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ABSTRACT BOOK 1 Contents Symposia 3 Roundtables 67 Papers 76 Posters 263 2 SYMPOSIA Abstracts Sorted by rising #numbers 3 #260950 - Symposium - I9.2 Children of parents detained in secure hospitals Chair:PamelaTaylor, Cardiff University (United Kingdom) Symposium Abstract: Up to half of people admitted to secure forensic hospitals are parents, but little is known about their children's needs. We will present hospital survey data, results of systematic literature reviews and preliminary child interview work which collectively support ways forward in research and practice. Individual Abstracts: Children separated from a parent who is mentally ill, criminally violent and locked in a secure hospital: setting the scene Pamela J. Taylor,Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK People who are detained in secure psychiatric hospitals because of the risk they pose to others are generally of child bearing age. A few have killed a child, very few one or more of their own children. How many patients are, in fact, parents and what did this mean in practice? How many children are likely to be affected? What is the nature and quality of the evidence on child needs and interventions on their behalf? Such hospitals may provide appropriate visiting facilities and generally have a child safeguarding policy, which speaks mainly to the physical safety of the child. How many engage in any more active assessment, care or treatment initiatives for children of such parents? There is a substantial literature on children with parents who have a mental illness, covering issues as diverse as the genetic risk of the child developing a similar illness, developmental delays and the psychosocial impact, however most of this refers to children and parents living together in the community, often with the child having a career role. There is also literature on children with a parent in prison. Are such adverse childhood experiences simply cumulative? How can we safely acquire first- hand accounts from children multiply disadvantaged by experiencing parental removal into a secure hospital to help clarify their needs and develop effective responses? This opening session will pose the key questions. How many parents in secure hospitals and how many children are separated by the admission? Sarah Argent, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK There are records based prevalence surveys from several UK secure hospitals of how many patients are parents; we have been unable to trace such material elsewhere. We conducted a nine-year period prevalence study of residents in one Welsh regional secure hospital. We found that nearly half (76, 46%) of all 165 patients were parents, a higher prevalence than previously recorded. There are practical complexities in identifying parental status among such patients, but this Welsh unit has a particularly active social work team, so we are able 4 to present some information about most of the children, including most under 18 years of age (thus legally dependent, at the time of their parent’s admission). Where children had been in contact with the parent before admission – as most had – with one exception, it was only dependent children who lost contact afterwards. We explore this further. We scrutinised the records for any clinical or social variables which distinguished the parent- patients from the childless patients. We found a range of socio-demographic and clinical features which characterised the parent-patients, including first use of psychiatric or psychological services, their relationship history and current relationship status, and their diagnostic comorbidity. The fact that, cumulatively these suggested that parents had had a more stable life prior to the current admission, than childless patients opens more questions about stronger support for maintenance of parent-child relationships in many cases. Next, we wanted to hear about parents’ perspectives, although we have begun to speak with some of the adult children. Patient-parents’ perceptions of their parenting role and their children’s needs. Fiona Parrott,Oxleas NHS Foundation Trust, London, UK In a qualitative study which furthers our understanding of the experience of parents living in a secure hospital, narrative interviews were carried out with 18 parents (8 mothers, 10 fathers) at a secure unit in England. These were analysed thematically using the framework approach. Just over a quarter (27%) of men and 38% of women at this unit were parents. Parenthood was of central importance to their emotional life, spanning experiences of loss and failed expectations but also joy, responsibility and hope. Fewer men than women were in contact with their children yet fatherhood remained a significant aspect of men’s identities. Although parenting was constrained during lengthy admissions and associated with professional support and surveillance it encompassed a wide range of meaningful practices. Provision of financial support was emphasised by fathers who maintained contact while mothers saw their mothering role and gift giving as privileged. Qualitative themes identified around being a parent included the impact of mental illness on parenting and concepts of offending and risk. Explaining mental illness and detention to children and the impact of different care arrangements were further themes. The challenges facing such parents ranged from living with intense feelings of shame and loss to finding ways to parent in an insightful manner in restricted circumstances. This study supports the case for ensuring that mental health professionals have the knowledge and skills to recognise these complex needs and work therapeutically to support a variety of parenting roles and experiences. The nature of current service provision for children of parents in secure hospitals Jacqueline Mansfield, Research Fellow, Forensic Mental Health, Canterbury Christchurch University, UK Staff working in medium secure units throughout the UK were invited to complete a questionnaire on their arrangements for child contact - both on and off site. Questions included how many patients were parents of children under age 18 and how many in contact with their children. We asked about the nature of the child visiting facilities and how the service supported other forms of contact. Enquiry was made as to who took responsibility for 5 arranging and supervising child visits and what training was provided for those involved. We were also able to report whether information was made available to children about the unit, visiting or about mental illness. Child visiting policies from each participating unit were considered as part of this review. Data from 22 participating units will be presented, with the key learning points for service development and training. Findings revealed that lack of understanding of a patient’s parenting role was commonplace, with gendered differences in approach. Many units did not have training for staff on how best to support patients with parenting responsibilities. During case reviews the role of parent was often forgotten, especially when fathers had no direct contact. Long delays were reported in arranging a first visit even when contact had been previously been occurring in the immediately previous period of imprisonment. The survey started a dialogue within units to address service provision including improving the Child Visiting Suite, developing resource material and exploring different ways in which parent-child contact could be maintained. The lived experience of children of parents in secure hospitals: building from what is already in the literature Molly Houston,School of Psychology and School of Medicine, Cardiff University, UK Literature about children of patients in secure psychiatric hospitals is scarce, so we have tried to understand their likely experience, by conducting a systematic review of reviews of different facets of their situation (Argent et al). Main themes cover the development and lived experience of children of parents with severe mental illness, children of parents who are imprisoned, and children who experiencing separation from a parent in more functional circumstances (e.g. parents who have long periods away from home for employment reasons). Here, we will consider two more circumscribed themes in more detail: the alternative carer (Houston et al) and stigma (Casey et al). When children are separated from parents, whether through deployment, parental incarceration, or secure hospital admission, many are placed with their grandparents. At least one population based study1 has shown that such children are more likely to have emotional and behavioural problems than children in nuclear families. Professional support using trauma, attachment or family systems models may boost resilience and help reduce risk of longer term harm2 but, to date, reviews have tended to focus on grandparental experience3. Our primary review question was: When the responsible parent can no longer care for his/her child because of imprisonment, hospitalisation and/or mental illness, what evidence is there of the child’s perspectives and preferences on placement? 1Smith & Palmieri, 2007, Psychiatric Services 58:1303-1310; 2 Strong et al, 2010, Children and Youth Services Review 32: 44-50; 3 Sprang et al, 2014, Center on Trauma and Children Reports, Kentucky, USA. http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1000&context=ctac_reports