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

[Tee2072]

I am very open about my MH issues but this is the worst idea in the world.

Just because I have those MH issues does not mean my child is more at risk than one with a mother without issues.

People would absolutely stop seeking help if this happened.

[HorryIsUpduffed]

Thinking about this more ... the only thing it would achieve is to relieve doctors of the burden of deciding how much someone's mental illness affects them, and giving that decision to a social worker instead

Given that the GP or psychiatrist is making that call as part of care anyway (ie to assess what medication and other support to recommend) surely they can be trusted to decide which patients are a potential danger to their families.

[MmeLindor]

Even if this didn't run the risk of terrifying many parents into not seeking help, what about the fact that MH support is - in some areas of the country - extremely patchy?

Wouldn't adding to the workload of MH professionals mean that even less patients could be helped?

Not to mention the already over stretched SS workers.

Terrible idea.

[PessimisticMissPiggy]

Oh my goodness. No way.

[tiredlady]

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.

Unfortunately, due to the massive case load of SS, even when quite serious things are referred to them, they simply do not have the capacity to deal with it.

[Jayne266]

I suffer from depression and I can tell when am getting bad and I go to the doctors at this point. (the doctors is happy with this as she knows I am good at controlling it) if ss were to be informed I can honestly say I would never go to the doctors about it again.

[Leaningtoweroflisa]

As a psychiatrist, I have to say I find this is not a helpful idea for the parents or professionals involved.

I am trained to assess people's mental health, the risks they pose to the,selves and others ( including their children) and any unmet needs adding to their MH condition. I'm pretty good at the first two but can't always make much of a difference to the third- where the sw on the team is often key. In addition I have mandatory child protection training on a regular basis. As tiredlady rightly says, we don't refer to as enough and not for emotional neglect, especially as ss is so over stretched.

Part of my job is assessing people for therapy and delivering therapy. I have to reach a balance between providing a therapeutic space where patients can safely talk about distressing and disturbing thoughts and fantasies - eg a mum with pnd or OCD needing to let out thoughts of hurting her child - while at the same time monitoring for signs of actual risk to self and others. I think if someone tried to enforce me having to inform ss on a mandatory basis in this part of my job, I would have to tell them to fuck off. In somewhat more polite and reasoned words.

As a mum who struggled horribly with pnd / post natal OCD and had just those awful sorts of thoughts, I would not seek help. It was bad enough being a psychiatrist and experiencing this, that was enough to stop me seeking help as I did not want to be referred to my colleagues. A mandatory visit from ss would have possibly pushed me over the edge of being able to cope - the idea of it. Instead of distressing and intrusive thoughts of hurting myself and ds, I would have been more likely to act on these if I'd managed to ask my gp for help and got smacked with a ss referral.

So to summarise my rambly post:

• insulting to me as a highly trained professional, this is something I see as a skill I need to maintain for my patients' well being
  
• would stop me seeking help as a patient
  
• would probably actually increase my risk of harming myself and ds.
  

Thank fuck I've recovered now.

[nenevomito]

This is an awful idea the further stigmatises mental health issues and one, that if implemented, would stop parents from seeking help with mental health problems for fear of social services becoming involved.

Having a mental illness does not automatically make you a bad parent or mean your children need intervention from external agencies and I strongly oppose the insinuation that it does.

I have quite serious mental health problems, but the treatment I have for them means that I am just as able to care for my children like any other parent. They do well at school and nursery, we have lots of good family time and they are secure, loved and well cared and very much loved. There are no reasons for social services to be involved at all.

Would it be better for my children to be parented by someone with mercurial moods who was unstable and untreated? Of course not. But would the knowledge that social services would be informed when I first went to the doctor for help stopped me from seeking that help? Yes it would.

Adult mental health services will already involve social services if they believe children to be at risk, just like any other professional body, but mental illness does not automatically mean that children will be at risk so there is no need whatsoever for them to be informed automatically.

Mental illness does not equal bad parent. Full stop.

[TheChaoGoesMu]

I think this is an appalling idea on many levels and it stigmatises parents with mental health difficulties. If a doctor thinks that the children are at risk then they absolutely should report to ssd. But if they dont then what is the point? Ssd are overloaded as it is, the last thing they need is a tick box exercise, and the extra workload will prevent them from actually trying to protect children in danger. In addition to this, parents will be unlikely to step forward and ask for help if they think ssd will automatically be involved. Which will have a catastrophic effect on parents that need help, and in turn some children that need protecting. Utterly ridiculous. Doctors need to be able to use their professional judgement rather than adhere to this shite which will make the social work profession even more ineffective with regard to the work they do.

[Lucyellensmum95]

Havin suffered from PND and now generalised anxiety and depression I can tell you that my DD is categorically not at risk. She is loved and supported just as much as any other child. I totally resent the implication that my MH issues affect my parenting ability or mean that i will somehow harm my child or not be as good a parent as someone without "issues".

Thankfully I have an understanding GP and in all the times i have been sobbing in her surgery not once has she ever even questioned anything re my DD.

I am on medication now and was before - i think if i wasn't on this medication and hadn't had counselling i might not be here - If i thought my GP would be compelled to inform SS and I would have to prove myself as a parent, I would never have sought help and that scares me!

[Lucyellensmum95]

tiredlady as a MH professional i am surprised you take this stance - what is it exactly that you do? I have been suicidal and the only reason I am still here is my DD - that is because I adore her, why the hell would i neglect her?

[curryeater]

Horrible idea. I thought the Hippopotamus oath was exactly because confidentiality is crucial in medicine.

[ReallyTired]

Referring MH patients to SS is over kill, it will overload SS and discourage patients from seeking help.

I think it would be better for GP surgeries to employ a CPN or a health visitor to visit families. They could deliever councelling and actually decide whether the family needs SS support after spending an hour in the family's home. A CPN could also feed back information to the doctor whether medication is working or not.

[DevonCiderPunk]

I can only see that this would dissuade struggling parents from seeking help at all.

Whilst it categorically does not follow that mentally ill parent = vulnerable child, it would be far better for parents to seek support from their HCPs and that HCP can then decide whether children are at risk on a case-by-case basis. Knowing that a referral is automatic would drive very desperate families away and leave any children at risk unknown. Far better to treat, support and empower a struggling parent, risk assessing as necessary, and referring only when risk is identified.

Besides the confidentiality implications, SS are overwhelmed with referrals already. Receiving a referral for every parent presenting with depression or anxiety would further dilute scarce resources.

[Macdog]

Tiredlady, I am so grateful you are not involved in my care.
Where there is risk to children, yes SS should be involved. But for other cases??!
I suffer from depression, and have done for a long, long time.
If I thought a MH professional would report me to SS for seeking help I would be horrified. It would put me off totally.

[KristinaM]

Another vote for this being a terrible idea. For all the reasons mentioned below

[TheChaoGoesMu]

In fairness to tired lady, I dont think she is saying every case should be referred? Just talking about her experience in an overwhelmed system that does struggle to provide help when its needed. If this is what you are saying tired lady then I agree that it is true.

[Floweryhat]

Something needs to be done to improve support for children who have parents with mental health problems. So many on this thread are coming at the issue from their own perspective as a parent who's had mental health problems. What this should be a discussion about is the needs of the children who have parents with these issues. I am not saying referrals to SS are the answer. However, children with depressed parents, parents with eating disorders, paranoid conditions, serious anxiety etc do need more support than they get, and parents with those issues are not the best placed people to objectively assess the impact that their condition is having on their kids.

I speak as an adult who grew up with 2 parents with different mental health issues.

[ReallyTired]

My understanding was that tiredlady said that many cases were under refered. I imagine that when someone has got the stage of actually having help from a mental health professional then their depression must be pretty severe. Prehaps tiredlady sees more extreme cases of depression than what the typical case that presents at the GP.

I feel that a struggling parent should have a home visit from a mental health professional. The mental health professional can then decide what type of support (if any!) is appriopiate.

In the past health visitors used to do listening visits and prehaps this is a better form of support.

[HorryIsUpduffed]

FloweryHat - sometimes the children need additional support. Many will be completely oblivious to the parent's illness.

[CantSewWontSew]

I work in MH. I absolutely agree that this would deter people from seeking help which in turn would increase any risk to children and cut off the parent from any type of support. I also know that SS cannot cope as it is, let alone with a huge new load of referrals to look into. However, I do think that support options should be discussed with parents who present with MH issues and also that better support should be available in schools for kids to access if they need. Place2Be is a good example.

[ReallyTired]

All young carers need support whether their parents have something respectable like cancer or shock horror! MH issues. Having a parent with serious long term disablity is hard.

It would be deemed ridicolous to refer a child automatically to SS just because Mum has breast cancer. Yet such a child definately needs extra emotional support from somewhere.

[SirBoobAlot]

This is a terrible idea. And I greatly feel that the conclusion they have come to is over simplified.

It will terrify people who need to access help. Those who might be suffering from PND, and also those suffering from longer term mental illnesses. So could - potentially - pose more issues for the child in the long run.

Tying in with that, if the children are not being supporting sufficiently, then the next logical thought is that evidently the parents are not receiving the treatment they need. Which they will be more unlikely to do with the threat of social services hanging over their heads.

I have Borderline Personality Disorder. I'm well aware of it, open about it, and educated surrounding my illness. I'm also aware of the impact it could have on my son, and have taken steps to prevent that. I am a good mother. I'm not perfect, I make mistakes - because I am human, not because I have a mental illness.

All professionals have a duty of care towards any children who may be in a situation where there is concern for the well being of a child anyway.

I remember being warned a while back about a new policy that was possibly coming in about parents having to disclose the medications they were taking. My reaction? I stopped taking my ADs and APs immediately.

Support people with mental health issues to be the best parents they can be though treatment, medication where needed and parenting groups aimed to deal with difficult situations. Don't put them under more pressure to appear 'fine'.

[joiemecconue]

I agree with ReallyTired.

[minkembra]

floweryhat it is true. children of people with ongoing MH issues should get support. i am not sure that an Ss referral should be automatic though nor the best source of support. (unless they were given more resources)
I do worry about what would happens to my kids if i were to become ill. i do not want them to have to 'deal' with it.
That applies to any illness.