Parental mental health and its impact on children and adolescents

‘Parental mental health’ is a broad term, and its meaning can vary depending on context. So, it’s vital to explore with clients what this term means to them, and not assume they’ll know what it means based on diagnosis.

I started my mental health nursing training (RMN) in 2004, and qualified as a family and systemic psychotherapist in 2012, predominately working within child and adolescent mental health services including inpatient and community services. These services are organised around the child or adolescent. However, part of the thinking and work within this specialism is looking at the mental health of the parent/caregiver.

Pre-engagement

A mental health diagnosis means different things to different people. So, health professionals must consider the language used to explore what the term ‘parental mental health’ means to that person and their family before thinking wider about the systems surrounding them, including school, work, society, and government.

Before their first family psychotherapy session, some parents/caregivers may have felt dismissed by other professionals, their family and society because of a mental health diagnosis. Dismissals are not always intentional but nevertheless may make the person feel that their experiences are being minimised, rejected and unvalidated. Examples are include hearing – but not listening – to the parent/caregiver’s mental health experience, making assumptions about what their diagnosis means (such as being depressed would have meant they have self-harmed), or attempts to problem-solve dismissively by encouraging them to take their medication, go for a walk or meditate. These are all useful strategies, but if presented in a poorly timed manner, the parent/caregiver may feel unheard or misunderstood and the practitioner will need to repair the damaged caused to the relationship.

Engagement and intervention

My experience is that parents/caregivers who have a mental health problem feel guilty and blamed. When working with families, recognising and exploring these feelings can be useful. Initially there is a possibility that boundaries aren’t adhered to or unclear, so miscommunication can occur. If the parent/caregiver’s view of their mental health diagnosis is negative, helping them to relabel or reframe it in a more positive way will likely have a positive impact on them, which will impact the relationship with their child or adolescent. The conversation can include the practitioner exploring ‘stories’ surrounding the mental health diagnosis. Some questions which may be useful are:

• What do you want to tell me about your mental health?
• How will I know or how will you let me know if I say something that doesn’t sound right to you when talking about your mental health?
• How could your diagnosis affect you on a daily basis? How does it affect your family?
• How do they notice when you are well? How do you notice when you start to become unwell? What does your family notice when they start worrying about you?

Depending on the diagnosis, if mental health issues have led to the parent/caregiver being absent, short tempered, sending mixed messages and/or not able to either tolerate distress or offer comfort, this can set a precedent for the child or adolescent to replicate in future relationships. Supporting parents/caregivers to practice communication skills, develop distress tolerance skills, and explore how they show care and comfort can help create a different relational story and possibly lead to more tolerant and meaningful conversations, including beliefs about mental health and relationships.

Risk and intervention

Depending on the context, you may also need to discuss risk. Does the parent/caregiver have thoughts or plans to harm themselves or others? The impact of alcohol and substance will also need to be taken into consideration. Some parents/caregivers discuss openly that they ‘self-medicate’ for relief from some of their mental health experiences by using alcohol or other substances.

You could start by asking ‘Do you know what I mean by a risk and safety plan?’ Your relationship and style of asking this question will influence how it is said and heard. By exploring these questions, you are starting a conversation about positive risk management and (hopefully) building a supportive relationship at the same time. Being supported, contained, and listened to can help build a non-judgemental and supportive therapeutic relationship, hopefully discussing potentially these uncomfortable topics.

Even with the increase in people discussing mental health and its coverage in the media, the stigma of a diagnosis remains present. Your curiosity regarding the impact of mental health on the person and the family is continuously assessed through the relationship you create with them to feel safe enough to explore what and how their needs can be supported.

This position of curiosity is what makes exploring these ideas with families so useful and enriching for all those involved.