A wide range of mental ill health can affect parents and their families. This includes depression and anxiety, and psychotic illnesses such as schizophrenia or bipolar disorder. Depression and anxiety are common. At any one time one is six adults in Great Britian may be effected. Psychotic disorders are much less commom with about one in two hundred individuals being affected. Mental illness may also associated with alcohol or drug use, personality disorder and significant physical illness. Approximately 30% of adults with mental ill health have dependent children, mothers being more at risk than fathers.
Appropriate treatment and support usually means that mental illness can be managed effectively and as a result parents are able to care successfully for their children. Mental ill health in a parent or carer does not necessarily have an adverse impact on a child's development. Just as there is a range in severity of illness, so there is a range of potential impact on families. The consequent likelihood of harm being suffered by a child will range from minimal effect to significant one. It is essential to assess the implications of parental ill health for each child in the family. This would include assessment of the impact on the family members of the social, physical ill health or substance use difficulties that a parent with mental health illness may also be experiencing. After assassment appropriate additional support should be provided where needed.
Given the wide range of mental ill health, the effect on parents and the potential impact on their capacity to meet the needs of their children is varied. Depression can result in the individual experiencing feelings of worthlessness and hopelessness which may lead to everyday activities being left undone. Parents may neglect their own and their children's physical and emotional needs. In psychotic disorders such as schizophrenia, when a person is actively psychotic, they can loose contact with reality, experiencing hallucinations and delusions with consequent inability to understand and respond to their children's needs. In some people with chronic psychotic illness self- neglect in a range of areas of life may be an issue and this may have an impact on their capacity to care for their children. Overall children of mothers with mental ill health are five times more likely to have mental health problems themselves- both emotional and behavioural difficulties. Parental mental illness (including substance use), particularly in the mother, is also associated with poor birth outcomes, increased risk of sudden infant death and increased mortality in offspring- probably through complex interaction of sociological, biological and risk behaviours such as smoking. This research indicates that these vulnerable families need additional support and help.
The majority of parentd with a history of mental ill health present no risk to their children. However, in rare cases a child may sustain severe injury, profound neglect, or even die. Very serious risks may arise if the parent's illness incorporates delusional beliefs about the child, and/ or incorporates the child in a suicide plan. Information from the National Inquiry into Suicides and Homicides suggests that there are about 30 convictions a year where a parent or step parent kills a child (this excludes those cases where the parent then goes on to commit suicide). In 37% of these cases the parent was found to have a mental disorder including depressive illness or bipolar affective disorder, personality disorder, schizophrenia, and/ or substance or alcohol dependence.
The potential impact of parental mental illness and the child's ability to cope with it is related to age, gender and individual personality.
For babies and infants post natal depression may hamper the mother's capacity to empathise with, and respond appropriatly to, her baby's needs. A consistent lack of warmth and negative responses increases the likelihood that the infant will become insecurely attached. Depression may also reduce the level of interaction and engagement between mother and child. Parents in these circumstances may have greater difficulty in listening to their children and offering praise and encouragement. Mothers who experience psychotic symptoms after giving birth, and those who continue to be depressed at six months after the birth, are more likely than other mothers to regard thier babies negatively and ignore cries for warmth and comfort. Women with a history of severe mental illness are at particular risk of relapse post partum and should be under the care of the psychiatrist, as should any mother who develops psychotic symptoms post birth. Mood swings a common feature in mental disorders, can result in inconsistent parenting, emotional unavaliability and unexpected and unplanned for seperations, which infants find bewildering and frightening. Young children can be supported by the vigilance of primary health care workers, the presence of an alternative caring adult, the support of wider family, and good communication facilities.
The prevalence of mental ill health in children experiencing mental health problems increases with the advent of adolescence. A survey of Children's mental health suggest 11% of children aged 11-16 years have a mental disorder. Parental mental ill health problems exacerbate the likelihood of young people experiencing psychological and behavioural symptoms. The volatility of this age group means that the impact of parental mental illness, while similar to that at a young age, maybe more intense. Teenagers whose mothers suffer from depression show more behaviour problems than those whose mothers are well. Conduct disorders, depression and a preoccupation with family problems affect young people's ability to concentrate and education and learning may be impaired. Education may also be interrupted when parental mental health problems become severe and young people stay at home in order to look after their parent or younger siblings. Although relationships between parent and child may suffer as a result of parental mental illness, the opposite may also be true. As children reach adolescence, and their understanding and empathy develops, parental mental health problems may stregthen the bond between them. However, this can also result in accelerating the normal pace of emotional maturity, resulting in the loss of childhood. Young people may not only become responsible for shouldering the burden of practical tasks, but also assume the emotional responsibility for a parent or younger siblings. To do this young people may curtail their leisure time and restrict their friendships. Friendships can be a great source of support, but an acute awareness of the stigma of mental illness may result in young people coping alone. It is essential that the needs of young carers are assessed to ensure they recieve the support they need. Many families in these circumstances would benefit from practical and domestic help. Young people value the support of sympathetic and trusted adults with whom they can discuss sensitive issues, a mutual friend and knowing who to contact in the event of a crisis regarding their parent.
It is important not to assume that all young people will have problems just because they grow up living with a parent who has mental ill health. Research has shown that the adverse effects on children and young people are less likely when parental disorders are mild, last only a short time, are not associated with family disharmony and do not result in the family breaking up. Children may also be protected from harm when the other parent or family member can respond to the child's needs, and the child or young person has the support of friends and other caring adults.
This information has been taken from Working Together to Safeguard Children 2010.
