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Introduction

'Parental substance misuse' is the long-term misuse of drugs and/or alcohol by a parent or carer.

This includes parents and carers who:

consume harmful amounts of alcohol (for example if their drinking is leading to alcohol-related health problems or accidents)

are dependent on alcohol

use drugs regularly and excessively

are dependent on drugs.

It also includes parents who aren't able to supervise their children appropriately because of their substance use (NSPCC, 2018).

Most parents and carers who drink alcohol or use drugs do so in moderation, which doesn't present an increased risk of harm to their children (Cleaver, Unell and Aldgate, 2011).

However, parents and carers who misuse substances can have chaotic, unpredictable lifestyles and may struggle to recognise and meet their children's needs. This may result in their children being at risk of harm.

Alcohol misuse

Alcohol misuse includes:

excessive and harmful drinking

alcohol dependence.

Harmful drinking is a pattern of alcohol use. It can cause alcohol-related problems including:

When someone is dependent on alcohol, they are likely to crave alcohol and continue drinking in spite of the harmful consequences. Alcohol dependence is associated with:

Drug misuse

Drug misuse is a dependence on, or regular excessive consumption of, psychoactive substances. It can lead to:

social problems

mental and psychological illness

physical illness

legal problems.

Drug misuse is more prevalent in socially deprived areas (National Institute for Health and Care Excellence, 2012).

In England and Wales the most commonly used psychoactive substances include:

Opioids such as heroin may be less common but can lead to the most significant health problems (National Institute for Health and Care Excellence, 2012).

Impact of parental substance misuse

Abuse and neglect

Living in a household where a parent or carer misuses substances doesn't mean a child will experience abuse, but it does make it more difficult for parents to provide safe and loving care. This can lead to abuse or neglect.

Neglect

Parents who misuse substances may have difficulty:

staying organised and giving their children effective and consistent support

keeping their home and family clean

recognising and responding appropriately to their own and their children's physical needs

paying for food, clothing and essential bills (for example if their income is being spent on drugs and alcohol)

keeping harmful substances and equipment such as needles and syringes safely away from their children.

Some parents who use drugs or drink excessively may lose consciousness, leaving no other responsible adult present to care for their child and ensure their safety (Cleaver, Unell and Aldgate, 2011).

Emotional abuse

Parents who drink excessively or misuse drugs can become emotionally unavailable to their children (Cleaver, Unell and Aldgate, 2011). Mothers with drug problems can be:

Parents who misuse substances can behave in a way that's irrational, unpredictable or withdrawn, which may frighten their children (Cleaver, Unell and Aldgate, 2011).

Physical abuse

Parents who misuse substances may have difficulty controlling their own emotions. Harmful and excessive drinking can contribute to child physical abuse (Cleaver, Unell and Aldgate, 2011; Velleman, 2001).

Impact on brain development

Abuse and neglect are types of adverse childhood experiences (ACEs), which can affect the healthy development of children's brains. The impacts of abuse and neglect on children's brains can stretch beyond childhood and into adulthood.

Possible impacts include:

(Shonkoff et al, 2011; Shonkoff et al, 2014).
> Find out more about the effect of abuse and neglect on child brain development
Criminal activity

Parents and carers who misuse drugs or alcohol may turn to crime to fund their dependency. This may mean exposing their children to unsafe adults or involving them in criminal activity (Brophy, 2006).

One girl told Childline:

"My dad has a drug and alcohol problem. He makes me sleep with other men so he can get drugs. He's also raped me before by putting drugs in my drink."
Childline counselling session with a girl aged 15
Other effects

The impact of parental substance abuse varies according to each child's health, stage of development, personality and relationship with their family.

Children whose parents misuse drugs or alcohol may be separated from their parents and/or family for short- or long periods of time due to:

They may have to take on the role of carer for their family. This could include doing the housework, preparing food and looking after younger siblings (NSPCC, 2018).

Psychological effects

Many young people talk to Childline about the psychological effects of parental substance misuse. One girl said:

"My mum is up and down - sometimes she's fine and sober - but it can quickly change and she becomes worse again...[she] gets abusive when she's drunk and gets angry at me and my sisters. I don't like being at home."
Childline counselling session with a girl aged 15
Other psychological effects include:

preoccupation with their parents' substance misuse

blaming themselves for their parents' behaviour

not being able to attend school regularly and/or having poor educational attainment

difficulty establishing and maintaining healthy relationships

developing behavioural, emotional or cognitive problems (Altobelli and Payne, 2014; Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013; Home Office, 2003; Templeton, 2014).

Risk and vulnerability factors

All families experience challenges from time to time. This doesn't necessarily mean children are at greater risk of abuse. But when problems mount up, it can be more difficult for parents to cope - particularly if they are isolated or lack support.

Children who live in families experiencing multiple adversities can be more vulnerable. These include children whose parents:

are involved in domestic abuse

misuse substances

have mental health problems

have learning difficulties.

Responding

Responding

Reporting

If you think a child is in immediate danger, contact the police on 999. If you have concerns that a child may not be receiving the care they need, but they are not in immediate danger, you should share your concerns.

Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our trained professionals will talk through your concerns with you and give you expert advice.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police.

Services will risk assess the situation and take action to protect the child as appropriate either through statutory involvement or other support. This may include making a referral to the local authority.
> See our information about recognising and responding to abuse
Assessment

Practitioners must work with children and families to identify and assess concerns and intervene appropriately so that the impact of parental substance misuse is minimised.

This involves carrying out a holistic assessment of the child's development, the parents' ability to meet the child's needs and the impact of broader family and environmental factors.

Practitioners need to identify each family's strengths. It's important to distinguish between immediate concerns for the child's safety and risks which can be mitigated with appropriate support (Bogg, 2013; Cleaver, Unell and Aldgate, 2011).

Effective assessments should:

focus on the child and their needs

give children the opportunity to discuss their experiences

listen to and record the child's views on the situation

identify any children who are acting as carers for their parents and siblings

treat children, parents and carers as individuals

make sure parents know they are being listened to

ask questions about the parent's drug or alcohol use

consider the wider environment such as support networks, housing and family finances

talk to any extended family members or friends who offer support to the family

collaborate with and seek the views of colleagues from other agencies who are involved with the family, such as health professionals, teachers, substance misuse services and criminal justice agencies (Bogg, 2013; Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013; Home Office, 2003).

Protective factors

Factors which help reduce the impact of parental substance misuse on children are:

the child being able to ask for help

parents being willing to acknowledge their difficulties and seek help and support

the parent and child having a positive relationship

social support being available to the family (for example relatives or friends who can provide the children with care and stability, offer financial support and make sure the home is clean and safe)

the parent and child having good general physical and mental health

having one parent who does not misuse substances

being able to maintain daily routines (Bogg, 2013; Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013).

Giving children a voice

It's vital to build safe and trusting relationships with children so they can speak out about any problems they are experiencing. This involves teaching children what neglect is and how they can get help.

Our Speak out Stay safe service for schools helps children understand abuse in all its forms and know how to protect themselves.

Supporting children and families

Supporting children and families

Intervention

Successful interventions to support families affected by parental substance misuse should use a holistic approach to look at and improve a family's:

day-to-day functioning

psychological functioning

parent-child relationships

social factors (such as the family's network, housing and financial situation) (Altobelli and Payne, 2014; Bogg, 2013; Cleaver, Unell and Aldgate, 2011).

The child's perspective should always be prioritised.

It takes time for parents to change their behaviour so time-frames for interventions need to be flexible. There should be a balance between long-term support and more focused time-limited services (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013).

Short-term support

Immediate support for families where there is parental substance misuse should involve setting pragmatic, realistic and timely goals which focus on solutions rather than problems.

For example, practitioners need to make sure:

younger children are taken to nursery/school

older children are not missing school

all children receive the appropriate support with their school work

children are taken to all necessary medical appointments/check-ups (including dental appointments).

Practical support for parents might include helping with:

In the short-term practitioners should focus on building a good working relationship with parents rather than putting them under pressure to change entrenched, problematic behaviours immediately. However, it's important to make sure that parents are addressing their substance misuse and are engaged with a drug or alcohol service (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013; Home Office, 2003).

Medium- to long-term support

In the medium-to-long-term the family may need intensive support and therapy focussing on recognising and changing unhelpful, repetitive patterns of behaviour.

Children should be given opportunities to express their ideas and feelings. They also need help to understand more about their parent's substance misuse. They need to know that it's not their fault and that they can't control or cure their parent's addiction.

It's important for practitioners working with the family to receive reflective and challenging supervision so they can maintain an unbiased viewpoint throughout their journey with the family. It's also essential to work with colleagues in other agencies to gain different perspectives on the situation (Altobelli and Payne, 2014).

A reduction in parents' use of substances doesn't always automatically result in improved parenting (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013). Parents may need support to learn:

parenting skills

how to cope with other challenges the family is facing.

Friend and family support

The family may suffer setbacks along the way, so it's important for members of their support network to be able to step in and help where possible.

Educating extended family members, friends and communities on the impact of substance misuse on children and families can enable them to provide more effective support (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013).

Monitoring progress

Practitioners must maintain a focus on the wellbeing of the child. They should monitor and review children's progress throughout the period of intervention and respond appropriately.

Strategy and guidance

Strategy and guidance

Statutory guidance across the UK highlights the responsibility of those in the education, community and care sectors to promote children's welfare. This includes providing support to children and families experiencing substance misuse.

In each nation of the UK the government has also set out how agencies should work together to tackle substance misuse.

In England, the drugs strategy From harm to hope: a 10-year drugs plan to cut down on crime and save lives, sets out the government's actions to tackle drug crime and reduce the impact it has on people's lives, including early intervention for young people and families at the greatest risk of drug use (HM Government, 2021).

Public Health England has produced guidance for local authorities on Safeguarding and promoting the welfare of children affected by parental alcohol and drug use (Public Health England, 2018).

Public Health England has also published a toolkit for child and family services and adult alcohol and drug treatment services. It contains guidance to help professionals who are supporting families affected by parental alcohol and drug problems (Public Health England, 2021).

In Northern Ireland, the strategic direction for alcohol and drugs includes provision for family support services (Department of Health, 2019).

Scotland's strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths has a section on getting it right for children, young people and families (Scottish Government, 2018).

The Scottish Government has also produced good practice guidance for agencies and practitioners working with children, young people and families affected by problematic alcohol and/or drug use (Scottish Government, 2013).

In the Wales, Substance misuse delivery plan: 2019 to 2022 sets out the Welsh Government's actions to reduce the harm caused by substance misuse (Welsh Government, 2021).

References and resources

References and resources

Altobelli, C. and Payne, C. (2014) Noticing the hidden harm. BACP children and young people, March: 4-8.

Bogg, D. (2013) Parental substance use: the challenge for social work. Families upfront, 9: 18-19.

Brophy, J. (2006) Research review: child care proceedings under the Children Act 1989 (PDF). London: Department for Constitutional Affairs.

Cleaver, H., Unell, I. and Aldgate, J. (2011) Children's needs: parenting capacity: child abuse: parental mental illness, learning disability, substance misuse, and domestic violence (PDF). London: The Stationery Office (TSO).

Cornwallis, T. (2013) A practical approach to tackling parental alcohol abuse. Community practitioner, 86 (2): 34-35.

Department of Health (2019) New strategic direction for alcohol and drugs. [Belfast]: Department of Health.

Home Office (2003) Hidden harm: responding to the needs of children of problem drug users: the report of an Inquiry by the Advisory Council on the Misuse of Drugs (PDF). London: Home Office.

HM Government (2021) From harm to hope: a 10-year drugs plan to cut crime and save lives. [Accessed 27/01/2022].

Kroll, B. and Taylor, A. (2003) Parental substance misuse and child welfare. London: Jessica Kingsley.

National Institute for Health and Care Excellence (NICE) (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: NICE.

National Institute for Health and Care Excellence (NICE) (2012) Drug use disorders in adults. London: NICE.

NSPCC (2018) Children living in families facing adversity: NSPCC helplines report. London: NSPCC.

Public Health England (2021) Parents with alcohol and drug problems: support resources [Accessed 27/05/2021].

Public Health England (2018) Safeguarding and promoting the welfare of children affected by parental alcohol and drug use: a guide for local authorities. [Accessed 27/05/2021].

Shonkoff, J.P. et al (2011) Building the Brain's "Air Traffic Control" System: How Early Experiences Shape the Development of Executive Function Working Paper 11 (PDF). Cambridge: Center on the Developing Child, Harvard University.

Shonkoff, J.P. et al (2014), Excessive Stress Disrupts the Architecture of the Developing Brain Working Paper 3 (PDF). Cambridge: Center on the Developing Child, Harvard University.

Scottish Government (2013) Getting our priorities right: good practice guidance for agencies and practitioners working with children, young people and families affected by problematic alcohol and/or drug use. [Accessed 27/05/2021].

Scottish Government (2018) Rights, respect and recovery: strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths [Accessed 27/05/2021].

Templeton, L. (2014) Supporting families living with parental substance misuse: the M-PACT Moving Parents and Children Together programme. Child and family social work, 19 (1): 76-88.

Velleman, R. (2001) Working with substance misusing parents as part of court proceedings. Representing Children 14: 36-48.

Welsh Government (2021) Substance misuse delivery plan: 2019 to 2022. Cardiff: Welsh Government.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read advice on parents and alcohol and drugs on the Childline website. You can also download or order Childline posters and wallet cards.

Related NSPCC resources
> See our research and resources on substance misuse
Further reading

For further reading about parental substance misuse, search the NSPCC Library catalogue using the keywords "substance misuse"; "addicted parents"; "alcoholic parents"; "children of addicted parents"; "drug and alcohol services".
> Find out more about the Library and Information Service

Introduction

'Parental substance misuse' is the long-term misuse of drugs and/or alcohol by a parent or carer.

This includes parents and carers who:

consume harmful amounts of alcohol (for example if their drinking is leading to alcohol-related health problems or accidents)

are dependent on alcohol

use drugs regularly and excessively

are dependent on drugs.

It also includes parents who aren't able to supervise their children appropriately because of their substance use (NSPCC, 2018).

Most parents and carers who drink alcohol or use drugs do so in moderation, which doesn't present an increased risk of harm to their children (Cleaver, Unell and Aldgate, 2011).

However, parents and carers who misuse substances can have chaotic, unpredictable lifestyles and may struggle to recognise and meet their children's needs. This may result in their children being at risk of harm.

Alcohol misuse

Alcohol misuse includes:

excessive and harmful drinking

alcohol dependence.

Harmful drinking is a pattern of alcohol use. It can cause alcohol-related problems including:

When someone is dependent on alcohol, they are likely to crave alcohol and continue drinking in spite of the harmful consequences. Alcohol dependence is associated with:

Drug misuse

Drug misuse is a dependence on, or regular excessive consumption of, psychoactive substances. It can lead to:

social problems

mental and psychological illness

physical illness

legal problems.

Drug misuse is more prevalent in socially deprived areas (National Institute for Health and Care Excellence, 2012).

In England and Wales the most commonly used psychoactive substances include:

Opioids such as heroin may be less common but can lead to the most significant health problems (National Institute for Health and Care Excellence, 2012).

Impact of parental substance misuse

Abuse and neglect

Living in a household where a parent or carer misuses substances doesn't mean a child will experience abuse, but it does make it more difficult for parents to provide safe and loving care. This can lead to abuse or neglect.

Neglect

Parents who misuse substances may have difficulty:

staying organised and giving their children effective and consistent support

keeping their home and family clean

recognising and responding appropriately to their own and their children's physical needs

paying for food, clothing and essential bills (for example if their income is being spent on drugs and alcohol)

keeping harmful substances and equipment such as needles and syringes safely away from their children.

Some parents who use drugs or drink excessively may lose consciousness, leaving no other responsible adult present to care for their child and ensure their safety (Cleaver, Unell and Aldgate, 2011).

Emotional abuse

Parents who drink excessively or misuse drugs can become emotionally unavailable to their children (Cleaver, Unell and Aldgate, 2011). Mothers with drug problems can be:

Parents who misuse substances can behave in a way that's irrational, unpredictable or withdrawn, which may frighten their children (Cleaver, Unell and Aldgate, 2011).

Physical abuse

Parents who misuse substances may have difficulty controlling their own emotions. Harmful and excessive drinking can contribute to child physical abuse (Cleaver, Unell and Aldgate, 2011; Velleman, 2001).

Impact on brain development

Abuse and neglect are types of adverse childhood experiences (ACEs), which can affect the healthy development of children's brains. The impacts of abuse and neglect on children's brains can stretch beyond childhood and into adulthood.

Possible impacts include:

(Shonkoff et al, 2011; Shonkoff et al, 2014).
> Find out more about the effect of abuse and neglect on child brain development
Criminal activity

Parents and carers who misuse drugs or alcohol may turn to crime to fund their dependency. This may mean exposing their children to unsafe adults or involving them in criminal activity (Brophy, 2006).

One girl told Childline:

"My dad has a drug and alcohol problem. He makes me sleep with other men so he can get drugs. He's also raped me before by putting drugs in my drink."
Childline counselling session with a girl aged 15
Other effects

The impact of parental substance abuse varies according to each child's health, stage of development, personality and relationship with their family.

Children whose parents misuse drugs or alcohol may be separated from their parents and/or family for short- or long periods of time due to:

They may have to take on the role of carer for their family. This could include doing the housework, preparing food and looking after younger siblings (NSPCC, 2018).

Psychological effects

Many young people talk to Childline about the psychological effects of parental substance misuse. One girl said:

"My mum is up and down - sometimes she's fine and sober - but it can quickly change and she becomes worse again...[she] gets abusive when she's drunk and gets angry at me and my sisters. I don't like being at home."
Childline counselling session with a girl aged 15
Other psychological effects include:

preoccupation with their parents' substance misuse

blaming themselves for their parents' behaviour

not being able to attend school regularly and/or having poor educational attainment

difficulty establishing and maintaining healthy relationships

developing behavioural, emotional or cognitive problems (Altobelli and Payne, 2014; Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013; Home Office, 2003; Templeton, 2014).

Risk and vulnerability factors

All families experience challenges from time to time. This doesn't necessarily mean children are at greater risk of abuse. But when problems mount up, it can be more difficult for parents to cope - particularly if they are isolated or lack support.

Children who live in families experiencing multiple adversities can be more vulnerable. These include children whose parents:

are involved in domestic abuse

misuse substances

have mental health problems

have learning difficulties.

Responding

Responding

Reporting

If you think a child is in immediate danger, contact the police on 999. If you have concerns that a child may not be receiving the care they need, but they are not in immediate danger, you should share your concerns.

Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our trained professionals will talk through your concerns with you and give you expert advice.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police.

Services will risk assess the situation and take action to protect the child as appropriate either through statutory involvement or other support. This may include making a referral to the local authority.
> See our information about recognising and responding to abuse
Assessment

Practitioners must work with children and families to identify and assess concerns and intervene appropriately so that the impact of parental substance misuse is minimised.

This involves carrying out a holistic assessment of the child's development, the parents' ability to meet the child's needs and the impact of broader family and environmental factors.

Practitioners need to identify each family's strengths. It's important to distinguish between immediate concerns for the child's safety and risks which can be mitigated with appropriate support (Bogg, 2013; Cleaver, Unell and Aldgate, 2011).

Effective assessments should:

focus on the child and their needs

give children the opportunity to discuss their experiences

listen to and record the child's views on the situation

identify any children who are acting as carers for their parents and siblings

treat children, parents and carers as individuals

make sure parents know they are being listened to

ask questions about the parent's drug or alcohol use

consider the wider environment such as support networks, housing and family finances

talk to any extended family members or friends who offer support to the family

collaborate with and seek the views of colleagues from other agencies who are involved with the family, such as health professionals, teachers, substance misuse services and criminal justice agencies (Bogg, 2013; Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013; Home Office, 2003).

Protective factors

Factors which help reduce the impact of parental substance misuse on children are:

the child being able to ask for help

parents being willing to acknowledge their difficulties and seek help and support

the parent and child having a positive relationship

social support being available to the family (for example relatives or friends who can provide the children with care and stability, offer financial support and make sure the home is clean and safe)

the parent and child having good general physical and mental health

having one parent who does not misuse substances

being able to maintain daily routines (Bogg, 2013; Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013).

Giving children a voice

It's vital to build safe and trusting relationships with children so they can speak out about any problems they are experiencing. This involves teaching children what neglect is and how they can get help.

Our Speak out Stay safe service for schools helps children understand abuse in all its forms and know how to protect themselves.

Supporting children and families

Supporting children and families

Intervention

Successful interventions to support families affected by parental substance misuse should use a holistic approach to look at and improve a family's:

day-to-day functioning

psychological functioning

parent-child relationships

social factors (such as the family's network, housing and financial situation) (Altobelli and Payne, 2014; Bogg, 2013; Cleaver, Unell and Aldgate, 2011).

The child's perspective should always be prioritised.

It takes time for parents to change their behaviour so time-frames for interventions need to be flexible. There should be a balance between long-term support and more focused time-limited services (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013).

Short-term support

Immediate support for families where there is parental substance misuse should involve setting pragmatic, realistic and timely goals which focus on solutions rather than problems.

For example, practitioners need to make sure:

younger children are taken to nursery/school

older children are not missing school

all children receive the appropriate support with their school work

children are taken to all necessary medical appointments/check-ups (including dental appointments).

Practical support for parents might include helping with:

In the short-term practitioners should focus on building a good working relationship with parents rather than putting them under pressure to change entrenched, problematic behaviours immediately. However, it's important to make sure that parents are addressing their substance misuse and are engaged with a drug or alcohol service (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013; Home Office, 2003).

Medium- to long-term support

In the medium-to-long-term the family may need intensive support and therapy focussing on recognising and changing unhelpful, repetitive patterns of behaviour.

Children should be given opportunities to express their ideas and feelings. They also need help to understand more about their parent's substance misuse. They need to know that it's not their fault and that they can't control or cure their parent's addiction.

It's important for practitioners working with the family to receive reflective and challenging supervision so they can maintain an unbiased viewpoint throughout their journey with the family. It's also essential to work with colleagues in other agencies to gain different perspectives on the situation (Altobelli and Payne, 2014).

A reduction in parents' use of substances doesn't always automatically result in improved parenting (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013). Parents may need support to learn:

parenting skills

how to cope with other challenges the family is facing.

Friend and family support

The family may suffer setbacks along the way, so it's important for members of their support network to be able to step in and help where possible.

Educating extended family members, friends and communities on the impact of substance misuse on children and families can enable them to provide more effective support (Cleaver, Unell and Aldgate, 2011; Cornwallis, 2013).

Monitoring progress

Practitioners must maintain a focus on the wellbeing of the child. They should monitor and review children's progress throughout the period of intervention and respond appropriately.

Strategy and guidance

Strategy and guidance

Statutory guidance across the UK highlights the responsibility of those in the education, community and care sectors to promote children's welfare. This includes providing support to children and families experiencing substance misuse.

In each nation of the UK the government has also set out how agencies should work together to tackle substance misuse.

In England, the drugs strategy From harm to hope: a 10-year drugs plan to cut down on crime and save lives, sets out the government's actions to tackle drug crime and reduce the impact it has on people's lives, including early intervention for young people and families at the greatest risk of drug use (HM Government, 2021).

Public Health England has produced guidance for local authorities on Safeguarding and promoting the welfare of children affected by parental alcohol and drug use (Public Health England, 2018).

Public Health England has also published a toolkit for child and family services and adult alcohol and drug treatment services. It contains guidance to help professionals who are supporting families affected by parental alcohol and drug problems (Public Health England, 2021).

In Northern Ireland, the strategic direction for alcohol and drugs includes provision for family support services (Department of Health, 2019).

Scotland's strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths has a section on getting it right for children, young people and families (Scottish Government, 2018).

The Scottish Government has also produced good practice guidance for agencies and practitioners working with children, young people and families affected by problematic alcohol and/or drug use (Scottish Government, 2013).

In the Wales, Substance misuse delivery plan: 2019 to 2022 sets out the Welsh Government's actions to reduce the harm caused by substance misuse (Welsh Government, 2021).

References and resources

References and resources

Altobelli, C. and Payne, C. (2014) Noticing the hidden harm. BACP children and young people, March: 4-8.

Bogg, D. (2013) Parental substance use: the challenge for social work. Families upfront, 9: 18-19.

Brophy, J. (2006) Research review: child care proceedings under the Children Act 1989 (PDF). London: Department for Constitutional Affairs.

Cleaver, H., Unell, I. and Aldgate, J. (2011) Children's needs: parenting capacity: child abuse: parental mental illness, learning disability, substance misuse, and domestic violence (PDF). London: The Stationery Office (TSO).

Cornwallis, T. (2013) A practical approach to tackling parental alcohol abuse. Community practitioner, 86 (2): 34-35.

Department of Health (2019) New strategic direction for alcohol and drugs. [Belfast]: Department of Health.

Home Office (2003) Hidden harm: responding to the needs of children of problem drug users: the report of an Inquiry by the Advisory Council on the Misuse of Drugs (PDF). London: Home Office.

HM Government (2021) From harm to hope: a 10-year drugs plan to cut crime and save lives. [Accessed 27/01/2022].

Kroll, B. and Taylor, A. (2003) Parental substance misuse and child welfare. London: Jessica Kingsley.

National Institute for Health and Care Excellence (NICE) (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: NICE.

National Institute for Health and Care Excellence (NICE) (2012) Drug use disorders in adults. London: NICE.

NSPCC (2018) Children living in families facing adversity: NSPCC helplines report. London: NSPCC.

Public Health England (2021) Parents with alcohol and drug problems: support resources [Accessed 27/05/2021].

Public Health England (2018) Safeguarding and promoting the welfare of children affected by parental alcohol and drug use: a guide for local authorities. [Accessed 27/05/2021].

Shonkoff, J.P. et al (2011) Building the Brain's "Air Traffic Control" System: How Early Experiences Shape the Development of Executive Function Working Paper 11 (PDF). Cambridge: Center on the Developing Child, Harvard University.

Shonkoff, J.P. et al (2014), Excessive Stress Disrupts the Architecture of the Developing Brain Working Paper 3 (PDF). Cambridge: Center on the Developing Child, Harvard University.

Scottish Government (2013) Getting our priorities right: good practice guidance for agencies and practitioners working with children, young people and families affected by problematic alcohol and/or drug use. [Accessed 27/05/2021].

Scottish Government (2018) Rights, respect and recovery: strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths [Accessed 27/05/2021].

Templeton, L. (2014) Supporting families living with parental substance misuse: the M-PACT Moving Parents and Children Together programme. Child and family social work, 19 (1): 76-88.

Velleman, R. (2001) Working with substance misusing parents as part of court proceedings. Representing Children 14: 36-48.

Welsh Government (2021) Substance misuse delivery plan: 2019 to 2022. Cardiff: Welsh Government.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read advice on parents and alcohol and drugs on the Childline website. You can also download or order Childline posters and wallet cards.

Related NSPCC resources
> See our research and resources on substance misuse
Further reading

For further reading about parental substance misuse, search the NSPCC Library catalogue using the keywords "substance misuse"; "addicted parents"; "alcoholic parents"; "children of addicted parents"; "drug and alcohol services".
> Find out more about the Library and Information Service

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Parental substance misuse | NSPCC Learning

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Long-term misuse of drugs and/or alcohol can leave parents and carers struggling to recognise and meet their children's needs and put them at risk of harm. Find out the impact of this on children and what works to support children whose parents misuse substances.

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Contents

Introduction

Substance misuse is the problematic use of drugs and/or alcohol.

Substance misuse usually refers to someone who inappropriately uses or is dependent on illicit drugs, alcohol, prescription drugs or solvents; and their use of these is associated with having a harmful effect on the individual, their family or the community. However, professionals should be mindful that a single use of alcohol and/or drugs can have consequences which are equally as devastating as long-term use.

Parents' dependent alcohol and drug use can negatively impact on children's physical and emotional wellbeing, their development and their safety. The impacts on children include:

physical maltreatment and neglect

poor physical and mental health

development of health harming behaviours in later life, for example using alcohol and drugs and at an early age, which predicts more entrenched future use

poor school attendance due to inappropriate caring responsibilities

low educational attainment

involvement in anti-social or criminal behaviour

( Safeguarding and promoting the welfare of children affected by parental alcohol and drug use: a guide for local authorities, 2018)

How substance misuse affects children

Parental problem alcohol and drug use affects children and their experiences of family life in a number of ways. And it's not just parent's dependent alcohol and drug use which is a problem. Parents who are using alcohol and drugs at higher risk levels can also have an impact on children.

Substance misuse can consume a great deal of time, money and emotional energy, which will unavoidably impact on the capacity to parent a child. This behaviour also puts the child at an increased risk of neglect and emotional, physical or sexual abuse, either by the parent or because the child becomes more vulnerable to abuse by others.

The circumstances surrounding dependent, heavy or chaotic substance misuse may inhibit responsible childcare. For example, substance misuse may lead to poor physical health or to mental health problems, financial problems and a breakdown in family support networks. Substance misuse may also impact on the ability of a parent or carer to assess and manage risks to their children, including the risk of harm.

The impacts on children can include:

physical and emotional abuse or neglect as a result of inadequate supervision, poor role models and inappropriate parenting

behavioural, emotional or cognitive problems and relationship difficulties

taking on the role of carer for parents and siblings

preoccupation with, or blaming themselves for, their parents' substance misuse

infrequent attendance at school and poor educational attainment

experiencing poverty and inadequate and unsafe accommodation

exposure to toxic substances and criminal activities

separation from parents due to intervention from children's services, imprisonment or hospitalisation

increased risk of developing drug or alcohol problems or offending behaviour themselves.

( NSPCC, Parental substance misuse)

A Family Approach

Research and data show that many families face multiple, entrenched and serious problems that will have a serious impact on the children and adults within the family. Research suggests that a multi-agency, 'family approach' can be effective in helping families, even for those who have not benefited from traditional service approaches.

A Family Approach is one that secures better outcomes for children (including unborn babies), adults with care and support needs, children and their families by co-ordinating the support they receive from Adult and Children and Family Services. The support provided by these services should be focused on problems affecting the family as this is the only effective way of working with families experiencing the most significant problems.

See the HIPS Family Approach Protocol.

What action can be taken

A referral to Children's social care in line with the Referrals Procedure should be made if there are concerns about a child living with parents with substance misuse. An assessment of the parent's capacity to meet the child's needs should take place to establish the impact on the child of the parent's lifestyle and capacity to place the child's needs before those of their own.

Children's social care should be the main contact point for child safeguarding concerns. All alcohol and drug treatment services should have a documented referral process into social care for where there are safeguarding concerns. All children and young people's alcohol and drugs services should have a 'designated practitioner' or 'dedicated and named practitioner'.

Substance misuse in pregnancy

Substance misuse in pregnancy can have serious effects on the health and development of the child before and after birth. Not every woman who uses substances will need additional support or a referral to specialist services. Many other factors affect pregnancy outcomes, including poverty, poor housing, poor maternal health and nutrition, domestic abuse and mental health. Assessment must be used to understand the impact of, and risks associated with, parental substance misuse and this must take account of other factors such as these.

The majority of pregnant substance misusing women will have been identified by maternity services and referred to the Substance Misuse Team. The Care Planning Approach / Care Co-ordination Approach will apply including input from the link midwives and a social worker from Children's social care, who will be invited to any meetings taking place in respect of the child/ren.

Where a newly born child is found to need treatment to withdraw from substances at birth, an assessment and a pre-discharge discussion should take place and consideration should be given to making a referral to Children's social care in line with the Referrals Procedure before the child is discharged home.

There is a clear need to assess the impact of the behaviour on the child as well as the wider family and community context. Some adult services may be reluctant to share information because of concern about confidentiality. However, the needs to safeguard children should be paramount and agencies with information regarding the parent will have a valuable contribution to make. See Sharing information procedure for more information.

Further information

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5.1 Children living in households where there is substance misuse

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Substance misuse is the problematic use of drugs and/or alcohol. Substance misuse usually refers to someone who inappropriately uses or is dependent on illicit drugs, alcohol, prescription drugs or solvents; and their use of these is associated with having a harmful effect on the individual, their family or the community.

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"We had to watch videos of people like arguing and talk about it. I thought that was quite good because you get to tell the truth to everybody [about what had happened at home]. [It was] a little bit hard but I felt quite good about myself because I let it all out. [Before DART] I kept it to myself . . . All the bad things were in my brain and now it's turned good. "
Boy aged 8 who attended DART

Domestic abuse can have a negative impact on a child's behaviour, brain development and wellbeing. Children need safety and security - and when those needs aren't met it can take a toll on their education and their mental health.

"I really need your help; my dad has been physical abusing my mum. He has an anger problem and it's getting out of hand. The smallest things make him angry and he starts shouting. I'm terrified of him and I've had enough, I can't take it any more - please help me!"
Boy, aged 14, Childline

Home isn't a safe place for every child, so the Covid-19 pandemic and 'stay at home' guidance put more children than ever at risk. With schools and face-to-face services closed - it was harder to spot if something's wrong and harder for children to speak out.

During the pandemic, NSPCC Helpline contacts about domestic abuse increased. Our helpline responded to over 11,600 contacts about domestic abuse in 2020/21, a 35% increase on the previous year.

We've been running DART for 10 years. In that time, we've worked with more than 2,000 women and children across the UK. Since 2018, we've trained over 300 professionals in partner organisations to deliver DART themselves.

We evaluated DART and we found that after completing the programme:

mothers' self-esteem and confidence in parenting increased

mothers reported more affection towards their children

children had fewer emotional and behavioural difficulties

the sessions helped children share their experiences of the abuse, and their mothers to understand them.

Read more about the impact our DART service has made in our evaluation on NSPCC Learning.

"I feel I and my daughter have learnt a lot coming here and we've become closer and understand each other more."
A mother attending the DART service

Even as pandemic restrictions lift and schools reopened - domestic abuse is still a danger outside of lockdown. With parents still facing economic and mental health pressures, and limited access to support, the need for specialist services like DART is stronger than ever.

"[My son] never spoke to me about how he felt [whilst the abuse was happening]. Only afterwards [during a DART activity] he made a house, showing me crying in the bedroom, and [the perpetrator] on top of me and [my son] crying, it hit home to me. I thought he'd forgotten about it...But these things were still in his mind. I never thought he thought about it."
Mother who attended DART

We want more families to be able to access support so we're looking to train and license more partners to help deliver the programme around the UK.

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"We had to watch videos of people like arguing and talk about it. I thought that was quite good because you get to tell the truth to everybody [about what had happened at home]. [It was] a little bit hard but I felt quite good about myself because I let it all out.

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Types and indicators of abuse: Safeguarding adults - SCIE

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Introduction

Many parents with mental health problems are able to give their children safe and loving care, without their children being negatively affected in any way. But sometimes, parents with mental health problems need support from family members, friends, neighbours and/or professionals, to help them care for their children.

We're using the term 'parental mental health problems' to mean that a parent or carer has a diagnosable mental health condition. This can include:

depression

anxiety disorders

schizophrenia

bipolar disorder

personality disorders.

Mental health problems can vary in severity and impact differently on people's day to day lives. This depends on parents' individual circumstances and the support they receive.

Parental mental health problems might occur alongside other stressful life experiences.

Challenges may arise as a result of the condition, contribute to the condition developing, or make it worse. For example if a parent is experiencing financial problems, this can negatively affect their mental health. And if the parent becomes unable to work due to their mental health, this can exacerbate their financial problems.

Coping with lots of challenges at once can make it difficult for parents to provide their children with the care that they need.

We've put together some information to help you recognise when parents with mental health problems need help to care for their children and how to provide appropriate support. This includes:

the impact of parental mental health problems on family life

signs that a child or their family might need support

carrying out assessments with families where parents have a mental health problem

providing appropriate and effective support

a summary of the relevant legislation and guidance from across the UK.

Impact of parental mental health problems

Many parents with mental health problems are able to manage their condition and minimise its impact on their children, particularly if they are able to access appropriate support. But sometimes it does affect their ability to cope with family life.

Parental mental health problems may affect children differently according to the severity and type of mental health condition, the child's age and stage of development, and the child's personality.

Coping with challenges

Some parents experience mental health problems along with other challenges such as:

divorce or separation

unemployment

financial hardship

poor housing

discrimination

a lack of social support

domestic abuse

substance misuse.

If they are facing several challenges at once, it can be very hard for parents to provide their children with safe and loving care, particularly if they are isolated or aren't getting the support they need (Cleaver, Unell and Aldgate, 2011; Gatsou et al, 2017; Grove, Reupert and Maybery, 2015; Hogg, 2013; Wolpert et al, 2015).

Research has found there is a greater risk to children's safety if parents with mental health problems are also experiencing domestic abuse or substance misuse (Cleaver, Unell and Aldgate, 2011).

Caring for children

Some parents and carers with mental health problems may need support to cope with the routines of daily life, such as housework, mealtimes, bedtimes, taking children to school, and taking children to medical and dental appointments.

They may also find it more difficult to:

control their mood and emotions around their children

recognise and respond to children's physical and emotional needs

engage socially with their children

set and maintain safe and appropriate boundaries and manage their children's behaviour.

If parents don't get the support they need from family, friends, neighbours and/or professionals, these challenges may escalate. In extreme cases, children may experience abuse and/or neglect.

Babies and younger children

Babies and young children rely on their parents and carers to give them the warm, nurturing care they need to grow.

If parents experience mental health problems in pregnancy or the first year of a baby's life, this can affect the way they are able to bond with and care for their child. This can have an impact on the child's intellectual, emotional, social and psychological development (Gajos and Beaver, 2017; Hogg, 2013).

This means it's important that practitioners are able to recognise if a new parent or carer is struggling with their mental health and help them access appropriate support.

Children's wellbeing

Many children whose parents have a mental health problem do not experience any negative effects. But if parents are not getting the right support to care for their family, this can have an impact on their children's wellbeing.

Signs that a child might need extra support include:

being worried about their parent or carer's condition

taking on a caring role for parents and other family members

putting the needs of their family above their own

having negative feelings about their parent's condition

finding it hard to make friends, feeling isolated or being bullied

not feeling able to talk to their parents or another trusted adult about their worries.

"My parents aren't having a good time. They both have mental health problems and anger issues. They are so aggressive and spark each other off.  I have been scared about something bad happening for a while. My parents don't seem to care about how much seeing them like this upsets me. I don't feel like I can talk to anyone about this. It feels like there is no solution to this situation and I am going to have to just deal with it and carry on hoping things will get better."
Childline counselling session with a girl aged 12
If a parent has severe mental health problems, children may have to cope with frightening and upsetting situations such as:

being separated from their parents, either because parents need to go into hospital and/or because the child is taken into care

a parent attempting to take their own life

a parent displaying extremely volatile behaviour.

If these things happen, it's important to consider how this has affected the wellbeing of everyone in the family and what support can be put in place.

Stigma

Sometimes families experience stigma related to mental health problems. This can make it harder for parents and their children to socialise, speak out and ask for support.

Parents and their families may experience discrimination from others, and this may be displayed consciously or unconsciously. For example, parents might find it harder to get work or access support services. Some children whose parents have mental health problems report being bullied.

Professionals have an important role to play in raising awareness about mental health problems, taking action to tackle discrimination and making sure families get the support they need.

Risk and vulnerability factors

All families experience challenges from time to time. This doesn't necessarily mean children are at greater risk of abuse. But when problems mount up, it can be more difficult for parents to cope - particularly if they are isolated or lack support.

The risks to children are greater when parental mental health problems exist alongside domestic abuse and parental substance misuse (Cleaver, Unell and Aldgate, 2011).

Responding

Responding

Reporting

If you think a child is in immediate danger, contact the police on 999. If have concerns that a child may not be receiving the care they need but they are not in immediate danger, you should share your concerns.

Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our trained professionals will talk through your concerns with you and give you expert advice.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police.

Services will risk assess the situation and take action to protect the child as appropriate either through statutory involvement or other support. This may include making a referral to the local authority.
> See our information about recognising and responding to abuse
Assessment

The impact of parental mental health problems varies according to the nature of each parent's condition, their child's health and stage of development, and relationships with other family members.

Practitioners should assess whether a parent or carer's mental health problems pose a risk to their child's safety and wellbeing, and whether these risks can be mitigated with appropriate support. You should also consider whether there are any protective factors which will increase the family's overall resilience, for example if the parent or carer is already receiving effective support from mental health services.

You should carry out a holistic assessment which takes into account:

the child's wellbeing and development

the child's thoughts and feelings

the impact of every day parenting on the parent or carer's mental health

the parent or carer's ability to meet the child's needs

whether the child has taken on a caring role

the parent or carer's background, medical history and current circumstances

the parent's thoughts and feelings about caring for their child

the views of colleagues from other agencies who are involved with the family, such as teachers

whether the parent or carer has support from another parent or relative, or if they are coping with parenting alone.

You should also consider broader factors that might make it harder for the parent or carer to cope. These include:

substance misuse

domestic abuse

financial hardship

housing problems

relationship problems

social isolation.

Always take threats of suicide or threats to kill a partner or child seriously and take immediate action to keep children safe.

Protective factors

Factors which can help reduce the risk to children's wellbeing include:

parents and carers who acknowledge their difficulties and are willing to accept support from services

friends or relatives who are able to care for children and help with household chores when needed

families receiving support for other challenges, such as income support, benefits and housing advice

families receiving additional support from other professionals who can also monitor the situation and share concerns if necessary, for example teachers

children having a trusted adult they are able to ask for help when needed

wider community support such as young carer's projects (Cleaver, Unell and Aldgate, 2011).

Supporting children and families

Supporting children and families

Early help

It's vital to identify parental mental health problems as soon as they emerge and provide families with appropriate support.

NSPCC services which provide early support include:

Supports parents who are at risk of, or are experiencing mild to moderate anxiety and depression during pregnancy and the first year after birth.
> Find out more about Pregnancy in Mind

Prioritising children's needs

Anyone working with parents or carers who have mental health problems must maintain a focus on their children's wellbeing.

Advocacy and mentoring

Children should be given access to a mentor and/or advocate who they can talk to about their parent or carer's mental health and who can help make their views heard.

Children need someone they can contact for support if they need to, especially if there is an emergency.

Be aware that children may be wary about being offered therapy or counselling. Depending on their parents' experiences, they may have negative associations with this kind of support. They may also have fears about developing mental health problems themselves, and think that being referred to a counsellor is a sign of mental illness (Cooklin, 2013).

Peer support

Children whose parents have mental health problems should have the chance to interact with other children in similar situations. This allows them to both offer and receive support. Successful peer support networks can have a positive impact on children's wellbeing and resilience by:

increasing self-esteem

improving understanding of parental mental health issues

teaching communication and coping skills (Foster, 2016).

Many children and young people use Childline's peer support message boards to express their feelings, talk about their experiences and share advice with others.

Empowering children

Children and young people should play a positive role in, and contribute to decisions about, their parent or carer's care (Royal College of Psychiatrists, 2011).

Children want to be involved in interventions to support their parents, and they want their views to be taken seriously (Cooklin, 2013).

Giving children and young people accurate, age appropriate information about mental health problems can address any misconceptions or fears they may have and can give them the language to express themselves (Grove, Reupert and Maybery, 2015).

Allowing children and young people distance from their parent or carer's emotions and behaviours can enable them to develop their own thinking and emotions (Cooklin, 2013).

Explaining a parent or carer's mental health difficulties can be a platform for wider discussions about relationships and emotions in general.

Educating children about parental mental health problems can have a number of benefits including:

increasing the child's resilience

challenging the child's misconceptions about mental health

increasing the child's understanding and empathy for their parent or carer

improving communications between the parent or carer and child (Grove, Reupert and Maybery, 2015; Wolpert et al, 2015).

Speaking out

It's vital to build safe and trusting relationships with children so they can speak out about any problems they are experiencing. This involves teaching children what abuse is and how they can get help.

Our Speak out Stay safe service for schools helps children understand abuse in all its forms and know how to protect themselves.
> Find out more about Speak out Stay safe
Family support

Family members can be reluctant to discuss mental health with each other. Lack of communication can result in misunderstandings and may make children feel worried or alone.

Interventions which encourage families to communicate with each other can help everyone understand the impact of the mental health problems (Grove, Reupert and Maybery, 2015).

Families can benefit from meeting and sharing experiences with other families. This can:

prevent relapses

reduce feelings of isolation and stigma

offer positive ways to interact with each other

support more open discussion about mental health across the wider family (Wolpert et al, 2015).

Some interventions help family members to design and implement 'staying well' plans. This could include:

sign-posting to other helpful services

setting goals

developing problem solving skills

offering advice on managing stress

recognising the early signs of a relapse

(Gatsou et al, 2017).

Monitoring progress

Practitioners must maintain a focus on the wellbeing of the child. They should monitor and review children's progress throughout the period of intervention and respond appropriately.

Legislation, strategy and guidance

Legislation, strategy and guidance

Key legislation

In England and Wales, the Mental Health Act 1983 sets out the assessment, treatment and rights of people who have a mental health issue.

The Mental Capacity Act 2005 sets out a framework for acting on behalf of adults who are unable to make decisions about their own wellbeing.

In Northern Ireland, the Mental Health (Northern Ireland) Order 1986 sets out the assessment, care, treatment and rights of people who have mental health issues.

In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 sets out the care, treatment and rights of people who have a 'mental disorder'.

The Mental Health (Scotland) Act 2015 extends independent advocacy rights, services and accommodation to mothers who have mental health issues.

In Wales, the Mental Health (Wales) Measure 2010 provides for primary and secondary mental health services and independent advocacy across Wales.

Strategy

Public Health England (PHE) has developed a Joint Strategic Needs Assessment (JSNA) toolkit to help health and wellbeing boards understand local needs and assess services (PHE, 2019a). Chapter six of the toolkit covers working age adults and asks health boards to consider how parental mental health might affect children (PHE, 2019ba).

In Northern Ireland, the Department of Health has published a mental health action plan (Department of Health, 2021).

In Scotland, the Government has published a Mental health strategy 2017-2027 (Scottish Government, 2017).

In Wales, the Government's strategy for mental health and wellbeing outlines plans to improve family, parenting and/or caring relationships, which includes parental mental health (Welsh Government, 2012). The mental health delivery plan 2012-2022 sets out how the strategy will be delivered (Welsh Government, 2020).

Guidance

In Northern Ireland, the Department of Health has published guidance on the assessment and management of risk in mental health and learning disability services. It shares principles of best practice for mental health and learning disability care professionals on assessing and managing the risk of service users to themselves or others (Department of Health, 2012).

The Department of Health's report on preventing harm to children from parents with mental health needs sets out actions for adult mental health services to help keep children safe (Department of Health, 2016).

In Wales, the Government has published guidance for practitioners on engaging with and providing support for parents to enhance their child's development, care and wellbeing. It includes a section on providing support to parents with mental health needs (Welsh Government, 2019a).

The Welsh Government's local mental health support services guidance sets out how local health boards can improve access to mental health care and support for individuals, including parents (Welsh Government, 2011).

The Welsh Government's code of practice on the Mental Health Act 1983 sets out how professionals should treat mental health issues and provide information to patient's families and carers. It includes best practice guidance on communicating and consulting with a child about their parent's mental health (Welsh Government, 2016).

Perinatal mental health

There is specific guidance for professionals on supporting parents' mental health during the perinatal period (during pregnancy and the first year after birth).

In England, chapter four of Public Health England (PHE)'s Joint Strategic Needs Assessment (JSNA) toolkit (PHE, 2019a) covers perinatal mental health (PHE, 2019c). It aims to help health and wellbeing boards understand local needs and assess services.

PHE has published guidance for local maternity systems on supporting good parental mental health (PDF) (PHE, 2021a).

PHE has also published guidance for health visitors on supporting maternal and family mental health (PHE, 2021b).

In Scotland, the Government has published a delivery plan for perinatal and infant mental health 2020-2021. It sets out 10 pledges that have been developed with women who have experienced perinatal mental illness (Scottish Government, 2020).

The Scottish Government has published an action plan for peer support in perinatal mental health services for 2020-2023 (Scottish Government, 2021).

The Scottish Government has also published a strategy to improve perinatal mental health services for women with perinatal mental health issues, their children, partners and families (Scottish Government, 2019).

In Wales, the Government's maternity services strategy 2019-2024 includes an action to improve parental and infant wellbeing and mental health, and improve perinatal mental health care (Welsh Government, 2019b).

The Welsh Government has also published guidance on the Flying Start health programme. This includes information on assessing a parent's social, emotional and physical wellbeing and supporting mental health during the perinatal period (Welsh Government, 2017).

References and resources

References and resources

Cleaver, H., Unell, I. and Aldgate, J. (2011) Children's needs: parenting capacity: child abuse: parental mental illness, learning disability, substance misuse, and domestic violence (PDF). London: The Stationery Office (TSO).

Cooklin, A. (2013) Promoting children's resilience to parental mental illness: engaging the child's thinking. Advances in psychiatric treatment, 19: 229-240.

Department of Health (2021) Mental health action plan. [Accessed 18/06/2021].

Department of Health (2016) Rapid response report: preventing harm to children from parents with mental health needs. [Accessed 18/06/2021].

Department of Health (2012) Promoting quality care: good practice guidance on the assessment and management of risk in mental health and learning disability. [Accessed 18/06/2021].

Foster, K. et al. (2016) Outcomes of the ON FIRE peer support programme for children and adolescents in families with mental health problems. Child and family social work, 21: 295-306.

Gajos, J.M. and Beaver, K.M. (2017) Maternal depression and risk for antisocial behaviour in children. Child and family social work, 22(1): 349-363.

Gatsou, L. et al. (2017) The challenges presented by parental mental illness and the potential of a whole-family intervention to improve outcomes for families. Child and family social work, 22(1): 388-397.

Grove, C., Reupert, A. and Maybery, D. (2015) Gaining knowledge about parental mental illness: how does it empower children? Child and family social work, 20(4): 377-386.

Hogg, S. (2013) Prevention in mind: All Babies Count: spotlight on perinatal mental health. [London]: NSPCC.

Public Health England (PHE) (2021a) Maternity high impact area: supporting good parental mental health (PDF). London: Public Health England.

Public Health England (PHE) (2021b) Early years high impact area 2: Supporting maternal and family mental health. [Accessed 18/06/2021].

Public Health England (PHE) (2019a) Mental health and wellbeing: JSNA toolkit. [Accessed 22/06/2021].

Public Health England (PHE) (2019b) 6. Working age adults. [Accessed 18/06/2021].

Public Health England (PHE) (2019c) 4. Perinatal mental health. [Accessed 18/06/2021].

Royal College of Psychiatrists (2011) Parents as patients: supporting the needs of patients who are parents and their children. [Accessed 15/06/2021].

Scottish Government (2021) Perinatal mental health - peer support: action plan - 2020 to 2023. [Accessed 18/06/2021].

Scottish Government (2020) Perinatal and infant mental health programme board 2020-2021: delivery plan. [Accessed 18/06/2021].

Scottish Government (2019) Perinatal mental health services: needs assessment and recommendations. [Accessed 18/06/2021].

Scottish Government (2017) Mental health strategy 2017-2027. [Accessed 18/06/2021].

Welsh Government (2020) Mental health delivery plan 2019 to 2022. [Accessed 18/06/2021].

Welsh Government (2019a) Parenting engagement and support: guidance for providers. [Accessed 18/06/2021].

Welsh Government (2019b) Maternity care in Wales: a five year vision for the future. (2019-2024). [Accessed 18/06/2021].

Welsh Government (2017) Flying Start: health programme guidance. [Accessed 18/06/2021].

Welsh Government (2016) Mental Health Act 1983: code of practice. [Accessed 18/06/2021].

Welsh Government (2012) Together for mental health: a strategy for mental health and wellbeing in Wales. [Accessed 18/06/2021].

Welsh Government (2011) National service model for local primary mental health support services. [Accessed 18/06/2021].

Wolpert, M.et al. (2015) An exploration of the experience of attending the Kidstime programme for children with parents with enduring mental health issues: parents' and young people's views. Clinical child psychology and psychiatry, 20(3): 406-418.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also read about contact Childline online or supporting a family member with a mental health issue on the Childline website. You can also download or order Childline posters and wallet cards.

Related resources

Read our briefing on the learning from case reviews about parents with a mental health problem.
> See our research and resources on mental health
Further reading

For further reading about parental mental health, search the NSPCC Library catalogue using the keywords "mental health"; "mental health problems"; "parents with a mental health problem".
> Find out more about the Library and Information Service

Introduction

Many parents with mental health problems are able to give their children safe and loving care, without their children being negatively affected in any way. But sometimes, parents with mental health problems need support from family members, friends, neighbours and/or professionals, to help them care for their children.

We're using the term 'parental mental health problems' to mean that a parent or carer has a diagnosable mental health condition. This can include:

depression

anxiety disorders

schizophrenia

bipolar disorder

personality disorders.

Mental health problems can vary in severity and impact differently on people's day to day lives. This depends on parents' individual circumstances and the support they receive.

Parental mental health problems might occur alongside other stressful life experiences.

Challenges may arise as a result of the condition, contribute to the condition developing, or make it worse. For example if a parent is experiencing financial problems, this can negatively affect their mental health. And if the parent becomes unable to work due to their mental health, this can exacerbate their financial problems.

Coping with lots of challenges at once can make it difficult for parents to provide their children with the care that they need.

We've put together some information to help you recognise when parents with mental health problems need help to care for their children and how to provide appropriate support. This includes:

the impact of parental mental health problems on family life

signs that a child or their family might need support

carrying out assessments with families where parents have a mental health problem

providing appropriate and effective support

a summary of the relevant legislation and guidance from across the UK.

Impact of parental mental health problems

Many parents with mental health problems are able to manage their condition and minimise its impact on their children, particularly if they are able to access appropriate support. But sometimes it does affect their ability to cope with family life.

Parental mental health problems may affect children differently according to the severity and type of mental health condition, the child's age and stage of development, and the child's personality.

Coping with challenges

Some parents experience mental health problems along with other challenges such as:

divorce or separation

unemployment

financial hardship

poor housing

discrimination

a lack of social support

domestic abuse

substance misuse.

If they are facing several challenges at once, it can be very hard for parents to provide their children with safe and loving care, particularly if they are isolated or aren't getting the support they need (Cleaver, Unell and Aldgate, 2011; Gatsou et al, 2017; Grove, Reupert and Maybery, 2015; Hogg, 2013; Wolpert et al, 2015).

Research has found there is a greater risk to children's safety if parents with mental health problems are also experiencing domestic abuse or substance misuse (Cleaver, Unell and Aldgate, 2011).

Caring for children

Some parents and carers with mental health problems may need support to cope with the routines of daily life, such as housework, mealtimes, bedtimes, taking children to school, and taking children to medical and dental appointments.

They may also find it more difficult to:

control their mood and emotions around their children

recognise and respond to children's physical and emotional needs

engage socially with their children

set and maintain safe and appropriate boundaries and manage their children's behaviour.

If parents don't get the support they need from family, friends, neighbours and/or professionals, these challenges may escalate. In extreme cases, children may experience abuse and/or neglect.

Babies and younger children

Babies and young children rely on their parents and carers to give them the warm, nurturing care they need to grow.

If parents experience mental health problems in pregnancy or the first year of a baby's life, this can affect the way they are able to bond with and care for their child. This can have an impact on the child's intellectual, emotional, social and psychological development (Gajos and Beaver, 2017; Hogg, 2013).

This means it's important that practitioners are able to recognise if a new parent or carer is struggling with their mental health and help them access appropriate support.

Children's wellbeing

Many children whose parents have a mental health problem do not experience any negative effects. But if parents are not getting the right support to care for their family, this can have an impact on their children's wellbeing.

Signs that a child might need extra support include:

being worried about their parent or carer's condition

taking on a caring role for parents and other family members

putting the needs of their family above their own

having negative feelings about their parent's condition

finding it hard to make friends, feeling isolated or being bullied

not feeling able to talk to their parents or another trusted adult about their worries.

"My parents aren't having a good time. They both have mental health problems and anger issues. They are so aggressive and spark each other off.  I have been scared about something bad happening for a while. My parents don't seem to care about how much seeing them like this upsets me. I don't feel like I can talk to anyone about this. It feels like there is no solution to this situation and I am going to have to just deal with it and carry on hoping things will get better."
Childline counselling session with a girl aged 12
If a parent has severe mental health problems, children may have to cope with frightening and upsetting situations such as:

being separated from their parents, either because parents need to go into hospital and/or because the child is taken into care

a parent attempting to take their own life

a parent displaying extremely volatile behaviour.

If these things happen, it's important to consider how this has affected the wellbeing of everyone in the family and what support can be put in place.

Stigma

Sometimes families experience stigma related to mental health problems. This can make it harder for parents and their children to socialise, speak out and ask for support.

Parents and their families may experience discrimination from others, and this may be displayed consciously or unconsciously. For example, parents might find it harder to get work or access support services. Some children whose parents have mental health problems report being bullied.

Professionals have an important role to play in raising awareness about mental health problems, taking action to tackle discrimination and making sure families get the support they need.

Risk and vulnerability factors

All families experience challenges from time to time. This doesn't necessarily mean children are at greater risk of abuse. But when problems mount up, it can be more difficult for parents to cope - particularly if they are isolated or lack support.

The risks to children are greater when parental mental health problems exist alongside domestic abuse and parental substance misuse (Cleaver, Unell and Aldgate, 2011).

Responding

Responding

Reporting

If you think a child is in immediate danger, contact the police on 999. If have concerns that a child may not be receiving the care they need but they are not in immediate danger, you should share your concerns.

Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our trained professionals will talk through your concerns with you and give you expert advice.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police.

Services will risk assess the situation and take action to protect the child as appropriate either through statutory involvement or other support. This may include making a referral to the local authority.
> See our information about recognising and responding to abuse
Assessment

The impact of parental mental health problems varies according to the nature of each parent's condition, their child's health and stage of development, and relationships with other family members.

Practitioners should assess whether a parent or carer's mental health problems pose a risk to their child's safety and wellbeing, and whether these risks can be mitigated with appropriate support. You should also consider whether there are any protective factors which will increase the family's overall resilience, for example if the parent or carer is already receiving effective support from mental health services.

You should carry out a holistic assessment which takes into account:

the child's wellbeing and development

the child's thoughts and feelings

the impact of every day parenting on the parent or carer's mental health

the parent or carer's ability to meet the child's needs

whether the child has taken on a caring role

the parent or carer's background, medical history and current circumstances

the parent's thoughts and feelings about caring for their child

the views of colleagues from other agencies who are involved with the family, such as teachers

whether the parent or carer has support from another parent or relative, or if they are coping with parenting alone.

You should also consider broader factors that might make it harder for the parent or carer to cope. These include:

substance misuse

domestic abuse

financial hardship

housing problems

relationship problems

social isolation.

Always take threats of suicide or threats to kill a partner or child seriously and take immediate action to keep children safe.

Protective factors

Factors which can help reduce the risk to children's wellbeing include:

parents and carers who acknowledge their difficulties and are willing to accept support from services

friends or relatives who are able to care for children and help with household chores when needed

families receiving support for other challenges, such as income support, benefits and housing advice

families receiving additional support from other professionals who can also monitor the situation and share concerns if necessary, for example teachers

children having a trusted adult they are able to ask for help when needed

wider community support such as young carer's projects (Cleaver, Unell and Aldgate, 2011).

Supporting children and families

Supporting children and families

Early help

It's vital to identify parental mental health problems as soon as they emerge and provide families with appropriate support.

NSPCC services which provide early support include:

Supports parents who are at risk of, or are experiencing mild to moderate anxiety and depression during pregnancy and the first year after birth.
> Find out more about Pregnancy in Mind

Prioritising children's needs

Anyone working with parents or carers who have mental health problems must maintain a focus on their children's wellbeing.

Advocacy and mentoring

Children should be given access to a mentor and/or advocate who they can talk to about their parent or carer's mental health and who can help make their views heard.

Children need someone they can contact for support if they need to, especially if there is an emergency.

Be aware that children may be wary about being offered therapy or counselling. Depending on their parents' experiences, they may have negative associations with this kind of support. They may also have fears about developing mental health problems themselves, and think that being referred to a counsellor is a sign of mental illness (Cooklin, 2013).

Peer support

Children whose parents have mental health problems should have the chance to interact with other children in similar situations. This allows them to both offer and receive support. Successful peer support networks can have a positive impact on children's wellbeing and resilience by:

increasing self-esteem

improving understanding of parental mental health issues

teaching communication and coping skills (Foster, 2016).

Many children and young people use Childline's peer support message boards to express their feelings, talk about their experiences and share advice with others.

Empowering children

Children and young people should play a positive role in, and contribute to decisions about, their parent or carer's care (Royal College of Psychiatrists, 2011).

Children want to be involved in interventions to support their parents, and they want their views to be taken seriously (Cooklin, 2013).

Giving children and young people accurate, age appropriate information about mental health problems can address any misconceptions or fears they may have and can give them the language to express themselves (Grove, Reupert and Maybery, 2015).

Allowing children and young people distance from their parent or carer's emotions and behaviours can enable them to develop their own thinking and emotions (Cooklin, 2013).

Explaining a parent or carer's mental health difficulties can be a platform for wider discussions about relationships and emotions in general.

Educating children about parental mental health problems can have a number of benefits including:

increasing the child's resilience

challenging the child's misconceptions about mental health

increasing the child's understanding and empathy for their parent or carer

improving communications between the parent or carer and child (Grove, Reupert and Maybery, 2015; Wolpert et al, 2015).

Speaking out

It's vital to build safe and trusting relationships with children so they can speak out about any problems they are experiencing. This involves teaching children what abuse is and how they can get help.

Our Speak out Stay safe service for schools helps children understand abuse in all its forms and know how to protect themselves.
> Find out more about Speak out Stay safe
Family support

Family members can be reluctant to discuss mental health with each other. Lack of communication can result in misunderstandings and may make children feel worried or alone.

Interventions which encourage families to communicate with each other can help everyone understand the impact of the mental health problems (Grove, Reupert and Maybery, 2015).

Families can benefit from meeting and sharing experiences with other families. This can:

prevent relapses

reduce feelings of isolation and stigma

offer positive ways to interact with each other

support more open discussion about mental health across the wider family (Wolpert et al, 2015).

Some interventions help family members to design and implement 'staying well' plans. This could include:

sign-posting to other helpful services

setting goals

developing problem solving skills

offering advice on managing stress

recognising the early signs of a relapse

(Gatsou et al, 2017).

Monitoring progress

Practitioners must maintain a focus on the wellbeing of the child. They should monitor and review children's progress throughout the period of intervention and respond appropriately.

Legislation, strategy and guidance

Legislation, strategy and guidance

Key legislation

In England and Wales, the Mental Health Act 1983 sets out the assessment, treatment and rights of people who have a mental health issue.

The Mental Capacity Act 2005 sets out a framework for acting on behalf of adults who are unable to make decisions about their own wellbeing.

In Northern Ireland, the Mental Health (Northern Ireland) Order 1986 sets out the assessment, care, treatment and rights of people who have mental health issues.

In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 sets out the care, treatment and rights of people who have a 'mental disorder'.

The Mental Health (Scotland) Act 2015 extends independent advocacy rights, services and accommodation to mothers who have mental health issues.

In Wales, the Mental Health (Wales) Measure 2010 provides for primary and secondary mental health services and independent advocacy across Wales.

Strategy

Public Health England (PHE) has developed a Joint Strategic Needs Assessment (JSNA) toolkit to help health and wellbeing boards understand local needs and assess services (PHE, 2019a). Chapter six of the toolkit covers working age adults and asks health boards to consider how parental mental health might affect children (PHE, 2019ba).

In Northern Ireland, the Department of Health has published a mental health action plan (Department of Health, 2021).

In Scotland, the Government has published a Mental health strategy 2017-2027 (Scottish Government, 2017).

In Wales, the Government's strategy for mental health and wellbeing outlines plans to improve family, parenting and/or caring relationships, which includes parental mental health (Welsh Government, 2012). The mental health delivery plan 2012-2022 sets out how the strategy will be delivered (Welsh Government, 2020).

Guidance

In Northern Ireland, the Department of Health has published guidance on the assessment and management of risk in mental health and learning disability services. It shares principles of best practice for mental health and learning disability care professionals on assessing and managing the risk of service users to themselves or others (Department of Health, 2012).

The Department of Health's report on preventing harm to children from parents with mental health needs sets out actions for adult mental health services to help keep children safe (Department of Health, 2016).

In Wales, the Government has published guidance for practitioners on engaging with and providing support for parents to enhance their child's development, care and wellbeing. It includes a section on providing support to parents with mental health needs (Welsh Government, 2019a).

The Welsh Government's local mental health support services guidance sets out how local health boards can improve access to mental health care and support for individuals, including parents (Welsh Government, 2011).

The Welsh Government's code of practice on the Mental Health Act 1983 sets out how professionals should treat mental health issues and provide information to patient's families and carers. It includes best practice guidance on communicating and consulting with a child about their parent's mental health (Welsh Government, 2016).

Perinatal mental health

There is specific guidance for professionals on supporting parents' mental health during the perinatal period (during pregnancy and the first year after birth).

In England, chapter four of Public Health England (PHE)'s Joint Strategic Needs Assessment (JSNA) toolkit (PHE, 2019a) covers perinatal mental health (PHE, 2019c). It aims to help health and wellbeing boards understand local needs and assess services.

PHE has published guidance for local maternity systems on supporting good parental mental health (PDF) (PHE, 2021a).

PHE has also published guidance for health visitors on supporting maternal and family mental health (PHE, 2021b).

In Scotland, the Government has published a delivery plan for perinatal and infant mental health 2020-2021. It sets out 10 pledges that have been developed with women who have experienced perinatal mental illness (Scottish Government, 2020).

The Scottish Government has published an action plan for peer support in perinatal mental health services for 2020-2023 (Scottish Government, 2021).

The Scottish Government has also published a strategy to improve perinatal mental health services for women with perinatal mental health issues, their children, partners and families (Scottish Government, 2019).

In Wales, the Government's maternity services strategy 2019-2024 includes an action to improve parental and infant wellbeing and mental health, and improve perinatal mental health care (Welsh Government, 2019b).

The Welsh Government has also published guidance on the Flying Start health programme. This includes information on assessing a parent's social, emotional and physical wellbeing and supporting mental health during the perinatal period (Welsh Government, 2017).

References and resources

References and resources

Cleaver, H., Unell, I. and Aldgate, J. (2011) Children's needs: parenting capacity: child abuse: parental mental illness, learning disability, substance misuse, and domestic violence (PDF). London: The Stationery Office (TSO).

Cooklin, A. (2013) Promoting children's resilience to parental mental illness: engaging the child's thinking. Advances in psychiatric treatment, 19: 229-240.

Department of Health (2021) Mental health action plan. [Accessed 18/06/2021].

Department of Health (2016) Rapid response report: preventing harm to children from parents with mental health needs. [Accessed 18/06/2021].

Department of Health (2012) Promoting quality care: good practice guidance on the assessment and management of risk in mental health and learning disability. [Accessed 18/06/2021].

Foster, K. et al. (2016) Outcomes of the ON FIRE peer support programme for children and adolescents in families with mental health problems. Child and family social work, 21: 295-306.

Gajos, J.M. and Beaver, K.M. (2017) Maternal depression and risk for antisocial behaviour in children. Child and family social work, 22(1): 349-363.

Gatsou, L. et al. (2017) The challenges presented by parental mental illness and the potential of a whole-family intervention to improve outcomes for families. Child and family social work, 22(1): 388-397.

Grove, C., Reupert, A. and Maybery, D. (2015) Gaining knowledge about parental mental illness: how does it empower children? Child and family social work, 20(4): 377-386.

Hogg, S. (2013) Prevention in mind: All Babies Count: spotlight on perinatal mental health. [London]: NSPCC.

Public Health England (PHE) (2021a) Maternity high impact area: supporting good parental mental health (PDF). London: Public Health England.

Public Health England (PHE) (2021b) Early years high impact area 2: Supporting maternal and family mental health. [Accessed 18/06/2021].

Public Health England (PHE) (2019a) Mental health and wellbeing: JSNA toolkit. [Accessed 22/06/2021].

Public Health England (PHE) (2019b) 6. Working age adults. [Accessed 18/06/2021].

Public Health England (PHE) (2019c) 4. Perinatal mental health. [Accessed 18/06/2021].

Royal College of Psychiatrists (2011) Parents as patients: supporting the needs of patients who are parents and their children. [Accessed 15/06/2021].

Scottish Government (2021) Perinatal mental health - peer support: action plan - 2020 to 2023. [Accessed 18/06/2021].

Scottish Government (2020) Perinatal and infant mental health programme board 2020-2021: delivery plan. [Accessed 18/06/2021].

Scottish Government (2019) Perinatal mental health services: needs assessment and recommendations. [Accessed 18/06/2021].

Scottish Government (2017) Mental health strategy 2017-2027. [Accessed 18/06/2021].

Welsh Government (2020) Mental health delivery plan 2019 to 2022. [Accessed 18/06/2021].

Welsh Government (2019a) Parenting engagement and support: guidance for providers. [Accessed 18/06/2021].

Welsh Government (2019b) Maternity care in Wales: a five year vision for the future. (2019-2024). [Accessed 18/06/2021].

Welsh Government (2017) Flying Start: health programme guidance. [Accessed 18/06/2021].

Welsh Government (2016) Mental Health Act 1983: code of practice. [Accessed 18/06/2021].

Welsh Government (2012) Together for mental health: a strategy for mental health and wellbeing in Wales. [Accessed 18/06/2021].

Welsh Government (2011) National service model for local primary mental health support services. [Accessed 18/06/2021].

Wolpert, M.et al. (2015) An exploration of the experience of attending the Kidstime programme for children with parents with enduring mental health issues: parents' and young people's views. Clinical child psychology and psychiatry, 20(3): 406-418.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also read about contact Childline online or supporting a family member with a mental health issue on the Childline website. You can also download or order Childline posters and wallet cards.

Related resources

Read our briefing on the learning from case reviews about parents with a mental health problem.
> See our research and resources on mental health
Further reading

For further reading about parental mental health, search the NSPCC Library catalogue using the keywords "mental health"; "mental health problems"; "parents with a mental health problem".
> Find out more about the Library and Information Service

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