Building Bridges

Working with families impacted by parental mental ill health

Briony HallamRosie Mather

Family Action’s direct services:

“work with individuals and families, helping to build on each individual’s strengths to overcome obstacles and to provide practical and emotional support when they are at their most vulnerable.”

(Annual Report 2004-2005)

Aims of workshop

• Increase awareness of the issues for families affected by parental mental ill health

• Improve knowledge of strategies to support parents and children

• Learn about findings from the recent independent evaluation of Family Action’s Building Bridges services

Overview

• Issues for parents and children • Working with competing needs• Feedback/discussion • Family Action Building Bridges

- outcomes

Identifying need• Approx 1 in 4 adults experience mental

distress (ODPM 2004)

• 30-50% of them have children (Gopfert, Seeman and Webster 2004)

• Parental mental illness can have an adverse effect on child mental health and development (Falkov 1998)

• Serious psychiatric disorder is a factor in cases of fatal child abuse (Part 8 reviews)

• Maternal morbidity (30% of women with PND are still ill one year post partum)

• Young carers – emerging evidence base

Impact: on children

• Developmental• Educational e.g. interaction, young

carer role

• Emotional e.g. impact of insecure attachment

• Social e.g. isolation, bullying

• Cognitive e.g. motor skills, concentration

My mum’s heart

Impact: on parents• Stigma• Uncertainty & complexity • Focus on risk rather than impact • Feeling “on trial about parenting abilities” • Parenting abilities and capacity – may need

help• Impossibility of parenting without family

and social networks• Fear

– of losing children, reality of it happening– of mental illness

• Access & reuniting with children• Recovery impeded by anxiety

Who does Building Bridges work with?

• Adults, whose diagnoses include:– Bi-polar disorder– Schizophrenia– Personality disorder– PTSD– OCD– Substance misuse

(dual diagnosis)– Depression-related

illnesses

• Don’t define parent by illness

• Non-stigmatising value of voluntary sector

• Don’t treat every case as inevitably a safeguarding issue

Who refers to Building Bridges?

Adult mental health

11%

CAMHS

3%

Education

9%

GP/Health Visitor

8%

Not known

4%

Self

16%

Social Services adult

1%

Social Services children/family

29%

Voluntary organisation

10%

Other

9%

What does Building Bridges do?• Build relationships• Provide models of behaviour• Monitor – reduce risk• Place the child at the centre of the

work• Contain – and prevent crisis• Information & advocacy• Value and increase self-esteem• Opportunities to develop

Evaluation and outcomes

Outcomes I: independent evaluation

Characteristics critical to successful interventions:

• close attention to getting, keeping and engaging parents

• a strong theory base• synthesis of practical and emotional support• working with both parents and children• a practical, flexible and partnership approach

which is valued by parents and other stakeholders

(Building Bridges, Morris J. July 2007)

Outcomes II: statutory services

• A reduction in the number of children looked after

• A statistically significant reduction in the number of children on child protection plans

• A statistically significant reduction in the number of adults on CPA

Evaluation: Parents’ views• Non-judgmental and flexible • Helps children to understand mental

illness• Helps families link in with other

agencies• Prevents deterioration in family

relationships Random sample of 40 closed cases resulted in 31

interviews with parents (response rate 78%).

BB Evaluation: other agencies’ views

• whole family focus - services are flexible and tailored to individual families;

• ability to work with families with high levels of need, including those where children are on child protection plans

• willingness to work with families where there are profound & enduring mental health problems

• synthesis of practical and emotional support• positive working relationships with other

agencies

“For families who are easier to engage there are more services. But Building Bridges works with those who are the hardest to engage with, who aren’t motivated to go to a parents’ group or whatever. When we agreed to fund them we agreed they would start with the harder to reach families and that’s what they’ve delivered”.

Local authority stakeholder, for BB Evaluation, 2007

Working with competing needs

Small group exercise:• Discuss the competing needs

between adult and child• Plan how you will address this with

the family• Identify your first three steps• Share key messages from your

discussion with whole group

Situation 1:

• School referral: 10 yr old truanting. On investigation you discover this is due to him accompanying his mother to medical appointments in order to interpret between her and medical staff. Mother (diagnosis schizophrenia/schizoid affective disorder)

• Conflicting need? M’s treatment needs vs. child’s education

Situation 2:

• GP referral: lone mother (diagnosis severe depression), one child, girl, 2 years old, identified language delay. The key issue is emotional neglect of the child – e.g. mother often puts the child to bed straight after nursery, and is not engaging with her.

• Conflicting needs? M’s need to focus on self vs. child’s need for relationship with mother and emotional stimulation?

Situation 3:

• YOT referral: Daughter, 13, involved with YOT. M’s diagnosis (bi-polar – often means inconsistent parenting, between harsh or no discipline). Mother needs to establish boundaries and build more positive relationship with her daughter.

• Conflicting need? Young person’s need for clear boundaries to support through teenage years vs. mother’s difficulties and need for support with her identified mental health problems.

Building BridgesFor more information, please

contact:

Family Action Building Bridges services: Rose de Paeztron, Strategic Development

rose.depaeztron@family-action.org.uk Building Bridges evaluation: download at

www.family-action.org.uk Join (free) Parental Mental Health & Child Welfare Network:

www.pmhcwn.org.uk