Parental Mental Health Guidance

1. Introduction

This practice guidance aims to assist all agencies working with parents or with pregnant women and their partners in identifying situations where action is needed to safeguard a child or promote their welfare as a result of the adult's mental ill health.

2. Statistics and Prevalence of Parental Mental Health Issues

• Approximately 68% of women and 57% of men with mental health problems are parents;
• In 1000 women giving birth, it is estimated that the following will be experienced in the described rates:
  • Postpartum psychosis: 2 per 1,000;
  • Serious mental ill health: 2 per 1,000;
  • Severe depressive illness: 30 per 1,000;
  • Mild-moderate depressive illness and anxiety states: 100-150 per 1,000;
  • PTSD: 30 per 1,000;
  • Adjustment disorders and distress: 150-300 per 1,000.
• 38% of first-time fathers are concerned about their mental health;
• Between 5 and 10% of partners report mental health difficulties in the perinatal period; [1]
• The estimated cost per birth for women experiencing perinatal mental health problems is £10,000.[2]

[1] Public Health England (2021). Methodology and Supporting Information: Children Living with Parents in Emotional Distress;
[2] NHS England. (2016). The Five Year Forward View for Mental Health. Accessed: The Five Year Forward View for Mental Health (england.nhs.uk).

3. Responding Proportionately

Mental ill health in a parent or carer does not necessarily have any adverse impact upon a child's development. Just as there is a range in severity of illness, so there is a range of potential impact upon families. The majority of parents with a history of mental ill health present no risk to their children, however even in cases of the more common mental health concerns such as low mood, anxiety and stress, the needs of the children should be paramount. It is essential that the diagnosis of a parent or carer's mental health is not seen as defining the level of risk. Similarly, the absence of a diagnosis does not equate to there being little or no risk. In Lincolnshire, professionals strive to support children and young people using a whole family approach, understanding that families can be worked with to achieve their potential, by either preventing difficulties or stopping things getting worse.

The age of the child or young person must be considered in responding to needs of the family, as the age of the child or young person will impact the work and support that needs to be provided. When the family unit includes a new-born, supporting bonding and attachment needs is vital. The birth experience and caring for a new-born should be considered major life events and supported as such. This period can be overwhelming and challenging, leading to potential negative mental health. Therefore, it is important to support the wellbeing of the caregiver so that there is positive emotional attachment. The security of this attachment forms the building blocks for the baby’s socio-emotional development. Disruptions in attachment (so-called insecure attachment styles) can lead to long term difficulties in the baby’s development, causing significant psychological, behavioural and functional impairment in later life. [3]

[3] National Institute for Health and Care Excellence. (2021). Postnatal Care: Emotional Attachment. Accessed: NG194 Evidence review O (nice.org.uk).

4. Parenting Capacity

As stated above, relying on a diagnosis is not sufficient to assess levels of risk. This requires an assessment of the impact of the adult's mental illness or disorder on their 'parenting capacity' and the impact this has on the family unit. Understanding and consideration of parenting capacity is imperative to ensure that the best possible support is provided to children and families. Where indicated there should always be an early assessment of need considering the child's developmental needs the family and environmental factors and parenting capacity. This assessment should be through Early Help Assessment however it is also helpful to consider the Assessment Framework Triangle below to inform this assessment and evidence the possible impact of mental ill health upon parenting capacity. This assessment may also identify strong family and community support which can build levels of resilience into families where there are parental mental health problems.

Click here to view the Assessment Framework Triangle.

5. Factors that may Impact Parenting Capacity

The following factors may impact upon parenting capacity:

• Unhelpful coping strategies i.e. drug and/or alcohol misuse, not prioritising own safety and basic needs
• Medication with an intended effect or side effect of sedation or other side effects that may exacerbate symptoms;
• Disordered eating;
• Self-harming and suicidal ideation;
• Lack of insight into illness and impact on child, or insight not applied;
• Not engaging with agreed treatment or support plan;
• Previous or current admission to a mental health hospital, where a person's mental ill health can only be assessed or treated in hospital this indicates a greater level of severity or impairment of the person's functioning;
• Mental ill health combined with or caused by domestic abuse;
• Parental conflicts;
• Mental ill health combined with isolation or poor support networks;
• Mental ill health combined with criminal offending;
• Previous referrals to local authority children's services for other children;
• Dual diagnosis (Co-existing mental health and alcohol and drug misuse problems).

6. Domestic Abuse

Mental health problems are a common consequence of experiencing domestic abuse, both for adults and children, and having mental health concerns can render a person more vulnerable to abuse.

SafeLives Insights IDVA 2017-18 dataset showed that 42% of people accessing support from a domestic abuse service had concerns about their mental health in the past 12 months, and 17% had planned or attempted suicide and these percentages increase if the person is either LGBTQ+ or has a disability.

Children growing up with domestic abuse have a higher rate of mental ill health compared to those who don’t. In the SafeLives National Dataset on children and young people in domestic abuse services, 21% were experiencing anxiety or depression and 33% said they felt unhappy.

SafeLives analysis of Perpetrator Programme ‘Drive’ found that 42% of service users had a diagnosed mental health condition. The most common of which were depression (38%), anxiety disorders (31%) and personality disorders (24%), and over a third (35%) had planned or attempted suicide. Compared to general population statistics these levels are incredibly high – estimates of around one in six (17%) adults in England in the past week have experienced a common mental health condition, and around 5% have experienced suicidal thoughts/attempts in the past year.

However, having mental ill health does not cause people to perpetrate abuse; the majority of people with mental health needs have never and will never be abusive. Perpetrators can use their mental health need as an excuse for their abusive behaviour or blame their abusive behaviour on a mental health need they do not have. Perpetrators are also known to use the mental health need of the person they are abusing in a way to make them feel that they are the one at fault and that the abuse is happening because of something they have done wrong, rather than the abuser being at fault, often referred to as gaslighting.

The relationship between a victim's mental health needs and/or alcohol and drug use and experiences of domestic abuse may not (or not all) be linked, if so assessment and interventions need to be conducted separately, although as part of the same work plan.

It is important to recognise other issues that can exacerbate the risk presented by mental ill health. For example, a child is at risk when there is also problematic drug or alcohol use and domestic abuse alongside mental ill health.

Please refer to the Multi-Agency Domestic Abuse Protocol and Safeguarding Children Affected by Problematic Drug and Alcohol Use (Parental and Child use) Procedure for more information.

There is training available on this via Complicated Matters: Domestic and Sexual Violence, Substance Use and Mental Distress (CPD Accredited) - AVA - Against Violence & Abuse (avaproject.org.uk).

7. Possible Effects of Parental Mental Ill Health on Children

When a parent is experiencing symptoms of their mental illness some parents may struggle to focus on the needs of their children as effectively as they do when these symptoms are reduced or not present. This can result in them neglecting their own or their children's physical, emotional and social needs. Their children may have caring responsibilities, which could be inappropriate to their age and could have an adverse effect on the children's development. Some forms of mental ill health may impair a parents' ability to consistently demonstrate emotions and feelings or could cause them to be appear "unavailable" or unresponsive to the child. In some circumstances children could be exposed to behaviour from the parent that they find confusing, distressing or could place the child at immediate risk.

Professionals must utilise the voice of the child to fully understand their lived experience and the impact they feel their parents’ mental ill health is having on them. However, professionals need to understand that the child may struggle to share the full picture due to the loyalty they feel towards their parents or the stigma that may be associated with mental ill health.

Research has found that:

• It is estimated that about 50,000 children and young people are caring for a parent with mental ill health;
• Evidence suggests that a person with mental ill health being supported by a young carer is less likely to be receiving treatment and support in their own right, compared to a person being supported by an adult carer; [4]
• 25% of children subject to Child Protection Conferences has a parent with mental ill health;
• 33% of children with emotional and behavioural disorders have a parent with a mental health problem;
• Post-natal depression can be linked to both behavioural and emotional problems in the children of affected mothers. [5]

The Assessment Framework Triangle may be beneficial for professionals to use in assessments to evidence the effects of parental mental ill health on the children and young people within the family.

[4] The Children’s Society (2018). Young Carers in Families Affected by Parental Mental Health Illness;
[5] Chorbadjian et al. (2020) Maternal Depressive Symptoms and Developmental Delay at Age 2: A Diverse Population-Diverse Longitudinal Study. Accessed: Maternal Depressive Symptoms and Developmental Delay at Age 2: A Diverse Population-Based Longitudinal Study | SpringerLink.

8. Indicators of Increased Risk

Children most at risk of Significant Harm are those who:

• Feature within parental delusions (i.e. false beliefs);
• Are built into the parent's suicidal plans;
• Become targets of parental aggression or rejection;
• Are being profoundly neglected physically or emotionally as a result of the parent's mental illness;
• Have a parent who is expressing thoughts of harming their child;
• Are involved in their parent's obsessive-compulsive behaviours;
• Have caring responsibilities inappropriate to their age and or meeting parents personal care needs;
• May witness disturbing behaviour arising from the mental health problems (e.g. self-harm, suicidality, sexually disinhibited behaviour, violence, responding to hallucinations);
• Are socially isolated because they feel unable to either bring other children home, or understand or have the words to explain what is happening at home to adults;
• Have parents experiencing paranoid delusions;
• Have a parent with factitious disorder. This is a disorder imposed on self or on another, most commonly a dependent child, and is characterized by feigning, falsifying, or inducing medical, psychological, or behavioural signs and symptoms or injury associated with identified deception. If a pre-existing disorder or disease is present, the individual intentionally aggravates existing symptoms or falsifies or induces additional symptoms. The individual seeks treatment or otherwise presents himself or herself as ill, injured, or impaired based on the feigned, falsified, or self-induced signs, symptoms, or injuries. The deceptive behaviour is not solely motivated by obvious external rewards or incentives;
• Where parents are in conflict around contact arrangements or court orders;
• Are being exploited;
• Are engaging in heightened risk-taking behaviours;
• Have other vulnerabilities such as unsafe emotional processing or behaviours.

9. Protective Factors for Children Living with Parental Mental Ill Health

Parental mental ill health will be less likely to have an adverse effect on a child when:

• The ill health is mild or short-lived;
• There is another parent or family member who can help;
• There is no other family disharmony;
• The child has wider support from extended family, including grandparents friends, teachers or other adults;
• A secure base – the child feels a sense of belonging and security;
• Good self-esteem – the child has an internal sense of worth and competence;
• A sense of self-efficacy – the child has a sense of mastery and control, along with an accurate understanding of personal strengths and limitations;
• The child has at least one secure attachment relationship;
• Access to wider supports such as extended family and friends;
• Positive nursery, school and or community experiences.

Note: An older child may seem more resilient but they can also be vulnerable in other ways. The risk to an older child is a different risk but they are not necessarily at any less risk. Further to this, the NSPCC reports on the role of adultification leading to a lack of support for some children and young people. Adultification is a form of bias where children from Global Majority backgrounds are perceived as more ‘streetwise’, more ‘grown up’, less innocent and less vulnerable than other children. [6]

[6] NSPCC (2022). Safeguarding Children Who Come From Black, Asian and Minoritised Ethnic Communities. Accessed: Safeguarding children from Black, Asian and minoritised ethnic communities | NSPCC Learning.

10. Responding to Concerns and Providing Support to Parents

The most effective response to children and families affected by mental ill health comes through all agencies adopting a holistic, whole family approach. This is based on coordinating the support provided by adult and children's services to a single family "at risk" in order to secure better outcomes for the children and adults through the use of targeted, specialised and whole family approaches to addressing family needs.

Many children whose parents or carers have mental ill health go on to achieve their full potential in life, particularly if their parents receive the right support at the right time (Hogg, 2013).

Fundamental to this approach is good inter-agency practice characterised by:

• Routine enquiry by all agencies of the parent's experience of their mental ill health;
• Professional curiosity being utilised to look beyond what is just 'seen';
• Robust inter-agency communication and information sharing;
• Joint assessment of need;
• Joint planning; and
• Action in partnership with the family.

Early Help processes with use of the Signs of Safety model should support this and, where necessary, Child in Need and Child Protection assessment and planning processes.

In any situation where there is a perceived conflict between the interests of the adult and those of the child, all agencies must treat the child's needs and safety as paramount. Agencies also have a responsibility to adopt a non-discriminatory, open and supportive approach and ensure adequate advocacy is provided to the parent, if required.

Some children and families will need some additional help, primarily from one professional or agency to prevent needs escalating. We refer to this as Early Help. Early Help is working with families to come to their own solutions to the problems they are facing as early as possible, so they can work together with agencies to stop these getting worse.

Agencies should also be sensitive to the fact that mental ill health may be only one of the factors affecting parenting and the children's wellbeing. As stated above, there is an established relationship between mental ill health and domestic abuse. There is also a relationship between mental ill health and substance misuse. Understanding a person's life experiences can assist in supporting the family and understanding where additional needs may arise from. People may present with symptoms such as a fear response or avoidant behaviours but this could be due to living in unsafe circumstances or previous unhelpful experiences and may not be a symptom of mental ill health.

Pattern mapping could be beneficial for professionals to understand the experiences of the family in relation to mental ill health, potentially identifying any triggers and strengths for the family. Watts (2022) [7] states that pattern mapping and chronology work can be crucial to capture significant events in the lives of children, young people and their families, stating that the use of this work can highlight patterns over a period of time, allowing professionals to identify escalations of behaviour or where risk of harm is occurring.

Where mental ill health is identified for a parent or person providing care to a child other adults in that child's life or the wider support network should be involved in support plans.

Where there is no existing Lead Professional or Social Worker and the professional believes that the child has additional needs requiring some level of support from other agencies, they should consider the need for Early Help or a referral to Children's Services in line with the Meeting the Needs Threshold document. When this is screened by the Customer Service Team or the Early Help Front Door, a referral may be made to Social Care, Early Help or Future4Me. For more guidance on a Future4Me referral, please visit Requesting support from Future 4 Me.

Professionals should follow their own agency's safeguarding procedures. They should consult their line manager or agency safeguarding lead if they are uncertain about the need to refer to Children's Services, this could be done during reflection time, a supervision or on an ad-hoc basis, as required. Children's Services, offers a consultation service about the appropriateness of making a referral.

Throughout their involvement with the adult and children, professionals must continually explore with the person, and family where appropriate, about the relationship between mental ill health and their parenting capacity and the safety and wellbeing of the children.

[7] Watts, R. (2022). Completing Social Work Chronologies: Practice Tool. Dartington: Research in Practice.

11. What Parents with Mental Ill Health Want

If the parent's mental ill health is impacting in any way upon their parenting ability then they are likely to already feel like they are a failure. Be positive in your communication and engagement. Even when things may seem difficult genuine excitement and interest in the child or the pregnancy can help people to feel more at ease. Agencies who point out a positive in a person's parenting can help them to feel like they are achieving and making progress for their children. This becomes more meaningful when this is explained in terms of the positive impact their parenting behaviour will be having upon the child.

A full explanation of agency roles and sufficient explanations of services, procedures and available choices is essential. Take the time to check understanding and allow and encourage questions. Do not assume that people understand how your service works and why decisions are being made for example if a mother is receiving universal plus or consultant led care during pregnancy then explain what this is and why they are receiving it.

Ask questions about a person's mental ill health, show interest and be open and honest. Hear what is being said and don't interpret it on behalf of the person. Even if you think a view or belief stems from someone's mental ill health don't dismiss it. Try and work collaboratively on it with the individual. Consider how and when complex or difficult information is imparted on the person and how you will support them afterwards. Remember to treat the person as an individual with interests and not just as a parent. Engage with them about other subjects not just parenting.

Advocating on behalf of a parent at difficult times can be really important. This could be through liaison with other services to guide them on how to interact or even when they may need to reduce intensity of support or withdraw.

Encourage the parent’s voice to be heard and understood. If you are unsure be curious and ask what it is they experience and how their experience impacts upon them on a day to day basis. Vague questions can lead to vague answers so it is okay to be direct and respectfully curious. Do not be afraid to gently challenge their conceptions as what they believe about their mental ill health may not be the reality. For example, someone with poor self-esteem and a lack of self-belief may find it difficult to identify their strengths and empowering them to recognising their successes as a parent can be helpful. At other times people may try to mask their difficulties by reporting that everything is going well but being open and honest about your worries and areas that need to be improved for the child’s safety can help the relationship by the person building trust in you to be open about your concerns and feel heard and understood.

Do not make assumptions that the parents responses and decisions, particularly in stressful situations, are as a result of their mental ill health.

Empower parents to make safe and appropriate decisions based on the information provided and using a problem solving approach. People with mental ill health may have had a reduced opportunity to take control in their own lives and to problem solve so may need some guidance in identifying the problem and how to identify different solutions, an initial difficulty in doing this should not be viewed as the person being unwilling to engage or unable to do so, they may just require support to empower them.

Do not exclude other supportive people in the environment who provide support and care to the person with mental ill health and the children. Involve them in planning and consider their needs and worries as part of the plan of care.

Take ownership of any concern at the time it is raised with you. If the parent is sharing a concern with you then they are trusting you with that information. It may be about their mental health but don't tell them it is not your role or to just discuss that with their mental health worker. Explore it and offer what support you can then continue to work collaboratively with any involved mental health worker.

Where there is an awareness of mental ill health prior to birth be proactive. Provide practical support and advice early. The parent might not need the advice when the time comes but it can be comforting to know there are solutions if needed. For example 'baby wearing' can help with attachment if a mothers mood is low post birth. Be honest about possible reactions and normalise them prior to the event not afterwards when a person may be less able to take information on board and believe it.

Emphasise the importance of Early Help as a mechanism of support for the entire family. Explain the benefits of drawing involved professionals closer around the family to reduce stress and build resilience.

Ensure plans and expectations of parents are clear and focussed. Long complex plans can be overwhelming. Take the time to collaboratively produce and explain the plans to ensure they are realistic and attainable.

12. Trauma-Informed Care

Trauma-Informed practice is an approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development. [8] The 6 key principles of trauma-informed practice are safety, trustworthiness, choice, collaboration, empowerment and cultural consideration.

Trauma may be more obvious events such as physical or sexual abuse, severe neglect, or being present at a major incident. People can also experience trauma through inconsistent care giving in their early life and not feeling safe and from not having the opportunity to learn to manage emotions which can sometimes come from being over protected in childhood.

It is the aspiration of services to approach everyone in a trauma-informed manner and work to empower them, validate their experiences and offer compassion, avoid re-traumatising processes, mitigate power imbalances, collaborate and consider the person’s strengths.

If the development of a person is considered in a biopsychosocial manner, it would be considered that a child is born with a temperament where some are naturally more emotionally sensitive and/or more confident and impulsive then their siblings or peers. Attachment and early life experiences will then further shape that person as well as relationships with their peers as they grow up and broaden their circle of interaction in their social development.

Their experiences can then have an impact on how that person feels which may contribute to a mental health problem. Such as a child who has been criticised a lot whilst growing up may feel they will never be good enough. As the child develops into adolescence and early adulthood, they will learn ways to survive in the world. The criticised child who has never felt good enough may be submissive and put others needs above their own, may strive to work really hard in their education, may have difficulties with trust or may do something that is harmful to them such as restricting their food to find a sense of control or punish themselves through self-harm. These responses will depend on many factors and will vary greatly between individuals.

Some people may avoid others and not want to seek support and some people may have grown up in circumstances that would not be viewed by professionals as a healthy, nurturing environment but to them has been their normal and they may not recognise there have been any problems. It may not be apparent to professionals working with parents and other family members what experiences they have had in their life and what impact this may have had, therefore being curious and open to understanding the individual is vital.

Medical diagnoses can be helpful in categorising symptoms or experiences and allow organisations to organise the services they provide. They can also be useful in the undertaking of research in limiting some of the variables within a study for the effectiveness of different treatments. Some people find them helpful on a personal level of providing an understanding of their experiences, being able to identify people with similar experiences and giving a succinct way to somewhat explain what they may be experiencing while other people find labels stigmatising and an insufficient explanation of their experiences.

When a person has a child more professionals will become involved in their life, some people will have experienced services previously, and may have a known mental health problem, but others may not. It may be at this time that other people begin to recognise some concerns about their mental health, or the person themselves may begin to experience mental health problems because of changes in hormones, worries about becoming a parent or about their ability at different stages of their child(ren)’s life, or due to events external to their parenting. Therefore, following the principles of Trauma-Informed Care is important when working with any parent.

Professionals, the parent or other family members may identify a pattern of difficulties in their relationships with fear of abandonment, difficulties in communicating what they need and at times rejecting others in order to avoid abandonment. This may pose a difficulty within professional relationships and within the informal support network. Within professional relationships if there is anger at an action taken or response the person may request an alternative worker, it is preferred, and very often achievable, to work to repair that relationship rather than provide someone new. The benefits of this are that it builds trust and role models to the person that difficulties in relationships can be worked through with honest communication. This may be achieved by validating the person’s feelings, offering further explanation of intentions and listening to the person about how they feel the breakdown occurred and what can be done differently in the future. All professionals are able to help by offering openness and honesty, good multi-agency liaison to ensure consistency of approach, providing consistent, predictable appointments, giving time and space for people to process information and their emotions, validating a person’s emotions, worries or experiences, empowering the person and clearly communicating, as far as possible, any changes in staff and the reasons for this to foster trust and reduce experience of abandonment. 

People may have experienced periods in their life where they have not been given control and agency over their decision making and their bodies. It is therefore particularly important to give people time to communicate their needs and help them problem solve to find solutions of how this can be achieved when meetings or assessments might be more difficult for them. This might be offering for the person to write things down, allowing them to have someone to advocate and communicate thoughts they have shared beforehand, or offering periods of silence while they formulate their thoughts and emotions and feel they have time to respond. We do not always know who has experienced trauma and this may not be something that a person chooses to share and therefore everyone should be invited to collaborate in their care and empowered to make their own choices at every stage to avoid retraumatising processes.

This is also very important when considering any physical intervention with the person. This may be relevant for expectant mothers or where practical support is being given within their pregnancy. Ensure they are involved in care planning and able to say how they feel about being touched or in close proximity to others.

People should always be assumed to have capacity for decisions unless there is a reason to assess their capacity and each small decision should be taken as a separate opportunity for them to make their own choices as far as possible, breaking each decision down can support a person to make a choice by understanding each part of the intervention and using this to inform and weigh each decision. If each intervention or action is explained this gives opportunity for the person to understand and feel in control of what is happening to them and their family. This is important for all professionals and this should be particularly held in mind when physical intervention is required in pregnancy.

People who have experienced trauma have survived these experiences and therefore are resilient and have many strengths. It is important to use the Signs of Safety model, or other means, to work with the person to recognise these strengths and reflect the strengths you notice in them.

[8] Office for Health Improvement and Disparities (2022). Working Definition of Trauma-Informed Practice. Accessed: Working definition of trauma-informed practice - (GOV.UK).

13. Multi-agency Working

Collaboration and liaison between mental health professionals working with the parents or carers and other professionals working with the family is essential. Wherever there is doubt over risks or concerns the services should work closely together to resolve these and achieve a shared understanding.

Joint assessments and joint visits should be undertaken between the agencies wherever possible to facilitate engagement and reached a shared understanding of the current needs and potential risks. Where they are known to be involved, Children's Social Care should be invited to and attend relevant meetings. Social Care should also be invited to any review and discharge meetings for an individual accessing mental health services.

Children's Social Care should always seek advice from Lincolnshire Partnership NHS Foundation Trust either through the identified mental health worker or via the Trust Corporate Safeguarding, Public Protection and Mental Capacity team. Where appropriate they should request access to a parents care and treatment history to understand them as an individual and assess the best way to work with them. Professionals should ascertain who the Lead Clinician is (if there is one currently) and liaise with them as appropriate. This approach assists with formulating how a person's history and life experience may impact upon their parenting capacity and therefore where support should be directed.

Mental health professionals should be invited to meetings convened by Children's Social Care, either as part of an assessment or as part of a continuing intervention. Such meetings can include Strategy Discussions; "professionals meetings"; Child Protection Conferences, Core Groups and other planning or review meetings. If invited, mental health professionals involved with the child's parent or carer should attend these meetings or, if this is not possible a written report should be shared.

Where there is evidence to indicate that the parent has delusional beliefs that incorporate the child or there is potential for the parent to harm the child as part of a suicide plan immediate liaison with mental health services should take place and a referral to Children's Social Care should be made. If the risk is immediate then the emergency services should be called.

Consistent with usual standards of good practice, where they have been involved in joint working, neither agency should cease their involvement without informing the other and without an assessment of the implications for the child.

14. Safeguarding Children Before and Immediately After Birth

Please refer to the Pre-Birth Protocol.

There may be concerns about a pregnant woman's ability to provide safe and appropriate care to a child. These may arise from her current mental health, her past history or her family circumstances. The concerns may also arise due to her partner's mental health or past history. Time must be given at the earliest opportunity in pregnancy to develop a plan of care and robust support. Professionals should never assume that a parent will become unwell given the right opportunities and levels of support.

Parents who are concerned about their own mental health or the impact on their children should speak to their GP. Practitioners who have concerns about a parent or carer's mental health should consult with any involved mental health worker.

Special consideration should be given to pre-birth planning for pregnant mothers who have a current severe and enduring mental illness, or a past history of a severe mental illness, whether this occurred after a previous childbirth or is unrelated to childbirth. These women are more likely to need support with parenting and after delivery.

A study in 2021 highlighted that 10.4% of new fathers experience depression but only 3.2% of these men seek help. The report found that fathers felt that there was a lack of support for men with mental ill health and that the focus was on the mother during this time. With positive links between engaged fathers and maternal wellbeing, balanced parental roles and a child’s physical, mental, emotional, behavioural and social development, professionals should enquire about the father’s mental health and provide support or guidance as required. [9]

[9] BMC Pregnancy and Childbirth (2021). What Kind Of Man Gets Depressed After Having a Baby? Accessed: “What kind of man gets depressed after having a baby?” Fathers’ experiences of mental health during the perinatal period | BMC Pregnancy and Childbirth | Full Text (biomedcentral.com).

15. Self-care for Professionals

For professionals who support others with their mental ill health, it is vital that they consider their own mental health to avoid burnout and compassionate fatigue. Self-care promotes the time for professionals to look after themselves. Self-care will look differently for every professional and can range from conversations with others to taking part in exercise. Professionals should self-reflect to consider how they can best engage in self-care.

Team leaders and managers should also be aware of the need for self-care within the team and should ensure to check on the wellbeing of professionals during time for reflection or the supervision process.

Agencies may have an emotional wellbeing contact or helpline so please refer to own agencies policies to seek this information.

Further to own agency helplines, the mental health organisation Mind offers support, resources and guidance to support mental health in the workplace: Workplace - Mind.