The emotional distress and burden of guilt is felt not only by birth mothers, fathers and wider family members, but by all the professionals involved in making the decision.
Yet the number of newborns appearing in care proceedings soon after birth in England and Wales has more than doubled over the last decade, and variations in numbers from region to region suggest that there are inconsistencies in practice and how and why decisions are being made.
While intervention is necessary in some cases, where there is an insurmountable risk to the child, there is growing recognition that providing parents with early pre-birth support could reduce the number of babies being removed. Once care proceedings are issued, the 26-week timescale for completion leaves little time for social care professionals to work preventatively with families, or for parents to make the changes needed to prove their ability to safely care for their children.
The importance of early intervention in pregnancy was highlighted in a report recently published by the Nuffield Family Justice Observatory which studied 1,000 mothers at risk of care proceedings in Wales. In particular, it uncovered the mental health issues experienced by this group of mothers (53 per cent reported an existing mental health condition at their initial antenatal assessment, and 77 per cent had a GP or hospital contact or admission related to mental health at some point prior to their child’s birth) – firmly underscoring the need for enhanced support. Mental health problems are treatable, and if help comes early enough, the likelihood of a baby being removed could be reduced.
And the opportunity for more intensive engagement, at an earlier point, is there. It is often assumed that women at risk of care proceedings delay contact with antenatal services (or even conceal their pregnancy out of fear their baby will be removed) – but the study shows that in Wales, 63 per cent had in fact made contact by the end of the first trimester.
There is a clear need for health and social care professionals to be attuned to pregnant women’s mental health needs, and for mental health to be given greater priority. Fortunately, local authorities in Wales are moving towards an earlier pre-birth response to all families referred to children’s social care services, and the government is investing in mental health perinatal services. Local authority workshops we recently held across England to share local data about the number of babies being taken into care further confirmed that pregnancy is an important window for preventative intervention.
However, while there seems to have been a general shift in practice towards earlier pre-birth assessments, budget and resource constraints mean the nature and quality of assessments can vary (as can access to services; in some places, austerity measures have reduced – even decimated – their availability).
Another issue to consider is whether professionals feel able to identify and respond to maternal mental health needs. Our workshops suggest pre-birth practice is seen as distinctive, with some social workers primarily focusing on assessment, and being less confident in their ability to offer psycho-social interventions. Identifying professional training needs is therefore an important next step.
The workshops also highlighted that midwives with specialist perinatal mental health knowledge are valued and contribute to best practice. We would therefore question whether the pivotal role midwives play – in identifying women who may be at risk of care proceedings and helping them access support at the earliest possible point in pregnancy – has been sufficiently realised.
The Covid-19 pandemic and lockdown has layered additional challenges on top, but in our conversations with services we have heard from professionals who have radically reconfigured their practices at incredible pace in response. The energy and willingness to try new things in the best interest of children during this time is clear.
Recent findings suggest the sharp rise in the number of babies being taken into care is as much a mental health crisis as it is a parenting crisis. It is essential that mothers receive holistic support early in pregnancy, including referrals to preventative services, and that resources are put in place to ensure the kind of intensive help families need is available.
Lisa Harker is director of the Nuffield Family Justice Observatory