The toxic trio: what social workers need to know

The past few years have seen an increased awareness of the frequency with which domestic and sexual violence, substance use and mental health problems co-exist, particularly in the context of safeguarding children and young people. Various terms have been coined to describe the concurrent experience of these three issues: the ‘toxic trio’, ‘the trilogy of risk’, and people with multiple and complex needs.

There is concern that terms such as the ‘toxic trio’ are problematic because they can lead to the parents – most often the mother who is frequently the victim of abuse herself – being deemed toxic or seen as the main source of risk, and therefore they don’t hold the perpetrator of domestic abuse to account for their behaviour.

What is the ‘toxic trio’?

The use of the term ‘multiple and complex needs’ is not necessarily any less stigmatising – it is yet another label applied to a person or family and one that is used to exclude some from services. Furthermore, any combination of needs may be complex, not just substance use and mental health problems. As such, supporting families affected by these three issues involves exactly that – talking explicitly about domestic abuse, substance use and mental ill-health and helping them to address the impact that these issues are having on them and their family.

Living with mental health problems, using alcohol or drugs, or experiencing domestic abuse does not automatically mean a parent/carer is unable to safeguard their child(ren) from serious harm. Furthermore, adequate support can reduce (although not necessarily eradicate) the risk of children experiencing long-term negative effects of growing up with such problems. This means children can outgrow their troubled childhood. This is particularly true where only one issue affects the family.

Major concerns arise when more than one of these problems is present, as is often the case. It is the ‘multiplicative’ impact of combinations of factors that have been found to increase the risk of harm to children, with family disharmony and domestic violence posing the greatest risk to children’s immediate safety and long-term wellbeing (Brandon et al, 2010).

So, identifying all three issues and how they impact on the adults and children present in any family is vital. Furthermore, professionals need an in-depth understanding of how the issues interlink – particularly in terms of what domestic abuse is and how victims may end up using substances as a way of coping with their experiences – to ensure the interventions that are put in place are as effective as possible in promoting the safety and wellbeing of all members of a household.

Gathering and analysing information

A key message that has emerged from serious case reviews is that practitioners need to gather and analyse more information; they “must be encouraged to be curious, and to think critically and systematically” to understand how the difficulties affecting families interact (Brandon et al, 2008, p98). Unless professionals are sufficiently curious, questions will go unasked and important information will not be gathered.

Each family member should be spoken to individually about what is happening in the household. This is particularly important given the tendency to focus on mothers in families where a child or children are at risk of harm. It has been noted that fathers can be more difficult to engage with, either because they refuse to talk to social workers, are absent from the home when professionals visit, or do not live in the home with the child (Farmer, 2006 cited in Cleaver et al, 2011). However, every effort must be made to engage with fathers, even more so in cases of domestic abuse where usually the father/male carer is the perpetrator and poses a high level of risk to the family.

Children should be spoken to away from their parents wherever possible as they may not feel able to talk about what is happening in the family in front of them. This is particularly true if they fear negative consequences for their parents/carers or themselves, eg if they disclose that one parent/carer is abusive towards the other or towards the children. Very often, children and young people don’t want to get their parents into trouble, and also fear the family being separated as a result of disclosing.

In a similar vein, in cases that involve domestic abuse, both parents/carers should be spoken to, and spoken to separately. It is unlikely that a victim of domestic abuse will feel able to speak freely in front of the perpetrator, and perpetrators will often use such ‘forums’ to further manipulate and control the victim.

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