Aim To investigate whether lack of identification by healthcare workers of children of adult mental health service users was related to negative staff attitudes and organisational barriers to incorporating a child perspective.

Method Qualitative analysis of how the workforce described the task of, and barriers to, taking a child perspective.

Results Difficulties were organisational, staff-related, child- and family-related, and contextual. Essential factors to be resolved in supporting these children were related to organisation and management, staff, families and context.

Conclusions Clinical practice will not change unless the organisation and the workforce have been adequately prepared and resourced.