English, and on tape” (CHANGE, 2005, p.17).

Parents’ learning disability can also impact on their children’s development for example; their own language difficulties may inhibit their ability to stimulate their children’s language development. This may mean they need advice about verbal interaction with children and/or additional support to children to help with language development (Cotson et al, 2001).

Children’s experiences

We know very little about the experiences of children of parents with learning disabilities, other than that which concerns their parents’ experiences of children’s social care and the child protection system. A study of assessments of families affected by parental learning disability found that half the children had severe developmental needs and two-thirds were experiencing family and environmental disadvantages (Cleaver and Nicholson, 2007).

One study interviewed 30 adult children of parents with learning disabilities about their experiences of childhood and adulthood. These were children who remained with their families and no comparison was made with children taken into alternative care. Four themes emerged from the interviews:

  • More attention needs to be paid to the protective factors which promote resilience amongst children and which “shield them from the potentially harmful effects of parenting deficits”
  • Families affected by parental learning disability are also particularly likely to experience negative attitudes, and worse, from those with whom they come into contact. For example; small scale studies (e.g. Cooke 2005) and messages from parents with learning disabilities themselves (e.g. CHANGE 2005) indicate that harassment, bullying and sometimes violence, financial or sexual exploitation, can be a major problem for parents with learning disabilities and their children.
  • Most parents with learning disabilities who receive core assessments from children’s social care also experience other difficulties such as “poor mental and physical health, domestic violence, growing up in care, or substance misuse” (Cleaver and Nicholson, 2007).
  • Parents with learning disabilities may also have low self-esteem and lack confidence, primarily because of previous experiences of discrimination, abuse and segregation. People with learning disabilities are more likely to have experienced physical, emotional or sexual abuse as children and young adults, and will carry the legacies of these experiences into their own parenting experiences.

Some professionals have raised concerns that parents with learning disabilities experience undiagnosed mental health problems including post-natal depression, and argued that it is important to diagnose and respond to such needs (Cotson et al, 2001).

Professionals consulted for this guidance raised their concerns that physical health problems experienced by parents with learning disabilities are also sometimes undiagnosed.

The presence or absence of social support would seem to be more important than the presence or absence of learning disability in terms of the implications for parenting capacity. Social support and stress are negatively correlated amongst mothers with learning disabilities ‘suggesting that the former may buffer the adverse effects of the latter’ (Feldman et al, 2002). The larger, more recent and more helpful the support network reported by mothers with learning disabilities, the better their psychological wellbeing and the greater likelihood of positive parenting experiences (Kroese, et al, 2002). This and other quotes from parents with learning disabilities, come from meetings held with parents as part of putting together this good practice guidance.

Taken from ‘Taken from Good practice guidance on working with parents with a learning disability’ (2007) University Of Bristol: Updated Sep 2016)

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