Safeguarding and dual diagnosis: the UK situation

Citation

Gilchrist, G. (2014), "Safeguarding and dual diagnosis: the UK situation", Advances in Dual Diagnosis, Vol. 7 No. 1. https://doi.org/10.1108/ADD-12-2013-0032

Safeguarding and dual diagnosis: the UK situation

Article Type: Editorial From: Advances in Dual Diagnosis, Volume 7, Issue 1.

It is estimated that one in 11 children aged under 16 in the UK are living in a family where there is an alcohol or drug problem (Manning et al., 2009). Research suggests around half of the children born to substance misusers in treatment are in local authority care, adopted or living with another family member (Forrester and Harwin, 2006; Gilchrist and Taylor, 2009). While it is important to stress that not all substance misusers are bad parents, substance use “may have an impact on their parenting capacity” (Murphy et al., 2003). However, drug using mothers report using a hierarchy of strategies to reduce harm to their children from ceasing drug use to getting someone they trust to look after their children while maintaining an active parental role in their child's life (Richter and Hammer, 2000). When parents are using drugs intensely the basic needs of their child are often neglected, however when their drug use is stable the impact on their children might be minimal (Barnard and McKeganey, 2004; McKeganey et al., 2002).

Both substance misuse and psychopathology play a significant role in the abuse and neglect of children (Brandon et al., 2012). Parental substance misuse, young parental age, low-educational achievements, adverse childhood experiences in their own childhood (absent father, being looked after) and psychiatric history are risk factors for child abuse and neglect leading to children being placed under child protection (Sidebotham and Heron, 2006). In their paper in the current issue, “Opioid dependence and intimate partner violence: associations with the current parenting behaviour of fathers” (pp. 3-14), Stover et al., found that a history of intimate partner violence more than substance misuse was associated with parenting behaviour that increased risk for abuse and neglect of children.

In 2012, there were 50,573 children on child protection registers or the subject of child protection plans in the UK. Around 100 children die in England each year from child abuse and neglect (Brandon et al., 2012). Series case reviews of these deaths highlight the inter-relationship between domestic violence, mental ill health and substance misuse or, the “toxic trio” (Brandon et al., 2012). In 86 per cent of cases, one of the toxic trio was present, and all three factors were present in over 20 per cent of cases. Two-thirds of cases featured domestic violence in the home, 60 per cent of cases identified parental mental ill health and in 42 per cent of cases, parental substance misuse was reported. Moreover, a systematic analysis of neglect in 800 serious case reviews in England, between 2003 and 2011 reported that children who had a child protection plan for neglect were more likely to have parent/s with alcohol (23 vs 15 per cent) or drug misuse (25 vs 19 per cent) than other children (Brandon et al., 2013). In the second paper in this issue, “Substance misuse, mental health problems and recurrent child maltreatment” (pp. 15-23), Laslett et al., found that children in families where the parent/s has/have a dual diagnosis of mental health and drug misuse, the risk of repeated maltreatment is greater than among families where there is evidence of mental health problems or other drug use alone.

Two key principles underpin the UK governments strategy Working Together to Safeguard Children (HM Government, 2013): first, safeguarding is everyone's responsibility and second, the need for a child-centred approach: for services to be effective they should be based on a clear understanding of the needs and views of children. The first of these, that safeguarding is everyone's responsibility was highlighted in the Munro Review of Child Safeguarding (Munro, 2011). This review of child protection stressed the importance of a system where professionals “work together well in order to build an accurate understanding of what is happening in the child or young person's life, so the right help can be provided”. In London, Multiagency Safeguarding Hubs (MASH) have been established in an attempt to create such a system, with a multi-agency team of co-located professionals who work together to provide “the bigger picture” by sharing information to ensure the safeguarding of children. This new approach is described in detail in the news item “Improving information sharing in safeguarding: MASH in London”. In the paper, “I worry when […] Insights into dual diagnosis from those who treat mothers misusing alcohol” (pp. 24-33), Marlow presents findings from semi-structured interviews with professionals who provide services to mothers who misuse alcohol to determine how different types of alcohol misuse are linked to different mental states and parenting behaviours.

In the final paper in this issue, “Maritime City: using serious gaming to deliver child protection training” (pp. 34-42), Davies presents a novel approach to delivering child protection training to health and social care professionals working with children and their families using serious gaming to supplement the delivery of child protection training. It is hoped that these approaches will enhance the safeguarding of children living in families affected by dual diagnosis.

Gail Gilchrist

References

Barnard, M. and McKeganey, N. (2004), “The impact of parental problem drug use on children: what is the problem and what can be done to help?”, Addiction, Vol. 99 No. 5, pp. 552-9

Brandon, M., Bailey, S., Belderson, P. and Larsson, B. (2013), Neglect and Serious Case Reviews, University of East Anglia/NSPCC, Norwich

Brandon, M., Sidebotham, P., Bailey, S., Belderson, P., Hawley, C., Ellis, C. and Megson, M. (2012), New Learning from Serious Case Reviews: A Two Year Report for 2009-2011, The Stationery Office, London

Forrester, D. and Harwin, J. (2006), “Parental substance misuse and child care social work: findings from the first stage of a study of 100 families”, Child and Family Social Work, Vol. 11 No. 4, pp. 325-35

Gilchrist, G. and Taylor, A. (2009), “Drug-using mothers: factors associated with retaining care of their children”, Drug and Alcohol Review, Vol. 28 No. 2, pp. 175-85

HM Government (2013), Working Together to Safeguard Children a Guide to Inter-Agency Working to Safeguard and Promote the Welfare of Children, Department for Education and Skills, London

McKeganey, N.P., Barnard, M. and McIntosh, J. (2002), “Paying the price for their parents addiction to drugs”, Drugs Education Prevention and Policy, Vol. 9 No. 3, pp. 233-46

Manning, V., Best, D.W., Faulkner, N. and Titherington, E. (2009), “New estimates of the number of children living with substance misusing parents: results from UK national household surveys”, BMC Public Health, Vol 9 No. 1, p. 377

Munro, E. (2011), Munro Review of Child Protection: Final Report – A Child-Centred System, Department of Education, The Stationery Office Limited, London

Murphy, M., Harbin, F., Calder, M. and Hackett, S. (2003), “The assessment of parental substance misuse and its impact on childcare”, in Calder, M.C. and Hackett, S. (Eds), Assessment in Child Care, Russell House Publishing, Lyme Regis, pp. 353-61

Richter, K.P. and Hammer, G. (2000), “A hierarchy of strategies heroinusing mothers employ to reduce harm to their children”, Journal of Substance Abuse Treatment, Vol. 19 No. 4, pp. 403-13

Sidebotham, P. and Heron, J. (2006), “Child maltreatment in the ‘children of the nineties’: a cohort study of risk factors”, Child Abuse and Neglect, Vol. 30 No. 5, pp. 497-522