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
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
- 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
- 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
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.”
For further information, please
McLoughlin in the Communications Department.
Telephone: 0203 701 2544 or 07738 349070
International Congress of the Royal College of Psychiatrists, Edinburgh, 21-24 June 2010.