Specialist Services and Procedures
Practice Guidelines for Child Care staff working with parents with mental health difficulties
Legislative Context and Background
The framework for the provision of care to people with a mental illness was first set out in a 1975 White Paper “Better services for the mentally ill”. This has been endorsed and built on by a succession of Government circulars, White Papers and Guides, notably
- “Caring for People” (1989 White Paper)
- “Building Bridges” (1995 Department of Health Guide)
- “Still Building Bridges” (1999 Department of Health Guide)
- “National Service Framework for Mental Health” (1999 Department of Health Guide) and
- “Effective care co-ordination in mental health services: modernising the care programme approach” (1999 Department of Health and Social Services Inspectorate).
The Integrated Care Programme Approach (ICPA) is the framework which provides for the assessment of need, care planning, monitoring and review of people referred to the Specialist Mental Health Service (psychiatric hospital/Community Mental Health Team).
ICPA combines the duties of the N.H.S & Community Care Act (a Local Authority-led process of assessment, care planning and reviewing of the needs of a disabled adult) and the Care Programme Approach (a Health-led system of assessment, care planning and reviewing of the needs of a person with severe mental illness).
There are two levels of ICPA:
- Standard – where the service user requires the support or intervention of one agency or discipline, or may require only low-key support from more than one agency or discipline.
- Enhanced - where the service user has multiple care needs (including child care issues) or may be in contact with a number of agencies or is likely to require frequent /intensive interventions or likely to have other problems (such as drug misuse) co-existing with mental health problems or at risk of harming self/others or at risk of vulnerability to abuse from others or is likely to disengage from services or the carer is at risk from the service user or there is a risk of care breaking down.
The ICPA process identifies a Care Co-ordinator.
Eligibility criteria
It is Government policy that the specialist mental health services target their resources first and foremost on severely mentally ill people. They are defined in terms of three key elements:
- Disability - with impaired ability to function effectively in the community
- Diagnosis - may include psychotic illness, dementia, severe neurotic disorder, personality disorder, developmental disorder
- Duration of illness – of any of the above, for periods which vary between six months and more than two years with the addition of two further dimensions:
- Safety - unintentional self-harm, intentional self-harm, safety of others, abuse by others
- Need for formal or informal care.
The Mental Health Act (1983) Section 114 gives the Local Authority the duty to appoint sufficient Approved Social Workers (ASWs).
Mental Health Act assessments consider compulsory hospital admission and guardianship.
One of the duties of the ASW is to ensure the outcome of the assessment is the least restrictive possible i.e. a plan of care in the community must be considered before hospital admission.
The Carers (Recognition and Services) Act (1995) states that the carer may request assessment of his/her needs.
Principles
- The focus is on service users, including sensitivity to the particular needs of individuals and a commitment to user and carer involvement in the planning and delivery of care.
- Issues regarding gender, class and ethnicity are relevant to undertaking an assessment of need and the provision of services.
- Specialist psychiatric services are provided by a multi-disciplinary team.
- ICPA is applied to all who are accepted by the specialist psychiatric services.
- ICPA is an approach, and local agencies have to agree how to implement it.
- ICPA is not a bureaucratic exercise, but aims to achieve better care through integration, consistency, a proper focus, responsibility for implementation, assessment of the needs of carers.
- The aim of these guidelines is to facilitate and ensure that all staff see the adult and see the child, and respond to the family as a whole by co-ordinating information, assessments, services and reviews. This should also identify if a child/young person has a caring role and the implications of this upon their daily life.
- Contact points are outlined in appendix 1&2
- CMHTs are multi-disciplinary and comprise social workers, community psychiatric nurses, psychiatrists, occupational therapists, psychologists. They are a secondary service.
- There are tertiary mental health teams covering: Rehabilitation, Assessment and Outreach and Crisis Intervention, these teams cover the B&NES area.
- Confidentiality. When a person’s needs are assessed under the ICPA, that person is asked to sign a form consenting to information being shared with appropriate personnel. If the person refuses to sign, or in certain circumstances (such as a Mental Health Act assessment or where there is risk of harm) the person’s wishes can be over-ridden.
In many Inquiries following adverse incidents such as homicides and suicides, agencies have been criticised for not sharing information about risk.
Information-sharing within the CMHT is covered by Government circular HSG (96) 18/LASSL 996) 5 “The protection and use of patient information”. Information can be shared with the individual’s consent or on a need to know basis in certain circumstances. They are:
- The recipient needs the information because he or she is or may be concerned with the patient’s care and treatment
- The use of the information can be justified for the sort of wider purposes – theses are listed and include co-ordinating care with that of other agencies
- The information is required by statute or court order
- Passing on the information can be justified for other reasons (usually for the protection of the public)
In circumstances where there are concerns about risks to child/ren, mental health staff MUST share information with child care colleagues in recognition of the paramount concern for the child, as outlined in the Children Act 1989.
6. Appendix 1 shows which CMHTs service which G.P. practices.
7. CMHTs work in conjunction with other specialist mental health services, such as the Home Support Team and Community Support Workers.
8. If it is identified through the screening process of a referral to the Children & Families service that the child or young person’s parent/carer is currently allocated to a Mental Health worker the duty social worker should liaise with the named worker. The purpose of the liaison is to:-
- Clarify what assessments have been undertaken, what was the purpose of the assessment and the mental health worker’s conclusion and recommendations. This would enable the Child Care social worker to:-
- Incorporate relevant information into the initial/core assessment process.
- Assess the current and future needs and risks to the child
- Make judgements about what action, if any should be taken.
9. If the parent/carer is known to a Mental Health worker and the Child Care social worker has concerns about a parent’s/carer’s mental health currently such that it is impairing the care given to the child, the Child Care social worker to liaise with the Mental Health worker to decide what actions should be taken. This would be in the context of a Child in Need Assessment.
10. If the case, though no longer current, has previously been known to the Mental Health Team then, if it is not possible to liaise directly with the worker who has previous knowledge of the case, the file should be retrieved from the Archives and any information relevant to the needs of the child/young person recorded and any actions if any, should be taken.
11. Referrals to Mental Health social workers can be made by anyone. Mental Health Social Workers deal with social care issues, not medical/nursing issues.
12. If the parent/carer is not known to a Mental Health worker but the Child Care social worker has concerns regarding the parent/carer and the concerns are to do with medical/health issues then consideration should be given to referring the parent/carer to the GP for an assessment. If the mental illness cannot be managed at primary care (GP) level, then the GP should refer to the CMHT. CMHTs work with people with severe mental illness.
13. If the parent/carer is not known to a Mental Health worker and the Child Care social worker has concerns to do with social care issues the Child Care social worker should make a referral to the Mental Health Team. Referrals can be made by:-
- Contacting Adult Care Duty Officer (Lewis House or The Hollies)
- Telephoning the appropriate Mental Health Team Manager or Team leader
- Writing to appropriate Mental Health Team Manager Team leader. (Appendix 2).
14. Referrals for a Mental Health Act assessment are usually initiated by GP, Psychiatrist, Mental Health social worker (if already involved), Community Psychiatric Nurse. They can be initiated by the Nearest Relative (as defined by the Mental Health Act). Requests for an Approved Social Worker are made via the Adult Care Duty Desk at Lewis House within office hours. If out-of-hours, contact the Emergency Duty Team.
Not all Mental Health social workers are Approved Social Workers. Only Approved Social Workers can undertake Mental Health Act assessments.
Reviewing Plans and Service Delivery
15. When a joint assessment (between Mental Health and Child Care teams) is undertaken and joint services provided, these must be reviewed within the appropriate forum (Children in need service plans, Child Protection, LAC Review, ICPA) and notice given of any proposal to cease a service. All relevant personnel must be invited to these meetings.
Administration
16. Referrals, assessments, services and reviews must be logged on the Care Records in Social Services Package (CRISSP).
17. It is the responsibility of the social worker who receives the information to ensure that this information is recorded on the file.
18. Whilst the administrative tasks of the procedure can be delegated to administrative staff, responsibility for carrying out the procedure remains with social work staff.
Professional Conflict
19. There may be occasions where the two services have different perceptions, priorities and goals. It is important that these differences are openly acknowledged and addressed.
Staff Training
20. There is an expectation that mental health staff will attend introductory training in Child Protection and Child Care staff should attend training on mental health issues
Financial Responsibility
21. Where there is a joint working arrangement in place, decision making about financial responsibility for provision of services should be shared. The guiding principle should be that if the service is to enable the adult(s) to exercise their role as parents, the CMHT is responsible. If the service is directly for the child then the C&F team is responsible.
November 2002