Are we starting to ‘think family’? evidence from a case file audit of parents and children supported by mental health, addictions and children's services

Claire McCartan, Gavin Davidson, Mary Donaghy, Anne Grant, Lisa Bunting, John Devaney, Joe Duffy

Research output: Contribution to journalArticlepeer-review

146 Downloads (Pure)


Globally, it is estimated that anywhere between 12 and 45 per cent of adults receiving mental health treatment are parents and up to one quarter of the child population lives with at least one parent with a mental health problem (Reupert & Maybery, 16). While the impact on parenting varies across the wide spectrum of mental health and substance use problems, many children will experience cognitive, emotional, social, physical and behavioural issues, and they will be exposed to other commonly associated stressors such as poverty, isolation, instability and stigma that can negatively affect family life (Royal College of Psychiatrists, 17).

Northern Ireland has the highest prevalence of parent mental health problems in the UK, with similarly elevated rates in the child and adolescent populations (Abel et al., 1; Bunting et al., 4). Recent research found that children in Northern Ireland were twice as likely to have an anxiety or depressive disorder if their parent reported mental health problems themselves (Bunting et al., 4).

Family-focused practice (FFP) provides support to a service user by acknowledging the context of their family relationships and endeavours to meet the needs of the whole family (Lagdon et al., 13). FFP can be beneficial for the whole family when parents have mental health and substance use problems (Cooper & Reupert, 6). The type and intensity of activities/processes may be influenced by the professional discipline, service type and beliefs about FFP (Maybery et al., 14). However, staff may work in isolation from other disciplines, guarding their professional territory amid fear of trespass, particularly if another service is seen as ‘responsible’ (Baistow & Hetherington, 3; Cowling & Garrett, 7). Uncertainty over professional responsibility for children where parental mental health problems are a concern has created tension within the social work profession, where perceptions of hierarchy can prioritise one service (child protection) above another (mental health/addictions) (Aldridge, 2; Coates, 5; Stanley et al., 18). Professional training in FFP has been limited with evidence of a skills deficit in practice, and parents can find it difficult engaging with services because of their mental health and associated fear, stigma and shame (Cowling & Garrett, 7; Grant et al., 11).

The Northern Ireland Think Family initiative represents a strategic effort to promote FFP within adult mental health and children's services, in order to improve collaborative working and information-sharing to help families achieve greater access to early intervention and family support services (Donaghy, 9). Think Family has resulted in a range of regional and local initiatives to improve assessment, planning and intervention. These include: the development of a joint protocol to provide clear guidance on service response and promote interagency collaboration; the revision of adult mental health screening and assessment tools; specialised training; and the introduction of Think Family Champions to promote joint working across services (Falkov, 10). Specialist Think Family social work roles have been created to work alongside established Hidden Harm social workers, providing support for parents and families with dual mental health and substance use problems.
Original languageEnglish
Article numbere2738
JournalChild Abuse Review
Issue number3
Early online date09 Feb 2022
Publication statusPublished - May 2022


  • Law
  • Pediatrics, Perinatology and Child Health


Dive into the research topics of 'Are we starting to ‘think family’? evidence from a case file audit of parents and children supported by mental health, addictions and children's services'. Together they form a unique fingerprint.

Cite this