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1.4.5 Mental health issues

Last Modified: 22-Mar-2022 Review Date: 04-Jan-2021

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Overview

A parent experiencing a mental health issue does not of itself indicate a child protection concern.  Many parents with mental health issues are able to care appropriately for their children, however, they may have a significant impact on thier ability to care appropriately for their children and keep them safe from harm. A mental health issue refers to either a:

  • mental health problem – where a person has diminished cognitive, emotional or social skills but not to the extent that the criteria for mental illness is met, or

  • mental illness – where a person has a clinically diagnosable disorder that significantly interferes with their cognitive, emotional and social abilities.

There are three general categories of mental illness – mood disorders, anxiety disorders and psychotic disorders. More information on these can be found on the COPMI website Different types of mental illness.

A mental health issue can significantly affect how a person thinks, feels, behaves and interacts with other people. For many people, mental health issues can impact on their ability to function and maintain relationships.  Areas where mental health issues could cause harm to a child include:

Ability to parent

Symptoms of mental illness may significantly interfere with the ability to parent adequately, for example, in providing supervision, making meals, organising routines, ensuring school attendance, and providing a safe and hygienic living environment. Parents with personality disorders may demonstrate erratic behaviour and poor relationship choices, that can increase the risk of children being placed in unsafe situations. The parent's ability to meet the child's needs should be your focus.

Direct effects on the child

A parent's mental health illness does not adversely affect all children, nor will it affect all children in the same family in the same way. Untreated mental health issues can impact on a parent's ability to protect or meet the needs of their children. Where this happens, children may demonstrate a range of social, behavioural and/or developmental issues. Some children may experience anxiety as a result of fears for a parent's wellbeing or be scared of their behaviour.  

Where neglect has occurred as a consequence of the parent's mental health issues children may be at risk of cumulative harm. For more information on how parental neglect impacts on a child, refer to the table below:

Parent's actions or inactions

Impact on the child

Inadequate provision of: 

Basic needs such as food, drink and general hygiene.

​Malnutrition, dehydration, poor physical health, death.
​Safe home environment (e.g. presence of animal or human faeces or urine, decomposing food, syringes or other dangerous drug paraphernalia).
Physical harm, serious injury, exposure to infections and diseases, poor health, death
​Supervision (e.g. placed in dangerous situations, exposing the child to, or placing them into the care of strangers or caregivers who may harm them).
​Harm to child, serious injury or death
​Medical attention (e.g. refusal of or failure to seek treatment or give the child required medications; denial or minimisation of health concerns).
​Exposure to infections and diseases, poor physical health, developmental delays.
​Nurturance, affection, boundaries (e.g. the parent consistency puts their own needs ahead of meeting their children's needs).
​Inappropriate or disruptive behaviours such as self-soothing, attention getting, revenge, power seeking behaviours and a display of general inadequacy.
​Emotional support and love (e.g. chronic inattention to the child.
​Neurological impairment and high anxiety levels, disrupted attachment, risk of physical injury, stress related illness, conditioned trauma response, dissociation, hyperarousal, eating disorders, bed wetting, sleeping issues.
​Appropriate stimulation (e.g. failure to enrol a child in school and inattention to special educational needs).
​Cognitive, language and communication delays.

Effects on the parent/child relationship

Many parents with mental health issues engage positively with their child, while others may be highly disorganised, disengaged or punitive. Children may become distrustful or angry with their parent when they are unwell. For very young children and infants the stress can affect the attachment between mother and child, as often the mother cannot develop and maintain sensitive involvement with the child.

Unreasonable expectations to look after their parent

When children care for a parent who has a mental or physical illness or disability, consider  the child's practical and emotional responsibility, in keeping with their age and level of understanding.

Children who care for parents who have a mental health or physical illness, or disability, may experience high levels of stress and anxiety and struggle to cope.  They may feel overwhelmed by the responsibility to act as carers, feel guilt about this, and worry about their parent's health. 

Isolated parents may keep a child home from school for company. Children may develop a strong sense of responsibility for their parents.  Both the child in the carer role and the parent may need assistance and other supports.  Consider and respond to impacts on parental capacity to care for their children, and also focus on and respond to the impact on the child from caring for their parent.  For more information refer to 'Are you a young carer' on the Children of Parents with a Mental Illness (COPMI) website.

Rules

 

Where parents are experiencing psychosis, severe mood or anxiety disorders and/or suicidal thoughts that impat on parenting and rational decision making, you must provide a priority response. 

If you have any concerns about the mental health of a child in the CEO's you must discuss them with your team leader and the district psychologist. If the district psychologist is not available, contact with the a senior consultant psychologist.

  • You must complete a Strengths and Difficulties Questionnaire – for more information refer to the Strengths and Difficulties Questionnaire section in Chapter 3.4  Viewpoint

  • You must consider inviting the child or parent's mental health specialist to participate in Signs of Safety mapping and planning processes.

Information and Instructions

  • Assessing parenting capacity and risk of harm
  • Working with parents with mental health issues
  • Reunification
  • Children in the CEO’s care experiencing mental health issues
  • Working with other agencies - accessing support and resources
  • Emergency support
  • Assessing parenting capacity and risk of harm

    Where a parent is experiencing severe mental health issues, you must use the Signs of Safety Child Protection Practice Framework to determine the level of risk and safety for the child. 

    Mental health issues are a complicating factor that may make a case more difficult. You may need more information to identify the worry or danger for the child.  Refer to Mental Health Issues - Signs of Safety Mapping and Planning Prompts (also in related resources).  

    To assess the impact of mental health issues consider:

    • the type, severity and frequency of the parent's mental health symptoms

    • whether they have a diagnosis and are compliant with treatment

    • the side effects of any medication

    • any previous abuse or neglect concerns due to their mental health issue

    • whether the parent has psychotic, homicidal or suicidal thoughts

    • whether the child or other family members are part of delusional or paranoid thoughts

    • their level of insight and ability to accept a diagnosis

    • whether the mental health problems are chronic or severe

    • the parent's willingness and capacity to engage in treatment or take medication

    • existence of other support such as family, friends or other services, and 

    • co-occurring alcohol and other drug issues - often mental health issues co-occur with drug and alcohol issues and family and domestic violence (FDV). This significantly increases the risk of harm to the child and these factors should be assessed collectively and not as isolated or unrelated issues.

    For more information refer to the following:  

    Infants are particularly vulnerable to harm when a parent is experiencing mental health issues. For more information refer to Mental Health Issues - Infant mental health and Chapter 2.2 High-risk infants,

    If a parent is involved with Adult Mental Health Services, request the following information from the support provider, and any other relevant information to inform the assessment and case planning:

    • The treatment plan and how the parent has responded.
    • The short and long-term prognosis.
    • Recovery from previous mental health issues. 
    • Symptoms impacting on the safety and wellbeing of the child.
    Consult with your district psychologist or relevant local mental health services early in the assessment and invite them to participate in the Signs of Safety case mapping to coordinate information and responses, and joint planning.

    Develop a chronology to establish patterns of behaviour that may have impacted on the child over time.  Mental health issues can be episodic and may change in their severity and duration; symptoms which present one week may not be present the next.

    Consider the needs and capacity of people with chronic mental health issues and how these may impact on their ability to participate in assessment and planning.  For example, people with severe anxiety or depression may find a Signs of Safety planning meeting overwhelming and may require breaks throughout the meeting.  

    Where a treatment plan is in place, you must continue to assess the parenting capacity of the parent, the impact of alcohol and dug or family violence issues, and whether other supports and services are required.  
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    Working with parents with mental health issues

    You must consider the impact of any co‑occurring FDV and alcohol and other drug issues.

    Where parents are experiencing psychosis, severe mood or anxiety disorders and/or suicidal thoughts that impact their parenting and rational decision making you must provide a priority response.

    Where there are co-occurring alcohol, drug or FDV issues, you should share relevant information and coordinate services. Refer to Chapter 1.4 Alcohol and other drug issues and Chapter 2.3 Assessing emotional abuse - family and domestic violence.

    Families with co-occurring and complex issues are often overwhelmed and may sometimes overstate their coping ability. These families may need support to access accommodation and other basic needs before they are able to address parenting issues.

    If the mental health issue requires urgent intervention and treatment, you should discuss and develop an agreed safety plan for the children's safety with the parents, where this is possible.  Engage other family members in the safety planning.  You must document the safety plan.

    When developing the safety plan consider: 

    • management and monitoring of the parent's mental health issues
    • partnership with other agencies to manage the identified risks, and
    • planning and managing risks when the parent's mental health issues may compromise their capacity to care for the child.

    For more information on the safety planning process refer to Chapter 1.2 Safety Planning.

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    Reunification

    Where reunification is being considered, assess the persistent nature of the parent's mental health issues alongside the child's need for stability. 

    In safety planning include how any mental health and co-occurring high risk issues will be managed in the future. Maintain contact with mental health and other support services throughout the reunification process - from pre-planning, and through the transition and post-reunification support periods.

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    Children in the CEO’s care experiencing mental health issues

    Many children in the CEO's care have experienced severe trauma or neglect, and this may have significant and enduring effects on their social, emotional and psychological wellbeing.

    When a child of four years or older enters the CEO's care, you must complete a Strengths and Difficulties Questionnaire within six months.

    While some children have a formal diagnosis of a mental illness before entering the CEO's care, certain events can trigger mental health issues, such as the:

    •   separation from their parent/s or extended family
    •   death of a family member or friend
    •   instability of foster care arrangement, or 
    •   anniversary of a significant negative event.

    Where a child has mental health issues, refer to their Quarterly Care Review to:

    • highlight any possible triggers, 
    • note any concerns in the case plan, and 
    • inform foster carers of the ‘triggers’ so that they can be vigilant and respond.

    You should also raise any concerns with your team leader and the district psychologist.  Refer to Chapters 2.2 Consulting a team leader and 4.2 Psychology Services.

    Where a Child and Adolescent Mental Health Services (CAMHS) is involved, invite them to Signs of Safety meetings to participate in case planning and developing harm and danger statements, safety goals and a safety plan.

    Any referral to CAHS should be made to the service closest to where the child lives, and align with the Bilateral schedule between the Department and CAMHS in related resources.

    When you are working with Aboriginal families, consult with the Aboriginal practice leader in your district or the Senior Consultant Aboriginal Services, Specialist Child Protection Unit – email: SpecialistChildProtectionUnitGeneralEnquiries@communities.wa.gov.au to discuss:

    • relevant cultural issues and considerations, and
    • engaging local culturally secure programs and services.


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    Working with other agencies - accessing support and resources

    Where a number of agencies are involved, clarify who the lead agency is, and assist to develop a coordinated plan.  Under s.23 Children and Community Services Act 2004, you can share relevant information with mental health support agencies and workers.

    Regular interagency consultation liaison meetings are held between CAHS and metropolitan districts, and some country offices, to discuss complex and contentious issues, clarify the roles and responsibilities of each agency, and exchange information where there are protective concerns and/or mental health issues.

    There are a range of other services, websites and resources to support people experiencing mental health issues:

    COPMI website: https://www.copmi.net.au

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    Emergency support

    Where an urgent response is required, consult with your team leader and your district psychologist immediately.  if the district psychologist is not available, contact the relevant senior consultation psychologist.  Emergency mental health assessment and support can also be accessed through:

    Metro callers: 1300 555 788
    Peel: 1800 676 822, and Country/Rurallink:  1800 555 002

    In an emergency call 000 or visit your local emergency department. 


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