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The Royal College of Psychiatrists Improving the lives of people with mental illness
Partners in Care

A checklist for professionals coming into contact with children of parents with mental health problems

Working in partnership with psychiatrists and carers

Introduction

This checklist has been designed after consultation with young carers. It aims to help the professional give children and young people the information they need to come to terms with their family member’s mental health problem.

Not every young person will need answers to all the questions, but this checklist should give you an idea of the issues to consider.

How to use the checklist

  • Consider the young person’s age, level of understanding, preferred language, their culture and religion.
  • Children should not be expected to take on adult roles. However, their knowledge and expertise should be respected and valued.
  • When there is someone experiencing mental health problems in their family, children and young people are usually very aware of the symptoms, but may be confused about the nature of the problem. This can lead to the young person feeling scared, frustrated, anxious or guilty. They may keep these feelings concealed if there is no-one to ask how they feel.
  • In some cases, the child or young person will be in a caring role inappropriate to their age and may have extra needs as a result.
  • The information you can share may be limited by the wishes of the person experiencing the mental health problem. Some adults hope that children and young people can be protected from knowledge of a mental health problem in the family – this is usually not the case. Even if the person with the problem does not want the young person to be involved, it may be in the child’s interest to give general information about mental health problems.
  • Ensure that you are familiar with your organisation’s Child Protection procedures – if you suspect that a child may be at risk of significant harm, you must make a referral to the appropriate statutory children’s services. The Children Act 1989 states that the best interests of the child over-ride all other considerations, but the parents should be involved in decisions, unless doing so could increase the risk to the child.

Information-sharing

Before talking to the young person, it would be useful if you had:

  • asked the person with the mental health problem how much information they are willing to share with the young person
  • agreed to review their views on information-sharing on a regular basis
  • recorded their views on information-sharing in their notes.

You can share general information about an illness (i.e. information about depression rather than information about a patient’s depression) without breaking confidentiality.

Confidentiality

At the beginning of an interview with a young person, ensure that they know that you may not be able to keep the information confidential.

Parents do not have an automatic right to know what their children have said to you, but it is good practice to keep parents involved if a young person under 16 is comfortable with this, and it is in their best interests. For children under 16 who are not able to understand the service that you offer, it is essential to gain parental consent before offering support, unless you are concerned that the child may be at risk of significant harm (see How to Use this Checklist). Your organisation should have a policy on this matter.

About the mental health problem

Explore the young person’s current level of knowledge and any assumptions they have made. Do not assume they would feel better not knowing the truth. Try to give age appropriate information:

  • what problem does their relative have?
  • how does this affect the way they feel and behave?
  • what is known about the causes of this problem?
  • what sort of things can help their relative get better?
  • is the problem likely to get better or worse?
  • what can be done to keep their relative safe?
  • who else can they contact if they are concerned?

About the young person

Children and young people will often hold a range of fears about their family member’s problem, but may feel they have to keep some feelings to themselves. Many of their fears will be unfounded. They may be wondering:

  • can I catch it?
  • was it my fault that my relative got this problem?
  • how likely is it that I will develop it when I get older?

If there is evidence of genetic factors, ensure that you put this in context. For instance, the young person could lessen the risk of developing a mental health problem by talking about their feelings, seeking help at the first signs of distress, maintaining a healthy lifestyle, being aware of the risks associated with drink and drugs etc.

  • is there anything I can do to make them better?

Avoid telling the young person to behave well for the person with the problem. It is important that they do not feel that they are responsible for their relative’s well-being.

The young person’s feelings

The young person may feel:

  • scared
  • angry with the person who is ill
  • guilty
  • embarrassed
  • frustrated or powerless
  • isolated
  • stressed
  • tired
  • confused

The young person may need help to express and explore their feelings. It is important for them to understand that it is normal to experience a range of emotions. Can they think of ways of coping with these feelings? Who can they talk to when they are feeling down (e.g. family members, trusted adults, friends)?

About care and treatment

  • What kind of help is their relative getting?
  • How will this affect them?
  • How long will it last?
  • Will it help them to recover?
  • Who else is, or will be, involved in helping them? What do they do?

The young person and the treatment

Young people should never be encouraged to take on responsibilities inappropriate to their age, such as interpreting for parents or supervising medication, however competent they appear to be. They should know, however, who to approach for help if they become concerned about their relative.

  • What aspects of supporting their relative do you expect to have an impact on the young person’s life?
  • How do they feel about that?
  • How can they get in touch with you?
  • Have you discussed confidentiality issues with their family member?

Medication

It is usually inappropriate for a young person to be responsible for reminding or giving their relative medication. The family may need extra support to protect the young person from the burden of this kind of responsibility.

  • What does the young person need to know about the medication being used?
  • If there are young children in the family, how will medication be stored safely?

Hospital treatment

  • Does their relative have to be admitted to hospital? Which one, and for how long?
  • What will happen to the young person if their relative goes into hospital?
  • Will the young person be able to visit them?
  • What arrangements will be made for visits? Will there be a private room?

Young carers’ needs

If the young person provides, or is likely to provide, emotional or physical care to their family member, they may be a young carer. Their nearest Young Carers Project can be found at the website listed overleaf.

  • Is their caring role having an impact on their relationships, education or leisure time?
  • What is the emotional impact of their caring responsibilities?
  • Who will support the young carer?
  • Do they know that they are entitled to an assessment and a care plan of their own?

An assessment is not a test, it is a chat with a social worker or other worker where the young person can request help and support. You can refer the young person to Social Services with their permission.

Other services for the young person

  • Are other agencies involved in supporting the young person?
  • Does the young  person want you to contact school, youth services etc?
  • Do you need to contact Social Services/ The Children’s Trust children and families team for help for the young person?
  • Does the young person have any problems at school (e.g. falling behind with work, staying off school to look after their relative, being bullied)? Do they want you to talk to their school?
  • Does the young person have any health needs of their own? Who could help them?
  •  Does the young person know who to contact if they are concerned about something? Who does the young person feel able to turn to?
  • Who is the young person’s emergency contact?
  • How does the young person make a complaint?

Further help

Training resource:

The Royal College of Psychiatrists has produced a training pack for professionals working with adults with a mental illness who have children entitled ‘Being seen and heard: the needs of children of parents with mental illness’. Cost £36. Available from Book Sales, Royal College of Psychiatrists, tel: 020 7235 2351 ext. 2551.

Carers Trust logo

The Princess Royal Trust for Carers has a website for young carers with information on mental health problems and can answer questions via email.

The Children’s Society has a list of the contact details for all the specialist services in the UK.

ChildLine is the free 24-hour helpline for children and young people in the UK. Children and young people can call the helpline on 0800 1111 about any problem, at any time – day or night and speak in confidence to a counsellor.

Young Minds is the national charity committed to improving the mental health of all children and young people. Its website provides information on mental health issues. The Young Minds Parents’ Information Service (0800 018 2138) provides information and advice for anyone with concerns about the mental health of a child or young person. Young Minds produces leaflets and booklets to help young people, parents and professionals to understand when a young person feels troubled and where to find help.


This leaflet was produced as part of the Partners in Care campaign, a joint initiative between the Royal College of Psychiatrists and The Princess Royal Trust for Carers.

One of the aims of the Partners in Care campaign was to show that if all those involved in the care of people with mental health problems or learning disabilities can work together, a trusting partnership can be developed between carers, patients and professionals which will be of benefit to all.

With grateful thanks to Alex Fox, Young Carers Development Manager, The Princess Royal Trust for Carers and members of the Royal College of Psychiatrists’ Child and Family Public Education Editorial Board for producing this leaflet.


Series Editor: Dr Philip Timms, chair, Royal College of Psychiatrists' Public Education Editorial Board.


© July 2012. Review date: July 2014.
 
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For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 7235 2351 x 2552. 
 

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Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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