Independent investigation: Patricia PhilpottsBen Philpotts, Trevarrian (2010)

A conference including specific learning about Parental Mental Health, and referring to all guidance, should be held and should include all relevant agencies. This will be organised by the Cornwall Partnership NHS Foundation Trust.

Recognition of current risk profile: Mental health staff must obtain and record as much relevant information as possible about a new service user with complex issues or uncertainty with the formulation of diagnosis or appropriate treatment in order to understand their initial presentation and to put their situation within an appropriate context. Where there is little known staff should: talk to relatives or staff from other organisations involved; discuss with the GP the service user’s Primary Care records which are likely to have the history from early childhood.

Where a service user has psychotic symptoms psychological interventions should be used as soon as practical. The service user should have access to a psychological therapist as an inpatient and a psychological approach tried whilst other variables may be more controlled. It is often too late if this approach is left until after discharge back to the community.

When a service user is known to have used violence in the past any additional risks should be identified and used to prepare an updated risk assessment and a management plan for that risk. Drinking alcohol and using illicit substances should always be recorded and included in the risk assessment. Any change which increases risk should be recorded and where possible acted upon.

Senior clinical staff must be encouraged to seek the advice of their colleagues when they have a complex situation. Peer group and/or senior Multidisciplinary Team Meetings must be held to seek alternative approaches. Where cases are especially complex and/or risky and or intractable, senior clinical staff should engage in Multidisciplinary Team discussion and peer group consultation and ensure this is documented.

Where serious risks are identified as a result of non-engagement, staff should probe the reasons and not accept the rationalisations the service user presents. To help understand the issues more assertive and focused questioning is required and a pragmatic approach to optimise contact should be taken. The rationale for the approach to be taken must be documented with the preferred response identified.