Friday, August 4, 2017

Parents with Mental Health Issues


I’m a parent and I have mental health problems and/or a personality disorder. Can a social worker take my children away? “Don’t ever let anyone tell you that your mental health challenges make you a weak person or a bad parent. Living and surviving and managing with all that stress and noise in your head requires strength, more strength than many other people will ever even have to find from within themselves. You are strong. Very strong indeed” Debbie, aged 35, living with her four children and with lifelong schizoaffective disorder Historically, there has been stigma and prejudice associated with parenting whilst living with a mental health challenge or personality difficulty. In the past, individuals who had or had been diagnosed with problems with their mental health were at unjustified risk of having their children taken from them. However, from the very beginning of disability rights legislation in the 1990s, mental health conditions have been recognised as disabilities. Therefore, people with mental health conditions have gained the right to protection from discrimination and parents with mental health conditions have gained the entitlement to support from Adult Services in their parenting role. Therefore, the courts should never allow a Social Worker to remove a child from a parent simply because the parent has mental health difficulties. Instead, Children’s Services would need to provide the court with evidence to demonstrate one or more of the following scenarios; The mental health difficulties of the parent are of such severity that the parent cannot safely look after their child, even with the supervision of family members and/or the support of professional agencies, and that the parent is likely to have these difficulties for the foreseeable future. For example, Katie is suffering from psychosis, holds the resulting belief that she needs to add bleach to her son Liam’s baby formula and does not appear to understand why giving Liam bleach is harmful to him. Children’s Services would need to prove to the court that there was nothing Katie’s husband Rob or any professional could reasonably do to prevent Katie from feeding Liam with bleach before the court would allow a Social Worker to take Liam into care. The parent is not engaging with the mental health treatment or social support necessary to enable them to safely look after their children. For example, single mother Shenaz is very depressed and struggling to keep the house clean, get her daughters Amira and Aisha dressed and ready for school and doesn’t want to take anti-depressants or have counselling and refuses to accept help from her ex or her sisters. Children’s Services would need to prove to the court that they had done everything possible to encourage Shenaz to accept help before the court would allow a Social Worker to place Amira and Aisha with their father or aunt. The mental health difficulties of the pregnant woman involve a lifestyle so chaotic, risky or unpredictable that it is reasonable to believe that the newborn baby would be exposed to an unacceptable level of risk. For example, Shannon is six months pregnant and constantly moving between squats comprised of people who grow and use cannabis, a substance which Shannon uses to self-medicate against the voices she hears. Children’s Services would need to prove to the court that Shannon would be highly likely to try and raise her as-yet-unborn child surrounded by drugs and drug users, and thus at extreme risk of cot death, abuse and neglect. Mental health advocacy services are experienced at helping parents to articulate and to explain to professionals their difficulties, and are skilled at helping parents to locate and request the help they need. Therefore, if a parent with current or historic mental health difficulties is able to explain and understand their difficulties and to explain the support they need, they should not find themselves in danger of losing their children. However, this advice can be problematic for people in the following situations I have a diagnosis of personality disorder. Can a social worker take my children away? You may also be interested in this post about personality disorder. Personality disorder is a contentious and disputed diagnosis, and one which can be used in different ways or mean different things to different professionals. Most people with a diagnosis of personality disorder have had difficulties for a long time, and most find that mental health services have not been able to help them. Therefore, people with diagnoses of personality disorder can find it difficult to access or engage with the sort of help they need. Professionals – including doctors and social workers – can sometimes find people with a diagnosis of personality disorder confusing or intimidating, and difficult to help. Many people with a diagnosis of personality disorder manage well as parents. However, some parents with diagnoses of personality disorder do need some help. Most people with a diagnosis of personality disorder have a history of childhood abuse or neglect, and some may therefore need guidance in understanding how to keep their own children safe and cared for. Many people with a diagnosis of personality disorder struggle to manage relationships and emotions, and some may therefore need support in responding to the behaviour of their children. Some people with a diagnosis of personality disorder cope with stress in self-destructive ways such as by self-harm, substance abuse, eating problems or sexual risk-taking, and these people may need help in ensuring that their children are not affected by their behaviour. It is this latter category – those parents who are harming themselves, and whose children are witnessing them harming themselves or whose unborn children are affected by them harming themselves – who are most likely to attract the concern of professionals. However, before allowing a Social Worker to remove a child from a parent with a personality disorder, the court must ensure that everything possible has been done to help and support the parent. In the past, personality disorders were regarded as ‘untreatable’ and some people with diagnoses of personality disorder may still be told they are ‘untreatable’: however, this attitude is now recognised as discriminatory and does not remove from statutory services the legal obligation to try and help. There is help and support available for people with diagnoses of personality disorder: treatments such as mentalisation-based therapy (MBT), dialectic behaviour therapy (DBT), cognitive analytic therapy (CAT) and therapeutic communities have been demonstrated as reasonably effective. Therefore, unless a person with a diagnosis of personality disorder is refusing all help, their Social Worker must do everything possible to find them the support they need before considering whether to take their children away. The medication I’ve been given means that I sleep so soundly I don’t wake up if the baby needs me in the night – and I’m a single parent. Can the Social Worker take my children away? Excessive sleepiness is a well-known side-effect of much psychotrophic medication, particularly the older antipsychotics. When prescribing, psychiatrists should be willing to take lifestyle factors such as the possible need for waking quickly into account – for most people, there will be alternative forms of medication to try. When a physically-disabled single parent needs support at night, Adult Services should provide and fund a carer or personal assistant. Parents who have a similar need due to medication should therefore have a similar entitlement. Therefore, the court would insist that Adult Services provide the help parent needs as an alternative to removing the children. In practice, however, single parents with both physical and mental health disabilities often have to work quite hard to access and secure funding for such levels of help. Advocacy services such as those run by Mind and Rethink can be very effective. I know I need therapy to be a good enough parent, but my Social Worker says the waiting lists mean that I won’t even get an assessment for another six months and that even then I mightn’t get any help because I’m too unwell or live too far away. Can the Social Worker take my children away? It can be very difficult for parents with mental health difficulties and personality disorder diagnoses to find and receive the support they need. Waiting lists often exceed the government’s 18 week target and parents can feel very frightened and isolated in the meantime, which may increase the level of risk of harm or neglect they pose to their children. However, Children’s Services should never consider removing children simply because of the difficulties in accessing help for the parent. The courts should ensure that this will not happen. National mental health charities and local advocacy groups can also be useful in helping parents to find the help they need within a reasonable time-frame – such organisations can often be more aware of available resources than social workers or psychiatrists. I know I could manage with the children if I had daily visits from a support worker, weekly counselling and 24/7 access to the Crisis Team. My Social Worker agrees, but says that there’s not enough funding within the system available to give me that much help. Can they take my children simply because it’s cheaper than giving me the help I need? This is a scenario which should never arise. However, given the current budget cuts within the public sector, all local authorities are under pressure to save money, if only in the short term. Ultimately, the courts make decisions based upon the best interests of the child rather than on the financial convenience of the professionals involved. It would therefore be very difficult for Children’s Services to persuade a court to allow Social Workers to remove children simply to avoid the expense of supporting a parent. Parents who are struggling to obtain the help they need often benefit from a good solicitor and the support of advocacy services. See for example, the advocacy services run by Mind and Rethink which can be very effective. I have problems other than with my mental health. Sometimes I fall over and wet myself due to seizures I have, but the Social Worker think it happens because I’m drunk even though the doctor I saw at A&E last year could tell it was a medical problem. Can the Social Worker take my children for being drunk, even though I don’t even drink? People who have mental health problems often find that any unexplained physical symptoms will be attributed to their mental health or behaviour: this is known as ‘diagnostic overshadowing’, and is very common. Furthermore, Children’s Services and the NHS do not always share information as effectively as necessary, and records and letters can be inaccurate, worsening the problem. The Patient Advice and Liaison Service (PALS) are generally very good at ensuring that doctors provide Social Workers with all the information they need. If Children’s Services were to make a court application on the basis of inaccurate information, the solicitor of the parent should successfully be able to highlight and challenge any errors. When I am most distressed, I can find it hard to talk to people or to explain what is wrong. I’ve tried to write things down, but I’m not very good at reading and writing and I don’t always understand what professionals say or write. This means that the Social Worker sometimes thinks that I’m not cooperating – can they take my children away? Many people who have both mental health problems and difficulties with communication or literacy find that the anxiety, stress and confusion associated with their mental health can make it especially hard to explain to professionals what is wrong and to understand what they are being told to do. All professionals – and especially Social Workers – should be trained in working with and communicating with people with range of needs and difficulties. However, advocacy services can be helpful, especially when parents have additional learning difficulties. The Social Worker told me that she ‘doesn’t believe in people with schizophrenia being allowed to be parents’. Can she take my children away? As explained above, this opinion is discriminatory, and to act on it would be illegal. Social workers and other professionals may believe in many things and may hold a range of personal opinions. However, the law does not give professionals the authority to act on the basis of their individual views. Before a Social Worker is able to apply to the court for the removal of children, both the Social Worker and his/her manager will need to agree that the children should be removed, and the solicitor employed by the local authority will need to agree that there is a reasonable chance that the court will agree with them. No local authority solicitor would advise Children’s Services to initiate court action based simply upon such views expressed by one individual Social Worker. I’ve read some things online about Social Workers. I now realise that Children’s Services have hidden a camera in my daughter’s teddy, and I know that the way the Social Worker dyed her hair last week means that they’re going to take my daughter. Is this true? Certainly, there are some frightening things written online. Many of these appear to have been written by people who suffer the unusual or scary thoughts often associated with diagnoses of paranoia, some personality disorders or psychosis. If a parent is frightened by their thoughts or beliefs, and if the parent is finding it hard to get these thoughts or beliefs out of their head, he or she may be experiencing a deterioration of their mental health. Parents with a diagnosis of schizophrenia, bipolar disorder or personality disorder sometimes hear persecuting voices that others cannot hear, and these voices can include those of authority figures such as Social Workers and psychiatrists. Looking after children whilst experiencing such intense distress would be hard for any parent with or without mental health difficulties. The best thing a parent can do in this situation is therefore just to ask for help from a mental health professional or a trusted friend. I know that I need help in looking after my children and my partner does help – he’s a great dad and does everything for them. However, he beats me regularly and I’m scared to tell anyone because I know he’ll convince them that it’s just my mental health making me imagine the beatings… even if I do leave, I know he’d get full custody of the children and ban me from seeing them because I know I couldn’t look after them on my own. If I ask for help, can a Social Worker take my children away? This is probably one of the most difficult scenario for a parent with a mental health problem or personality disorder diagnosis. The Women’s Aid website provides some thoughtful and realistic advice here. Parents who find themselves in this very vulnerable position would do best to approach Children’s Services and mental health support via the support of an independent domestic violence advocate, who will help the Social Worker to understand what is happening and what will help. Some women’s refuges have intensive support available to mothers with specific mental health needs, and some refuges can allow women to stay for up to five years. However, the mother will need legal advice and representation to protect themselves from their abusive ex-partner, which is currently available free of charge to all domestic violence victims through legal aid. You might also find it helpful to visit our section on domestic violence and abuse. I’m on my own with the children all week and I’m hearing voices telling me to kill myself and I’m having thoughts of doing frightening things. I want to phone 999 and ask for help – but will a Social Worker come and take the children away? If the suicidal or severely distressed parent has no adult family members or friends around to help, it is possible that the children may be taken into temporary local authority care in order for the parent to receive the urgent help that s/he needs. Children’s Services should make a priority of initiating any longer-term support necessary to support the parent to care for children in the future. Therefore, the parent should never be afraid of asking for help in a crisis or emergency. PLEASE if you are feeling suicidal and you haven’t got anyone else you want to talk to, call the Samaritans. http://childprotectionresource.online/reporting-post-natal-depression/