Andrea Davies Clinical Psychologist Bro Morgannwg NHS Trust South Wales

1. Parents with Severe and Enduring Mental Health Difficulties: The Experiences of Mothers and the professionals who Provide Support Andrea Davies Clinical Psychologist Bro Morgannwg NHS Trust South Wales

2. Prevalence of Parents • Implications of The Community Care policy • Between ½ and ¼ of mental health service users are parents (Gopfert & Mahoney,2000) • 26% of adults diagnosed with schizophrenia and 60% of women with a chronic mental health difficulty are living in households with a child under the age of 16 (Oates, 1997)

3. How can mental health difficulties impact with parenting? • Reciprocal relationship • Parental Behaviours • Social Network • Medication

4. Potential Impact on Children • Rutter and Quinton (1984) • Singer (2000): Psychological difficulties may be found in up to 2/3 of children whose parents are known to mental health services. • Landau et al, (1972); Scacknow, (1987): Delayed speech development, eating and sleeping problems, aggressive behaviour and difficulty relating to peers

5. Risk OfAbuse • Child maltreatment is not an inevitable feature of parenting with mental health difficulties, yet the risk of abuse increases if services are unable to work together: “Service provision is fragmented and there is lack of inter-agency communication. In general, professionals working with children lack expertise in adult mental health and there is insufficient emphasis on child welfare ad child protection amongst adult psychiatric services”(Falkov, 1996)

6. Aims of Research • To gain insight into how Community Psychiatric nurse (CPNs) understand and support parents with severe mental health difficulties • To gain insight into how mothers with severe mental health difficulties experience services that provide support.

7. Methodology • 2 X CPN focus groups (N=7) • Individual interview with mothers (N=5) • Thematic Analysis (Boyatzis,1998)

8. Thematic Analysis:CPNs • Theme 1: Position of Mental Health Services sense of responsibility to client responsibility to client's child responsibility to client as parent tribunals mobilising a family-orientated approach

9. “People with schizophrenia, their affect is blunted and they always need someone to be an advocate” • “I wouldn’t want to comment necessarily on people’s parenting skills, I’m not qualified to do that…I think you would look for outside expertise” • “Not us!” • “You’ll find that if a referral comes in with a mother and baby, that will always take priority, we do definitely try, with all our families, to keep it family orientated”

10. Theme 2: Parent-Child Dyad mental health and parenting child separation

11. “She couldn’t handle her own anger, her temper and aggression towards other people, so we were concerned that she wouldn’t be able to control her temper with the baby” • “The thing that strikes me as well is that some people cope very well, bring up children very well” • “She was quite psychotic, and she had kept the older girl up, who was six, telling her all night that there were demons behind the curtain and witches were going to get her” • “Well, if she could have had those children she would have, but we had to drag her down the corridor, she didn’t want to leave the children”

12. Theme 3: Position of child-orientated services Responsibility to child Knowledge of mental health

13. “The people who are on these tribunals, who are there for the children, protect the family at any cost” • “Sometimes, you can easily think that it is because they have schizophrenia or enduring mental illness…they are not served quite so well” • “A lot of them don’t really understand mental health” • “There is an assumption that this person is schizophrenic, therefore they can’t be a good parent. Agencies need to have more awareness of mental heath, some of them are still scared of it”

14. Theme 3: Multiagency working effective working roles and responsibilities barriers

15. “It’s the communication that is the main thing…good communication between the various agencies…straightforward face to face, almost informal stuff is the key thing” • “There is always a bit of a chance for roles to become confused. If they set up case conferences, then you become more aware, and you can make sure you are not doing someone else job”

16. Thematic Analysis:Mothers • Theme 1: Motherhood pregnancy medication restrictions being a mother

17. “My CPN at the time…I wasn’t feeling very well, and she was well ‘it’s your fault, you shouldn’t have got pregnant” • “Before I was pregnant, the command hallucinations would tell me to self-harm, I didn’t think it would change when I was pregnant, but it did…the thoughts were more about harming the baby” • “She wasn’t on the ward with me…she couldn’t bond with me”

18. It’s brilliant” • “Oh, I love it, its’ so rewarding” • “I was a bit paranoid that social services were going to take the baby off me”

19. Theme 2: The Family support staying together understanding of mental health

20. “When I came out of hospital, I was shattered at night. My Mum has been fab” • “My family couldn’t care for [child] and she had to go into foster care” • “The family were brilliant. My Dad found it really hard seeing me unwell” • “It does worry me, because I’ve been having a lot of difficulties with my ex-partner, and I don’t want to give him any ammunition to say I can’t look after her”

21. Theme 3: Support types remit feature of helpful support features of less helpful support suggestions

22. “It’s a bit of everything; they ask how the children are and how they are sleeping, because it would affect my mental health” • “I knew my consultant and CPN, that really helps. You’re not so embarrassed then if things go wrong” • “My family social worker had no real understanding of my mental health problems like self-harm” • “It would be nice for people who have suffered a similar thing to maybe get together”

23. Methodological Limitations • Recruitment Difficulties: ? Who might meet the criteria ? perceived stress in taking part in interview about experiences of motherhood • Methodology: Interpretation of the data is specific to these participants and this researcher, in that it represents one set of stories and one of a number of possible constructions

24. A Step in the right direction • Mental health professionals might be clear about their responsibility towards child protection • Confidentiality not cited as problematic • Women with severe mental health difficulties can be reflective about their experiences of motherhood. • Facets of support received had been useful to the women

25. Not quite there yet? • Special interest vs core work • Physical environment • Difficulty in talking about needs • Training needs

26. Making Space for Parents in Mental Health Services • Safe conversations • Core Business- Utilising Care Programme Approach: continuity care plan carers assessment training for care managers (inc, Children Act 2004; Every Child Matters, 2007)

27. References • Aldridge, J. (2006) The Experiences of children living with and caring for parents with mental illness Child Abuse Review 15, 79-88. • Reder, P., McClure, M. and Jolley, A (2000) Family Matters: Interfaces between child and adult mental health Routledge. • Duncan, S and Reder, P. (2003) How do mental health problems affect parenting? In P. Reder abd S Duncan (Eds) Studies in the Assessment of Parenting Bruner-Routledge. • Falkov, A (1998) Crossing Bridges. Dept of Health • Plant, K & McGrath, J(2002) Parent with psychosis. Australian e-Journal for the Advancement of Mental Health, 1 (1), • Stallard, P., Norman, P., Huline-Dicknes, S., Salter, E. and Cribb, J. (2004) The effects of parental mental illness upon children: a descriptive study of the views of parents and children. Clinical Chid Psychology and Psychiatry