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When 11-year-old Liam Goodman was asked to draw his mother's depression, he drew a picture of her head with flies buzzing around it trying to get inside. Younger brother Jake drew a large heart cracked down the middle and with tears pouring out. Reactions such as these have left their mother Maria in little doubt that her illness is having a massive impact on her children.

"They've witnessed me crying many times. It scares them. They sit round me and cuddle me. On one bad day I was driving and just burst into tears. My son held my hand and said 'It's alright mummy'."

Maria has been diagnosed with clinical depression and has been taking antidepressants for six years. Following a nervous breakdown in February she was referred to a psychiatrist who she has been seeing ever since. She is starting to feel better, but her sons are experiencing their own mental health difficulties - Liam is depressed and has an obsession with food while Jake has been diagnosed with attention deficit hyperactivity disorder.

As a mentally ill mother Maria is not alone - up to half of all adults who use mental health services are parents.1 Parental mental health problems can have a significant impact on children's social and emotional well-being and at least a third of children who have parents with mental health problems will experience difficulties themselves. At school the children may be bullied because of their "psycho" mum or dad. At home they often shoulder the emotional burden as well as becoming responsible for the household chores. Yet despite the negative impact of their parent's mental ill-health, many of these children's needs may never be identified, let alone adequately met.

For a start, many of the 6,000 to 17,000 children who care for a mentally ill parent will remain hidden because their mother or father has not come forward for help. Some parents, especially women, are frightened of obtaining services because they fear their children will be taken into care. And this fear is a realistic one - many parents feel that their parenting abilities have been unfairly questioned because of their mental health. This is backed by research that has shown that discrimination from professionals can lead to family separations and child protection procedures.2

But even where parents do come into contact with mental health services, there is no guarantee that their children's needs will be looked at. Saul Becker, professor of social policy and social care at Loughborough University, says that often the children of mentally ill parents become almost invisible.

"When people from adult services go into a family where there is parental mental illness they will generally focus on the parent and their condition and often they fail to notice the children's role within the family. If the intervention is organised around the parent then often the children are ignored."

Of course this can also happen the other way around. Child care social workers estimate that 50 to 90 per cent of parents on their caseload have mental health problems or substance misuse issues. Yet even when a child is known to a children's team the parent's mental health problem may be overlooked.

But not because practitioners don't know what to do, says Marie Diggins, a mental health social worker who has carried out research into parental mental ill health.

"It's not because people working in the services don't have the skills, it's because of the frameworks people work in. In overstretched teams workers have to look at the primary client. For children and families it is the child, and for mental health services it is the adult."

Diggins is also a practice development manager at the Social Care Institute for Excellence. In an effort to improve joint working between adult mental health and child care services Scie has launched a group - the Parental Mental Health and Child Welfare Network - bringing together health and social care staff who work with parents with mental health problems and their children.

In addition, Scie is to publish new guidelines on how health and social care services should support parents with their parenting skills. Parents, particularly those suffering from severe and enduring mental health problems, are rarely offered parenting or family support - not surprising given that standard mental health assessments do not include routine questions on the individual's family circumstances.


"Mental health services may look at other social issues like housing, employment and finances but often they don't consider the person's role as a parent. It's not always asked how the parent is getting on in terms of their relationship with the child and whether they need any help. The children's ages may not even be known," says Diggins.

Much of the problem is down to the fact that services and practitioners have become so separate and specialised. Mental health workers may feel ill-equipped to deal with the practicalities of parenting while children and families workers may not feel they are qualified to handle mental health issues. In these situations it is vital for cases to be referred to more appropriate services, but knowing how to make the referral can be confusing in itself.

"It's frightening how little mental health staff know about how the children and families service is organised and vice versa," says Paul James, mental health community services manager for South London and Maudsley NHS Trust and Lewisham social services department. He says that practitioners need to understand how different teams work.

"We get children and families staff phoning up and asking for a mental health social worker. Within our community mental health team the social work service and nursing service are integrated. They need to refer to the duty desk rather than the social work desk. The receptionist probably wouldn't understand who is a social worker or who is a nurse."

Without a doubt, more efficient ways are needed to identify and support those children whose mother or father has a mental health problem. Adult mental health and children's services must learn to work more closely, carrying out joint visits where necessary, to make sure these children are not left to cope on their own. CC

Maria says that she and her children have benefited from the Building Bridges project in Greenwich, south London. There are nine Building Bridges projects across the country offering practical and emotional help to families where a parent has mental health problems. They are run by the Family Welfare Association. For information go to www.fwa.org.uk/MentalHealth.html

¹ Mental Health and Social Exclusion, Social Exclusion Unit Report, 2004

² Children Caring for Parents with Severe and Enduring Mental Illness, Centre for Child and Family Research, 2002

What children want

Ten messages for social care and health workers from children who have a parent with a mental health problem:  

Introduce yourself, tell us who you are and what your job is."   "Give us as much information as you can." 

•  "Tell us what is wrong with ur parent". 
• "Tell us what is going to happen next." 
•  "Talk to us and listen to us. Remember it is not hard to speak to us, we are not aliens." 
•  "Ask us what we know and what we think. We live with our parents, we know how they have been behaving." 
•  "Tell us it is not our fault. We can feel guilty if our mum or dad is ill. We need to know we are not to blame." 
•  "Please don't ignore us. Remember we are part of the family and we live here too."  l
• "Keep on talking to us and keeping us informed. We need to know what is happening." 
•  "Tell us if there is anyone we can talk to. Maybe it could be you." 

Source: Keeping the Family in Mind project, part of Barnardo's Action with Young Carers project in Liverpool.