Parent / Carer Mental Illness and
the potential impact for
dependant children
Vicky Finch
Jo Farthing-Bell
Aims and Objectives
 Aim: To be introduced to the key features associated with common
mental health problems and consider how parent/carer mental health
problems may impact on the child and family.
By the end of the training participants will:
 Have a basic understanding of common mental health problems and be
able to describe some of the associated features.
 Have an opportunity to explore the impact of parental/carer mental illness
on children through the use of practical activities and case scenarios.
 Consider their role in supporting and working in partnership with families
and agencies to promote good outcomes for children living in families
where parent /carer mental illness is present.
 Be able to identify factors associated with parent /carer mental illness that
indicate a child or young person may be at risk of significant harm and
know what procedures to follow.
Learning lessons, taking action:
Key messages from SCR’s
 Parental mental health problems were identified as a factor in over half
of a sample of 33 serious case reviews in England from 2009-2010
(Brandon, 2011)
 Mental illness was a feature in families with long standing concerns but
also in the background of families where there were no current
concerns
 Learning difficulties and/or disabilities were often linked with mental
health issues for both parents and the children. Poor mental health
affects 25% - 40% of adults with a learning disability
 Concerns about drug and alcohol misuse were identified in 17 reviews.
 Concerns about domestic violence featured in 15 serious case reviews.
 Some parents were receiving support from agencies in their own right,
including from services for adult social care, adult mental health,
substance misuse, housing and probation. These agencies were found
to have held important information about the family circumstances, but
too often this was not shared early enough.
What is Mental Illness ?
 ‘Mental illness is a mental physical, social, existential experience in
which the individual is making sense of and working out how to survive’
(Seedhouse ,2002)
 ‘...mental health is not simply the absence of disease’ (WHO, 2006)
 any of various disorders in which a person's thoughts, emotions, or
behaviour are so abnormal as to cause suffering to himself, herself, or
other people (collins english dictionary)
 ‘ those whose symptoms are ‘sub-threshold’ are often viewed as having
poor prognosis’ (Middleton and Shaw, 2000)
Prevalance
 About a quarter of the population will experience
some kind of mental health problem in the course of a
year, with mixed anxiety and depression the most
common mental disorder in Britain
 Women are more likely to have been treated for a
mental health problem than men and about ten
percent of children have a mental health problem at
any one time
 Depression affects 1 in 5 older people
 Suicides rates show that British men are three times
as likely to die by suicide than British women and selfharm statistics for the UK show one of the highest
rates in Europe: 400 per 100,000 population
 Only 1 in 10 prisoners has no mental disorder.
 Anxiety is one of the most prevalent mental health
problems in the UK and elsewhere, yet it is still underreported, under-diagnosed and under-treated.
 (source: Mental Health Foundation)
Types of Mental Health
difficulties that people face
Anxiety
Features
 Feeling Tense/ inability to relax
 Worrying / apprehension/ feeling unable to cope
 Physical Symptoms of arousal
 Cardiovascular – palpitations, chest pain, rapid heart beat,
flushing
 Respiratory – hyperventilation, shortness of breath
 Neurological – dizziness, headache, sweating, tingling and
numbness
 Gastrointestinal – chocking, dry mouth, nausea, vomiting
diarrhoea
 Musculoskeletal – aches, pains, restlessness, tremors, shaking
 Phobias – anxiety is evoked only, or predominantly by certain
well defined situations or objects.
Associated behaviours / difficulties
 Avoidance
 Reassurance Seeking /Needing physical presence of
another
 Introspection / preoccupation
 Poor concentration
 Fear of death of self or other
 Depressive disorders
 Can vary from mild unease to extreme terror
 Anxiety becomes worse during intercurrent depressive
episodes
Anxiety
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Treatment
CBT
Psychological therapies
Psychosocial
interventions
 Exposure Therapy
 Exercise
 Medication
Depression
Reactive depression
Endogenous depression
Key Symptoms
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Persistent low mood/sadness
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Loss of interest or pleasure
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Decreased energy and/or increased fatigue
Associated symptoms
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Disturbed sleep
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Appetite disturbance
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Tearfulness
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Reduced concentration & attention, self esteem and self confidence
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Agitation or slowing of movement
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Ideas of guilt or unworthiness
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Bleak & pessimistic views of the future
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Ideas and or attempts of self harm or suicide
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Decreased libido
Depression
 Treatment
 Talking therapies
 Counselling
 Psychosocial
interventions
 Medications
Bi-Polar Disorder
Characterized by repeated (at least two) episodes in which the patient’s
mood and activity levels are significantly disturbed
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Hypomania
Elevation of mood
Increased – activity / restlessness
Difficulty concentrating / distractible/ flight of ideas
Pressure of speech
Decreased need for sleep
Increased sexual energy
Disinhibition
Overspending / reckless behaviour
Psychosis
Grandiosity
 Depression
 Often unresponsive to circumstances
 Exacerbation or pre-existing phobic or obsessional
symptoms
 Irritability / agitation
 Lowering of mood
 Decreased energy
 Loss of interest / enjoyment
 Decreased energy
 Fatigue
 Diminished activity
 Marked tiredness after only slight activity
 Ideas of self harm and / or suicide
Bi-polar disorder
 Treatment
 Psychosocial
Interventions
 Counselling
 Medications
 Mood stabilisers
Obsessive Compulsive Disorder.
Recurrent obsessional thoughts or compulsive acts
Ideas, images of impulses that enter the individuals mind over and
over again.
 Recognised as the individuals own thoughts
 Almost invariably distressing
 Originate from within the mind of the client
 Repetitive and unpleasant
 Client tries to resist but is unsuccessful
 No pleasure derived from obsession / carrying out ritual
 Obsession causes distress/ interferes with functioning
 Anxiety symptoms often present
 Depression often present
OCD
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Treatment
CBT
Medication
Support mechanisms
Specialist placements
Personality Disorder
Deeply ingrained and enduring behaviour patterns,
manifesting as inflexible responses to a broad range of
personal and social situations
 Pervasive and persistent
 Associated with personal and social disruption
 Extreme or significant deviations from the way the average
individual in a given culture perceives, thinks feels and
particularly relates to others.
 Developmental condition
 Appear in childhood or early adolescents and continue to
manifest in adulthood.
 Not secondary to other mental disorder or brain disease / injury
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Personality Disorder
Additionally
• Deviation is pervasive
• Personal distress and /or adverse impact
• Of long duration (onset late childhood / adolescence)
• Unexplained by another disorder
• No organic cause
• Falkov (1996) reported that 28% of the parents in his
sample of fatal child abuse had identifiable personality
disorder.
Personality Disorder
 Abnormal behaviour pattern is enduring, not limited to
episodes of mental illness.
 Poor regulation of emotions / poor impulse control
 Negative coping strategies / self harm / substance
misuse / constant reassurance seeking
 Can lead to considerable personal distress
 Cluster A:
 Paranoid Personality Disorder
 Schizoid Personality Disorder
 Schizotypal Personality Disorder
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Cluster B:
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Cluster C:
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive Compulsive Personality Disorder
Personality Disorder
 Treatment/ Management
 Talking therapies
 DBT –Dialectical
Behaviour Therapy
 Mindfulness
 Specialist placements
Schizophrenia
Characterized in general by fundamental and characteristic
distortions of thinking and perception
Positive Symptoms:
• Psychosis – a lack of contact with reality
• Perception disturbed
• Hallucinations – auditory
• Colours or sounds may seem unduly vivid or altered
• Thought insertion or withdrawal
• Delusions may develop to make sense of these experiences.
• Thought Disorder / Breaks in the train of thought, resulting in
incoherence or irrelevant speech
Negative Symptoms:
• Blunting of emotions
• Social withdrawal
• Lowering of social performance
• Loss of interest / aimlessness
Schizophrenia
 Treatment
 Medication
 Psychosocial interventions
 Insight work (Assessing
insight)
 Family Therapy
 Exercise
 Physical health promotion
 Early Intervention in Psychosis
Maternal Mental Health
 Post Natal Depression
 Post Partum Psychosis
 Perinatal mental health covers the period from conception to
1 year as studies note the impact on the foetus of anxiety and
depression
 11.8% women probably depressed (EPDS > 13) at 18 weeks
pregnancy ( Evans et al 2001)
 10%-15% women suffer from postnatal depression
( Cox et al 1996, Wisner 2012)
 33% of women continue to suffer from postnatal depression
into their second year
 10% continue into their third year
Maternal Mental Health
 Suicide leading cause of maternal morbidity in
developed countries(Oates 2003)
 Nearly all these were an early abrupt onset of
psychotic illness. 85% were receiving treatment and
had psychiatric problem identified.
 Previous history of a serious mental illness, post
partum psychosis or family history poses a risk of reoccurrence following child birth of between 1 in 4 to
as high as 1 in 2 (RCP 2014)
Maternal mental health
 Post partum Psychosis (suicide risk)
 Post partum Psychosis can result in confusion,
hallucinations, irrational behaviour.
 Sudden in onset, usually within the first 2 weeks post
delivery
 7 in 10 women will attempt to hide their symptoms of
PND or underplay their significant impact
 Prolonged symptoms of PND can lead to poor
outcomes for children
Maternal mental health
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Treatment
For psychosis, hospital admission usually required
Medication
CBT/ counselling
Extended support due to major changes of having
had a child and dealing with these difficulties
 Exercise therapy
MENTAL ILLNESS, PARENTING AND INDIVIDUALISED ASSESSMENT
Illness
 Pattern
 Severity
 Chronicity
 Specificity
Individual
 Insight
 Treatment Concordance
 Violence / aggression/ offending history
 Coexisting substance misuse
Family / Social
 Support
 Domestic abuse
Child
 Resilience
 Vulnerability
Stress and resilience factors in parents with mental health
problems and their children:
 Over one third of all UK adults with mental health problems are
parents. (With most parents with MH problems parenting their
children effectively).
 Children’s resilience is enhanced by a secure and reliable family
base in which relationships promote self esteem, self efficacy and
a sense of self control.
 A parent’s resilience is enhanced by family (particularly children’s)
understanding, satisfactory employment, good physical health,
community and personal support.
Potential Stressors:
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Lack of money
Breakdowns in valued relationships
Bereavement
Loss of control at work and long working hours.
Age of Child
Psychiatric disorder:
 The level of ‘dangerousness’ that stems from psychiatric
disorders relates to history and mental state.
 Previous violence
 Substance misuse
 Domestic Violence.
 Poor compliance (recent discontinuation of psychiatric
treatments)
 Recent severe stress
 Unstable Lifestyle
 70% of parents who seriously harm their children were themselves
abused as children (Dale & Fellows 1999 ; Oliver 1993).
Risk in relation to Mental State:
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Agitation
Hostile and / or suspicious behaviour
Angry mood
Thought disturbances (such as delusions of
persecution / jealousy)
 Impulsive and Aggressive behaviours.
Group Activity
Consider mental disorder and possible impacts for
dependant children
ANXIETY possible impacts
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Socially isolated/ withdrawn/ social avoidance
Low self esteem – projected onto children
Reassurance seeking
Caring role
Inconsistency in care
Learnt behaviours
Behaviour issues
Depression: Possible Impacts
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Too much sleep/inability to sleep
Supervision/ routines may be affected
Neglect (own needs and children)
Low self esteem
Caring role
Feelings of gloom, worthlessness and hopelessness,
everyday activities left undone (Cleaver 2011).
 Poor stimulation
 Suicidal intent including child
Bi-Polar Possible Impacts
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Delusions/hallucinations including the child
Instability – routines affected
Over/under stimulated
Inhibitions affected – associated risks
Neglect
Financial issues
carer
OCD: Possible Impacts
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Rituals – children may be involved
Learnt behaviour
Insecurities
Developmental opportunities may be reduced
Neglect
Stigma
Caring role
School attendance
Personality Disorder: Possible impacts
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Developmental delay
Impaired judgement/risk taking behaviour leading to risk of harm
Introspection
Poor coping strategies
Reassurance seeking
Associated anxiety/self harm
Behaviour issues
Neglect
bullying
Parents poor emotional regulation leading to emotionally
immaturity with child(Cleaver 2011)
 Caring role
 Lack of stability
Schizophrenia: Possible Impacts
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Neglect
Low self esteem
Unstable mood, poor routines/ boundaries
Caring role
Hallucinations/ delusions/ suicidal ideation may involve children
Delusions / hallucinations can result in significant preoccupation (Cleaver et al
2011).
Risk of associated concern ie drugs, alcohol
Periods of absence from parent
Stigma
School attendance
Attachment difficulties
Maternal mental health possible impact
Increased behavioural and emotional problems
Hospital admission for mum in psychosis and
therefore separation from baby effecting bonding
Impaired cognitive and language development due to
lack of stimulation
Insecure attachment
involvement in delusional thoughts with psychosis
Neglect
Responsiveness to needs
Risk of physical abuse
Social isolation
Suicidal intentions involving the child
Break
time
Assessment Framework 2000
 Basic Care
Parenting Capacity
providing for physical needs, medical ,dental , hygiene, food warmth etc
 Ensuring Safety
from harm or danger in and out of home; from unsafe adults, other
children and self etc
 Emotional Warmth
sense of being specially valued, of racial and cultural identity , comfort
,cuddles, praise etc
 Stimulation
promoting learning via cognitive stimulation, social opportunities,
ensuring school attendance, communication, responding to questions
and joining in play etc
Parenting Capacity cont...
 Guidance and Boundaries
 enabling the child to regulate own emotions and behaviour by
demonstrating emotional and behavioural control in emotions and
interactions with others e.g. social problem solving, anger management.
Setting boundaries which enable the child to internalise pro social
behaviour as opposed to being rule dependant.
 Stability
 providing a stable family environment which enables secure
attachments with consistency of warmth over time, maintaining
appropriate and similar responses to similar behaviour according to
child's development. Enabling positive family contact
Early Help
 Providing early help is more effective in promoting the welfare of children than
reacting later
 Effective early help relies upon local agencies working together to:
 • identify children and families who would benefit from early help;
 • undertake an assessment of the need for early help; and
 • provide targeted early help services to address the assessed needs of a child
and their family which focuses on activity to significantly improve the outcomes
for the child.
 Professionals should, in particular, be alert to the potential need for early help
for a child who:
 is in a family circumstance presenting challenges for the child, such as substance
abuse, adult mental health problems and domestic violence
Continuum of Need Model
CHILDREN/YOUNG
PEOPLE
WITH ADDITIONAL
NEEDS
CHILDREN/YOUNG
PEOPLE
WITH NO IDENTIFIED
ADDITIONAL NEEDS
CHILDREN/
YOUNG PEOPLE
WELFARE
CONCERNS/ FAMILIES
WITH
COMPLEX PROBLEMS
CHILDREN/YOUNG
PEOPLE IN NEED OF
PROTECTION
Protecting the child – NPSA
Rapid response Report 2009
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Referrals must be made to Children's Social Care if :
Service Users express delusional beliefs involving their children and / or
Service Users might harm their child as part of a suicide plan
A consultant psychiatrist should be directly involved in all clinical decision
making for clients who may pose a risk to children
 All assessment, CPA monitoring, review, and discharge planning documentation
and procedures should prompt staff to consider if the service user is likely to
have or resume contact with their own child or other children in their network of
family and friends, even when the children are not living with the service user.
 If the service user has or may resume contact with children, this should trigger an
assessment of whether there are any actual or potential risks to the children,
including delusional beliefs involving them, and drawing on as many sources of
information as possible, including compliance with treatment.
 Children should never be considered a protective factor for parents who feel
suicidal. In some cases professionals inappropriately viewed the child as a
protective element who could help to reduce the parent’s risk of self -harm. This
belief significantly increases the risk to the child. (NSPCC 2015)
Self Harm
 Majority of self harm occurs between 11-25 yrs old.
 Also known to occur in very young and adults.
 Why??
 controlling mood
 a way of expressing themselves
 control/punishment - a form of trauma reenactment
Types of self-harm
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cutting the skin
burning the skin
punching your own body
hair pulling
interfering with wound healing
ingesting toxic substances or objects
misusing alcohol or drugs
eating disorders, such as deliberately starving
yourself (anorexia nervosa), binge eating or bulimia
 Reckless driving, unsafe sex
Suicide
 Ideation - is a medical term for thoughts about, or an
unusual preoccupation with, suicide.
 Suicidal ideation can be passive, involving a desire to
die but without a plan to bring about one's death.
 Suicidal ideation can be active and involve a current
desire and plan to die.
 Protective factors – e.g. children….
High risk of suicide
 Recent marital conflict
 Current untreated severe mental illness
 Alcohol misuse
 Previous suicide attempts
 Family history of suicide
Group Activity
Using :
 The Assessment Framework and
 The Continuum of Need
 Consider the scenarios and what actions you may
need to take?
Case Scenario A
 Dawn is a 37 year old single mum who lives with her 14 year old daughter
Jane and her 2 ½ year old son Tom. Jane has problematic school
attendance and the education welfare officer has told Dawn she feels
she is not assertive enough as a parent. Jane see’s a Connexion’s Worker
in School and Tom is currently having assessments for visual difficulties
and a squint. Dawn had a ‘panic attack’ 3 months ago and is currently
experiencing physical symptoms of anxiety, palpitations, sweating and
nausea with an accompanying fear that she will pass out. As a result,
Dawn always takes Tom out in his ‘buggy’ as a coping mechanism and
only shops locally. She only goes to town if she is accompanied by her
daughter as she feels unable to get on the bus alone. Her son has
recently missed an optical appointment which she claims is due to her
fear of lifts at the hospital and because Jane refused to come with her.
Case Scenario B
 Helen lives with her 6 year old daughter, Abigail and her husband John. They
have been married for 10 years and Helen was diagnosed with Schizophrenia
8 years ago during the final year of her teacher training. Helen has been
detained under the mental health act twice, the last time was shortly after
Abigail's birth when she began hearing voices telling her Abigail had
leukaemia and she must develop a cure. Helen takes regular medication and
sees a Psychiatrist 3 monthly. Helen has recently begun a college course and
working a few hours in a local shop now Abigail has started school. John
works away from home regularly. School have noticed that Helen has been
muttering to herself in the playground and appears preoccupied and that
Abigail has seemed a little withdrawn recently and has refused to eat her
lunch for the last 2 days. When asked why she is not eating Abigail becomes
distressed and states that her mummy has told her that people are trying to
poison them while daddy is away and she can’t eat or she will die.
Case Scenario C
 Sarah is 23 years old, is unemployed and in debt. She has a 3 month old
baby, Luke, and lives alone in a private rented flat which is in a poor
state of repair. Luke’s father has intermittent contact with Luke and
little is known about their relationship. Sarah has recently been feeling
very low and is finding it difficult to motivate herself to get up and
dressed or to prepare meals. The health visitor has noticed a decline in
the home conditions, and has noticed that Sarah wasn’t responding
when Luke was crying. Sarah has lost all her pregnancy weight. She says
that she is upset easily spends some time most days crying and isn’t sure
why. Sarah admits that she is unsure what Luke wants when he is crying
and feels overwhelmed by the demands of looking after him.
Case Scenario D
 Paula is 23 years old and has been living with her boyfriend Simon for 3
months. Paula has a daughter Jessie who is 7 years old. Paula believes
that Jessie should not have contact with her birth father Jake stating
that he used to smoke cannabis when they were together however he is
pursuing contact and sees Jessie every other weekend at a contact
centre. Paula has been ordered by the court to maintain this contact and
she is making a complaint against the CAFCASS worker who she feels is
siding with Jake and often turns up late to limit the contact. Paula has a
tense relationship with her mother Louise because she does not believe
that Paula’s step father who died 9 years ago sexually abused her. Paula
often phones the mental health crisis team distressed and threatening
to kill herself after having had arguments with her mother and has a
history of superficial self harm by cutting her thighs and wrists and also
of taking small overdoses of paracetamol. She refuses any ‘talking
therapies’ that have been offered. Jessie called an ambulance at 11.45pm
yesterday after Paula cut her wrists whilst intoxicated following an
argument with Simon.
Case Scenario E
 Rebecca and Tom are in their 40’s, they both have mild learning
disability, and Tom suffers with depression. They both have alcohol
problems. They have a 4 year old son, Robert who has “query” Foetal
Alcohol Spectrum Disorder, he has significant learning disability and
behaviour challenges, he attends a special school. On a routine visit,
Tom’s support worker finds Robert hanging upside down from the
banister over the stairs, Rebecca and Tom appear unable to control his
behaviour and maintain his safety. Robert has a social worker, there is a
CAF and he has regular child in need meetings. Robert has regular
contact with Tom’s sister in another city, he spends his weekends and
school holidays with them. The sister’s children are both drug users, on
Methadone programmes. Tom’s sister is very critical of Tom and
Rebecca’s parenting of Robert, this causes frequent arguments. These
arguments are usually in front of Robert on contact changeover at
weekends. The police have been called on several occasions.
Case Scenario F
 Jayne is 45yrs, she has been a victim of domestic violence and
her ex husband was also a drug user and had a diagnosis of
schizophrenia. Her oldest son Dean is 17yrs, has mild learning
disability, ADHD, he regularly smokes Cannabis and takes MCAT.
Dean has symptoms of psychosis, a psychiatrist visits him at
home. Dean should take Risperidone for psychotic symptoms
and to stabilize his mood. He is not engaging and refusing to
take the medication. Dean can be aggressive, and has also been
involved in burglaries and fights in the neighbourhood. Jayne
has refused to give Dean money, when he has spent his own
money. In a rage he has attacked her hitting her around the head
with a shovel. There is a younger child in the house. Mitchell,
who is 8 years old. Jayne feels that there is no risk to Mitchell
and that she can keep him safe.
Case Scenario G
 Paula is 36yrs, her husband Lee has Bi Polar disorder and uses
amphetamines. Lee has support through adult mental health, and drug
and alcohol services. They have 8 children, aged between 12 yrs and 7
months, Paula is 6 months pregnant and has attempted to conceal the
pregnancy. One of the children Wayne, has severe learning disability,
ADHD, epilepsy and severe challenging behaviour displayed as self
harm, stripping and smearing faeces. Wayne often appears anxious and
distressed in the family home. The children are all subject to a child
protection plan under the category of physical abuse, following an
incident of domestic violence in the home where the police were called.
Lee had put a plastic bag over Paula’s head to suffocate her, believing
she was having an affair. Professionals report that the family home is
chaotic, untidy and dirty. Paula and Lee will only engage with certain
professionals that they trust. They do not attend core group, but are
making attempts to work with the child protection plan. The other son
attends A & E with a burn to his foot, having climbed on the cooker to
get to sweets in the cupboard.
Case Scenario H
 Razia is 36yrs, she lives with her husband and 3 children. Razia
has a learning disability and receives support through her local
advocacy service. The two youngest children have learning
disability, one having ADHD also, the other has significant health
needs. Razia is having difficulty managing the children’s
behaviour. There have been A & E attendances where the
children have sustained injuries through risky behaviour,
including running into the road in front of cars. Razia’s family
and her husband’s family are very critical of her parenting. Her
husband does help with parenting, and will not engage with
professionals, after the children were removed by social care in
the past. Currently, the middle child has fractures to both legs,
after coming down the stairs on a sledge. He is sleeping with
Dad in the downstairs room.
Bradford SCR – key findings
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Serious case review. Bradford safeguarding children’s board. March 7th 2011.
Key findings:Brother using cannabis – contraindicated in psychosis.
Psychiatrist did consider admitting the brother under the MH act, decided to
continue caring in the community.
Sister also using cannabis and committing offences.
Child displayed a deterioration in well-being in school – dishevelled, lethargic,
disruptive in class, aggressive to other children.
Brother detained under MH act, social care closed the case.
When discharged the brother continued to attack the mother and sister. No
social care input. No CPA meeting.
On the day of the stabbing the brother was seen by CPN and GP, at the request
of the family.
No child protection case conferences held at any time in 15yrs.
Poor interagency communication.
Lack of professional supervision – poor and irregular.
Felicia Boots
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Suffocated her 10 week old and 1 year old daughter
Had PND with 1 year old
Had recently moved home, and was also concerned about the effects of antidepressants on
breastfeeding
Had stopped taking her medication 2 weeks prior
Felicia then apparently had a paranoid delusion that her children would be taken into care,
and killed them before attempting, and failing, to take her own life.
“A prison sentence would be wholly inappropriate … this is an almost indescribably sad case
… I unreservedly accept that what the defendant did to the two children she and her
husband so loved and nurtured was solely the result of psychiatric and bio-physiological
factors truly beyond her control." Judge Fulford, on sentencing her after accepting a plea of
guilty to manslaughter on the grounds of diminished responsibility, and placed her under a
hospital psychiatric order
Croydon SCR key findings
 Published 2015
 Death of a 3-year-old boy in March 2013. Mother carried Josh into the
path of an oncoming train, killing them both
 mother had a history of severe anxiety disorder and had been receiving
treatment from her GP and various mental health services in the months
preceding Josh's death
 During this time mother: took an overdose of prescribed medication;
held a knife to her throat; and self-reported suicide ideation and fears of
self-harming.
 None of the professionals working with mother, nor maternal
grandmother, considered mother to be a direct risk to Josh
Nottingham SCR findings
 Death by drowning of a 10-month-old baby girl in May 2012.
Mother stated she briefly left her infant unsupervised in the bath
and pleaded guilty to involuntary manslaughter
 Family were known to a number of services
 failure to recognise the impact of parents' mental health,
domestic abuse and substance misuse issues on children
 professionals basing decisions on parents' self-reported
information and a simplistic perception of the woman as the
survivor and the man as the abuser
The family as a whole……
 Professionals must respond to the needs of the
“whole family” in the context of “threshold”
http://www.bradford-scb.org.uk/scr.htm

http://www.rdash.nhs.uk/services/our-services/adult-mental-health-services/
 Improving Access to Psychological Therapies (IAPT)
Doncaster – The Talking Shop
63 Hall Gate,
Doncaster
DN1 3PB
Phone: 01302 565650
 If someone you know has concerns about their immediate health and you or they are already
registered with one of our services then please use the following contact methods to get the
help you need:
During office hours
 Phone your GP
 Phone your care coordinator / lead professional or other mental health worker
 Phone Mental Health Access Team/Single Point of Contact – 01302 566999
 Outside of office hours
 Doncaster – 01302 566999
Thankyou for attending
Any questions?