SEMINAR Parental mental health and child welfare Making the shift; Cost effective transition to embedding whole family approaches as core business within adult mental health and children’s services Gloucester 18 th February 2016

Structure of Health & Social Care in Northern Ireland Northern Ireland Executive Belfast Health & Social Care Trust South Eastern Health & Social Care Trust Northern Health & Social Care Trust Southern Health & Social Care Trust Western Health & Social Care Trust Minister of Health, Social Services & Public Safety Depart of Health, Social Services & Public Safety Health and Social Care Board

Health & Social Care Board its role Three functions: 1. To arrange or ‘commission’ a comprehensive range of health and social services for the 1.8 million people who live in Northern Ireland 2. To performance manage Health and Social Care Trusts that directly provide services to people 3. To effectively deploy and manage its annual funding from the Northern Ireland Executive –currently around £4 billion

Public Health Issue children living in a family where there are parental mental health issues and/or substance abuse are at high risk in relation to their mental health, physical health, social and relationship difficulties as well as educational attainment. (Beardslee et al (2011). “Mental health problems are estimated to cost the country over £77 billion a year through the costs of care, economic losses and premature death” (Social exclusion unit, ODPM (2004 p.3). “Poor mental health carries an economic and social cost of £105 billion a year in England”. (Centre for Mental health (2010 p.1)

Background /Context  O’Neill Inquiry 2007  Think Family Pilot  SCIE

Aim  Better understanding of mental health and children’s roles and responsibilities  Improve practice through enhanced collaborative working  Introduction of Family Model

Evidence Base  Selection of papers from the last century  Canavan & Clark (1923) The mental health of 463 children from dementia praecox stock  Preston & Antin (1932) A study of the children of psychotic parents  Buck & Laughton (1959) Family patterns of illness: the effect of psychoneurosis in the parent upon illness in the child  Rutter (1966) Children of Sick Parents: An environmental and psychiatric study  Rieder (1973) The offspring of schizophrenic parents: a review  Bleuler (1974) The offspring of schizophrenics  Beardslee et al (1983) Children of parents with major affective disorder: a review  Watt et al (1984) Children at Risk for Schizophrenia: A longitudinal perspective  Asarnow (1988) Children at risk for schizophrenia: converging lines of evidence  Downey & Coyne (1990) Children of depressed parents: An integrative review  Taken from:  The Family Model Handbook. An Integrated approach to supporting Mentally Ill parents & their children. Falkov, A. (2012) Page 48

Evidence Base – cont’d  COPMI  SCIE Guidance  Monds-Watson 2010  “The siloed approach is still apparent and to a degree the dominant approach within mental health and family and children’s service”. (Monds-Watson et al 2010).  The Family Model 2012 – Dr Adrian Falkov  Parental Mental Illness can affect children  Mental Illness can affect parenting and the parent/child relationship  Parenthood can precipitate, exacerbate or otherwise influence Mental Illness  Children’s Mental Health and development needs can have an impact on Parental Mental Health(Falkov 2012 pg. 12)

The Family Model

What we planned to do (2009 – 2012)… Achievements  PTL Action Plan  Strengthened documentation-Think Family Focus  Linked with ongoing regional initiatives  Developed regional adult and children’s services joint protocol  Strengthened UNOCCINI (Appendix 1)

What we planned to do (2009 – 2012)… Achievements continued…  Family experience and staff survey  Knowledge and Skills Framework  Training programme for managers  Aide Memoire  Resource literature –Talking to Children

Think Family Northern Ireland Phase 2  Core business for HSCB under Children & Young Peoples Strategic Partnership (CYPSP)  Linking to current initiatives and strategic direction  Structure – Regional Think Family Sub Group  Regional Action Plan – 3 key themes  Separate Performance measurement task

CYPSP Regional sub Group Regional Think Family Communications Plan Think Family Collaboration Group- Performance SW Strategy TF SW Assessment Working Group Developed products for communication & information sharing Regional implementation of Champions Model Shape Strategic Direction Phase 2-Think Family NI

Health & Social Care Trusts Interface Groups Think Family Practitioner Linked into Performance Agenda Develop Local Champions Connections with other Trust forums regarding accountability Develop Think Family Communications Plans South Eastern Trust Pilot

2 Commissioning a change in mind set to develop a change in culture 3 Power of Lived Experiences 4 Harness upon what already exists 5 Data Collection 1 Evidence Base to inform It’s Everyone’s Responsibility Strategic Operational Clinician/ Practitioner Making the Shift

Shape Strategic Direction  Adult Mental Health Service Framework  Children & Young Peoples Service Framework  Regional Mental Health Care Pathway  Children & Young People Strategy  Families Matter Strategy

Shape Strategic Direction – cont’d  10 year Social Work Strategy  Regional Informatics  Scoping exercise with QUB & UU  QUB & UU Think Family Study – 2year benchmarking of family focused practice  International links  Develop 3year evidence based workplan

Conclusion  Dedicated short term investment - 3 year Pilot £280k  Current funding - £130k  Its everyone's responsibility  Strengthen existing infrastructure  Shape and influence  Find interested and committed people

Questions? Mary Donaghy Social Care Commissioning Lead Mental Health & Learning Disability/ Regional lead Think Family NI HSC Board Linenhall Street Belfast BT2 8BS Tel: Mob: net