Children in families where a parent has a mental illness Part 2

Last week I introduced the topic of families where a parent has a mental illness. This week I want to look more specifically at the children in these families and what can be done to meet their needs.

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.

Unfortunately, mental illness still has some degree of community stigma attached to it, and this often extends to keeping children in the dark about what is going on.  As a result, they may develop all sorts of strange explanations for themselves about what is happening.  Even toddlers can understand simple explanations like 'mummy (or daddy) is sick', and that 'the doctor (nurse, social worker) is helping mummy to get better'.  Older children need more information and they also need the information to ask questions.  These questions need to be taken seriously, even when they are strange or difficult as they often help sort out confusion and fears that they hold.  As they grow, more complex explanations and opportunities for questions are needed. It is important that all this is done in such a way that the children are supported and their respect for and relationship with the ill parent is maintained. 

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.

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
beyondblue