Using longitudinal administrative data to characterise mental health problems and substance misuse among women whose children enter care in England

Background Maternal mental health problems and substance misuse are key risk factors for child maltreatment and are common among children entering care in England. Better evidence about the health needs of women whose children enter care is needed to inform prevention and service responses across the family courts, children’s social care and healthcare. Methods I used area-level and person-level linked administrative data from health, children’s social care and family justice in England. First, I performed an ecological analysis of the association between maternal health before birth and infant entry into care using national data. Next, I used linked mental health and substance use service use and family court data for 3226 women in court proceedings concerning their child(ren)s entry into care in the South London and Maudsley NHS Foundation Trust catchment. I generated evidence on the type, severity and timing of health problems and identified predictors for returning to court with a new child. Results Parts of England with higher prevalence of maternal history of mental health, substance misuse or violence-related hospital admission among births had higher rates of infant entry into care, adjusting for potential confounders. Among women in proceedings in the SLaM catchment, 66% (of 3226) linked to a SLaM patient record and 54% were known to SLaM before their first recorded set of proceedings. Women who linked had high rates of schizophrenia spectrum disorders, personality disorders and substance misuse, compared to other female SLaM patients. They also had two-fold higher expected mortality rates, adjusted for age, and higher rates of service disengagement. I found six common trajectories of SLaM inpatient and outpatient contact among women in proceedings, which revealed that many (53%) women had little or no service contact around proceedings despite most having a SLaM referral. I found that being younger, having a young child in proceedings, and having parental responsibility curtailed or terminated were most predictive of returning to court with a new infant. Conclusions Mental health problems and substance misuse are common among women involved in proceedings, with healthcare needs often acute and complex. Given the scale of this issue, family law and social care policy reform is needed to ensure adequate and timely treatment for maternal mental health problems