1. The Impact of Parental Mental Illness on Children & Young People Lucy Hoad & Alison Towersey Hertfordshire Safeguarding Children Board Training Managers

2. Workshop Objectives To consider definitions of mental illness To recognise why parents with mental health issues may experience difficulties in meeting the needs of their children & the impact on children To take away key messages from children & young people To highlight the importance of good communication & appropriate referrals to ensure their welfare & safety

3. Adult Mental Health Parenting & Parent - Child Relationship Child Mental Health & Development Risks / Stressors & Vulnerability Factors Protective Factors & Resources THE FAMILY MODEL – illustrating key components of the links between child & adult mental health

4. Mental Illness Quiz

5. A Child’s View Very few children think their parents are completely sane. They’re right: we’re all potty half the time. Children are mystified by their parents’ behaviour. They have to cope and want to do so. They have a deep sense of allegiance. We have to open our eyes to how wide eyed are the children who are watching us. The more severe the parents illness, the more perplexing it is for the child’. Peter Wilson, Director of Young Minds, opening a conference on the impact of parental mental health problems

6. General points Strong association between parental mental ilIness and difficulties in the development and psychosocial adaptation of their children Care in the community means that mentally ill parents and their children will be spending more time together When parents require repeated hospitalisation - child care and stability of relationships are likely to be seriously disrupted Not all children whose parents are mentally ill will inevitably experience difficulties

7. The Interplay Between Inequalities Clear links have been demonstrated between poverty, mental illness, discrimination and social exclusion The combination of being from a minority ethnic group and being a woman, coupled with having parental responsibility increases risks and onset or exacerbation of mental illness, which compounds the experience of discrimination and social exclusion for all family members Royal College of Psychiatrists 2002

8. Impact on Parenting Some parents may: Be unable to ensure basic physical care & safety of child Attend to above but fail to provide warmth and praise Not appreciate child as autonomous person with own age dependant needs Expect child to behave as adult Be unable to play and provide adequate stimulation Struggle with guidance, boundaries and stability Become frustrated with unsuccessful attempts to discipline Be unaware of nature and extent of child’s emotional needs Royal College of Psychiatrists 2002

9. Factors Associated with Greater Likelihood of Parents Struggling to Meet Child’s Needs & Ensure Safety Impact of illness on adult especially chronic severe illness with co-morbid disorders Poor compliance with treatment and poor relationship with professionals Personality factors such as hostility, irritability, self preoccupation Self harm and suicidal behaviour Parents own experience of severe childhood trauma & adversity i.e. being in care, abuse History of violence, perpetrator & victim Environmental stressors, social isolation, material deprivation, poverty Parents with learning disability Royal College of Psychiatrists 2002

10. Video

11. Impact on Children Low self esteem Educational underachievement Poor quality relationships Emotional & behavioural problems Caused by: Persistent negative views expressed including rejection Emotional unavailability, unresponsiveness & neglect Inability to recognise child’s needs & maintain parent-child boundaries Ongoing use of child to meet parent’s needs Distorted, misleading, confusing communications Ongoing hostility, irritability, scapegoating & criticism Inconsistent or inappropriate expectations of child (Crossing Bridges 1998)

12. Impact on Children - Maternal Depression Risk of neglect increased (and physical abuse decreased slightly) as severity of maternal depression increased from moderate to severe More severe effect on children when symptoms actively involve the child If mother depressed in child’s first year of life cognitive deficits seen at 4 yrs, also problems in reading, cognitive tasks and behaviour at school Begum Maitra, Consultant Child and Adolescent Psychiatrist - HSCB Conference 2006

13. Parental MentaI Illness and Child Maltreatment Falkov 1996 Parents with personality disorder - children more frequently exposed to parental substance abuse, violence, suicide attempts, chronic verbal abuse Attempted suicide = increased risk of child abuse Parental depression, alcohol and drug dependence and personality disorders most frequently implicated in child abuse and child fatalities Where the paranoid delusion involves the child = HIGH RISK

14. Children more able to cope with Parental Mental Illness Tend to be older at time of onset Are more sociable & have positive relationships More intelligent Have a parent who has a discreet episode of mental illness and is fine between times Has alternative support from a trusting relationship Is successful outside of the home (Crossing Bridges 1998)

15. Messages from research /guidance helpful to your DSP role Child is at risk from their parent’s BEHAVIOUR, NOT from their diagnosis (Reder & Duncan (1999) Lost Innocents: A follow up study of Fatal Child Abuse) Your role is to assess the impact on the child and refer any concerns - irrespective of / or in the absence of information & / or formal diagnosis of Mental Illness.

16. Messages from research /guidance helpful to your DSP role Focus on specialisation (of services) has led to neglect of the overlap between adult mental illness, parental status and child development - this can sometimes make working together more problematic Importance of working in partnership - Adult and child, mental health professionals, education services, children’s social workers, health visitor and midwives, school nurses must share information in order to be able to assess risks (Recognising the vulnerability of children in particular circumstances - Mental Health of Parent or Carer 4.11.6 HSCB Child Protection Procedures 2007