Comments about school professionals 12. Firstly we considered if it was appropriate to ask Ms L to tell B the school and teachers could be trusted.
13. The relevant guidance in this case, NHS Constitution, emphasises the importance of working together for patients, and involving professionals inside and outside of the NHS in this process. We consider this to include professionals within the school.
14. Further NSPCC guidance on promoting mental health and wellbeing states “Every child and young person should have trusted adults they can talk to about any worries, concerns or questions they may have. Help them identify who these adults are by talking with them about who they trust and are most comfortable talking to.”
15. We recognise B has vulnerabilities on account of her mental and physical health conditions. We understand Ms L feels the Trust has not truly considered these or their impact. B’s conditions alone are not evidence she was at risk of grooming or exploitation if she were to trust the school or teachers.
16. We have reviewed the records in detail and we have not identified any evidence the Trust should have considered any other specific factors when asking Ms L to encourage B to trust the school and teachers.
17. We also asked our mental health adviser to review the records. They agreed there was no indication the Trust’s recommendation was inappropriate.
18. Next we considered if there is any evidence the Trust told Ms L to lie.
19. In its complaint response the Trust recognised its comments were challenging for Ms L as she had been threatened by prosecution by the school. We recognise Ms L had an ongoing grievance with the school and this may have affected her trust in the organisation and its staff. Consequently we can understand why she felt uncomfortable trusting the school herself.
20. We have not seen any evidence the information the Trust asked Ms L to share with B (to trust the school and teachers) was not true, or said with the intention to deceive anyone. For these reasons we have seen no evidence the Trust told Ms L to lie.
21. Taking all the available evidence into account, NHS Constitution and NSPCC guidance both support the Trust’s comments, and we have seen no evidence that suggests the Trust were asking Ms L to lie. Overall we are satisfied the Trust acted in line with guidance and we have seen no indication of failings in this part of Ms L’s complaint.
Written comments about Ms L 22. Firstly we considered the July 2021 and March 2022 records.
23. In July B’s lead practitioner noted they had discussed Ms L’s wellbeing and anxiety with another of B’s care professionals, as it seemed to be impacting B. In March the lead practitioner recorded an observation that Ms L’s anxiety about B’s school place was a possible reason for B’s increasing anxiety.
24. We asked our adviser what we would normally expect to be considered in relation to the young person’s family, when considering the young person’s needs. Our adviser explained supporting families is a recognised component of good mental health care. They explained this must also include consideration of safeguarding issues.
25. Government safeguarding guidance on inter-agency safeguarding practices explains practitioners should be particularly alert to the potential need for early help for a child who is in a family with circumstances presenting challenges such as adult mental health issues.
26. The notes in B’s records show the Trust considered the impact Ms L’s behaviour had on B. Recording this information demonstrates the Trust is considering safeguarding issues in line with the guidance. For this reason we are not critical the professionals view of Ms L was recorded in B’s record.
27. Ms L told us the comments are a misrepresentation of her and it is a perfectly natural response for her, as a mother, to be concerned and feel emotional about the level of extreme distress she sees her daughter in every day. We fully recognise Ms L’s position and we were sorry to hear how much distress B experiences on a daily basis.
28. We do not dispute Ms L’s account of her own presentation. However we also take account that the Trust’s comments were the opinion of the lead practitioner, not intended to be a diagnosis.
29. We are not critical of the use of ‘anxiety’ as it is normal for most people to experience moments of anxiety on a daily basis without this being a diagnosed condition for them, or an indication of a wider mental health concern.
30. Next we looked at the comments in August 2022, when the lead practitioner completed a social services referral. This included context about the family situation, lack of respite for Ms L and overall impact on her wellbeing.
31. We asked our adviser if the referral was completed to a level they would normally expect to see. Our adviser confirmed the referral provided relevant context about the family situation and highlighted the impact of B’s needs on her mother’s wellbeing.
32. Ms L told us the Trust’s contact with social services prompted a ‘child in need’ assessment which was distressing and upsetting. This is an assessment where the local authority consider if a child needs extra support to maintain reasonable standards of health and development. We appreciate this process was very difficult for Ms L.
33. We cannot comment on social services interpretation of the information provided. We have not seen any evidence the Trust stated B was a child in need or that Ms L’s actions put B at any risk.
34. When we look at the information shared with social services we are satisfied it was an appropriate use of other professional services in line with NHS Constitution and considered B’s needs in line with Government safeguarding guidance, for this reason we have seen no indications of failings in the information recorded about Ms L in B’s records.
35. We understand why Ms L brought these matters to us for review. We hope our report clearly explains how we have reached our view and reassures her the Trust’s actions in relation to these issues were in line with guidance.