In need of friends

It stands to reason that children will have some sort of
reaction to their mother’s emotional state. As to what
extent, it’s been suggested that when mothers feel sad or
anxious their children can still feel the effects as long as 24
hours later. So what are the consequences for children whose
mothers feel depressed over a long period of time?

How to help mothers who feel miserable is something that Sure
Start initiatives are desperate to crack. Angie King, deputy
programme manager for Sure Start Ladywood in Birmingham, says that
as many as a quarter of mothers have some sort of depression.

“Feeling isolated, living in poverty, not feeling part of
society, and not having the money to do the things that you see
everyone doing on TV increases the feelings, and who is to say at
what point that becomes depression?” she asks.

A number of “structural” reasons, such as poverty, poor housing,
high unemployment, and crime play their part. But for refugees and
asylum seekers there are addition problems. “People don’t
have family connections in this country, let alone near where they
live,” says King.

Inevitably this has an impact on how supported a woman feels and
whether she is socially isolated. “Women very commonly make friends
with people who have children the same age as theirs. They might
attend antenatal classes or be in hospital together or attend well
baby clinics, and get talking,” she says.

Depressed women may report waking up very early, not sleeping,
or may be over-anxious about their child’s development. And
many have serious money problems. “It’s not really surprising
that they should be withdrawn, tearful, report not being able to
cope, or feel anxious or numb or nothing. Some mums will not be
dressed at midday and will keep the curtains closed because
it’s a horrible world out there,” says King.

The first course of action is for workers to talk to the mothers
and to signpost them towards help. Building up their informal
networks is crucial, with drop-in sessions where mums can chat
while their children play proving invaluable. However it’s
not always easy to persuade mothers to attend. Some strategies are
more successful than others.

“It’s easier for mums if the attention is focused on the
child. Then mums are actually quite motivated,” says King.

So it may mean portraying a meeting as being an opportunity to
learn about their child’s development. Pampering services,
such as aromatherapy or massage, can lead to surprising
benefits.

“Although mothers enjoyed them at the time, they said that the
best thing was actually being able to talk to someone. Friendship
is more lasting than a service. It means that the person is not
reliant on a service or a professional,” she says.

Of course, if a woman is suffering from serious depression they
may need encouragement to access mainstream mental health services.
But where their social isolation is the main problem, efforts can
be made to overcome this. “From a Sure Start point of view we try
and combat some of the isolation people are feeling and try to
provide community support. If people need help on a one-to-one
basis they can come and have a coffee and chat with us,” says Joan
Fernandez, a health visitor at Sure Start York. “One woman gave us
a nice quote recently. She had been depressed for a long time. She
said that Sure Start had given her what antidepressants never
could, in terms of feeling better and her mental health.”

Her Sure Start team includes a family learning tutor whose role
is to encourage people onto courses. These may be aimed at
improving their English or may be on topics such as first aid. “She
will visit people at home to help them make the first step. Coming
to any group can be a big step in the first instance,” she
says.

Fernandez is also keen to look out for any signs of depression
early on, and has helped to set up a “time and space in pregnancy”
group for pregnant women to attend.

It’s important that services reflect the cultural
diversity within a community. Debbie Ross, designated nurse for
looked-after children at Burnley, Pendle and Rossendale Primary
Care Trust, and previously a Sure Start health visitor, says that
in some cultures depression can be seen as a natural part of the
childbirth process. “Mental health is not high on the list of
priorities in the area. There isn’t a lot of knowledge about
mental illness and there is a view that if it can’t be seen
then it doesn’t exist,” she says.

Equally, people’s routines and responsibilities must be
taken into account in the way services are organised. “You need to
get the time right when people can attend these things.
There’s an expectation that women cook and clean in this
area. It can be difficult to get people to come during the day so
it can be better to do it at the weekend,” she says.

Mother to mother supporter schemes can also be useful, says
Ross, where women having problems with breastfeeding can share
their experiences with others who have been in the same boat. Such
schemes could also help women who have experienced some sort of
depressive episode.

With a mother’s depression unlikely to have anything other
than a negative effect on her children, anything that might help is
surely worth a try.

Children of depressed mothers…

…are more likely to:

• be fussy
• receive lower scores on measures of intellectual and motor
  development
• have more difficult temperaments
• react more negatively to stress
• perform worse academically
• have lower self-esteem
• have higher levels of behavioural problems
• develop a psychiatric disorder.

Source: Mutual Influences on Maternal Depression and Child
Adjustment Problems, 2004

Mother courage

Eight-year-old James’s behaviour has seen him ostracised
at school, and his parents at their wits’ end.

A month further down the line, and we still have no child and
adolescent mental health services appointment for James.

He is still having problems at school and as a result of this
and his other anxieties has started having soiling accidents at
home and at school. Dealing with the implications of this is
horrible for him emotionally and physically, and horrible for us
emotionally and practically.

We are seeing a specialist who is trying really hard to help but
as yet to no avail. It is really difficult to try and keep tabs on
how bad it is from week to week because James tries to hide the
evidence of his accidents.

Last week I embarked upon a much-needed tidy of his room. When I
start it resembles a jumble sale before the jumble has been sorted,
but half an hour in I am beginning to make some progress. Then, at
the back of the wardrobe, I spot a large white plastic bag. Closer
inspection reveals that it is stuffed full of about 12 pairs of
heavily soiled underpants that James clearly does not want me to
find. Deciding not to make an issue of it, I shove them outside the
door to add to the pile that is soaking in the bucket
downstairs.

I turn my attention to the muddle on the table and pull it
towards me only to hear a loud crash. The cause? A large ceramic
bowl that was once filled with jelly, and a spoon. The jelly is
long gone – James is a pass master at smuggling food upstairs and
eating it when no one is looking. I get down on my hands and knees
and discover that this bowl is only the start of it – hidden under
a toy box are six more empty jelly moulds and another spoon –
obviously all that is left of the last batch of jelly we made.

I know I shouldn’t do it, I know it won’t help, but
despite this I call him up and ask him what is going on. The look
on his face is dreadful to see and the moment he comes into the
room I hate myself for making him be there. He doesn’t know
what’s going on or why taking and eating food in this way
makes him feel, albeit temporarily, better. He just knows it
does.

Bedroom completed, I deposit the pants in the bucket downstairs
and nip to the loo where I find another pair of pants stuffed
behind the wash basin.

I’ve had better days.