One of the first things these children need is honesty about what is happening to their parent, in language they can understand and which re-assures them that:
- their parent is ill;
- they have done nothing to cause or worsen the illness;
- they cannot 'catch' the illness;
- their parent is receiving treatment, whether this is medication, hospitalisation, counselling or some combination of these.
These explanations are often best provided by some one the child already knows and trusts like the well parent, a grandparent or other family member, but it may also be done by people involved in assisting the parent, particularly if he or she is a sole parent. Nannies working in these families need to be informed of the situation and to discuss with the family what their role is in supporting the children with information and reassurance. On line there are also information sheets and resources likes DVDs and books available for purchase which can help those providing information or to use with children as well as information in age appropraite language.
As I mentioned last week, some children may take on a care taking role with their parent, often described as 'parenting their parent.' To help reduce the unfair burden that this can place on children, it is important treatment plans are set up in such a way that the parent or another adult takes responsibility for ensuring that the parent's needs are met. For this reason, it is important that those involved in supporting and treating a mentally ill person know that that patient is a parent with the care of dependent children, and that the children's needs are considered in the case planning.
All children need consistency and stability, and thus a degree of predictability in their environments to maintain their own development. For children with a mentally ill parent, it is important that as far as possible these needs are met by the well parent and the broader family network. Signs that the children are under stress include 'acting out' with impulsive or attention seeking behaviours (eg aggression, tantrums) or signs of anxiety like bed wetting, thumb sucking, or moodiness and withdrawal. Where nannies are working with these children they need to be alert to these behaviours and not take them personally. Useful strategies include maintaining the usual behavioural management techniques and consistency along with lots of reassurance, warmth and opportunities to find more positive ways for children to express their feelings. The parents should also be informed of these behaviours and the strategies being used to meet them, ensuring good communication is maintained.
If a parent is separated from a child for an extended period, children become distressed, hence the slow process introducing children to childcare and school, so it is not surprising that if a parent is hospitalised because of physical or mental illness there will be an effect on the child, especially as this often happens suddenly. In the case of mental illness this may follow a sudden episode when the parent has been acting in a way that the child finds unusual or strange. Ideally the child would continue to live at home, with the well parent's care supported by known and trusted family and friends. A nanny may be introduced to the family in these circumstances, and so the child is faced with coping with the temporary loss of a parent and a new person at the same time, which is likely to produce some of the behaviours mentioned above. of course, where there is no extended family and the family does not have the means to employ a nanny, the child may face the even greater disruption of being placed in out of home care eg foster care, and consequently even more profound reactions may take place and professional help may be needed to assist their recovery.
Like all other children, those with a parent with a mental illness need time, space, love, nurture, understanding to grow into healthy resilient adults who can engage positively with the world and those who care for them need commonsense, good communication skills, a sense of humour and boundless patience.
Next week I will look look further at issues I have touched on before about raising resilient children.