Australian mental health services are predominately reactive. Services either work with people in crisis or treat previously diagnosed disorders. While both approaches are important, critical opportunities for prevention and early intervention are missed.
A significant group of children are at risk of developing mental health issues. Children whose parents have a mental illness are twice to three-times more likely to develop their own mental health issues than their peers. But we do nothing, or very little, until they either present to clinicians with their own problems or come to the attention of child protection authorities.
Clearly, it’s not inevitable that these children will have mental health problems. One-third of children whose parents have a psychiatric disorder have no emotional or behavioural problems. One-third experience transient problems. The final third experience serious and long-term adjustment issues.
While genetics play an important role in the transmission of mental disorders from parents to children, environmental factors are also critical. Having a psychiatric disorder, for instance, may disrupt parenting and parent-child interactions because the parent is emotionally unavailable or preoccupied.
The impact of a parent’s illness on children will vary in terms of how severe and chronic the illness is, and how much support the family has access to, both formally and informally.
We can do better to assist these families. By better supporting at-risk families, we can prevent the “transmission” of mental illness from parents to children.
Incorporating parenting into treatment plans
One in five adults attending mental health services are parents with dependent children. In the first instance, mental health professionals need to ascertain whether the person they are treating is a parent, or an expectant parent, and offer follow-up support. This is far from routine, as mental health professionals often report having limited time and skills to support clients in their parenting role, or to consider the needs of their client’s children.
Parenting is an important role for many and, once acknowledged in treatment plans, may motivate clients to remain in therapy. So it’s better for the parent, and his or her children, for treatment to occur within the context of the family.
We are currently trialling a brief two- to three-session intervention called Let’s Talk about Children. This involves clinicians and parents working together to empower the parent to support his or her children, within the context of their disorder.
One of the main objectives of the intervention is to embed conversations about family life into standard treatment. Clients are invited to talk about their children, and identify and address any concerns about how their illness may be impacting their children.
Parents involved in randomised control trials of Let’s Talk about Children in Finland reported greater understanding of the impact of their illness on children, and reduced guilt and shame. Children reported significant reductions in emotional symptoms.
Let’s Talk about Children is currently being trialled across various adult mental health, rehabilitation and family-centred organisations across Victoria.
Early detection and family support
Interventions such as Let’s Talk about Children need to be part of a broader service response that identifies and supports families with mental illness at the earliest possible opportunity.
The National Health and Medical Research Council recommends identifying parents with a mental illness by asking appropriate questions at baby checks, which occur from one to four weeks after birth. The same questions need to be asked of fathers, and in other settings and at other times.
Parental status should be recorded at admission to an adult psychiatric facility and time should be provided for working with families. Family friendly visiting areas need to be made available in those settings where parents are treated, including acute settings.
Health professionals need training to ensure they can facilitate these sensitive discussions with parents. The Children of Parents with a Mental Illness (COPMI) national initiative is a world leader in this area, having designed a suite of e-learning resources that aim to raise professionals’ awareness and skill for working in this area.
Cinicians have a role in supporting the parent to hold these conversations with their children, and answering any questions or concerns the child might have. This can be difficult as parents may struggle to find the language to explain their illness to children. Families should have access to more intensive supports, such as case management which caters to the individual family members.
Clinicians have another opportunity to work with families if or when children present with their own mental illness or behavioural disorders.
We have a means of identifying young people at risk of mental health issues when their parent presents for treatment for their own mental health issues or during baby checks. If governments, services providers and mental health professionals respond appropriately, outcomes for parents and their children can improve.
This article was co-authored by Philip Robinson, President of the Australian Infant Child and Adolescent Family Mental Health Association.