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Parental Mental Health and its impact on Parenting Capacity.

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Parental Mental Health and its impact on Parenting Capacity.

  1. 1. Professor Colette McAuley Chair of Social Work University of Bradford 9th BASPCAN Congress 12-15 April 2015 Edinburgh
  2. 2.  Parental mental illness-prevalence  Parental mental illness, parenting capacity and child abuse/neglect  Factors associated with better child outcomes  The impact of parental mental illness on children’s development  Listening to children in the general population about what affects their well-being  Listening to children in families experiencing difficulties  What children and young people want from services
  3. 3. It is estimated that  between 30-68% adults with a mental illness in the UK have dependent children  there are between 50,000 to 200,000 children and young people in the UK caring for a parent with a severe mental illness (Mental Health Foundation 2010) Moreover  many studies report the rates of mental illness for mothers only  there is much less evidence regarding fathers and male carers This means that  prevalence amongst parents generally is likely to be underestimated;  there is little knowledge about the impact of fathers’ mental health on child development  the number of children living with both parents with mental illness is likely to be greater than currently known
  4. 4.  Mental health difficulties can impact on a person’s daily functioning in a number of different ways  In some cases, it can influence a person’s ability to parent their child  Some (but not all) parents may need support to meet their child’s needs  In extreme cases, it can contribute to a parent abusing/neglecting their child or putting their children in a situation where they are abused by someone else  The majority of parents who experience mental illness do not neglect or harm their children simply as a consequence of the disorder
  5. 5.  Children are more vulnerable to abuse and neglect when parental mental illness coexists with other problems such as substance misuse, domestic violence or childhood abuse  The impact of parental problems such as mental illness, substance misuse, domestic violence and learning disability on children’s welfare has been repeatedly highlighted in English child protection research studies (DH 1995) and Serious Case Reviews (Rose and Barnes 2008; Brandon et al 2009; 2010; 2012)  This is consistent with findings from Australia, Ireland and the USA.
  6. 6.  The issue of co-occurrence and its association with child abuse/neglect has been particularly highlighted in more recent research from both the UK and Australia  The impact of such parental problems on children’s development has become a core element of SW training in the UK and beyond  Understanding of child development itself been been highlighted in Serious Case Reviews as a key area for improvement in professional training. This is currently being addressed in SW training.
  7. 7. We have considerable research evidence on the factors which are associated with better child outcomes: Parent/family factors  when the parental mental health difficulty is mild in nature and short in duration  parents are more aware of the mental health difficulty and more willing to seek support/treatment  there is a secure and reliable family base  they are living in a two parent family Worse outcomes are associated with living in one- parent families or when both parents are dealing with mental health difficulties
  8. 8. Child factors  children are older at onset  children have strong coping strategies and are able to adapt to stress  children who develop an understanding of their parent’s mental health difficulties as something outside their representation of the parent as an attachment figure
  9. 9. Societal factors  Availability of other support/attachment figures  Higher socio-economic status  Having access to preventative services eg after school care, child and adolescent services and preventative programmes
  10. 10.  Likely to be multiple risk and protective factors influencing whether a child is at risk  An accumulation of risk factors can produce a negative outcome  Children are at greater risk if their parent has a mental health difficulty in conjunction with low socio-economic status, a substance abuse problem, domestic violence and/or intellectual disability  Whilst not every child living with these family problems is at risk, practitioners need to be aware of the different factors and their interplay and consider carefully when undertaking an assessment of needs
  11. 11.  Recent research has collated what we know about the child’s needs at different developmental stages  Alongside this, they have considered the impact of parental behaviours such as parental mental illness on their capacity to meet the child’s needs at each stage  Any assessment would also consider the wider family and environmental context  Some examples:
  12. 12. Parents may be less attentive to the baby’s health needs and unable to complete basic care or keep routine health checks The baby’s cognitive development may be affected because interaction between mother and baby is reduced A consistent lack of warmth and negative responses may result in the infant/child becoming insecurely attached The relationship between parents and babies may be affected if the parents’ behaviour is inconsistent or they are emotionally unavailable
  13. 13. Children may have an increased risk of heath problems due to missed school medicals Children may not attend school or on time or schooling may be disrupted due to unplanned moves Children may have a more negative self-image and/or suffer from low self-esteem Children may be fearful and anxious about their parents’ behaviour and/or display behavioural problems Inconsistent and unexpected parental behaviour may cause attachment problems. Children may be expected to assume too much responsibility for themselves and siblings
  14. 14. Adolescents may have to cope with puberty without support Parents may be unable to attend school events or encourage learning at home Adolescents may exhibit behaviour problems and emotional disturbances Adolescents may feel responsible for their parent’s difficulties and suffer low self-esteem Young people’s friendships may be restricted due to their parents’ unreliable behaviour.
  15. 15.  A crucial part of any assessment is listening to the children  Children’s subjective well-being and the factors which affect it are the subject of increasing international interest ( see Child Indicators Research Special Issue Nov 2012)  We know from quantitative surveys with children in the general population that relationships with family, positive relationships with friends and experience of being bullied had respectively the first, second and third highest effect on their subjective well-being (Goswami 2011)
  16. 16.  We know from qualitative interviews with children in the general population that close family relationships are very important to children and that they are characterised by a sense of trust related to availability and shared activities.  ‘Best friends’ provided both companionship and emotional support and the children demonstrated agency in the choice of friends and when/what they would do together n their ‘own time’  Peer bullying was a predominant issue in the lives of most children  Friends were seen as a strong protective factor (McAuley, McKeown and Merriman 2012)
  17. 17. Review of UK studies (1990-2003) where children views of living in families where there are issues of domestic violence, parental mental health difficulties or substance misuse Gorin (2004)  Children were more aware of the problems than parents realise  Some parental behaviours left them feeling confused and frightened, the most distressing being violence and conflict  The unpredictability of parents’ moods and behaviour compounded this I’m frightened to leave her in case she goes into a fit or something. When we were little…she got really down and started taking overdoses and that really scared us…when she’s really down she says I’m going to take an overdose…I’m frightened to leave her (Newton and Becker 1996 p 25 cited in Gorin 2004) It’s not just the caring that affects you…What really gets you is the worry of it all, having a parent who is ill and seeing them in such a state…of course it’s upsetting, you think about it a lot. Someone who is close to you and desperately ill is pretty hard to deal with (Frank 1995 p42 cited in Gorin 2004)
  18. 18.  Feelings of insecurity and living in an unsafe environment can impact on their school lives-poor concentration, missed days, home and school moves  Friendships can be a source of support but making and maintaining them can be very difficult for children in these circumstances leaving them isolated  The stigma and secrecy associated with violent addictive behaviours and associated chaotic impoverished lifestyles can perpetuate their sadness and isolation and affect children’s self-esteem  Likely to be the target of bullying They (local youths)… used to bully us, well they used to bully me. And hit and punch me and everything…and they would go ‘At least I haven’t a mental dad or something’ (Aldridge and Becker 2003 p 81 cited in Gorin 2004)
  19. 19.  Children’s relations with their families are often complex. They may have very close relationships with their parents and a strong sense of love and loyalty towards them  Often torn between that and feelings of anger, hurt , resentment and embarrassment  They may worry about their parents, both in relation to their parents’ safety or ability to look after themselves  Often they are in a parental role.
  20. 20.  Children in the same house may react differently and can have different experiences within the same family  Children who take on the role of carers of parents with physical and mental health problems may miss out on opportunities to mix with peers and may miss out on school  School staff may not be sufficiently aware of a particular child’s situation to provide support or make allowances
  21. 21.  Some children will find it very hard to talk to anyone about their problems  Reasons-fear of the consequences of telling, fear of not being believed, not feeling anyone could help, sense of shame and stigma  They want someone they can trust, who will listen, provide reassurance and confidentiality  They will seek informal support as main means of accessing help-wider family, siblings, friends or pets
  22. 22.  Children do not always know where to go for help-advertise where young people gather  Often favour contacting helplines initially to obtain control, remain anonymous and are available outside office hours when crises may occur-ensure helplines provide information on wider support available
  23. 23. They appreciate professionals who:  avoid jargon  listen or talk directly to them  ask them for their views  provide age-appropriate information (verbal and written) which explains what is going on in their family Often they want:  some time from problems in home and  the chance to get to know other children in similar situations
  24. 24. Aldgate, J. et al (2006) The Developing World of the Child. London: Jessica Kingsley Publishers. Brandon et al (2012) New Lessons from Serious Case Reviews: A Two Year Report for 2009-2011. London: Department for Education. Bromfield, L., Lamont, A., Parker, R., & Horsfall, B. (2010). Parenting and child abuse & neglect in families with multiple and complex problems. Child Abuse Prevention Issues, 33 Cleaver, H. et al (2011) Children’s Needs-Parenting Capacity. Child Abuse: Parental Mental Illness, Learning Disability, Substance Misuse and Domestic Violence. Second Edition. London: The Stationery Office Davies, C. and Ward,H. (2012) Safeguarding Children Across Services: Messages from Research. London: Jessica Kingsley Publishers. DH (1995) Child Protection: Messages From Research. London: HMSO. .
  25. 25. Department of Health, Department for Education and Employment and Home Office (2000) Framework for the Assessment of Children in Need and their Families. London: The Stationery Office. Gorin, S. Understanding What Children Say: Children’s Experiences of Domestic Violence, Parental Substance Misuse and Parental Health Problems. London: National Children’s Bureau. Goswami (2011) Social Relationships and Childen’s Subjective Well-Being. Social Indicators Research 3, 575-588. McAuley, C. et al (2006) Enhancing the Well-Being of Children Through Effective Interventions: International Evidence for Practice. London: Jessica Kingsley Publishers. McAuley, C., McKeown, C. and Merriman, B (2012) Spending Time with Family and Friends: Children’s Views on Relationships and Shared activities.’ Child Indicators Research 5 (3) 449-467. McAuley, C. et al (forthcoming) A Review of International Literature on Child Protection. Dublin: Irish Research Council/Department of Children and Youth Affairs Rose and Barnes (2008) Improving Safeguarding Practice. London: DCSF.

Notas do Editor

  • SCRs=local enquiries into death/serious injury of child where abuse/neglect known/suspted
  • Bronfenbrenner (1979) The Ecology of Human Development-considers children within their environment-suggests that children are surrounded by successively larger social groupings which have an influence on them.

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