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

[FannyFifer]

Fuck no!

[Nilgiri]

De88, a GP offering to refer someone to an existing service already happens. And the patient being referred can then (usually) make their own decision about whether they're actually getting something useful or supportive out of the service. Just like with all other health services.

What's been suggested above is completely different. There's no service actually on offer, and may never be. And who are these "other agencies"? What are they planning to do with this information?

Also, who will take responsibility for its accuracy?

I gather from MN there are already problems with midwives and HVs writing utter bollocks and casually ticking wrong boxes in maternity notes and red books. Now imagine that wrong box tick being passed automatically to SS and going on a watch list. It's next to impossible to get any correction ever to anything claiming you're mentally ill, because "You would say that, wouldn't you."

[Goldmandra]

GPs and psychiatrists already have a responsibility to inform SS if they feel a child is at risk. I can't see how this would be enhanced by automatic reporting of MH problems. Surely GPs and other medical professionals are better placed than SWs to judge whether the MH problem itself puts a patient's children at risk.

This would simply mean a heavier load on SWs and fewer people asking for help with MH problems, possibly putting more children at risk as a result.

[Blu]

The currency of reporting needed within usual Safeguarding protocols (i.e a duty to repot if there is a child actually at risk) would durely be diluted if every patient with MH difficulties was reported!

And aren't doctors and specialists better used for treating people with depression and MH problems than spending more time filling out endless reports?

[raininginbaltimore]

I have contacted woman's hour about this, but it is an awful idea.

I have two children (aged 3 and 8 months) and I have Bipolar Disorder. After the birth of my daughter 8 months ago I was monitored by the perinatal team and began to become unwell. They were assisting me at home and planning for me to be admitted to a Mother and Baby unit to adjust my medication and care for me more fully.

They were satisfied that although becoming unwell, I was not a danger to my children in any way. However a community mental health worker, without specialist perinatal experience, referre me to social services as a risk. In itself the referral was handled badly, but it left me anxious and paranoid about my own mental health.

I think it is wrong to assume that mental health automatically means danger. I needed support, which social services couldn't provide. As it was they assessed that I was in need to hospital care. There is a huge gap in services for women with mental health problems during and after pregnancy. There is medication from GPs and then there is in-patient care (of which there is a massive shortage). There needs to be support groups, home help, talking therapies etc. so many women are afraid to speak about how they feel because they believe their children might be taken away.

[coppertop]

The message this sends is "Seek help and we'll report you".

Not exactly something that will encourage people to seek help, is it?

It's a terrible idea. I can also see abusive partners using this as a threat. "Do what I say or I'll tell the doctor I think you've got a MH problem. Then they'll get social services on to you."

Doctors are surely there to help and treat their patients, not report them purely because they have a problem that affects their mind rather than their body.

[MrsMarigold]

I agree with what's been said already - a terrible idea.

[HorryIsUpduffed]

If HCPs with genuine concerns about the capability of resident parents to care adequately for their resident children already have access to make easy reports to SS, or offer additional support via HVs, what possible good will compulsion do?

I was borderline suicidally depressed before and after DC2, and on the HVs' radar. My children were genuinely at no risk at any time. They were clean, well nourished, emotionally well cared for, etc. But I wouldn't have sought even the minimal support I asked for if I had thought there would have been an automatic SS referral.

[DisorganisednotDysfunctional]

What a totally stupid, self-defeating idea! This thread is packed with arguments and anecdotes that show just how idiotic it is. Dreadful!

Oh, and whatever happened to patient confidentiality? My understanding is that a breach is only acceptable in order to prevent and support detection, investigation and punishment of serious crime and/or to prevent abuse or serious harm to others. This proposal goes a long way beyond that.

[tilder]

When I had pnd depression I was terrified of asking for help as I was convinced they would take my children away. They didn't and the help I received was amazing.

My counselor actually said everything we discussed would be confidential, unless she felt I was a danger to my children (she didn't).

I have no experience of other mental illness when children are involved though.

Agree with all the comments on patient confidentiality, but would be interested to know how things work at the moment. Are we just talking gps or other health professionals as well? IME they do work as a team.

[perspective]

What an awful idea.

I am a CPN and work with many parents suffering various mental health problems. Only a very tiny percentage are referred to Childrens Services, usually because of gross concerns. If we are involved with a family, it is often because SS have referred to us for some support for parents

I agree, many parents with mental health problems are not supported enough but this is because of the cuts to both social and health services. It's a sad fact that childrens centres are loosing funding. We used to have support workers in our team who could do short term intensive support to help parents get plugged in to other support, but hey, they're being cut too. Its very depressing but Childrens Services would simply not be able to offer the majority of parents the sort of support that might be useful.

[EauRouge]

What a completely terrible idea, which idiot came up with this?

Like tidler, I had PND and was reluctant to ask for help because I was paranoid that DD1 would be taken away from me. This kind of scheme will make things a hundred times worse, not better- who the hell is going to ask for help knowing that it will be passed on to SS?

Most mothers with PND are not a risk to their child, they just need a bit of extra support. How about setting up support groups in the local community rather than snitching to SS?

[AllPurposeNortherner]

They already inform SS IF it is thought the child is at risk! Obviously! But 99% of the time this is not the case.

Stupid attention seeking story that will cause terrible problems.

[poppypebble]

Terrible idea that will lead to people not seeking help and at the extremes committing suicide.

Often people with MH problems are already convinced that they are worthless failures - add into the mix the idea that someone thinks you are dangerous to your children and what is left to live for?

I'm not a parent, but I am a teacher with depression and PTSD. I have upwards of 150 children a day in my care. Ofsted think I'm an outstanding teacher - who would I need to be reported to?

[joiemecconue]

In cases of severe mental health problems I think it could be a good idea (I have bipolar disorder and at times as a single parent) to ensure that someone explains to the children about the illness and ensures they are well cared for and supported while the parent is in hospital. I'm not sure if this is a job for social services or a specific youth worker, qualified to answer questions about mental illness and to liaise with other agencies (CMHT/CRHTT) as necessary.

Relatives might not be comfortable or sufficiently informed to allay children's anxieties, community mental health workers are there to support the individual with the illness so there is a big gap in provision for young people who may be frightened and confused when their parent goes into hospital. There is also in my experience little to no support in returning to a parenting role on leave or once discharged. Support workers will take you swimming or dress shopping but don't help with school runs or groceries. Social services might not be the ideal agency but there should be something for families where a parent has a major mental health problem.

[joiemecconue]

Social services are not only there to protect children from 'dangerous' parents but to support children and families during difficult times. I thought it was about accessing services and support.

Nobody with a severe mental illness is going to be managing just fine otherwise how is the illness causing the 'severe impairment' necessary for diagnosis?

[pippibluestocking]

I work in a frontline professional role assessing people with acute MH problems. Like all my colleagues, we have training in safeguarding children and what the risk factors. If we assess a parent whose MH presentation might present a risk to the welfare if their children, we make a referral to Social Services, if we don't think that there is a risk to the children, we don't refer. Incidentally, a parent presenting with very large or repeated overdoses would warrant a referral. The first thing social services will do is see what support they can put in place when a parent is experiencing MH probs, not to take the children away, that is always the last resort, and even I have been surprised by the extents they will go to to keep the family together rather than remove the children. Social Services have limited resources and could not respond effectively if every person presenting with a MH prob was referred. You need to rely on the judgement of professionals in determining who needs to be referred.

[Nilgiri]

Reversing cuts to MH services and increasing support services to be taken up where wanted = good idea.

Creating compulsory SS "and other agency" list of citizens diagnosed with MH issues = awful awful idea.

[TeWiSavesTheDay]

I kind of think yes - but, caveat, only of the Dr feels the children are likely to be at risk - I'm thinking of things like unintentional neglect by a depressed parent.

AND ss would need the funding (buckets of it, which I know is pie in the sky thinking) and staff to do what is helpful in these situations, carers around in the morning/afterschool. Children invited to take part in play therapy/youth clubs with other kids in similar situations/therapy for themselves.

All if these things would gave helped enormously as a child with a bi-polar mother. Would she have welcomed them? Absolutely not. But it would have given ME a chance. Maybe things would not have got so bad that she started to hit us.

[quoteunquote]

to get a gun license in this country you need to see your GP, who must give you a clear bill of mental health,

This has created a big problem which appears not to have any resolution, a lot of countryside social lives revolve around shooting, so those who are experiencing difficulties are reluctant to volunteer that they are experiencing depression, because it will mean isolation from their peer group, when they lose their licence.

There is a very high rate of depression in farming and rural industry, with terrible consequences.

If people know their information will be passed on, they will be far less likely to seek help, so fewer people will receive help,

It would be far better to enable the GPs to provide more and better services,

Access to instant long term counselling and therapy, would be a start, at the moment people wait months for a few short sessions, which is not acceptable, and achieves little, it tends to create additional frustration.

[Dawndonna]

Further stigmatising mental health sufferers helps nobody.

[minkembra]

No, unless it is because they can offer practical help and support.

I saw perinatal psychiatric team before i had dcs because i was high risk for PND. they were great and had practical help and advice to offer including letting me know that if i needed it there was the option of going into a PND unit with the dcs. so i would not be scared to ask for help.
The HVs were also excellent and kept an extra eye on me and again offered practical help.
plus they were there to keep an eye on the dcs which is of course the most important thing. (the dcs were fine and i was mostly fine but it helped to know there was a net if i fell. i am not sure Ss can offer the same net for what is after all a medical problem)

[colditz]

If I thought for a second that my depression would result in my being reported to the social services, there is no way in hell I would have ever sought help. My children would have been raised by a severely depressed mother all their lives, but nobody would have noticed because I've never abused or neglected them.

How is that better than them being raised by someone who seeks treatment for the medical problem she has, when she has it?

Someone with cancer is going to have problems raising their children without support, should they all be reported like criminals too?

[Selks]

Terrible idea.

GPs need sufficient training in child protection so that they can recognise and report to social services any children that are at risk - from parental MH issues or for any other reason. They can then refer if necessary.

Other than that absolutely no call for automatic reporting. Would do much more harm than good to child welfare as people would just hide the fact that they're struggling with their MH

I'm a social worker.