Parental Mental Health and its Impact on Parenting Capacity and Child Development:

Key Messages from International Research Evidence

Professor Colette McAuleyChair of Social Work University of Bradford9th BASPCAN Congress 12-15 April 2015 Edinburgh

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

The paper will address:

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 carersThis 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

Parental mental illness-Prevalence

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

Parental mental health, parenting capacity and child abuse/neglect

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.

Parental mental health , parenting capacity and child abuse/neglect

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.

Parental mental health , parenting capacity and child abuse/neglect

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 familyWorse outcomes are associated with living in one-parent families or when both parents are dealing with mental health difficulties

Factors associated with better child outcomes

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

Factors associated with better child outcomes

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

Factors associated with better child outcomes

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

Co-occurrence and the risk of child abuse and neglect

The Assessment Framework-A developmental/ecological perspective (Department of Health et al 2000)

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:

The impact of parental mental illness on children’s development

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

Birth-12 monthsChildren at this stage have a variety of different needs relating to health, cognitive and language development, emotional and behavioural development and family and social relationships. Parents may be preoccupied with their own emotions and fail to respond to the baby’s feelings. Source: Cleaver et al (2011)

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-esteemChildren 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

Children aged 5-10 yearsChild in this age group have changing health, educational, emotional/behavioural and family/social needs. They are starting to develop a sense of their own identity and learning self-care skills. Source: Cleaver et al (2011)

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.

Adolescents 11-18 yearsAlthough more able to care for some of their needs, adolescents are still vulnerable in many ways . They often need additional support when going through puberty, both from the physical and emotional perspectives. Source: Cleaver et al (2011)

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)

Listening to children in general population

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)

Listening to children in the general population

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 thisI’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)

Children living in families experiencing difficulties

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 bullyingThey (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)

Children living in families experiencing difficulties

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.

Children living in families experiencing difficulties

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

Children living in families experiencing difficulties

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

Children and informal support

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

Children and wider services

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

What children want from services

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, 33Cleaver, 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 OfficeDavies, 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. .

Key references

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 AffairsRose and Barnes (2008) Improving Safeguarding Practice. London: DCSF.

Key references