Tuesday, 16 April 2013

Children in families where a parent has a mental illness, Part 1

Today I want to look at a situation that is much more common than is generally recognised: children who are raised in families where a parent has a mental illness.

Recent statistics suggest that almost half of the Australian population will suffer some form of mental illness during the course of their adult life, and about one in five during any one year.  This includes illnesses like severe depression, anxiety disorders, substance abuse, psychotic illnesses (eg schizophrenia) and other conditions including senile dementia.  About 3% will suffer severely from illnesses like schizophrenia (1%) and bipolar disorder, previously known as manic depression (2%).  This is not a picture of a country with robust mental health, and certainly suggests that;
  • many children are raised in families where the mental health of a parent is an issue
  • we need to be concerned with raising all children to be resilient and thus more able to withstand the pressures of modern life.
 In the "old days" people with severe mental illnesses were confined in institutions, often for most of their lives as drug and other therapies were not effective in treating their conditions.  This meant that children would continue to live with the well parent, or if necessary be placed in care.  In these more enlightened times, and with far better treatment, this situation has changed, with patients living in the community and engaging in everyday life.  They can work, form relationships, marry, have children, drive, buy houses...just like everybody else. Some, however, may be so severely disabled that their lives are permanently damaged and they are unable to live so well in the community eg some 80% of the homeless have a mental illness.

With this degree of prevalence, there is no excuse for prejudice: we all probably know someone within our immediate circle of family and friends.  Nor is there any reason for the persistence of myths like people with schizophrenia having two personalities, that the mentally ill are violent and a danger to society, particularly children.  As a community and as individuals we need to be informed not ignorant, sympathetic and caring not blaming or avoiding, but we also need to be realistic and recognise that many people at times, have an enormous struggle to keep well and functioning appropriately.

Untreated and under-treated mental illness not only makes life difficult for the person but also for those around them, and those who are closest, particularly family members can be seriously affected.
  • It is very hard work for example to be the partner of someone so affected by depression that getting out of bed is too hard, whose thoughts and ideas are all negative, who may talk of death or wanting to die.  
  • It is hard as an adult to be confronted by someone you love who is hearing voices telling them to do all sorts of strange things; or who suddenly believes you are the devil or some other enemy; or that they have superpowers.
Imagine how much harder it is for a child to be confronted with this.  Then imagine that your parent has no partner, that you and your siblings are the only ones who see and hear this.  You might have to look after yourself, get your own meals, wash and keep yourself clean as best you can, get yourself to and from school.  Most children are aware of what is OK and what is not OK, they may find it exciting to go on expeditions with a parent at all hours of the night, but they also know at another level that this is not what their friends do.  Children, like most of us, don't want to stand out as different so they often cover up what is happening at home, and it often takes crisis signs like frequently having no lunch, being dirty or absent from school to bring the family situation to the attention of adults who can intervene.

It is also not uncommon, for children, not only to have to care for themselves but to take on a caring role for their parents, making them food, reminding them when to take medication, or attend appointments, or even ringing mental health services to get help.  They may also take on extra responsibility for younger siblings.  They can grow up before their time, losing their childhood and becoming overly responsible.  In extreme cases, they may even believe that they are in some way to blame for their parent's current episode.

Reading this, you may be struck how sad this is, and be angry that the parents don't make an effort to look after their children, but remember, the parents are ill, and if they are aware of what is happening, they often are ashamed and this just adds to their negative self talk.  If they are unaware of what is happening, when they have been treated and told of what has happened, again they can be overwhelmed by shame.  Just because parents are mentally ill, it does not mean they don't love and care for their children.

Of course the situation should be much easier if the mentally ill parent has a partner, but often the load on this partner to be the wage earner, and to care for their partner and children is very heavy.  Family and friends are not always as helpful as we like to think we would be.  They all might be worn out from caring.  Unfortunately, too, if the person had a chronic physical illness or even a terminal illness, our attitudes and those of the general community would often be different.

It has not been my intention this week to stigmatise those with a mental illness or their families;  they are doing the best the can under very difficult circumstances.  I have wanted to point out some of the issues that such families face as from time to time we come across these issues in the families that contact the agency looking for a nanny.

Next week I want to look at some of the ways children in these families can be helped, and what can be done to strengthen the resilience of children in our care.

Helpful links:
Sane Australia
Children of Parents with a Mental Illness
Mind Matters
Better Health Victoria

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