Should doctors working with parents with mental health issues be compelled to pass that information to social services?

[JaneGMumsnet]

Hi,

BBC Radio 4 Woman's Hour are discussing depression tomorrow morning, in the light of an Ofsted report which says that children whose parents have mental health difficulties are poorly supported and protected, and they've asked us to ask you what you think.

In the light of the reports, Ofsted and the Care Quality Commission are proposing there should be a legal requirement for doctors and specialists working with parents with mental health issues to pass that information on to Social Services and other agencies. What do you think?

Would this improve joint working between children's social care and adult mental health services, and lessen risks for children?

Or would such a requirement mean that fewer mothers would be willing to talk about their mental health issues, including post-natal depression, with their doctors?

Many thanks for sharing your thoughts,
MNHQ

[BrittaPie]

I once had a sw come and see me because I was very very mentally ill, to check baby dd was ok.

The woman had a brew, quick chat about how we were, if we had support, if I was accepting treatment, then said we were fine and off she went.

It wasn't as bad as you'd think. Pointless, because she wouldn't have uncovered anything from that, but not the terrible event that I was worried about.

[Goldmandra]

While ss are visiting me, they are not visiting someone who's children are at risk.

Have you been told that it is because they believe that your children are at risk? Could it be that they have referred your family for support services?

Sometimes SWs can appear to be looking for abuse when they have actually been tasked with finding support for a family. Don't make any assumptions. Ask direct questions and expect honest and clear answers.

Try to find some reassurance in the fact that SS work very hard to keep children with their parents, even when what's happening at home appears to be really dire. You certainly don't sound like you're likely to lose yours.

Also try to see the SW as a key to support for your children. Explore carefully what might be available for them and expect the SW to do whatever he/she can to help them access that support.

I hope the process improves for you very soon.

[ReallyTired]

If a single mother needs hospitalisation then there may well be no choice for social services to be involved. If a single mother had cancer then her children might have to be taken into care while she had high dose chemo.

[UterusUterusGhali]

Hmmm.

I've recently (in the last couple if days) visited my GP and had an emergency mental health review.

Ss and children's services have been informed.
I wish I'd never gone. Cs have phoned my estranged husband, which has given him another stick to beat me with.

I'm NOT a bad mother. The fact I sought help and was very honest surely should count for something.

While ss are visiting me, they are not visiting someone who's children are at risk.

[hellhasnofurylikeahungrywoman]

I am a mental health professional and have often referred patients of mine to SS. I feel that MH services as a rule don't refer people often enough. Whilst physical/sexual abuse would never be ignored, I find that emotional neglect - which is a HUGE issue in my patients and their children, gets overlooked by lots of staff. The effects of emotional neglect are harder to see, and often if a child is fed, clothed and going to school, SS won't take the case futher.

As the child of a mentally ill mother that was my experience growing up. Social services could've and should've done more to protect our (mine and my siblings) emotional well-being without necessarily breaking up the family. My experiences were 40 years ago now but it seems to me that things are no further along now than they were then. Huge stigma still surrounds mental illness and help for those affected by it is still sadly lacking.

[tiredlady]

Viking
please don't cancel your appointment. Doctors only refer patients when they have concerns about a child's welfare. Simply having a diagnosis of a mental health illness doesn't mean anything. Doctors should ask their patients about how their illness affects their functioning, and that includes their ability to look after children. If you have no concerns about your parenting then the doctor won't either.

[Lucyellensmum95]

OMG viking - i am gobsmacked reading that about your HV!! She needs to be struck off! That is total and utter bollocks right there! Please please please don't cancel the appointment.

I totally don't trust HVs im sorry but I have heard too many horror stories usually revolving around them being misinformed or thinking they know more than they actually do.

Take mine for example - When i had my DD, i was dealing with the terminal illness of my father who was being mistreted in a "care" home, he had alzheimers. I had PND (i can see this now) and also had to have surgery. I was absolutely paranoid that either me or my DD would die. My doctor (different GP to the one i have now) sent my HV round as emergency - She made come comments about some bin bags in the front garden (We were having a clear out FFS), did the Edingburgh Test - told me i was clinically depressed and that she was extremely worried about me. She then went on to suggest that i would help myself greatly by letting DP take the baby out for a day on a sunday and have a cooking day so that i could cook food for the freezer - she even went on about how she would cook beouf bourginon etc (to the point of talking about the recipe) etc . She then re-iterated how concerned she was and that she would be back the following day - do you know what, that was the very last time i saw her - or any other HV apart from at weigh clinics etc. Never followed it up. My depression wasn't picked up for another year, by which time i was pretty screwed. So forgive me if i have no truck with non-medically trained "professionals" idea of support.

[Lucyellensmum95]

I think this too REally tired. To be fair, i would want my child to get support if she needed it due to my illness, as with any illness - however if i felt that SS would have become involved then I would have categorically not asked for help.

How would you provide that support though, from a child who is being emotionally neglected? If i was neglecting my child emotionally how is a SW going to help? Genuine question?

I feel quite gutted to be honest, i try my very best to be a good parent but now feel that I am going to ruin my DD's life which has always been my biggest fear :(

[PlentyOfPubeGardens]

Horrendous idea. Normal safeguarding measures are sufficient - GPs have training in this and I trust their professional judgment. Why single out people with MH problems? It's stigmatising and discriminatory. At a time when support and services are being cut to the bone it can do nothing but harm.

[SirBoobAlot]

Viking please do not cancel your appointment. Instead complain to the supervisors and request a different HV.

As for emotional neglect going unnoticed... This is not exclusive to families with mental illness concerns though.

[ReallyTired]

As I said before unintentional emotional neglect is a HUGE issue and I think children are being failed because SS, MH, schools etc just don't know what to do about it

Unintentional emotional neglect happens in families without mental health problems as well. Should every family in the UK be referred to ss just incase?

[Goldmandra]

As I said before unintentional emotional neglect is a HUGE issue and I think children are being failed because SS, MH, schools etc just don't know what to do about it

Something clearly needs to happen but telling SS about a whole bunch of families, some of whom may need support, but without them getting extra funding to offer the support isn't going to help anyone.

My HV told me that "everyone knows ASD is a result of neglect or abuse by the mother. And people who are abused usually abuse their own kids". She truly believes this.

That is terrifying! Have you reported her to her superiors? She seriously needs some training before she does any more damage

[VikingLady]

I can see this from both sides - a child affected (and still adversely affected) by my mother's MH issues, and as a mother awaiting dx for ASD.

DM delayed seeking help for many years as she was convinced SS would take us away, with the result that her PND turned into long term depression. It's ingrained now, and she is still fighting it 30 years later. If SS had got involved, she believes the stress and the implication that she was a bad mother would have led her to actually commit suicide, rather than just thinking about it (she came pretty close). No-one offered us children any support, but she was herself supported by a fantastic psychiatrist to be a good mother. I still rank her as one of the best mothers I know, and I learnt some very valuable lessons from her about taking care of people, empathy, and how to carry on when you feel like you can't. I wouldn't change it, and neither would she (I asked).

I am partway through the dx process for asd. I know there is very little to be done about it - no treatment as it is not exactly an illness, but I am doing this because of DD. I have been a good mother to her so far (when I concentrate on something, I do it to the nth degree!), and am going for a dx to access help/information in how to bring her up if she is NT. If this comes in, I will have to stop the process. I don't know whether that would impair her in any way, but I certainly don't trust SS to take a balanced view of my circumstances - they are human, and humans can be irrational and prejudiced. My HV told me that "everyone knows ASD is a result of neglect or abuse by the mother. And people who are abused usually abuse their own kids". She truly believes this.

Can't risk it.

Cancelling appointments tomorrow.

[tiredlady]

LucyEllensmum and Macdog.

I don't think i made my earlier post clear.

I did not say I agreed with the suggestion at all. I think it will deter people from seeking help and SS will grind to a halt under the weight of so many inappropriate referrals.

However the point I was trying to make is that overall, I think MH professionals should be making more referals than they are. I don't think enough MH workers think about the children of their patients enough and they rarely look beyong the obvious physical and material things

As I said before unintentional emotional neglect is a HUGE issue and I think children are being failed because SS, MH, schools etc just don't know what to do about it

[poppypebble]

My sister is seriously mentally ill. She is also the best parent I've ever met. She has 4 DCs and my god they adore her and she adores them. She does have a social worker as she has been sectioned a few times and spent 6 months in a mother and baby unit after DC 4 was born. The SW checked up a few times and that was that - my sister has a husband and family who would step in if needed, but she is the children's primary carer and she is fantastic.

My other sister, with no MH issues, is actually quite cold to her children and over the years has spent less and less time with them to the extent that if they wanted a hug they went to their dad or their aunties. The youngest is 14 now and she makes no secret of the fact that she can't wait for her to leave home. She loves her dogs, the kids come lower down the list.

I know which mother I'd rather have.

[Lucyellensmum95]

I am always honest with any health professional about my thoughts and feelings, I believe I am a good and attentive mother. I am not perfect but I am probably a better mother than a fair few parents without MH issues. Some parents are just feckless lazy fuckers who put the needs of their children afer their own - what support to THOSE children have?

All of the counsellors/Drs I have spoken to about my mental health have made it clear that If they feel i am a danger to myself or anyone else or unable to care for my children they would have no choice but to involve other agencies. This is referred to in the blurb at the begining of each section of treatment i have had and then not mentioned again.

I don't need help looking after my DD, i don't need parenting classes, sometime i need help to realise that walking in front of a train is a really bad idea, but the reason i don't do this is because I love my children.

[Floweryhat]

Oh, and our family had a social worker at one stage. He was brilliant and my mother and I both have only positive memories of him and his involvement with us. It was just a shame the support was withdrawn so fast.

[Floweryhat]

"I know enough about my own mental illness to recognise retrospectively that when I've been ill in hospital or having treatment at home nobody has put the children first. It shouldn't be stigmatising to ask the question about how best to support young carers."

^THIS^

My own parents would argue to the hilt that they haven't neglected me emotionally or ignored my needs or my sbling's. They would especially have failed to notice the impact their conditons were having on me at the very time it was happening. The reality as a child living through it was very different than what they imagined they were providing in the way of emotional stability. Of course it will not be the same for all, but the fears of parents should not prevent children being supported. And I re-iterate, reporting all to SS isn't necessarily the answer!

I find myself wondering why a referral for support is such a stigma, however?

[Goldmandra]

Maybe all that needs to happen is some training and conferences to help the two agencies understand each other's services better and improve communication. Then they can work together to make the changes they feel will be most effective without anyone being required to jump through hoops which make parents feel threatened.

[joiemecconue]

I was thinking more along the lines of the approved social worker, but yes, they could at the very least meet the children and hand out leaflets for local young carers and other things. Although why can't cpns do this without being asked it's a tiny extension of their role?

[ReallyTired]

"Perhaps it doesn't need to be the main ss, perhaps a mh sw with special training in supporting young carers in a family context could be attached to each community team?"

Such a person used to be called a health visitor. Prehaps we need health visitors type people to work with families up to the age of eleven or maybe 13.

[Goldmandra]

But SS isn't/shouldn't be just about that. It should also be about putting families together with the help they need to get through a rough patch. If they had more funding, this kind of thing would be so, so helpful to those children.

Absolutely but SS referrals can already be made for families that need this support. The reason they don't get it is funding.

If there is a concern that MH workers are not referring families for support they could get then they simply need to be better informed. IME MH workers can see the need for support in families, they refer them and then SS say there is nothing they can do.

The proposals are about requiring MH professionals to refer certain patients' families to SS. They are still expected to decide which ones need help. Requiring them to refer to a service that doesn't have the resources to help unless the family is in crisis isn't going to change any outcomes.

[Nilgiri]

What do people think is the best way of not overlooking children's needs

joie, you clearly aren't overlooking your children's needs. You'd love to have support for them - but it isn't on offer.

The best way to help children is to spend money on running such services. Which ain't gonna happen right now.

It strikes me that compulsory notification is a way to appear to be "doing something", without actually spending the money.

[madamginger]

I do think that children of parents with MH problems need help though. My mum had very severe depression all through my teens and i had absolutely NO-ONE to talk too.
When I was 17 i tried to commit suicide because of the stress of living through my mothers problems, she was in and out of hospital and my sister and I were farmed out to family members.
It was SHIT.