Sunday, 8 September 2019

Toxic Trio- What you need to know

Photo by Tom Pumford on Unsplash

The Toxic Trio. We've all heard about it and maybe worked with it, but what is it? and what does it mean for individuals.

Here, I have put together a Brief information sheet regarding the Toxic Trio to remind us all of it's severity in people's lives, references, links and further information at the bottom of the page.

What is the Toxic Trio? 

The trio includes Substance Misuse, Domestic Abuse and Mental health. Whilst all three can be stand alone issues, together they make the Toxic Trio.

They are viewed as indicators of increased risk of harm to children and young people and vulnerable adults.

Domestic abuse occurs when any person, over the age of 18 years acts in such a way as to control, abuse, harm or coerce another. This including physically harming, restricting money, restricting access to family and friends, using fear and intimation to keep control. For it to be classed as Domestic Abuse, persons need to be over the age of 18 years otherwise, it is known as child abuse.
Two under 18 year old would be classed as child on child abuse.

Substance misuse is where a person misuses alcohol and or uses misuses drugs (this can include over the counter medications) The individual would be reliant on the substance and may find it challenging to recognise there is an issue.

Mental health issues cover a wide range of issues including eating disorders, anxiety or depression and Psychotic disorders such as Bipolar or schizophrenia.

Facts and Figures: 

"100,000 children in England (0.9% of all children in England) are in a household where a randomly-selected adult faces all three ‘toxic trio’ issues to a severe extent"

"420,000 children (3.6% of all children in England) are in a household where a randomly-selected adult faces all three ‘toxic trio’ issues to a moderate/severe extent."
       Photo by Joel Overbeck on Unsplash
More than 1,796.000 children in the UK, live in a home with Domestic Abuse. (NSPCC)

250,000-978,000 children are thought to live with a parent who misuses either drugs or alcohol or both. (NSPCC)

50,000 - 2 MILLION children are affected by adult mental health (NSPCC)

"A review of Serious Case Reviews (2007-2011) found nearly ¾ of children lived in families where two or more of these issues were present." (Ofsted, 2011)

How it impacts on the family: 

  • Research shows that the environment in which a child lives is crucial to his or her health, safety and well-being.

  • There is a large overlap between these risk factors and cases of child death, serious injury and generally poorer outcomes for children. 

  • The Toxic Trio as a whole, and as individual issues, affect children of all ages. 

  • Children may not thrive

  • Risk of non accidental injuries. 

  • Some of the child's indicators that Domestic Abuse is happening: behaviour in school/ attainment changes/ not participating in extra curricular activities. Low self esteem, blaming selves for parents behaviour, self harm and or running away. 

  • Some of the child's indicators that there are parental mental health issues: Child acts as a young carer, missing lots of school, not taking part in recreation, self harm, possible substance misuse. 

  • Some of the child's indicators that there are parental substance misuse issues: Child does not have adequate amounts of food/ signs of neglect. Taking on caring role, missing school, experimenting with drugs and alcohol, child takes/brings drugs to school, isolated from peers, low self esteem. 
Support that can be offered: 

  1. Assess Risk, is the child(ren) in immediate danger? 
  2. Professionals to work together TAC (Team around the child) 
  3. Is there a need for a CIN (Child in need) or CP (Child Protection) plan? 
  4. Regular core groups/ MARAC (multi-agency risk assessment conference) and reviews are needed. 
  5. Gather the views of each family member, don't forget about the men in the house or loose sight of the child(red) 
  6. Be mindful of Disguised compliance and ensure you capture the voice and lived experiences of the child(ren) 
  7. Avoid getting lost in the parents issues and loosing sight of the child's. 
  8. Where families are not on board or working cooperatively with the plans, discussions around PLO or issuing proceedings may be needed. 

Mental health, Substance misuse and Domestic Abuse are huge topics in their own right, all of which I aim to cover in more depth in later blogs, but for now, I have provided a very brief overview of the Toxic Trio. Below are a number of links to external and online sources for further detail. 

The Last link, Practice Guidance, provided by Greenwich children's safeguarding board, contains lots of useful information and pitfalls in practice to be aware of, so be sure to check it out. 

Reference/ Further information: 

Save Lives Powerpoint:

Community care article:

Childrens Commissioners report, July 2018: Estimating the Prevalence of the Toxic Trio:


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