1. Building Bridges Working with families impacted by parental mental ill health Briony Hallam Rosie Mather

2. Family Actions direct services: work with individuals and families, helping to build on each individuals strengths to overcome obstacles and to provide practical and emotional support when they are at their most vulnerable. (Annual Report 2004-2005)

3. 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 Actions Building Bridges services

4. Overview Issues for parents and children Working with competing needs Feedback/discussion Family Action Building Bridges - outcomes

5. 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

6. 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

7. My mums heart

8. 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

9. 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 Dont define parent by illness Non-stigmatising value of voluntary sector Dont treat every case as inevitably a safeguarding issue

10. 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%

11. 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

12. Evaluation and outcomes

13. 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)

14. 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

15. 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%).

16. 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

17. 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 arent 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 thats what theyve delivered. Local authority stakeholder, for BB Evaluation, 2007

18. 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

19. 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? Ms treatment needs vs. childs education

20. 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? Ms need to focus on self vs. childs need for relationship with mother and emotional stimulation?

21. Situation 3: YOT referral: Daughter, 13, involved with YOT. Ms 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 persons need for clear boundaries to support through teenage years vs. mothers difficulties and need for support with her identified mental health problems.

22. Building Bridges For more information, please contact: Family Action Building Bridges services: Rose de Paeztron, Strategic Development rose.depaeztron@family- action.org.ukrose.depaeztron@family- action.org.uk Building Bridges evaluation: download at www.family-action.org.ukwww.family-action.org.uk Join (free) Parental Mental Health & Child Welfare Network: www.pmhcwn.org.uk www.pmhcwn.org.uk