Issues for the safety and wellbeing of children in families with multiple and complex problems
- How do drug and alcohol misuse, mental health problems and domestic violence affect parenting?
- The co-occurrence of parental mental health problems, substance misuse and domestic violence
- Social exclusion: The wider context of multiple and complex problems
- Trauma histories of parents with multiple and complex problems
- Responding to families with multiple and complex problems
- The structure of the service system: A whole-of-government approach to service delivery
- Early intervention and capacity building in an integrated service system
The co-occurrence of parental mental health problems, substance misuse and domestic violence
The previous section explored how mental health problems, substance misuse and domestic violence individually affect parenting, the effects of which may diminish parenting capacity. This in turn can place children at heightened risk of abuse and neglect. Individually, parental mental health problems, substance misuse and domestic violence represent significant risk factors for child abuse and neglect, but the reality is that parenting problems rarely occur in isolation. Instead, they tend to be part of a complex and inter-related group of problems.
Australian child protection services do not routinely provide data that report the characteristics of parents involved with child protection. However, where data have been published, the co-occurrence of multiple and complex parenting problems (particularly parental substance misuse, domestic violence and parental mental health problems) are the norm for Australian child protection clients. For example, data published in the report on the Special Commission of Inquiry into Child Protection in New South Wales (Wood, 2008) showed that across 302,977 child protection reports in New South Wales during 2007-08, domestic violence (31%), drug and alcohol problems (20%) and mental health (14%) featured prominently as one of the (up to) three issues prompting the report (Wood, 2008, p. 130). Earlier data from Victoria show that in 2001-02 the four most frequent "concerning characteristics" of parents in investigated cases were:
- domestic violence (40%);
- substance abuse (25%);
- alcohol abuse (21%); and
- psychiatric illness (15%).
Additionally, the 2001-02 data were compared with data from 5-years earlier (1996-97) and it was found that the number of families presenting to child protection with multiple and complex problems was increasing over time (Allen Consulting Group, 2003).
Research investigating the parental characteristics of children on care and protection orders or in out-of-home care in South Australia shows a similar pattern to the New South Wales and Victorian data. In a study on parental substance abuse and children in out of home care, the South Australian Department for Families and Communities found that of the children entering care due to a parental substance abuse problem, 69% of parents also experienced domestic violence and 65% had mental health problems (Jeffreys, Hirte, Rogers, & Wilson, 2009).
One might look at these data and assume that, as they are based on the characteristics of parents referred to child protection services, the statistics represent "the worst of the worst" and that most parents who experience either mental health problems, substance misuse or domestic violence will not experience multiple problems. But research into domestic violence, substance misuse and mental health as problems in their own right and separate from child protection or parenting issues shows that individuals who experience any one of these problems are likely to also experience other complex problems. For example, substance abuse has been identified as the most common co-morbid condition among people with a severe mental health issue (Hegarty, 2004). Often referred to as "dual diagnosis", substance abuse and mental health problems have been linked in large representative samples, particularly in clinical settings (Hegarty, 2004; Stromwall et al., 2008). Prevalence estimates of substance abuse issues in mental health service settings consistently report rates of over 25% with estimates of up to 80% (Todd, Sellman, & Robertson, 2002).
Research also consistently indicates strong associations between domestic violence and substance misuse - particularly alcohol abuse (Chan, 2005; Lipsky & Caetano, 2008; Thompson & Kingree, 2006). The Australian Bureau of Statistics Survey on Women's Safety (1996) indicated that 40% of physical or sexual assaults on women within a 12-month period involved the use of alcohol. A review by Klostermann and Fals-Stewart (2006) also indicated strong relationships between alcohol use and domestic violence in primary health care settings, drug and alcohol treatment programs, family practice clinics and prenatal clinics. It has been argued that drug use and heavy drinking, especially among men, may increase the risk of violence toward an intimate partner due to its inhibiting effects on cognition and perceptions (Chan, 2005). Alcohol and other drugs may also be used by victims of domestic violence to relieve the physical and emotional pain of abuse (Chan, 2005).
Practitioners need to be aware that parents involved with child protection services are likely to be experiencing multiple complex problems and that these problems do not just coincidently co-occur; they co-occur because they are inter-related.