Parental mental health

Kim Rutter, Marketing and Communications Manager at the Social Care Institute for Excellence (SCIE), UK, describes research commissioned by SCIE into the experiences of parents with mental health problems and their children, and how families can best be supported by services.

Over one-third of all adults with mental health problems in the UK are parents. Mothers are more likely to suffer mental health problems than fathers, and single mothers are most vulnerable. Potential stressors leading to parental mental health problems include a lack of money, bereavement, breakdowns in valued relationships, loss of control at work and long working hours.

The Social Care Institute for Excellence (SCIE) has recently published three research briefings relevant to parental mental health. This article highlights some key messages from the briefings. The research shows that most parents with a mental health problem are able to parent effectively.

Less than a quarter of parents with a long-term mental health problem are in work, so many have to rely on state social security benefits, meaning that their children may be living in poverty or at least living with the consequences of being a member of a low-income family. It is not unusual for these families to experience social disadvantage and low social support. Children from black and minority ethnic (BME) families face additional stress when they feel that services are discriminating against them because of their ethnic origin.

A multi-agency approach

Research clearly indicates that stress (and resilience) within families where parents have mental health problems can arise in various contexts. Service organisations therefore need to take a multi-faceted and multi-level approach to building resilience through the provision of effective support for individuals, families and communities.

In practical terms, overall effectiveness in service delivery involves a multi-agency approach that brings together child and adolescent mental health services with adult mental health and children's services to surmount organisational barriers and deliver partnership working. This also needs to be coupled with early intervention and vigorous outreach.

Research shows the reluctance of some adult mental health professionals to take a whole-family approach because they feel, in particular, that childcare issues are not their responsibility. Practitioners are therefore advised to read the National Social Inclusion Programme which emphasises the need to work in partnership with families.

In order to be effective, research also shows that services promoting resilience will need to recognise the social and cultural contexts in which such resilience is expressed. This is particularly relevant where the needs of different groups have been overlooked, for example in terms of gender and ethnicity.

Practical support for children

Research with children of parents with a mental health problem shows that there are a number of practical ways that they can be supported. Children value information about their parent's mental health condition. They want to be included in planning and decision-making and to be seen as knowledgeable about their parent's condition so that their observations are taken seriously.

They need their teachers to show more understanding about their situation and help to find time and a suitable environment to complete schoolwork if needed. The opportunity to enjoy time outside the home to follow their own interests without feeling guilty is also important, as are befriending schemes and young carer support groups.

Black and minority ethnic parents

People from BME communities are poorly served by mental health services. BME parents with mental health problems are often reluctant to use existing services as these are often not culturally sensitive to their needs. In turn, reluctance to access services may result in mental health problems becoming more severe before diagnosis, treatment and support are obtained.

Mental health problems among BME parents, compounded by lack of support and treatment, can have enduring effects upon their children and contribute to their over-representation in the childcare system.

Limitations of research

A recent exercise by SCIE, that examined the literature on parental mental health problems in families, recognises the limitations in the current state of research, identifying:

  • the lack of research on males within families
  • a predominance of research material focusing on depression
  • a limited recognition of the child's perspective within the family.

Research related to the cultural context of stress and resilience is limited in both the US and the UK, and remains an area to be more thoroughly investigated. The absence of fathers in research suggests that there is much work to be done in investigating the importance of their role within families experiencing mental health problems. Finally, a greater emphasis on mental health problems other than depression needs to be developed, so that the impact on families of conditions such as schizophrenia can be assessed.

There is evidence to show that the 'voices' of individual service users and carers, especially children's voices, have been largely ignored. In listening to service users, recognition that resilience is present within families should encourage the demand for assessments and services to recognise, build on and maintain the strengths of service users. Allied to this would be assessments identifying those strengths in the wider community that can facilitate access for support and guidance.

Practice guidelines

In late spring of 2009, SCIE, in collaboration with the National Institute for Health and Clinical Excellence (NICE), is publishing practice guidelines about planning, delivering and evaluating services to support parents with mental health problems and their children. The guidelines will be for health and social care staff in adult and children's services and will be available on the SCIE website.

References

Parrott L, Jacobs G and Roberts D. 2008. Research briefing 23: Stress and resilience factors in parents with mental health problems and their children. London: SCIE.

Roberts D et al. 2008. Research briefing 24: Experiences of children and young people caring for a parent with a mental health problem. London: SCIE.

Greene R, Pugh R and Roberts D. 2008. Research briefing 29: Black and minority ethnic parents with mental health problems and their children. London: SCIE.

The SCIE research briefings are all available on its website (www.scie.org.uk) or can be ordered directly from SCIE.

Social Care Institute for Excellence
www.scie.org.uk

Telephone: +44 (0)20 7089 6840
email: info@scie.org.uk

National Institute for Health and Clinical Excellence
www.nice.org.uk

First published DPPI Journal, Issue 65: Spring 2009

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