Talking to children about parental mental illness: The experiences of well parents

Talking and making meaning about parental mental health problems: The role of children's family caregivers

When a parent is less able to meet their children's needs due to a severe and enduring mental health problem (MHP), other adult family members often help with childcare. We present a Grounded Theory of how children's family caregivers construct meaning about the parental MHP and communicate about it with children. Nineteen caregivers participated in qualitative interviews. Each supported at least one related child aged 4-17 years with a parent with MHPs. We found that caregivers engaged in a Core Social Process of providing protection in uncertainty. This comprised three categories as follows: shaping the interactional space, communicating through the developmental process, and engendering a sense of safety. Caregivers appeared to act from a Key Social Positioning of developing a caregiver identity. The findings implicate family-focused provision of mental health and social care. Clinical recommendations are made for whole-family interventions and the role of marital and family therapists.

Obstacles and facilitators to communicating with children about their parents' mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa

BACKGROUND

Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts.

METHODS

A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis.

RESULTS

Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations.

CONCLUSIONS

This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.

PROTOCOL: The support needs of families living with parental mental illness: A qualitative systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows: To review existing qualitative research on the experiences of families living with parental mental illness from the perspective of (i) children, (ii) parents who have a mental illness) and (ii) the well parent. To synthesise qualitative evidence on the experience of living with parental mental illness and the experience of and attitude towards services from the perspective of (i) children, (ii) parents who have a mental illness and (ii) the well parent in order to develop the understanding of the needs of families and the implications for service provision.

Parenting experiences of Chinese mothers living with a mental illness

BACKGROUND

Although the experiences of mothers with mental illness are well researched in Western countries, little is known about the experiences of Chinese mothers. This study aims to explore the experiences of family life and parenting of Chinese mothers, in the context of their mental illness.

METHODS

Fourteen Chinese mothers with mental illness undertook in-depth, semi-structured interviews. Interpretative Phenomenological Analysis was employed to guide the data analysis.

RESULTS

Seven themes were identified: motherhood as a central identity, the stigma associated with being a mother with mental illness, participants' perceptions about the impact of mental illness on parenting and their children, experiences of talking to children about mental illness, how having children impacts mothers' illness and recovery, and support obtained and needed. Similar to Western mothers, Chinese mothers experienced stigma and fluctuating mental illness symptoms which impacted on parenting. Unlike mothers based in Western countries, the mothers interviewed in this study highlighted complicated co-caring relationships with parents-in-law and did not raise child custody concerns.

CONCLUSIONS

Mental health professionals need to have the skills to identify and recognize the mothering role of their clients. Culturally sensitive interventions are required to assist Chinese families where mothers have a mental illness. Future research is required to investigate family experiences of parental mental illness from the perspectives of children, partners, and mental health professionals.

A Sustainability Model for Family-Focused Practice in Adult Mental Health Services

BACKGROUND

Translating evidence-based practice to routine care is known to take significant time and effort. While many evidenced-based family-focused practices have been developed and piloted in the last 30 years, there is little evidence of sustained practice in Adult Mental Health Services. Moreover, many barriers have been identified at both the practitioner and organizational level, however sustainability of practice change is little understood. What is clear, is that sustained use of a new practice is dependent on more than individual practitioners' practice.

DESIGN AND METHOD

Drawing on research on sustaining Let's Talk about Children in adult mental health services and in the field of implementation science, this article proposes a model for sustaining family focused practice in adult mental health services.

SUSTAINABILITY MODEL FOR FAMILY-FOCUSED PRACTICE

An operational model developed from key elements for sustaining Let's Talk about Children identifies six action points for Adult Mental Health Services and their contexts to support the sustainability of family-focused practices. The model aims to support Services to take action in the complexity of real-world sustainability, providing action points for engaging with service users and practitioners, aligning intra-organizational activities, and the wider context.

CONCLUSION

The model for sustaining family-focused practice draws attention to the importance of sustainability in this field. It provides a practical framework for program developers, implementers, adult mental health services and policy-makers to consider both the components that support the sustainability and their interconnection. The model could be built on to develop implementation guides and measures to support its application.

Family understanding and communication about an adult relative's mental health problem: A systematic narrative review

WHAT IS KNOWN ON THE SUBJECT?: Adults who support an adult family member with a severe and enduring mental health problem often experience carer burden. Over time, this often negatively affects their mental and physical health and social well-being. Understanding and communicating about mental health problems in families can help to improve resilience and coping among both adults and children. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: We conducted a review of studies looking at how adult relatives understand and communicate about an adult family member's mental health problem. The findings highlight that how relatives make sense of MHP is related to historical family relationships, their mental health literacy and whether they see themselves as a "carer" or not. The findings also show that little research to date has explored how adult relatives talk with children about their parent's difficulties, and how the adults' understanding might affect what children learn about the MHP. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a research gap to be addressed regarding family communication with children about parental mental health problems. This knowledge gap likely impacts family-focused mental health nursing and therapy provision. Mental health nursing, therapeutic and support workers and advocates are ideally positioned to assist relatives with improving their mental health literacy and confidence communicating about mental health, and to promote inclusion of relatives and children in interventions. ABSTRACT: Introduction Relatives are profoundly affected by an adult family member's severe and enduring mental health problem (MHP). The burdens of caring impact on adult relatives' emotional, physical and social well-being. How relatives make meaning and communicate about the MHP is thought to affect family talk about mental health, and this can impact family coping and well-being. Aim No review has yet drawn together research about how adult relatives of people with severe and enduring MHP make meaning and communicate about their relatives' difficulties. We aimed to address this gap. Method We conducted a systematic review of peer-reviewed primary research. SCOPUS, PubMed, Psychnet, SCIE, Cochrane and CINAHL+ databases were searched. Results Nineteen papers qualified for inclusion. Findings are organized under four themes: making meaning about the MHP and affected individual; conceptualizing the self in the presence of the MHP; meaning-making processes underlying relatives' well-being outcomes; and relatives' perspectives on family talk about the MHP. Discussion Historical relationships, caregiver identity and mental health literacy moderate relatives' understanding and talk about the MHP. Implications for practice Psychoeducation and communication support for relatives should be provided by mental health practitioners. Future research should address familial communication about MHP, including with children.

[Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services]

Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services Parenting can be a key element in the psychiatric rehabilitation process, but it may come with many challenges for parents with mental health problems. Illness symptoms, together with social and sociocultural factors, can have adverse effects on family life or parenting behaviors and entail severe consequences for a child's psychosocial development. Bidirectional interactions can increase parental burden and thus worsen a parent's course of illness. This vicious circle can be broken by the provision of early and adequate support of mothers and fathers with mental health problems. Adult mental health services can make an important yet often underestimated contribution here. This article refers to parents' resources and needs and introduces both opportunities and challenges for adult mental health services when it comes to dealing with parenting needs. Mental health professionals are in a pivotal position for extending adequate support to clients on their parental needs. These professionals' skills and knowledge regarding parenting are essential for the successful implementation of family-focused practices in adult mental health services. Beyond the individual level, there is a need for policies and guidelines stipulating the integration of family and child perspectives in adult mental health services. In a broader view, a program from Finland shows how mental health professionals as well as peers can support parents and their families during the treatment process.

Children of Parents with Mental Illness: The Need for Family Focussed Interventions in India

Family interventions have been an integral part of mental healthcare in India for several decades. This paper highlights the need for an emerging change in the nature of family interventions in India-from generic interventions for heterogeneous caregiver groups to interventions addressing particular needs based on family stages and structures. It makes a case for recognizing the experiences and needs of one such group, that is, families affected by parental mental illness with children in their care and summarizes the current status of research on this topic in the Indian and global context. It presents implications for future research in India and discusses preliminary ideas for professionals working in adult mental health settings to address the needs of children and families affected by parental mental illness.