Nurses are assessing mothers with mental health issues despite lack of guidance and formal training

May 6, 2009

Researchers have raised serious concerns about the lack of guidance and training provided for nurses involved in assessing the parenting capacity of mothers with serious mental illnesses.

Writing in the May issue of the Journal of Psychiatric and Mental Health Nursing, the team have highlighted the need for an audit of current UK services and greater links between health and social care professionals.

But they point out that the basic issues they explored are pertinent to health care systems worldwide.

"There is evidence that social workers responsible for child protection rely heavily on mental health parenting assessments if the mother is receiving psychiatric care" explains Sarah Rutherford from the Faculty of Health, Psychology and Social Care at Manchester Metropolitan University, UK.

"These assessments have major implications as they can lead to mothers being separated from their children. Despite this, mental health nurses receive no formal training for this difficult role and there is little information available about how these assessments are being carried out and to what standard.

"Guidance issued by the UK Department of Health on assessing children in need stresses that mental health professionals have a key role to play in determining whether adults are able to care for their children. However, there is no specific guidance on how these assessments should be carried out."

Ms Rutherford, who is a registered mental health nurse and now works as a Practice Trainer adds: "Although our research focused on the situation in the UK, the issues that our paper raises are global concerns as changes in the care and treatment of those with mental illness have led to more women demanding the right to raise their children."

The team's review of current policies and almost 30 social work, medical and nursing studies shows that women with serious mental illness are increasingly involved in parenting as a result of improved medication, enhanced community care and human rights reforms. Studies suggest that as many as 80 per cent are involved in the care of at least one child.

Research also indicates that social workers feel that assessments carried out by mental health nurses are very important when it comes to making decisions about a child's best interests.

But there has been little research to show how mental health nurses are influenced by their own opinions and instincts or whether they take into account how ethnicity, culture, race, religion and socio-economic status can affect how mothers care for their children.

"There are no national UK guidelines or validated tools for assessing the parenting capacity of mothers with a mental illness and no available evidence about how assessments are currently being conducted in psychiatric units" states Ms Rutherford.

"Where local assessment tools are employed, they tend to be used inconsistently and are open to the interpretation of the individual nurse using them. This raises real questions about the quality and objectiveness of the information being gathered."

The situation is being compounded by a lack of formalised training for mental health nurses involved in parenting assessments. And there are no shared professional learning forums with child social workers to ensure that multidisciplinary guidelines can be developed to support families.

As a result of their study, the researchers say the following are vital:

1. An audit to show how parenting capacity is currently being assessed in psychiatric units, including how the results are being reported and what staff training is being provided.
   
2. A qualitative study to establish the training needs of mental health nurses carrying out parenting assessments, in order to develop a standardised assessment tool.
   
3. Further follow-up studies of mothers who have undergone parenting assessments, to establish whether the assessments meet the appropriate needs and outcomes.
   
4. Joint training between mental health nurses, child protection nurses and child and family social workers to develop effective multidisciplinary working and optimise outcomes.
   
5. Appropriate and adequate clinical supervision of mental health nurses carrying out parenting assessments, to tackle issues such as the conflict between protecting the child and caring for the mother.

"Each healthcare system has its own policies and requirements when it comes to assessing a parent's ability to look after their child" concludes Ms Rutherford. "But the concerns about who should determine their capacity, and the training, support and assessment tools they need to help them carry out that role, are pertinent to any system."

More information: Assessing parenting capacity: are mental health nurses prepared for this role? Rutherford et al. Journal of Psychiatric and Mental Health Nursing. 16, 363-367. (May 2009)

Source: Wiley (news : web)