Applying the Recovery Approach to the Interface Between Mental Health and Child Protection Services

• J. Duffy et al
• Child Care In Practice, (2016)

It has been suggested that mental illness affects one in five adults, of which 30 to 50 per cent are parents. The impact of mental ill-health on parenting can range from negligible to severe. At the more severe end, children can experience a range of adverse parenting, which can be compounded if parents also have problems with substance abuse and domestic violence.

While many parents involved with child protection services may also be involved with mental health professionals, interdisciplinary working across these systems can be challenging. This article discusses the potential of the "recovery approach" increasingly used to improve interagency work across mental health and child protection services. It also uses a fictitious case to illustrate the potential application of the recovery approach.

What is the recovery approach?

The recovery approach involves redefining the goals of mental health services to prioritise the person's own goals rather than practice focusing almost exclusively on their illness. Shephard et al (2008) described the approach as characterised by "openness, collaboration as equals, a focus on the client's strengths and resources, reciprocity and willingness to go the extra mile". Therefore, engagement with the client and partnership working are central to the approach. The principles of openness, choice, partnership and respect are also crucial for working effectively with reluctant and involuntary service users.

The Scottish Recovery Network identified the key elements of the recovery approach as:

• Hope, meaning and purpose
• Control and choice
• Self-management techniques
• Positive risk-taking
• Relationships
• Social inclusion.

Professionals support recovery by:

• Facilitating access to information and peer support
• Helping clients to develop confidence and self-esteem
• Using assessment and person-centred planning to amplify strengths, foster personal responsibility and encourage self-management.
• The recovery approach is not intended to replace evidence-based interventions, but rather to provide a framework within which interventions can be provided.

Interdisciplinary challenges

A range of professionals and agencies are likely to be involved with families where there are mental health problems and child protection concerns. This can create challenges in relation to service user engagement, assessment and intervention. Examples of challenges include:

• Mental health workers may focus on the needs of parents and fail to recognise risks of harm for the child. Social workers, on the other hand, may have limited knowledge around mental health problems and question the possibility of positive change in the parent.
• Stigma associated with mental illness can act as an obstacle to parents sharing information with professionals. Parents may also withhold information because they mistrust professionals and fear that their children will be removed into care. This can result in inadequate assessment and a lack of support services for parents and children.
• Lack of integration between adult and children's services, which means that services fail to address the holistic needs of the family.

Implications for practice

The author proposes that children's welfare can be advanced through the recovery approach. She characterises the recovery approach as:

• Consistent with existing practice (for example, strengths-based approaches) and can provide a framework for promoting more effective inter-agency working for families where there are parental mental health and child protection concerns.
• Focuses on the whole family and involves risk being assessed and managed through collaboration, empowerment, partnership and openness.
• It can help parents to cope better with aspects of their mental health that prevent them from meeting their children's needs. The focus is on the behaviour of the parents rather than their psychiatric diagnosis and symptoms.
• A crucial element of the recovery approach is balancing the needs of parents with those of children, without the main principle being compromised and without unrealistic optimism about the parent's mental health. Good inter-agency working can help guide workers in mental health and child protection towards better informed and safer decision-making.
• Having dyadic key workers with roles in mental health and child welfare can provide insight into the procedures, legal provisions and interventions specific to each service. This could also help in forging good inter-disciplinary relationships and more collaborative working, making it easier to manage any challenges that arise.

The research section for this special report is based on a selection of academic studies which have been explored and summarised by Research in Practice part of the Dartington Hall Trust.

This article is part of CYP Now's special report on Children's Mental Health. Click here for more