Stigma of poor mental health – the need for early intervention before care proceedings
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12/05/2025
A large proportion of parents or carers involved in family law proceedings of any description suffer from poor mental health.
This may either be the catalyst for the issue of proceedings, a contributing factor to the same or a consequence of the proceedings themselves. In any scenario, there needs to be acknowledgement by all those working in the sphere of children’s safeguarding that poor mental health is an issue that needs to be handled sensitively and effectively.
In this article, Francesca Massarella suggests there should be a change in the way poor mental health is perceived and approached, particularly before the point of care proceedings being issued.
Author
The Numbers
According to the Ministry of Justice’s Family Court Statistics in the quarter of July to September 2024, there were 4,073 public law cases issued which was a 3% increase compared to the equivalent quarter in 2023.[1]
According to the mental health charity, ‘Mind’, 1 in 4 people in England will experience some sort of mental health problem each year and 1 in 6 will experience a common mental health problem such as anxiety or depression, in any given week. It must follow then that a proportion of these people will be parents, and a further proportion will be parents who have social care involvement with their family.[2]
A study was completed in September 2024 by University College London and Great Ormand Street Institute of Child Health of social and health characteristics of mothers involved in family court care proceedings in England. Part of this involved studying mothers involved in care proceedings and other women using mental health services in four local authorities in south London.[3] The aims were to:
- Create a research database that linked records of mothers involved in care proceedings in south London to mental health service data and assess linkage accuracy.
- Compare the characteristics of mental health service use among mothers involved in care proceedings and other women using mental health services.
- Compare the risk of death among mothers involved in care proceedings with other women using mental health services.
- Evaluate patterns of mental health service use before and after start of care proceedings.
The key findings of this part of the study were as follows:
- Out of the 3,226 mothers involved in care proceedings that were studied, 66.2% of these mothers were linked to a mental health service record, meaning they had been referred to or attended a mental health service.
- 2% of mothers involved in care proceedings studied had a diagnosis of mental illness requiring secondary or tertiary mental health services.
- 34% of mothers involved in care proceedings studied had two or more diagnoses.
- 1% of mothers involved in care proceedings had substance use problems.
- Despite the high prevalence of serious mental illness, mothers involved in care proceedings studied were more likely than other users to have referrals rejected and to be discharged for failure to engage.
- Service contacts increased before care proceedings for 34.1% of mothers involved in care proceedings studied but declined steeply after proceedings started in 25.6% of those studied.
Two of the key conclusions of this study were that there needs to be a) improved access and continuity of mental health services for vulnerable mothers and b) joint working between social care, family courts and mental health services for mothers before, during and after care proceedings.
Many parents who are subject to care proceedings or other levels of local authority involvement in their lives have experienced adverse childhood experiences (‘ACES’) of their own. This contributes to their own ability to parent and/or can cause parents to be vulnerable to addiction and involvement in problematic adult relationships. All of this can be compounded when involvement of social care begins, especially when this escalates to care proceedings, which can be incredibly stressful for anyone involved.
A parent who struggles with addiction to substances or alcohol may be using such substances as a crutch or form of self-medication for their mental health struggles. Conversely, the longstanding use of alcohol or substances may have given rise to mental health issues themselves. For example, some individuals who misuse cannabis or cannabinoids to excess over time can experience drug-induced psychosis. Alternatively, the use of such substances could have exposed the individual to becoming involved in criminality or unhealthy relationships which centre around mutual substance misuse.
A parent who struggles with forming healthy relationships and is the victim of or perpetrates domestic abuse, may do so because of an undiagnosed mental health condition. Again, contrarily, those who perpetrate or are the victims of domestic abuse, may develop mental health issues because of the trauma they have suffered or inflicted.
According to the UK Adult Substance Misuse Treatment Statistics 2022/2023 of the 137,749 adults who were admitted to a drug and alcohol rehabilitation facility to overcome substance addiction, 71% required mental health treatment in addition to their substance addiction treatment. [4] According to the National Centre for Domestic Violence, it is estimated that every day almost 30 women attempt suicide because of experiencing domestic abuse and every week 3 women take their own lives.[5]
This is the lens through which all social care involvement and/or care proceedings needs to be viewed. Poor mental health is the epidemic which courses through the veins of the issues which cause children to require state intervention. Whilst this is at various degrees, there is more likely than not always going to be a need for parents and/or carers to have some kind of mental health support at some stage of this intervention.
[1] Ministry of Justice, December 2024
[2] https://www.mind.org.uk/information-support/types-of-mental-health-problems/mental-health-facts-and-statistics/#References
[3] Georgina Ireland et al, September 2024
[4] Office for Health Improvement & Disparities, December 2023
The Stigma
A survey completed by the mental health charity ‘Mind’ in March 2024 of over 2000 UK adults, found that 51% of the UK population believed that there is still a great deal or fair amount of shame associated with mental health conditions. 56% of the respondents to the survey experiencing mental ill health still felt ashamed and 12% believed that individuals living with mental illness should be ashamed of their mental health problem. It was also found that around 20% of those surveyed thought the following terms were acceptable everyday terms – ‘sociopath’, ‘totally OCD’ and ‘a bit mental’.[6]
This is the environment within which those suffering with mental illness are expected to seek help. Whilst this problem continues to be widespread, the likelihood of parents and carers suffering with poor mental health, a) identifying that they need to access some mental health support and, b) taking steps to access the same, is low. The consequence of this is that those individuals are unlikely to address the other issues in their lives that are either exacerbating their poor mental health or are the consequence of it. This then puts the child(ren) in their care in the centre of the storm of risk.
[6] https://www.mind.org.uk/news-campaigns/news/half-of-uk-adults-believe-there-is-still-a-great-deal-of-shame-associated-with-mental-health-conditions/
The Need for Change
S.1(1) Children Act 1989 makes clear that the child(ren)’s welfare is the court’s paramount consideration and rightly so. Similarly, Rule 1.1 of the Family Procedure Rules sets out that the overriding objective is for the court to deal with cases justly.
Whilst, by their very nature, the focus of any social care involvement with a family or care proceedings must focus primarily on the safety and welfare of the child(ren) involved, there also needs to be a step back to take in a broader view of the situation. If the parent(s) are given the right support, especially for their mental health, this can make a significant difference to the welfare of the child(ren) involved. The aim of any Local Authority should be to keep families together where it is safe to do so and where it is in the child(ren)’s best interests. Mental health support is a key part of achieving this aim.
The current attitude towards mental health issues is often a superficial view of the concerns at hand or considering such issues in isolation from one another. If a parent has an addiction to alcohol or substances, that is often viewed as the key problem which requires direct action or intervention. Similarly, if the issue is domestic abuse, the victim and perpetrator are both directed towards practical support services. The same is often done in cases of neglect or where parents require support in learning basic care skills. Whilst all of this is important and often has a positive impact, it regularly fails to target the root cause or the byproduct of these issues. This needs to change so that early interventions become more likely to produce successful outcomes.
The primary responsibility for a child, of course, lies with their parent(s) or carers rather than the state, in the first instance. It is not unreasonable to expect a parent to act of their own volition to ensure they are in a fit state to provide the care their child both needs and deserves. However, parents who are subject to social care intervention often face a substantial number of pre-existing problems that have been the catalyst for the involvement of the local authority. In such interventions, it is frequently ineffective to simply signpost a parent or carer to available resources and expect them to go and seek that support for their mental health on their own.
Asking for help to deal with poor mental health is an incredibly challenging thing for anyone to do, let alone someone who is faced with state intervention in their family life and who is likely to have suffered, or be suffering, trauma. To expect someone in this position to have the confidence to go to their GP – where they can still face being dismissed as time-wasters or simply offered medication, without proper explanation, as a ‘quick fix’ – is an enormous ask. To require such an individual to make a self-referral to or attend a mental health charity can be harder still.
Some may say that such parents or carers could be supported by friends or family to access the help that they need for their mental health. However, this is only possible if the people in their network are willing and able to do so. Some parents or carers will feel too ashamed to reach out to their support network, not only because of their mental health struggles (if they even recognise these are apparent) but also due to the involvement of social care in their lives. Others simply will not have such a supportive circle at all, as many of these parents and carers have been subject to care proceedings or statutory intervention during their own childhoods. This is where the state needs to act and alter its approach for the benefit of the children, they, and we as a society, are responsible for.
the need for early intervention
It is plain that if there can be positive early intervention that may avoid the need for lengthy state involvement in family life and/or care proceedings, this can only be a positive thing for all concerned. The route to achieving this is through proactive steps being taken by the Local Authority before the situation deteriorates. This is an aim that the President of the Family Division has been keen to implement in the ‘Return to the PLO’ and focus on there being front-loading of work completed before care proceedings are issued.
This begins with in depth training of social workers to understand effectively the impact of poor mental health on parents and carers so that they can approach all cases with sensitivity and acknowledge the dignity that these individuals deserve. There needs to be a clear focus on moving away from the damaging rhetoric that has been prevalent in our society previously that those with poor mental health should be ashamed. The vast majority of social workers, of course, approach all cases with compassion and empathy, that being the heart of their vocation. However, it can only assist by reminding all social work professionals, especially those who are just starting out, of the importance of their approach with those suffering with poor mental health.
It must also be made clear to all social work professionals that mental health problems present themselves in a variety of ways, as discussed above, and is not always obvious. The person suffering with poor mental health may not even recognise that they are mentally unwell or struggling. Furthermore, there needs to be an understanding that poor mental health is not always an isolated issue and is often interlinked with many other factors present in a person’s life. It may be prudent to ensure that during a student social worker’s training, there is mandatory provision made for mental health professionals to deliver in depth work and guidance to such students to ensure that all social workers are provided with the right tools from the beginning of their career.
Early Help is often used as a vital tool to signpost parents to parenting work, domestic abuse interventions and substance misuse programmes. This should be extended to offering signposting to mental health support in all cases regardless of the obvious issue at hand, acknowledging that it is likely that those other issues have stemmed from or are likely to cause poor mental health. Such signposting needs to be handled sensitively but also in a clear, easily accessible way. Handing over a leaflet identifying a mental health charity is not enough. There needs to be a conversation with the individual involved about the services available in their area, how to access these and why they might be helpful to them. This is extremely important if there is to be an effective opportunity for parents to access mental health support promptly and before matters deteriorate to the point that further statutory intervention or care proceedings are required. If there is intervention from a mental health perspective early on, this has the potential to stop the progression of other intertwined issues like substance misuse and domestic abuse.
Taking this one step further, when it is identified that a parent or carer needs intervention for their mental health, more support should be put in place to assist those individuals in accessing that support. This could include something as simple as allocating a Family Support Worker to assist an individual in attending their GP or a mental health service in their community. It could further extend to a social worker providing a letter of support or a summary of the issues the family are facing (with that individual’s consent) for the parent or carer to take with them to a medical professional, acknowledging that often those suffering with poor mental health are not in the best place to advocate for themselves or articulate the issues they are grappling with.
If appropriate, there needs to be early communication and an effective co-working relationship with adult mental health services, adult social work teams and children’s social care to ensure that families have access to the right professional support networks as quickly as possible. This should also extend to a parent’s Community Psychiatric Nurse, should they have one. This would, of course, require a parent or carer to provide the requisite consent for information to be shared and they would need to be willing to engage with these professionals. However, providing these individuals with the resources and tools at an early stage gives the best chance for the child(ren) in their care to remain there and remain safe.
There also needs to be, in implementing all of the above, realistic explanations of how parents will respond, depending on the stage of local authority intervention. For example, a parent in the PLO process may struggle to engage in mental health support more than a parent engaging with a Child In Need Plan because of the additional stressors that come with the looming prospect of their child possibly being removed from their care, that are less present at earlier stages of intervention. When identifying the realistic expectations of a particular parent, there then needs to be thought given to how much support needs to be in place to counter-balance those additional stressors.
Finally, during those early stages of social care intervention, it is important that parents who do engage positively with mental health support continue to be monitored by the professionals involved, particularly children’s social care, during the consolidation period following the therapeutic or other types of interventions. If professionals step away too soon, there is a risk that matters will decline again in the absence of ongoing support and oversight.
The Consequences
All the above suggestions are reliant on the parents and carers concerned being willing and receptive to help and change. Many will be neither. However, the more effective support that can be offered to families in an accessible and compassionate way, the more likely they will be to choose to engage with that support. This can only be a positive thing for the child(ren) in their care and it can only be right that everything possible is done to provide children with the chance to have a safe, loving upbringing with their parent(s) or other family members.
Local authorities are currently all struggling with limited resources. Whilst on first look, it might seem as though these suggestions put an additional financial burden on local authorities, it must be remembered that care proceedings (particularly cases which require the provision of foster care and/or residential care placements) are extremely costly in and of themselves. To reduce the number of cases brought to the door of court would actually make available funds to spend on other areas of their responsibilities, including early interventions.
There is also likely to be a positive impact on our wider society if there is less need for lengthy and costly state intervention in families’ lives, which ultimately comes at a cost to all of us, in one form or another.
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