Parents with mental health problems and their children

About two million children live in households where at least one parent has a mental health problem, and more than one-third of all UK adults with mental health problems are parents. Most parents with mental health problems are effective parents. However, problems can arise in areas including family poverty, as less than one quarter of adults with long-term mental health problems are in work.

Changes in policy towards people with mental health problems over the past 20 years mean that more adults who have mental health problems now live in the community. Moreover, those who have recovered from mental health problems are increasingly voicing their concerns for improvements in mental health services that will enhance community inclusion. For children, changing attitudes towards child care practice have also meant an increased emphasis upon either keeping children with their birth parents, or maintaining contact with them. As a result of these policy changes, more children will be living with a parent with a mental health problem and more parents with a mental health problem will be experiencing the challenges of parenting their children.

Research-based knowledge about stress and resilience factors for parents with mental health problems and their children can help health and social care professionals make better assessments and to develop services.

Stress

A review of individuals’ interactions with their social environment noted that inequality and poverty were significant stressors in families with mental health problems. A further study identified three sets of mediating factors impacting upon family members:

● Biological (in utero) influences on foetal development.

● Relational influences such as mother-child discipline, exposure to negative behaviours, child attachment, and behaviour by parents.

● Factors that indirectly affect maternal and child functioning such as income and a lack of social resources.

Many studies have found that the stress of poverty – often due to parents with mental health problems being unable to work – are profound, and can affect the health and wellbeing of both parents and their children.

Similarly, a lack of community supports also impacts upon families and children. A study of black children’s experiences of caring found an additional burden of care where there was a lack of culturally appropriate services. It also found that these children had less contact with school and friends. Schooling can provide a complementary secure base that improves resilience a reduction in contact can lead to significant stress by reducing children’s opportunities to develop social networks and self-esteem. Wider research on “young carers” concurs with this view, noting the potential for increased isolation and impairment of educational prospects.

Research also emphasises the relationship between maternal depression and child distress. The effect is cumulative: maternal depression may result in parenting that is either too intrusive or withdrawn, creating a further cycle of disruptive behaviour by the child. One of the major stressors for families is that of loss, including the complex loss created by mental health problems because the person who has been “lost” is still present in the family. Families may feel anger towards the person with a mental health problem and subsequently experience feelings of guilt, which impairs relationships but also inhibits the process of “bereavement”. Given the importance of secure attachments in promoting and maintaining resilience, the experience of being parented or living with a person who no longer interacts with, and relates to, family members in recognised ways, can be a significant stressor for family members.

Depression among mothers has also been found to lead to children experiencing problems of attachment and bonding with their fathers, even when the father has no mental health problems. The presence of depression in either parent has also been shown to increase father-child conflict which, in turn, can create developmental problems for children. Indeed, the risk of depression among children whose fathers had depression is 45% greater than where fathers had no identified depression. Studies have also identified gender differences in how depression is expressed, with males more likely to withdraw from social situations, and to become more irritable and cynical. Several studies have also concluded that depression among fathers had negative impacts upon communication within the family. One study further noted that negativity within families was significantly more prevalent with paternal rather than maternal depression.

Resilience

Research on resilience has gone through three stages focusing on:

● Individual factors, for example, temperament and well-being.

● Relations within families.

● Ecological dimensions, highlighting the interactions between the individual and their social environment.

In addition, some research now acknowledges how the values, beliefs and everyday practices that are associated with coping are shaped by culture. An understanding of specific cultural beliefs and practices that help build resilience within individuals and families is significant. These beliefs may also challenge professionals’ own cultural and professional values.

Key building blocks for developing resilience in children and parents come from a sense of security, recognition of self-worth and the experience of control over one’s immediate environment. The importance of a secure base for individuals, and the chance to experience multiple social roles beyond that of parent or child is essential in building resilience. The foundations built through this security can enable children to explore the wider social world where friendships can be made and talents and interests pursued. A parent’s resilience is enhanced by satisfying employment, good physical health and professional, community and personal support.

Recognising the coping capacities inherent within children and parents is therefore an important prerequisite in building upon the strengths of individuals and identifying appropriate interventions.

Further reading

● SCIE research briefing: Stress and resilience factors in parents with mental health problems and their children

● Resource guide 09: Working together to support disabled parents

● Knowledge review 11: Supporting disabled parents and parents with additional support needs

● National Social Inclusion Programme Best practice guidance. 2007, NSIP