‘It’s alright mummy’

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.