A significant number of children and young people are caring for a parent or parents with mental health problems defined as serious or severe, and enduring. Children and young people with these responsibilities are often referred to as young carers. It is important that they are recognised as children and young people in the first instance, then as carers. And what helps these young people most is the support that is provided to their parents.
The nature of social care provision in the UK means that a high proportion of care is delivered by informal carers who are often family members. Carers’ rights and needs, as distinct from those they support, are now more widely acknowledged by practitioners, academics and policy makers. Young carers, however, combine the role of child and carer. Consequently, tensions exist between the rights of the person requiring care, the rights of the child (as enshrined in the UN convention), and the rights of the carer.
Care provided for parents with mental health problems can differ from the types of care provided for other people. More people with mental health problems are co-resident parents. They therefore live in the same household as their children, who often act as carers but remain potentially vulnerable, making it necessary to consider who is providing “informal care” and on what basis.
Stigma and education
Research shows that the stigma attached to mental health problems means that a child or young person caring for a parent with these difficulties may steer away from social activities and reduce opportunities for normal social development. This may be as simple as not taking friends home or an inability to include social activity in their daily routine because they feel unable to leave their parent. They may feel they are at increased risk of bullying if their parent’s disability is known. Stigma can also make it more difficult for others to identify the needs of a young person who cares for a parent with a mental health issue.
Interviews with young carers indicate that school rarely provides an environment in which professionals accurately and routinely observe and identify behaviour that may indicate need on the part of the child or young person. Young carers attribute this to a lack of awareness of the realities of caring on the part of education professionals. As a result they cite bullying, fatigue, lateness and inability to meet deadlines as points at which their needs could have been better
investigated and responded to. They also identify a need for the education system to be more flexible, so that they can deliver work and still have time to care. Examples include negotiable deadlines, access to additional support with curriculum content, access to pastoral support at times of stress, and a general willingness to treat the realities of their care-giving role as a legitimate reason on occasions when they are unable to comply with the demands placed on them at school.
Much has been written about the concern that young carers may experience a “role reversal” and “grow up too quickly”. Despite this, evidence shows that most young carers still appreciate their role as the child in the family. Recent thinking on the issue therefore focuses on notions of interdependence – the idea that the caring contribution of the child is matched by the parental contribution of the adult. On this basis, the delivery of care for those with mental health problems may become one which is regularly, if informally, negotiated to reflect the changing needs of the parent but where the young carer retains the role of child in the overall relationship. While there is some evidence to show that this can present difficulties with becoming independent of the parent when older, it is not inevitable. The “real world” skills acquired in the caring role, particularly where it is supported, can lead to very positive outcomes for young carers.
Research shows that, despite a growing realisation of the importance of the connection between child care and mental health care, few services use whole-family approaches. This is an issue for both child and adult mental health services and the Social Care Institute for Excellence (Scie) is working with the National Institute for Health and Clinical Excellence (Nice) and other agencies to produce guidance for this area that can cut across social care, health, children and adults’ services.