Assess harm and acts of protection

Assess immediate safety

As part of completing a safety assessment, gather information from a wide variety of sources. Practitioners engage with families, children, young people and communities whose culture, ethnicity, economic status, age, gender, spirituality and sexual orientation may differ greatly from their own. It’s important to remember that practitioners can be influenced by their own personal experiences and therefore biased when assessing others where difference exists. This is why it is essential that information is gathered not just from the family but the extended family, the network and cultural elders or advisors to ensure we are able to make a rigorous and balanced assessment.

Below are key factors to consider during a safety assessment when there are worries about parental mental illness. This section is not intended to be exhaustive or directive but to prompt and support thinking and planning. There are many considerations to explore with the family to inform the safety assessment.

The immediate harm indicator that reletes to parental mental illness is immediate harm indicator 8: ‘Parent’s mental health concern, emotional instability or intellectual or physical disability results in behaviours that create imminent danger to the child’.

Consider the following when assessing safety:

The pattern of parental mental health issues

• Is the parent currently unwell?
• If they are unwell what are the current symptoms that are of concern, and how do they impact on the safety and wellbeing of child?
• Does the parent have a diagnosed mental illness?
• If they have been diagnosed with a mental illness, what are the common symptoms of that diagnosis and how might they affect the parent’s functioning and parenting?
• Are there concerns about the parent’s ability to regulate their emotions and behaviours in a way that impacts the immediate safety of their child?
• Does the parent experience rapid, unpredictable changes to their emotions and behaviours?
• Does the parent have immediate thoughts of harming themselves?
• Does the parent have thoughts of hurting their child?
• If they have thoughts of harm, do they have a plan about how they will do this?
• Does the parent have hallucinations? Are they hearing voices or seeing images telling them to do things?
• Does the parent have delusions about the child?
• Does the parent currently use alcohol or other drugs?
• Does the parent seem affected by substances? What did you observe that indicates this?
• Is the parent currently a patient/consumer of a mental health service?
• Do they have a treating doctor (GP) or psychiatrist?
• When was the last time they met with a mental health service or their GP?

The impact of the mental illness on parenting

• When the parent is unwell, is the child well looked after?
• Does the parent have a support network?
• If the parent is unwell, can they still care for their child?
• If the parent can care for their child, what does this look like?
• Does the parent’s capacity to care for their child fluctuate with periods of wellness compared with periods when they are unwell?
• Is the parent able to think about the child’s needs and attend to these?
• Is there another supportive adult available to help the parent and child?
• Is there food, clothing, health care and warmth available for the children?
• Is the child attending school regularly? Or, for a child not yet at school, does the parent support their learning and exploration?
• Are the children involved in age-appropriate social activities?
• Does the parent show consistent and predictable warmth, sensitivity and comfort to the child?  Is there affection shown toward the child?
• Are the children taking on exhaustive or inappropriate parenting roles for younger children or their parent? What does this look like?  How does this impact on the child’s development?

The family’s home environment

• Is the home safe for children?
• Is the family in danger of being homeless or evicted?
• Does the family move home frequently?
• If they do move home a lot, why is this?
• Does the parent share a bed with a baby?
• If they are sharing a bed, does the parent take medication that makes them drowsy?
• Is the parent at risk of falling asleep with a baby on a couch or other unsafe sleeping arrangement?
• Who else lives in the home?

Parent’s medication use

• Is the parent prescribed medication to treat their mental illness?
• Are they taking any other prescribed medication?
• Is medication stored safely?
• What side effects does the medication have? Could these side effects impact their parenting? Are there times when the parent is more or less impacted by their medication (for example, mornings, afternoons, particular days or weeks)?
• How does the parent feel about taking their medication?
• Do they take the medication as prescribed? If not, what impact does this have?
• Is the parent using alcohol and other drugs or taking non-prescribed prescriptions, in addition to their medication? What impact does this have on their presentation? Refer to the practice kit Alcohol and other drugs.

Parent’s ability to understand the concerns about their mental illness

• Does the parent understand why Child Safety is worried about their mental illness?
• Have the impacts of their mental illness on the children been explained?
• Have they worked with Child Safety or other agencies before? What was that experience like for them?

Child and family’s safety and support network?

• Does the family have a supportive social network?
• Are relatives aware of the parent’s mental illness?
• Are the family’s relatives supportive?
• Who is in the family’s safety and support network?
• What kind of involvement do these people have with the children?
• Will the parent accept help from their networks, relatives or other agencies?

Consider the below scenario where domestic and family violence intersects with mental health:

‘I asked the mum what she would do if her ex-partner turned up at her door. She said she would ask him to go. I said we would want her to call the police. She said she wouldn’t.

Afterwards I read through mum’s criminal history and discovered that on the many times police were called for domestic violence, they had taken her to the hospital for a mental health assessment. When police would arrive to her house, there she was, still really upset and he would be calm. He would tell police she was crazy and she had assaulted him.

It was a hard lesson for me, but an important one. It is not helpful to impose a safety plan on a mother. I realised that any planning I undertook with a mother needed to start with her views and experiences – and an understanding of her partners’ pattern of violent and coercive behaviour.

In this case she was being pressured to do something that she knew would not work. She was in a no-win situation because even though she knew my directions would not help her and her children – she also had the fear that her kids would be taken away if she did not comply with my directions.

Without taking the time to understand Deborah’s story and experiences (in the context of his pattern of behaviour), I could never do a good job of helping her with safety planning.’

Consider immediate harm versus risk

One of the key challenges of assessing safety is to differentiate between the immediate harm and risk of harm, or the worry about what may happen in the future if no intervention and support is provided. 

Using the questions previously suggested can help practitioners to assess whether a parent’s mental illness is:

• an immediate harm to a child
• a risk to a child (worry)
• causing no harm or posing no significant risk to the child.

Consider how the worries about mental health issues may change over time, through periods of wellness and periods of illness. Look for other worries or complicating factors that might be present in a family and how they are connected (or not) to a parent’s mental health difficulties and a child’s safety.