Social workers have great opportunities to support children of parents with mental illness. Get 10 tips on how to help.
“Sometimes I [June, aged 9] would come home and she [my mom] would say, ‘Who are you? Get out of my house,’ and she’d threaten to call the cops. She had no idea who I was. I was always afraid that she was going to call the police, and they would come and see that she’s insane, and they would take me away from my sister.”
— Excerpt from Daughters of Madness: Growing Up and Older with a Mentally Ill Mother by Susan Nathiel
“And at home she [Mary Wells, a mother of two girls] went to pieces. She scarcely got up to make the girls breakfast or to see them off to school in the morning, and she was often still lying in bed in the back room, drinking gin and smoking, when they came home in the afternoon. They would come to her room and stand in the doorway and look at her. Sometimes they would lie down on the bed beside her and go to sleep in that place that used to be so pleasant and comfortable. More often now the two sisters would fight with each other when they were home and she would call them to stop, but other times she would simply get up and shut the door and light a cigarette and lie down again.”
— Excerpt from Eventide by Kent Hanuf
Scope of the Issue
Although each child’s experience is unique, living with a parent with an SMI or PTSD can be embarrassing, confusing, lonely, and scary. To date, these children have received little attention. Social workers—whether they specialize in treating adults or youths—have a tremendous opportunity to see and hear these children.
Effects of Parental Mental Illness on Youths
Sometimes, parents living with an SMI “act out” in confusing, upsetting ways, such as during times of active psychosis (as described in June’s story above). Parents with difficulty dealing with strong feelings may explode in anger, scaring the child. Parents living with mood disorders may struggle with suicidal thinking and behavior, which can be very distressing. When parents act out in these ways, children may experience their parents as hostile, scary, out of control, and unpredictable. In turn, the children feel anxious, ashamed, sad, and angry.
Parents (and the other parent/family members in the home) often become preoccupied with managing the illness, and much of the family’s attention is directed to that person. Furthermore, the parent living with the SMI may detach (intentionally or unintentionally) from the child. Parental hospitalization and other separations from the parent (sometimes including the child living with other family members) can disrupt the parent-child bond. Particularly with PTSD, many parents develop emotional numbness, which also interferes with the development of close relationships. Detachment, physical separation, and emotional numbing can directly impact the parent’s ability to engage the child in everyday activities. Confused by the parental unavailability, children often feel uncared for, unloved, left out, and lonely. Children may also blame themselves for the change in their parent.
It is important to note that children growing up with parents with an SMI can also develop valuable personal strengths. For example, adults reflecting on their upbringing in this family situation have described enhanced awareness of their own compassion, sensitivity, resourcefulness, strength, and independence (Marsh, Appleby, Dickens, Owens, & Young, 1993).
Research on Child Outcomes
In general, child outcomes relate not only to the parent’s illness but to a wide range of other factors, including the child’s coping skills, the family’s socioeconomic status, the level and quality of social support, and access to treatment (Nicholson et al, 2005). As large numbers of parents with an SMI lose custody of their children (some research estimates rates of 70% to 80%, e.g., Joseph, Joshi, Lewin, & Abrams, 1999), the changes in living arrangements and family configurations can also affect child functioning.
Preliminary research has found some positive outcomes for prevention programs for children of parents living with an SMI (e.g., Beardslee et al, 2003), but more research is needed. Programs such as the Mental Health America’s Invisible Children’s Project (Hinden, Biebel, Nicholson, & Mehnert, 2002), which provides home-based, family-centered case management for parental mental illness, are promising, but little dissemination has occurred.
What Do These Young People Need?
The current arrangement of most mental healthcare separates treatment of adults and children. Youth and adult providers often do not even know each other. The facilities may be geographically distant from one another. Funding sources and chains are often distinct. Collaboration of treatment for a family is rare. Sadly, this arrangement creates a gap in care and perpetuates the problem of minimal attention to the parenting/children.
Social workers, with skills in navigating complex systems, coordinating care among a wide range of providers, and empowering the underserved, are in a unique position to address this problem. Workers specializing in treating adults (such as in adult inpatient psychiatric units, Veterans Administration hospitals, day treatment programs) are challenged to open the dialogue with all their clients about this topic. Asking about the challenges faced in parenting, the impact of the illness on their children, and what community support is available for the children can be extremely helpful.
In addition, social workers primarily treating children are encouraged to assess this facet of the child’s experience. Remembering that one in five families has a member living with an SMI, many children who social workers serve have parents dealing with these issues. Assessing the impact of the parent’s illness on the youth and asking about other adults who can help when the parent is unable can be useful.
Children of parents with an SMI need information, support, and hope. Social workers can see, hear, and support these young people in many important ways. The following are 10 concrete things that these youths need:
1. Reassurance that they’re not alone.
2. Honest acknowledgement of the parent’s difficulties.
3. Information about the illness.
You may host a family day or children’s program in which you provide psychoeducation. You can talk about famous people who have mental illness. May (National Mental Health Month) and October (containing Mental Health Awareness Week) are especially good times to highlight these topics. Talking openly about these issues helps reduce the stigma and encourages young people to confide in you.
4. To be told that they are not to blame.
5. To know that the parent loves them.
6. To be able to be kids.
7. Support in knowing how to deal with stigma and their friends.
Social workers can empower teens by providing education and support in dealing with friends. For example, social workers can role-play with teens about how to respond to friends’ unkind comments. Social workers can help teenagers weigh the pros and cons of talking about family problems with trustworthy friends.
8. Safe people to talk to.
A social worker can be this important person. You can be emotionally present and supportive to these youths and their families, providing a confidential, accepting environment. You can listen to and validate teens’ emotional pain without judging them or rushing in to give advice. Making time to be available and providing a supportive, listening ear can be invaluable.
Despite the challenges involved in dealing with mental illness, facing difficulties can bring families closer together. Both parents and children may discover strengths, resilience, and courage in themselves and each other that never would have surfaced otherwise. Families can grow by communicating openly and supporting each other so that they can navigate future difficulties more effectively.
— Michelle D. Sherman, PhD, is a licensed clinical psychologist, the director of the Family Mental Health Program at the Oklahoma City Veterans Affairs Medical Center, and a clinical associate professor in the department of psychiatry and behavioral sciences at the University of Oklahoma Health Sciences Center. She cowrote two books for teens, Finding My Way: A Teen’s Guide to Living with a Parent Who Has Experienced Trauma and I’m Not Alone: A Teen’s Guide to Living with a Parent Who Has a Mental Illness (www.seedsofhopebooks.com).
Beardslee, W.R., Gladstone, T.R., Wright, E.J., & Cooper, A.B. (2003). A family-based approach to the prevention of depressive symptoms in children at risk: Evidence of parental and child change. Pediatrics, 112(2), e119-131.
Beardslee, W.R., Versage, E.M., & Gladstone, T.R. (1998). Children of affectively ill parents: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry, 37(11), 1134-1141.
Clarke, L.A. (2006). Wishing Wellness: A Workbook for Children of Parents with Mental Illness. New York: Magination Press.
Hinden, B., Biebel, K., Nicholson, J. & Mehnert, L. (2002). The Invisible Children’s Project: A Family-Centered Intervention for Parents with Mental Illness. Retrieved June 24, 2007 from http://www1.nmha.org/children/invisibleChildrensProject.pdf
Joseph, J.G., Joshi, S.V., Lewin, A.B. & Abrams, M. (1999). Characteristics and perceived needs of mothers with serious mental illness. Psychiatr Serv, 50(10), 1357-1359.
Marsh, D.T., Appleby, N.F., Dickens, R.M., Owens, M. & Young, N.O. (1993). Anguished voices: Impact of mental illness on siblings and children. Innovations & Research, 2(2), 25-33.
Nathiel, S. (2007). Daughters of Madness: Growing Up and Older with a Mentally Ill Mother. Westport, CT: Praeger.
Nicholson, J., Biebel, K., Katz-Leavy, J., & Williams, V.F. (2004) The prevalence of parenthood in adults with mental illness: Implications for state and federal policymakers, programs, and providers. In: Center for Mental Health Services. “Mental Health, United States, 2002.” Manderscheid, R.W., & Henderson, M.J., eds. DHHS Pub No. (SMA) 3938. Rockville, MD: Substance Abuse and Mental Health Services Administration, pp. 120-137.
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Sherman, M.D., & Sherman, D.M. (2007). I’m Not Alone: A Teen’s Guide to Living with a Parent Who Has a Mental Illness. Edina, MN: Beavers Pond Press.
Weintraub, S. & Neal, J. M. (1984). Social behavior of children at risk for schizophrenia. In N.F. Watt. E. J. Anthony, L. C. Wynne and J. E. Rolf (Eds.), Children at Risk for Schizophrenia: A Longitudinal Perspective (pp. 243-263). New York: Cambridge University Press.