Mental health workers ‘must ask patients if they’re parents’

Embargoed until 22 June 2010

Children of people with mental health problems may be at risk because some mental health professionals fail to ask whether or not their patients are parents or carers – in direct contravention of guidelines published by the National Patient Safety Agency (NPSA) in May 2009.

Over a third (37%) of homicides of children between 1997-2004 in England and Wales were committed by a parent or step parent with a mental disorder, And yet in half of all cases psychiatrists and mental health workers, who deliver first-line care to the mentally ill, often forget to ask if their patient is a parent or in charge of children.

The audit, unveiled at the 2010 International Congress of the Royal College of Psychiatrists in Edinburgh, was conducted by Dr Aarohee Desai-Gupya, a specialty trainee in psychiatry from Manchester.

They analysed 50 case records from out-patient clinics, the accident and emergency department and a maternity ward, of patients who were seen by psychiatric trainees, specialist liaison nurses and a consultant psychiatrist. The researchers discovered that only 29 per cent of the 50 case records had a mention of whether or not patients were parents or carers of children.

The researchers also collated data from a questionnaire survey of 34 doctors and liaison nurses working in the accident and emergency department. In the survey:

• 12 respondents (35 per cent) said they had no training in safeguarding children.
• 12 (35%) said they did not routinely ask patients about their contact with children
• 11 (32%) said they did not ask their patients whether they harboured thoughts of harming children as part of a suicide plan,
• 18 (53%) said they failed to ask patients whether they contemplated harming children as part of delusional beliefs.

Nearly three quarters (72 per cent) of mental health professionals said they never contacted a patient’s friends or family to find out about the safely of any children involved. In four cases, staff who were concerned about the welfare of a child, failed to discuss their concerns with a consultant psychiatrist.

Following the publication of the NPSA guidelines, some trusts will have improved the training of mental health professionals to ensure that children were safeguarded, said Dr Desai-Gupta. However, the authors concluded that the criteria set in NPSA guidelines were not being adequately met when it comes to assessing and managing adult patients with mental health problems who may pose a risk to children.

Speaking at the International Congress, Dr Desai-Gupta said: “Asking the right questions would certainly reduce the risk to children if appropriate remedial actions are taken when risks are flagged up - but it wouldn’t necessarily cover all those at risk. Not all the homicides done by people with psychiatric problems had contact with mental health services.

“Asking the right questions can be overlooked while managing a busy case load. We hope, that publishing our results will motivate mental health professional across the country to conduct similar audits to see whether or not the guidelines are actually being implemented and to see whether or not the policy and procedures they are have in place are effective. There is scope for improvement of training provision on safeguarding children for doctors at all stage in training and A & E liaison nurses.”

References:

International Congress of the Royal College of Psychiatrists, Edinburgh, 21-24 June 2010.