B was an eight-year-old boy admitted to a child and adolescent mental health in-patient unit as an emergency, because of extremely challenging behaviour. He had been referred to his local community child and adolescent mental health service several months previously and was diagnosed with autism spectrum disorder. He also exhibited features of hyperkinetic conduct disorder.
He was subject to a child protection plan and accommodated by the local authority on a voluntary basis at the time of admission. Because of episodes of extreme unprovoked aggression and sexualised behaviour B had been excluded from a special school and two foster placements had broken down. On admission, B received a comprehensive package of care, which included assessments and interventions by nursing and medical staff, psychologists and other therapists.
He received a carefully structured intervention involving nurses experienced with younger children, play therapy, education appropriate to his developmental level and medication methylphenidate. B was nursed away from the older adolescents within a self-contained children's area of the in-patient ward.
He had two members of nursing staff with him at all times because of his challenging behaviours, including highly sexualised behaviour, physical aggression and destruction of property. He required regular, difficult restraints involving up to four members of staff at a time, and occasional use of seclusion to maintain his own safety and the safety of others. The Code of Practice for the Mental Health Act advises that seclusion of an informal patient should be taken as an indication of the need to consider formal detention.
With legal advice from trust and local authority solicitors, it was agreed that as long as B met criteria for detention under the Mental Health Act , this was the preferred route. However, it is undoubtedly necessary in cases where the option for informal admission is not appropriate or the risks in managing the child informally are too great. A patient may be detained under section 2 of the Mental Health Act for a period of assessment of up to 28 days. The application is based on the recommendations of two medical doctors, and an approved mental health practitioner is the applicant.
The professionals must be satisfied that the following grounds are met:. In this case, B both had mental disorder autism spectrum disorder and hyperkinetic conduct disorder and was presenting in a way that put his own safety, and that of others, at risk. Following a Mental Health Act assessment and close consultation with local authority and trust legal services, B was detained under section 2. B appealed to the mental health tribunal with the assistance of his independent mental health advocate and solicitor.
His detention was upheld. During the period of detention, the local authority obtained an interim care order and acquired parental responsibility. The local authority questioned whether it would be able to agree to B being in hospital informally, however, the clinical team felt that the treatment decisions about restraint and seclusion required fell outside of the zone of parental control, regardless of who had parental responsibility.
B's behaviours did begin to settle and he gradually ceased to require the restraint and seclusion that he had earlier in his admission. He was therefore discharged from section 2 shortly before the end of the day period and remained on the ward as an informal patient while an appropriate community placement could be identified. Following several months' intervention it was possible to discharge B safely to a children's home, where he has not required restraint. Detention of such a young child using the Mental Health Act is unusual and we could find no published case that would discuss this, although, anecdotally, others have faced similar decisions.
In this case, the team was confident that B's age and immaturity prevented him from being regarded as Gillick competent and therefore he could not provide authority for his own admission and treatment. Both of B's parents had parental responsibility and were supportive of his admission to hospital.
Initially, the clinical team had relied on their agreement. However, in the light of B's deprivation of liberty parental consent to treat him could not be relied upon. In addition, the child protection plan raised concerns about the parents' ability to act in the best interests of the child. The team therefore decided that the decisions that now needed to be made about B fell outside of the zone of parental control.
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The nation, through the actions of federal, state and local governments, and citizens in innumerable roles, united and moved forward. However, the medical traumatic effects of those events impacted many people, for months or even years. USA Today reported it this way: "The terrorist strikes and their devastating aftermath are triggering the largest mental health challenge ever faced by employers and straining the USA's army of grief counselors, not just at the attack sites but in workplaces across the country.
The emotional fallout was expected to be so widespread that some health insurers are loosening restrictions on employees' use of mental health services. For example, just in Arlington County, Virginia, "some 20, to 40, of the county's , residents could experience a traumatic stress reaction from the attacks, officials estimate, pointing to an earlier Surgeon General's report on mental health and disasters. Mental Health Benefits and Hurricane Katrina Victims The widespread harm inflicted by Hurricane Katrina includes health impacts and longer-term mental and emotional harm.
Some, but not all, of the varying state health insurance mandate laws may require coverage of either emergency or longer-term mental health services. The list below is a general survey of these laws. Medicaid plays an important role in financing mental health services in the United States and will play a key role in ensuring access to behavioral health services under the health reform law. Mental Health Financing in the United States: A Primer , provides an overview of behavioral health care, reviews the sources of financing for such care, assesses the interaction between different payers and highlights recent policy debates in mental health.
It also discusses the role of Medicaid, currently the largest source of financing for behavioral health services in the nation, covering a quarter of all expenditures. This comprehensive resource serves as a guide for those who want to understand the complex system of behavioral health financing in the United States. Medicaid Policy Options for Meeting the Needs of Adults with Mental Illness under the Affordable Care Act , examines the salient issues raised in a recent roundtable discussion of national and state experts convened by the Commission, in partnership with the Bazelon Center for Mental Health Law, to discuss Medicaid policy options available under health reform to help meet the needs of adults with mental illness.
The Patient Protection and Affordable Care Act will expand the Medicaid program, offering the opportunity to improve access to care for millions of Americans with mental health disorders. States face several decisions about designing benefits, structuring service delivery and conducting outreach and enrollment for this population, which has unique health and social service needs. This report highlights key policy opportunities and challenges related to these decisions.
The discussion was the latest in an ongoing series of Health Reform Roundtables that explore key issues related to implementing the expansion of Medicaid under health reform. July 1, On or after Oct. Group,does not apply to any plan where application would result in a 1. After Nov. March 31, Mental or nervous conditions; alcoholism and drug addiction [i]. July 4, June 21, July 2, Treatment limitations or financial requirements on coverage of services for mental illness; June 30, Group policies to companies with more than 50 employees, public employees and small businesses that currently have mental health coverage.
Kansas mental health parity act; Insurance coverage for services rendered in treatment of alcoholism, drug abuse or nervous or mental conditions; ST , ; ST ,a ; Eff. July 15, ,. Group, blanket, and association health insurance, treatment for alcoholism and drug abuse; R. Severe mental illness and other mental disorders; R. Jan 1, Mental health services coverage; ST T. Equitable health care for alcoholism and drug dependency treatment; ST T.
Treatment for substance abuse; ST Fear of being bullied, singled out and stigmatised by other children and adults. Losing the closeness they may have enjoyed with their parent before they were ill. Their parent or carer might never recover or that their condition might get worse. The family would be the object of shame or stigma. The family would split up and they would be taken into care.
Cooklin, Impact of mental health problems on parenting It's important to remember that most parents or carers who experience mental ill health will not abuse or neglect their children. Stressful life experiences The risks to children are greater when parental mental health problems exist alongside domestic abuse and parental substance misuse Brandon, ; Cleaver, Parents and carers with mental health problems may go through other stressful life experiences like: divorce or separation unemployment financial hardship poor housing discrimination a lack of social support.
Parental mental health and child abuse and neglect Parenting difficulties can result in children experiencing abuse, in particular, emotional abuse and neglect. Mothers who experience mental ill health after birth may struggle to provide their babies with the sensitive, responsive care essential to their social, emotional and intellectual development. Parents and carers may: experience inappropriate or intense anger or difficulties controlling their anger around their children have rapid or extreme mood swings, leaving children frightened, confused and hyper-vigilant be withdrawn, apathetic and emotionally unavailable to their children.
They may have trouble recognising children's needs and responding to cues view their children as a source of comfort and solace, which may lead to children taking on too much responsibility for their age have distorted views of their children. In rare cases of severe mental illness, parents and carers may have delusions related to their children, for example they may believe they are possessed, have special powers or are medically unwell.
Cleaver et al, ; Hogg, Assessing the risk of parental mental health problems Parents' and carers' mental health problems may affect children differently according to their age, development and personality. Factors to consider when assessing risk. Related stresses such as poverty, poor housing, family separation and lack of social support can also increase the risk of children suffering harm. Young children rely on their parents and carers to give them the warm, nurturing care they need for healthy development.
Teenagers also need strong parental guidance and support as they transition to adulthood.
Always consider the severity of a parent or carer's mental health symptoms. Children may be more at risk of harm if the parent or carer experiencing difficulties is living alone with them without the support of another adult. Consider if any of the children had to take on caring responsibilities for their parent, carers or siblings. Cleaver et al, Carrying out risk assessments.
It is of paramount importance to focus on the child. Give children the opportunity to discuss their experiences. Listen to and record their views on the situation. Perinatal health teams should feel comfortable and confident asking women about their mental health and use evidence-based tools to help them detect problems and offer support during pregnancy and after the mother has given birth. Assessment should be informed by the parent or carer's background, medical history and current circumstances.
Pay attention in particular to other risk factors alongside mental ill health such as substance misuse, domestic abuse, financial hardship or relationship problems.
Author information Article notes Copyright and License information Disclaimer. With legal advice from trust and local authority solicitors, it was agreed that as long as B met criteria for detention under the Mental Health Act , this was the preferred route. B met the criteria for detention under section 2 of the Mental Health Act and therefore the legal authority for B's assessment and treatment was provided without a court application needing to be made. This letter also provides preliminary guidance to the extent that mental health and substance use disorder parity requirements apply to State Medicaid programs under title XIX of the Act. Looking after parents during pregnancy and early years Professionals working with pregnant women and mothers who have just given birth should make sure they are aware of the signs of mental ill health and know how to look after their emotional wellbeing. Reviews 'The text is most useful for colleagues working in child and adolescent health or social care but some content is pertinent to educational psychologists. Helping Families Stay Intact Parental mental illness alone can cause strain on a family; parental mental illness combined with parental custody fears can cause even greater strain.
These difficulties may increase vulnerability and pose a greater risk to the child. Really listen to what parents and carers are saying. If they tell you they are not coping well with looking after their children, provide support at the earliest opportunity. Always take threats of suicide or threats to kill a partner or children seriously. Children are also at risk if the parent or carer has psychotic beliefs about them, or if their mental ill health is isolating them or making it very difficult for them to function on a day-to-day basis.
Do not over-estimate the ability of a well parent or carer to cope with both parenting and supporting a partner with mental health problems. This will ensure professionals fully understand how the situation is affecting children and help identify risks at an early stage. Professionals should also seek the views of colleagues from other agencies who are involved with the family, such as teachers. If a child is assessed as in need or at risk of harm, draw up a care plan or child protection plan to provide support which involves adequate supervision and checks and balances.
Educating children and young people about mental health problems. Giving children and young people accurate, age-appropriate information about mental health problems can address any misperceptions or fears they may have. It can also give them the language to help share their views and experiences Grove et al, It's important to help children and young people achieve some distance from their parent or carer's emotions and behaviour so they can develop their own thinking and identify and understand their own emotions and experiences Cooklin, Explaining a parent or carer's illness can be a platform for wider discussions about relationships and emotions in general.
Discussions should be respectful of what the child already knows or has concluded, particularly if the child is a carer. Information about mental health should be produced in a range of different formats or delivered in workshops Cleaver et al, There is some evidence indicating that children may prefer to receive this information when their parent or carer is present, so they can join in to help them make sense of the mental illness.
They may also find it helpful to receive this information alongside other children affected by parental mental illness Grove et al, Research suggests that educating children about parental mental health problems has a number of benefits including: increasing the child's resilience challenging the child's misperceptions about mental illness, for example, making it clear that mental ill health isn't contagious and it isn't the child's fault increasing the child's understanding and empathy for their parent or carer improving communication between parent or carer and child Grove et al, ; Wolpert et al, Mentors and advocates for children.
It can be beneficial to provide children with access to a mentor so they can discuss their parent or carer's illness and contact them during a crisis. They can also act as the child's advocate if necessary Cooklin, Avoid automatically offering the child therapy or counselling as this may increase the child's identification with their ill parent or carer and confirm any fears they might have that they will get ill themselves Cooklin, Peer-support for children and young people.
Peer-support programmes give children the chance to interact with other children in similar situations.
Evidence suggests if peer-support programmes focus on a family's strengths, they have a positive impact on children's well-being and self-esteem, coping abilities and relationships Foster, Support from peers in a similar situation may also give young people the strength to stand up to people trying to bully them over their parent or carer's illness Cooklin, Group support for families. A whole-family approach.
Parental mental health problems affect everybody in the family. Family members can be reluctant to discuss mental illness with each other. Lack of communication can result in misunderstandings and children may feel worried or alone. They may not understand that their parent or carer's withdrawn behaviour is a symptom of mental illness.