This information is for any woman with a mental health problem who is planning a pregnancy, pregnant or has recently had a baby. It should also be helpful to partners, family and friends. It covers:
- what “safeguarding children” means
- referral to Early Help Services
- referral to Children’s Social Care (social services)
- what might happen after a referral is made to Children’s Social Care.
This leaflet provides information, not advice.
The content in this leaflet is provided for general information only. It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice.
You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.
If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.
If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.
Although we make reasonable efforts to compile accurate information in our leaflets and to update the information in our leaflets, we make no representations, warranties or guarantees, whether express or implied, that the content in this leaflet is accurate, complete or up to date.
You and your partner may worry that if you seek help for a mental illness, people may think that you can’t care for your baby or other children – or even that your baby could be taken away from you. In fact, getting help and treatment for your mental health problems shows you are trying to do the best for your children – and people will want to help you do this.
Being a parent is enjoyable but also demanding. Every new mother needs help and support from the people around them - both when you have your baby, and as your children grow up.
Even the best mothers can need extra help if they become unwell – particularly if there isn’t anyone to help care for your children when you are unwell. The symptoms of a mental illness can stop you from looking after your child as well as you can when you are well. If this does happen, it is not your fault, but you may need help to make sure that your children are still looked after well.
Partners, other family members, friends, professionals and voluntary sector organisations can all help support you. And it’s better (and easier) to plan as early as possible for any extra help you might need, rather than waiting for a crisis to happen.
Any nurse, doctor or social worker will want to help parents look after their children as well as possible. So, most women with mental health problems are never referred to Children’s Social Care (social services). However, if you are referred you will need to understand why this has happened and how the process works.
It is a set of actions that can be taken to encourage children’s welfare and protect them from harm. It applies to all children up to the age of 18. It also applies to unborn babies. It means1:
- Preventing children’s health and development being damaged.
- Making sure that children are safe and well-cared for as they grow up.
- Doing things to make sure that children have the best outcomes.
- Protecting children from abuse and harm.
Laws in the UK2-3 help to protect children from abuse and neglect. Local authorities are responsible for safeguarding, and promoting the welfare, of all children and young people in their area. There are some differences between the systems in England, Scotland, Wales and Ireland but the principles are the same. This leaflet is based on the system in England.
Safeguarding is everyone’s responsibility1. Any organisation that works with children has to have safeguarding policies and processes to make sure that every child is protected from harm. They also need to provide training for staff. This includes all NHS services.1,3
Any professional who is concerned about an unborn baby or a child has a duty to make sure that child is safe.1,3
If professionals talk to you about safeguarding, this is not usually because they think you mean to harm your child. The most common worry is that mental health problems might interfere with how you can look after your child – or children.
All professionals you see during pregnancy, and after birth, will ask you questions like this. This includes your GP, midwife, obstetrician, mental health professionals and health visitor.
They might ask for details of your children’s names, dates of birth and which school they go to. They might also ask who else is involved in looking after them.
Any professionals should consider how any difficulties you have might affect your children. The might ask about other problems that might affect a child. These include domestic abuse, substance misuse, learning difficulties, homelessness and physical illness or disability.
If a professional is concerned about your unborn baby or child’s wellbeing, they should talk to you about why they are worried. They may also want to talk to your partner, another family member or other professionals involved in your care.
If there are some problems, there are a number of ways to help you and your family:
- Making a plan, with your partner or family, to ensure you have any extra help and support you need. A referral to services for extra help may not be needed.
- You could be referred for “Early Help” services - see below.
- You could be referred to Children’s Social Care (social services) - see below.
You and your family may have the same worries as the professionals and so may want some extra support - or you may not agree that you need extra help. A professional will only refer you to Children’s Social Care without your consent if they think that you baby or child is at some risk.
They would still have to tell you about it. A professional would only (very rarely) refer you without telling you if they thought that a child was at immediate risk - or when talking to parents might endanger the child.
If there is any doubt, professionals will get advice from their supervisors or the person in charge of local safeguarding. If you disagree with the decision to make a referral to Children’s Social Care, ask any of the professionals involved to find out who you can contact for advice. Some of the organisations listed at the end of this leaflet can help with this.
You may worry that being referred to Children’s Social Care means that professionals think you are a “bad parent” or can’t care for your children – or that they want to take your baby away.
This is very rare. All professionals, including social workers, want to help families to stay together. It is best to have help early on, especially during pregnancy, so that there is plenty of time to work out a plan that you, your partner and family are happy with.
Early Help services are there to support families as early as possible1. This can stop problems from getting worse or becoming more complicated.
Research has shown that it’s better to help children in their early years, so getting help when you are pregnant or have a young baby can be really important.
Your midwife, health visitor, GP or the mental health professionals working with you may suggest a referral to Early Help services.
Extra help and support can be for anything that may affect your unborn baby or child’s health development, wellbeing or safety. This could include:
- Parenting classes.
- Nursery placements.
- Having a support worker.
- Making sure older children attend school.
- Help with budgeting or other practical issues.
Once a referral has been made, a member of the Early Help Service team will get in touch to discuss the type of help you need.
They will help to organise this and will keep in contact with your family, to make sure you are getting the right support.
Anyone can make a referral to the local authority Children’s Social Care (social services) if they are concerned about a child’s wellbeing.1 This can include a child, family member, member of the public, any healthcare professional, a teacher, or the police.
Professionals have a legal duty to share information, so that your unborn baby, child or children get the help and support they need. If they have concerns about a child’s wellbeing, they have to discuss this with Children’s Social Care.1
When Children’s Social Care receive a referral, they decide whether they need to meet with the mother. A social worker from the Children’s Social care team may contact you for more information, to help them decide whether they need to do this. If they do decide to come and see you, a social worker will contact you to arrange this.
The Children’s Social Care assessment will try to:
- Gather information about your child and family - this includes your family’s strengths as well as any difficulties.
- Understand your unborn baby, child or children’s needs and/or the nature and level of any risk and harm.
- Decide whether your child is a “child in need” or is suffering, or likely to suffer, significant harm.
- Help your family to build on their strengths, to deal with problems, to help the child and keep them safe.
The allocated social worker will usually visit you at home. He or she will speak to you and your partner (if you have one). They will also speak to your children, depending on their age, to hear their point of view. They will take into account any cultural or religious factors.
The social worker may ask your permission to contact people who know the family. This may include family members or other professionals such as your GP, mental health team, midwife, health visitor, school or nursery.
The assessment will be based on the needs of your child or children. Social workers will consider all the factors in the Assessment Framework.1,4
The Children Act2-3 is clear that decisions have to be made in the best interest of the child. Your child, or children’s, needs have to come first.
Children’s Social Care works together with parents as much as possible. It’s best to be open and honest and give as much information as you can. Some people worry about this, or even feel guilty, ashamed or embarrassed. Remember that all professionals, including social workers, want the best for your children.
The more you can help them to understand your family, the easier it is for them to make sure you get the right help and support.
The assessment has to be completed within 45 days of referral.1 The social worker will often see you and your family more than once. They will talk to you after the assessment and tell you what they will recommend. The possibilities include:
- No further action is needed and Children’s Social Care do not need to see your family again.
- Your unborn baby, child or children may become a “Child in Need”.
- There may need to be a “Strategy Meeting” to decide whether a Section 47 enquiry is needed.
You will be given a written copy of their assessment.
The Children Act 19892 defines a “Child in Need” as any child under 18 who:
- Needs local authority services to achieve or maintain a reasonable standard of health or development.
- Needs local authority services to prevent significant or further harm to health or development.
- Is disabled.
If, after assessment, it is decided that your child is a “Child in Need”, you (and your partner or other family members), will be invited to meet with a social worker and the other professionals involved. Together you will agree a Child in Need Plan, which will describe the extra support your family needs. There will be further meetings to review the plan, until everyone decides this extra help is no longer needed.
Quote from a woman whose children were the subjects of a Child in Need Plan:
“When I had severe postnatal depression after my second child was born, I had a period of feeling very suicidal. I was so unwell that I needed to be seen in A&E where staff started a safeguarding process for our baby and 5-year old. Our ‘Child in Need’ plan actually really helped.
"The team put in place a school nurse to provide some support sessions for our 5-year old and free counselling sessions for me through the Children’s Centre which really helped with the guilt.”
The Local Authority has a duty to make enquiries under Section 47 of the Children Act 19892 if they “have reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm”. This is sometimes referred to as a “Section 47 enquiry” or a “Child Protection Enquiry”.
When concerns are identified, it is usually not because of worries that a parent will deliberately harm their children. It is usually more to do with how mental health problems can stop you from looking after your children as well as you usually would.
You may find it hard to shop, cook, do the laundry or get your children to school. Sometimes children may see a parent behaving in a way that they would not usually do when they are well.
If a referral or assessment suggests that there is “reasonable cause to suspect that a child is suffering, or likely to suffer, significant harm” the social worker will hold a Strategy Discussion meeting. All the professionals working with your family will be invited. They will share information and decide whether there is enough concern to start a Section 47 enquiry. After this discussion, they will decide if:
- No further Children’s Social Care involvement is needed.
- An assessment is needed to decide whether your child is a “Child in Need”.
- A Section 47 enquiry is needed.
- If there is any suggestion that a crime has been committed (e.g. if a child has been sexually abused) then the police will be asked to investigate.
A Child Protection Conference brings together family members and all the professionals involved. It is a formal meeting chaired by a senior social worker who is not involved with the family.
Before the Conference all the invited professionals will be asked to write a report on their contact with your family, their concerns and your family’s strengths. You will be given a copy of these reports.
The Chair will meet with you (and your partner or other family members attending with you) before the Conference. They will tell you about what to expect.
At the Conference all the professionals will be asked to say what they know. You will also be given a chance to talk. Professionals know that it can feel worrying or even scary to attend a Child Protection Conference. They should try to make this as easy as possible for you.
Try to be as honest and open as you can. Everybody is there to make sure that your children are safe and well looked-after. If the conference decides that there is reasonable cause to suspect that your unborn baby or child is being harmed, or is likely to be harmed, your child or children will become the subject of a Child Protection Plan under one of the following four categories:
- Physical abuse - this can involve many types of physical harm e.g. hitting, shaking, poisoning, burning or suffocation.
- Emotional abuse- this involves deliberately making a child frightened, humiliated, ignored or isolated.
- Sexual abuse - when a child is forced or persuaded to take part in sexual activities.
- Neglect – is a failure to meet a child’s basic needs.
- Children who aren’t given enough food, or who are smelly and dirty because they or their clothes aren’t washed.
- Children who are not supervised enough, or who are left home alone when they are too young for this to be safe.
- Children who are emotionally neglected, by not being given the love and attention they need.
Your unborn baby can become the subject of a Child Protection Plan even if you have no other children. This does not mean that you have caused or mean to cause any harm.
The conference may be concerned that this could happen, unintentionally, if you become unwell. Mental health problems can affect how you care for your baby in many different ways, such as feeding, changing, interacting with your baby or keeping your baby safe.
If a child is subject to a Child Protection Plan, a “core group” of closely-involved professionals and family members is identified. You will all need to meet within 10 working days of the first Child Protection Conference1 and regularly after that. The core group will make sure the Child Protection Plan is implemented and review progress.
The Child Protection Plan will include the changes that are needed to reduce the risk to your unborn baby, child or children. It will describe the visits from professionals to support your family and check on the child or children’s welfare. It will also outline the support offered. Examples of support include:
- A nursery placement for a pre-school child.
- A psychological intervention for you or your partner.
- A support worker for the family.
- Parenting classes.
In most cases, parents and professionals are able to work together and agree on plans which allow children to remain at home. Separating a child from his or her parents is always a last resort. It may be a temporary plan while a parent has the treatment they need to get better. Sometimes, sadly, it seems better for a child to be permanently cared for by someone else.
Very few women with mental health problems in pregnancy or the year after birth will have their baby or other children removed from their care.
As this is a major decision, only a court can decide that a child should not live with his or her parents. Children’s Social Care will look at all other possibilities before going to court. If this is being considered the social worker will talk to you about this and they will advise you to get legal advice.
NSPCC - The leading children's charity in the UK. Helping to prevent abuse, protect children at risk and support children who have been abused. Information and advice about abuse and neglect and how to keep children safe. Information about safeguarding and child protection. Childline – support line for children.
Family Rights Group - A charity working with parents whose children are in need, at risk or are in the care system and with members of the wider family who are raising children unable to remain at home. Advice for parents, grandparents and other relatives about their rights and options when social workers or courts make decisions about their children’s welfare.
Action for Children - Practical support and advice for families. Help for disadvantaged children through fostering or adoption.
YoungMinds - Parent Helpline-confidential support for anyone worried about the emotional problems or behaviour of a child or young person
Family Lives - Charity offering advice for parents, grandparents and other relatives on all aspects of parenting. Helpline, volunteer befrienders, community support groups.
Family Action - Work with families facing complex needs and challenges including mental health problems, domestic abuse and substance misuse. Helping families to enable them to reach their full potential. Many different forms of support in Children’s Centres and families’ homes.
The ‘Building Capacity, Psychiatry Leadership in Perinatal Mental Health Services’ project: commissioned by NHS England in partnership with Health Education England and delivered by the Royal College of Psychiatrists.
Expert review: Dr Nikolett Kabacs and Dr Lucinda Green
- Service users: West London Mental Health Trust’s Perinatal Mental Health Experts by Experience Group
- Series Editor: Dr Phil Timms
- Series Manager: Thomas Kennedy
Published: Nov 2018
Review due: Nov 2021
© Royal College of Psychiatrists