Tool for Assessing and Responding to the Impact of Parental Mental Ill Health on Children

Tool for Assessing and Responding to the Impact of Parental Mental Ill Health on Children

This practice tool is intended for use by anyone involved in:

• Providing services to adults who are parents and/or carers
• Providing services to children and young people 

When to use this tool

This tool is to be used when when considering how likely and with what severity an adults mental ill health will impact on a child. It involves the practitioner thinking about the nature of risk and also the protective factors for the child so it includes the practitioner’s professional judgement.

Process to follow:                       

Follow the flowchart below

The PAMIC Check will support your assessment.

The Confidentiality and Information Section will support you in decision making regarding consent, confidentiality and information sharing.

Record Keeping

The assessment and actions taken should be fully recorded along with the resulting outcomes on individual organisation recording systems.

PAMIC check

Potentiality for the Adult’s Mental Ill Health to Impact on the Child (updated June 2022)

The PAMIC check is a tool to support you when considering the likelihood and severity of the impact of an adult’s parental mental ill health on a child; it is not intended to replace professional judgement.  You need to think about the nature of risk but also the protective factors for the child.  When undertaking an assessment, consideration should always be given to any other current or previous safeguarding concerns particularly if those previous concerns have been associated with parental mental ill health.  It is also important to understand if a family are open to Children’s Social Care or any other support services, including Early Help.

Examples of protective factors include:

• There is another adult that can be depended upon to meet the needs of the child and they are fully aware of the potential risk associated with parental/ carer mental ill health.
• The individual has insight into their problems, can take action to significantly reduce the impact of their behaviour on the child and is sufficiently supported.

Risk of Significant Harm

If any of the following factors are present they are highly likely to have a direct impact on the safety and well-being of the child.   Immediate referral to Children’s Social Care in line with LSCP Safeguarding Children Procedures(North Yorks: https://www.safeguardingchildren.co.uk/about-us/worried-about-a-child/ , City of York: https://www.saferchildrenyork.org.uk/about-the-cyscb.htm)

• Delusional beliefs/ideas involving the child and or
• Risk that child will be harmed as part of a suicide plan.
• A pregnant woman has a history of post natal psychosis, particularly when this was associated with significant harm to a child
• The child is a target for parental aggression or rejection.
•   Co-existing domestic abuse, drug or alcohol abuse.
• There is no other adult that can be depended upon to meet the needs of the child. (Children of lone parents or isolated parents are at greater risk as they are less likely to have an alternative caregiver when a parent is in crisis).
• The  child is the parent’s carer and this is impacting on the child’s welfare.

Moderate Risk of Harm

Where factors such as the following are present, although not of the same severity as above, they can potentially impact on parenting and result in concern for the child’s care. Seek consent for a referral to Children’s Social Care for an assessment. 

• The presenting mental ill health (including the effect of medication/treatment) is impacting on the parents’ capability to consistently meet the needs of the child.
• The parental mental health disorder is designated ‘untreatable,’ either totally or within time-scales compatible with the child’s best interests.
• Where there is non engagement with mental health support services and it is considered that this could lead to potential risk to a child / unborn baby.  

Low Risk of Harm

Where factors such as the following are present they require an assessment of the child’s needs to support planning for the child’s care.  Seek consent for Early Help assessment.

• Parental learning disability rendering the child more vulnerable.
• Non-compliance or inconsistent compliance with treatment, reluctance or difficulty in engaging with necessary services, lack of insight into illness or its impact on the child.
• The child is vulnerable due to, for example,  age, illness, disability or behavioural/emotional issues.
• Changes in the child’s behaviour since the onset of the parent/carer’s mental ill health.

Not considered at risk

No obvious impact on the child’s health and well-being are evident. Liaise with key others where appropriate and consent to do so is obtained.  As events may change keep under review.

Confidentiality and Information Sharing

Information Sharing

Good information sharing is a crucial element of successful inter-agency working, allowing professionals to make informed decisions, thus improving outcomes for service users and children. Sharing of information is lawful where:

• The patient/client has consented for information to be shared.
• The public interest in safeguarding the child’s welfare overrides the need to keep information confidential.
• Information must be shared under a court order or other legal obligation.

Information Sharing with Consent

Individuals can give their consent to personal information about them being shared with third parties, but it must be explained why this information is needed, what will be shared and who it will be shared with.  If the information is sensitive in nature, for example relating to a person’s mental health, consent would need to be clearly recorded on the case file in line with organisational procedures.

A young person aged 16 years or over is capable to giving consent on their own behalf; children under 16 years can only give consent if it is thought that they fully understand the issues and are able to make an informed decision.  If not, the decision must be made by the person who holds Parental Responsibility for them.

Where an adult is deemed incapable of giving consent to information sharing, consent should be sought, where possible, from a person who has the legal authority to act on that person’s behalf.

If it is not possible to obtain consent to information sharing, information can be disclosed without consent under the circumstances listed.

Information Sharing without Consent

Where consent has not been given, or it is thought that to seek consent from a parent or carer may place the child at further risk, professionals should consider whether it is lawful for them to share the information without consent.

Clearly, it would be lawful to share information in order to safeguard a child’s welfare, but professionals must consider the proportionality of disclosure against non-disclosure: is the duty of confidentiality overridden by the need to safeguard the child?  Where information is shared, it should only be relevant information and only shared with those professionals who need to know.  Professionals should consider the purpose of information sharing and remind those with whom information is shared that it is only to be used for that specified purpose and should otherwise remain confidential.

If practitioners are unsure whether it is appropriate to share information, they should seek guidance from organisational safeguarding/legal teams.

Further guidance on information sharing with regard to safeguarding children is contained in Information Sharing (HM Gov; 2018) https://www.gov.uk/government/publications/safeguarding-practitioners-information-sharing-advice and What to do if you are Worried a Child is being Abused (HM Gov; 2015) https://www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being-abused–2