Making Decisions about Parental Mental Health: An Exploratory Study of Community Mental Health Team Staff

Adult mental health problems can impact on parents, and research highlights that their children are at higher risk of developing mental health problems. In extreme cases, mental health problems are associated with a risk of fatal child abuse. Despite this, there are few studies exploring clinical decision-making by adult mental health professionals. 'In extreme cases, mental health problems are associated with a risk of fatal child abuse' This study used qualitative methods to explore Community Mental Health Team (CMHT) workers' experiences of decision-making in the interface between mental health and child welfare. Workers were interviewed about their experiences of clinical decision-making regarding child welfare. Interviews and accounts were analysed using Interpretative Phenomenological Analysis. Influences on decision-making were explored and triangulated with the accounts of Named Nurses for Child Protection. The findings revealed that CMHT participants were aware of their responsibilities towards children, but a complex synthesis of factors impacted on their sense-making about risk and welfare. Three superordinate themes emerged: the tensions of working across systems; trying to balance the perceptions and feelings involved in sense-making; and the role that interpersonal dynamics play in the understanding and management of risk. This paper focuses in particular on perceptions and feelings.