Mental health and family Law
Family breakdown key factor of mental illnesses, new report claims
The increase in cases of mental illness in Britain can in part be attributed to the high levels of family breakdown, according to a new report.
Mental Health: poverty, ethnicity and family breakdown is an interim report written by a working group of experts for the Centre for Social Justice, which was founded by Conservative MP Iain Duncan Smith in 2004.
The report puts the cost to the nation of mental illness at £105 billion. The think-tank claims that mental illness is frequently a consequence of family breakdown, with 60 per cent of the people they surveyed taking this view. By contrast, only one-third thought poverty was a major cause of poor mental health.
Family breakdown in all its forms is strongly associated with poor mental health in adults and children, the report says, yet went unacknowledged in the Government's mental health strategy launched last week. The report’s author that the role family breakdown plays in causing these problems is frequently overlooked by experts.
"Family breakdown and conflict were considered to have the biggest adverse impact on children's well-being," the report says.
"Conflict between parents has been associated with an array of adjustment problems in children, for instance, poor peer interaction, conduct problems, ill health, and depression and anxiety.
"Children with separated, single or step-parents are 50 per cent more likely to fail at school, have low self-esteem, experience poor peer relationships and have behavioural difficulties, anxiety or depression."
The report calls for a renewed effort to break the stigma and fear surrounding mental illness, the development of a family-focused approach breaking down divisions between services treating different age groups of patients, a bigger role for family doctors, placing a greater emphasis on recovery from mental illness and a reinvigoration of care in the community.
Detailed recommendations for reform of the existing treatment services will be published later this year.
https://www.parliament.uk/business/publications/research/key-issues-parliament-2015/social-change/mental-health-stigma/
Mental health stigma
"Most people are coming to regard mental illness and disability in much the same way as physical illness and disability" – Report of the Royal Commission on the law relating to mental illness and mental deficiency, 1957.
Anti-stigma campaigns and the growing profile of mental health issues in recent years appear to have gone some way to changing views and dispelling misconceptions about mental illness.
But with nine in ten people with mental health problems still experiencing stigma and discrimination, nearly sixty years after the Royal Commission's optimistic assessment, there may still be some way to go in changing public attitudes.
What is mental health stigma and what are its implications?
Mental health stigma is summarised by the anti-stigma campaign group Time to Change as the set of negative attitudes, pre-judgements, prejudices and behaviour that can make it harder for individuals with mental health problems to live a normal life.
It includes, among other things, misconceptions about the risks posed to the public by those affected by mental health problems, and the use of pejorative or flippant language in describing mental illness and those affected by it. It may be exacerbated or perpetuated by the negative portrayal of mental illness in the media.
Mental health stigma may manifest itself in discrimination, making it harder for people to make friends, to obtain and hold down jobs, and to access housing and other services.
It may also lead to loss of self-esteem, thereby aggravating existing mental and physical health problems, and make those affected feel unable to seek the help they need to manage their condition or make a recovery.
The previous Government's commitment to reducing stigma
The previous Government made a number of commitments to reduce stigma and discrimination in relation to mental illness. Its mental health strategy, No Health Without Mental Health, had as one of its six long-term objectives that "fewer people will experience stigma and discrimination".
Meanwhile, the Deputy Prime Minister's 2014 strategy, Closing the gap: Essential priorities for mental health, contained 25 objectives, one of which was to "stamp out discrimination around mental health".
These commitments came in the context of the Government's pledge in the NHS Constitution and the NHS Mandate for 2014–15 to achieve "parity of esteem" between mental and physical health.
This follows from a recognition that those with mental illnesses are sometimes poorly served by the NHS, not least because many have co-existing physical conditions, and there is insufficient integration of mental and physical health services.
What has Parliament done?
In recent years, MPs from across political parties have pledged their support for reducing mental health stigma.
A backbench business debate in June 2012 was considered a watershed moment in tackling stigma when, for the first time, MPs spoke about their personal experience of mental health problems, and received cross-party support for doing so.
After that debate, Gavin Barwell MP announced the introduction of the Mental Health (Discrimination) Bill in the Commons, to "remove the last significant form of discrimination in law in our society".
The Private Member's Bill repealed discriminatory legislation that prevented people with mental health problems from sitting on a jury, being a company director or being an MP.
The Bill passed through the Commons and Lords with Government and Opposition support, and received Royal Assent on 28 February 2013.
Anti-stigma campaigns and changing attitudes
The principal means of tackling negative attitudes and dispelling misconceptions about mental health has been through public awareness campaigns.
The largest of these is the Time to Change campaign, run by two charities – Mind and Rethink Mental Illness – and funded by the Department of Health, Comic Relief and the Big Lottery Fund (its funding was recently extended until March 2016).
The campaign uses various media, including blogs, TV advertisements and promotional events, to raise awareness of stigma and its effects. It has also encouraged employers to sign a pledge to support employees with mental health problems, raise awareness and reduce stigma in the workplace.
Since the campaign began in 2007, there are signs that public attitudes to mental health are becoming more favourable, with a lower proportion of survey respondents expressing fear of those with mental health problems; higher support for integrating people with mental illness into the community; and higher levels of tolerance and sympathy for those with mental health problems.
Chart : Public attitudes about mental illness
Public attitudes to those with mental illness have changed over time, particularly in recent years: percentage of survey respondents agreeing with selected statements (given below and identified as 'A' to 'D' on the left of chart), 1994–2013.
However, a fifth of respondents said that they would be uncomfortable talking about their own mental health with friends and family; and almost a half said they would feel uncomfortable talking to their employer about their mental health.
Strategies that seek to provide information to improve public understanding of mental health may not on their own be sufficient. Stigmatising views can be entrenched, and prevalent even among those who are knowledgeable about mental health problems.
Some campaigns, including Time to Change, have sought to provide more opportunities for the public to meet and interact with people with mental illness, an approach that research shows to be particularly effective in changing attitudes.
As Time to Change acknowledges, there is still work to be done before the stigma surrounding mental health is eradicated.
Isn't discrimination illegal?
If a mental health condition meets the definition of 'disability' under the Equality Act 2010 – namely, if it is has a substantial, adverse and long-term effect on the sufferer's day-to-day activities – then it is unlawful to discriminate against them on the grounds of that condition.
However, the legal situation may not be well-understood, particularly in the workplace. In a 2009 survey, Time to Change found that 92% of people believed that admitting to a mental health condition would damage someone's career, and 56% would not employ someone experiencing depression, even if they were the best candidate for the job.
On average, those with severe mental illness die 15 to 25 years earlier than the rest of the population, largely from preventable illnesses such as diabetes and heart disease.
Mental Health Allegations in Child Arrangement Order Court Applications
Mental health allegations in child arrangement order court applications can take many different forms but the allegations can affect the order made by the family court. In this article, our family law solicitors look at how mental health allegations are assessed in children law proceedings.
Types of mental health allegations in child arrangement order applications
Parents can raise concerns during child arrangement order proceedings about the other parent’s mental health or their child’s mental health.
Mental health allegations against the other parent can include:
Mental health issues arising from alcoholism or drug usage
Unresolved feelings of depression or anxiety arising from the relationship breakdown or divorce
Psychological issues such as narcissistic personality disorder
Psychiatric issues such as psychosis or schizophrenia
Mental health issues give rise to anger management and domestic violence or abuse
Mental health concerns about children in child arrangement order court proceedings can include:
Low mood and low self-esteem
Anger management issues – this can result in involvement in school bullying or issues at home over self-control and inappropriate behaviour towards parents or siblings
Anxiety and depression – these concerns can have an impact on a child’s school performance or their attendance at school
Eating disorders such as bulimia or anorexia nervosa
Thoughts about self-harming
Assessing mental health allegations in child arrangement order court applications
If concerns are raised by a parent about the other parent’s mental health or their child’s mental health, the court will consider the seriousness of the allegations and the relevance of the allegations to the court proceedings.
The family court is alert to the fact that on occasion malicious false allegations can be made by one parent against the other to try and help support their case. In other situations, the mental health allegations may have little bearing on the outcome of the court application but they may still require investigation and assessment. For example, many parents experience depression but that does not mean that they are not loving and capable parents.
If a parent raises mental health allegations about the other parent it is important that their family law solicitor puts them into context so the court understands the reasons behind the parent’s concerns. For example, you may be concerned about your child’s anxiety because of the domestic violence your child observed during your relationship with your ex-partner or you may be worried about your former partner’s ability to look after your baby because of the parent’s depression and its impact on their ability to meet your child’s physical and emotional needs. Alternatively, if your child has an eating disorder you may be worried about your child’s welfare during contact because the other parent does not accept the child’s diagnosis and will not support or adhere to the child’s dietary regime.
Court-ordered reports and assessments
Once court proceedings have been started no assessment should be undertaken without court permission. A judge can order:
A report by CAFCASS – this report is undertaken by the Children and Family Court Advisory and Support Service and an officer is appointed to investigate and report
A report by social services – this is referred to as a section 7 report and can be ordered where there is existing social services involvement with a family or there are safeguarding concerns
A report by a psychologist or psychiatrist – the court cannot order a report on an adult if the adult agrees to the report. If an adult refuses to participate in an assessment and report then the court may draw inferences from the refusal to engage in the referral. If an assessment of a child is necessary the court can ask a specialist child psychologist or child psychiatrist to see the child and prepare a report
How does mental health impact on child arrangement order applications?
In children law proceedings the court has to consider a range of factors before making a child arrangement order, specific issue order, or prohibited steps order. Those factors, referred to as the welfare checklist, include:
How capable each parent, and any other person in relation to whom the court considers the question to be relevant, is of meeting the child’s needs
Any harm the child has suffered or is at risk of suffering
The ascertainable wishes and feelings of the child considered in the light of the child’s age and understanding
The child’s physical, emotional and educational needs
The likely effect on the child of any change in their circumstances
The child’s age, sex, background, and any characteristics which the court considers relevant
The range of powers available to the court
A court will carefully assess the extent and relevance of mental health allegations. For example, a parent may acknowledge that they have anger management problems but be committed to attending counselling, or a parent who has previously refused to accept their child’s mental health diagnosis may agree to attend family counselling.
A court may conclude that whilst a parent does have mental health concerns that their health can be managed because of the importance to the child of maintaining a relationship with both parents. The court could conclude that any risks presented by mental health concerns could be managed through supervised contact, injunction orders, or the input of social services.
In child arrangement order proceedings that involve mental health allegations, court proceedings can become complicated. For example, the court could order that domestic violence allegations should be the subject of a finding of fact hearing or the court could order that a child of sufficient age and understanding should be made a party to the court proceedings. Specialist family law solicitors can help look at the relevance of the mental health allegations to what child custody or child contact orders are in the best interests of your child.