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 health issues. 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 If there is an immediate harm indicator in relationthat relates to parental mental illness is , this relates to immediate harm indictor 8: ‘Parent’s mental health concern, emotional instability or intellectual or physical disability results in behaviours that create imminent danger to the child’.
It is not a parent’s mental illness alone that is an issue, rather, it is the impact their mental illness is having on the child. There are many parents who have a mental illness or mental health issue that parent their child safely.
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?
- How do these impact upon the safety and wellbeing of the child?
- Are there concerns about the parent’s ability to regulate their emotions and behaviours?
- 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?
- What observations lead you to thinking this?
- Is the parent currently a patient/consumer of a mental health service?
- Do they have a treating doctor or psychiatrist?
- When was the last time they met with a mental health service?
- Does the parent have a diagnosed mental health issue?
- If they have been diagnosed with a mental illness, what are the common symptoms of that diagnosis and how might they affect a parent's functioning and parenting?
Read the overview part in the practice kit Mental Health for further information and links on common mental health difficulties.
The impact of the mental health issue on parenting
- When the parent is unwell, is the child well looked after?
- 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 attend to these?
- Is there another supportive adult available to help the parent and child?
- Is there food, clothing, rest, 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 health issue?
- 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?
- 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 in addition to their medication? What impact does this have on their mental health?
Parent’s ability to understand the concerns about their mental health
- Does the parent understand why Child Safety is worried about their mental health?
- 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 health issues?
- 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?
Remain open and curious to what else is happening in a family’s life. Mental health issues can appear as a response to significant stressors, such as domestic and family violence. Partners can be quick to use a person’s mental health against them as a form of coercion and control. This can lead to damaging service responses especially when people who need help are pathologised or confined while abusers are free. For further information on domestic and family violence, refer to the practice kit Domestic and family violence.
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 health 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 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.
Case study: Parenting with depression and violence
This case study is an example of how mental health may move from a danger to a potential risk:
‘Lilly has had depression since she was a teenager. Sometimes she feels so flat she can’t get out of bed. When she’s like this it can be hard for her to do everything she needs to do for Tyler — her 8 year old son.
You visit Lilly at her home and she tells you she’s been seeing a doctor and hasn’t felt depressed for a few months now. She also tells you she is worried about her and her son’s safety because Tyler’s father, Daniel, is violent and controlling. He sometimes hides her medication.
There is bruising on Lilly’s face. She says that Daniel punched her in the head last night. Lilly thinks that Tyler was asleep, however she knows that Tyler has seen the bruising to her face and knows she has been crying. You can tell that Lilly is scared, however determined to make sure Tyler is safe and cared for.’
Right now, there are immediate harm indicators present, but they’re not related to Lilly’s mental health issues. Lilly’s current emotional, psychological or cognitive functioning does not seem to be affecting her ability to supervise, protect or care for Tyler. Lilly’s mental health issues should be considered in the context of Daniel’s violence and patterns of coercive control, and how this could make Lilly’s mental health worse. The immediate harm indicator is Daniel’s use of violence.
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