The role of the Child Safeguarding Practice Review Panel is to learn from serious incidents when children die or experience serious harm because of abuse or neglect. We do this by exploring patterns in multi-agency safeguarding practice and looking at where improvements are needed. On the 12th December 2024, we published our fifth annual report which revealed that 485 children were affected by serious safeguarding incidents between 1st April 2023 and 31st March 2024.
Over half of the incidents that involved a child aged 1-to-5 years old featured a parent or relevant adult with a diagnosed or undiagnosed mental health condition. We know that mental health challenges can affect a parent’s ability to care for their children safely. We also know that support for families can diminish after the post-natal period of intensive service provision, leaving a significant gap in support. That is why one of our spotlight themes in this year’s report examines safeguarding pre-school children with parents with mental health needs.
Reviews revealed that agencies often possessed information about parents’ mental health needs, however, this was not thoroughly explored or assessed when evaluating the risks to pre-school children. Instead, assessments and interventions tended to focus on the immediate issues that prompted engagement, and parents’ mental health needs and their ability to provide safe care for their child were frequently overlooked. Learning from reviews emphasised that practitioners should consistently be considering the daily experiences of children living with, and being cared for, by a parent facing mental health challenges.
As we already know from our earlier report The Myth of Invisible Men, there are ongoing challenges engaging with fathers leading them to become invisible to agencies. Unfortunately, this issue continues to feature in reviews. Agencies were not always aware of men (including biological fathers) who were involved in the child’s life and information regarding any of their potential mental health needs were not known or shared with agencies. We would like to see practitioners strengthen their response to this by ensuring that all men in a child’s life are appropriately assessed, including whether they experience or have experienced mental health difficulties.
Challenges surrounding information sharing often hindered a practitioners’ ability to fully assess the risks to children cared for by parents with mental health needs. In particular, information sharing between children’s services and adult’s services was a key feature of safeguarding reviews. We acknowledge that this issue is not new but rather the data reinforces longstanding challenges that practitioners are facing and areas where multiagency information sharing still needs to improve.
Good practice was also identified. Some reviews highlighted that GPs and health visitors were successfully managing risks related to parental mental health. This included persistent follow-up on missed appointments, making urgent referrals to perinatal mental health teams, and challenging other services. Good use of pre-birth assessments and mental health screenings to address vulnerabilities was also noted, along with effective support from perinatal mental health and health visiting teams. Some reviews also highlighted strong information sharing and action planning by multi-agency partners over years of involvement with families.
Our report consolidates key learning points for practitioners who are working with families and parents with mental health needs. We have developed a series of reflective questions designed for use by practitioners, strategic leaders, and senior and middle managers to encourage reflection on current practices and identify areas for improvement. We invite safeguarding professionals to utilise the information in our report to critically examine their current safeguarding practices and use the learning shared within it as an opportunity to continue to strengthen their work with vulnerable children and parents.
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