Children and adolescents whose parents have a mental illness

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Children and adolescents whose parents have a
mental illness

• Dr Kim Foster
• School of Nursing, Midwifery Nutrition
• James Cook University, Cairns, Australia
• kim.foster_at_jcu.edu.au

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Childhood and adolescence an uncertain time..

• Trying it on for size experimentation
• Whos in charge? autonomy and
  dependence/independence
• Who can I trust? peer other relationships
• Who am I? - identity development
• Brain neuronal changes continue well into the
  20s, so opportunities to shape adaptive
  functions/positive change (neuroplasticity)
  (Harvard MH Letter, 2005)

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Being a young person in a family with PMI -
background

• In Australia
• 20-25 population have a mental illness (MI)
• 3 have serious MI such as schizophrenia,
  bipolar disorder, schizoaffective disorder. ?
  equal numbers of men women (SANE Aust., 1998
  Bennett Fossey, 2001)
• 29-35 of parents have a MI (Farrell et al. 1999
  Hearle et al., 1999 Jablensky et al., 1999/2000)
• Over a million children live with at least one
  parent with an MI (21.73-23.52) (Maybery et al.,
  2005)

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Being a young person in a family with PMI - risks

• 25-50 chance of psychosocial problems (Billings
  Moos, 1983 Worland, Weeks Janes, 1987)
• 2/3 experience adverse psychosocial /or mental
  disorders as adults (Rutter Quinton, 1984
  Werner, 1995)
• Risk factors include
• individual (genetic, temperament, gender, age
  intelligence, etc)
• social environmental (poverty, housing,
  education, isolation),
• family (marital conflict, family stress),
• parental (psychosis, conflict/violence/abuse,
  parentification)

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Being a young person in a family with PMI -
resilience

• Dialectical relationship between risk
  protective factors -gt vulnerability resilience
• 5 clusters of outcome largest cluster (30)
  appeared competent. Over half functioning okay
  across all domains (Mowbray et al. 2004)
• Protective factors include
• Internal (eg. intelligence, internal locus of
  control, easy temperament, problem-solving,
  sense of humour, optimism, hobby, ve
  self-concept, high EI)
• External (eg. ve caregiver relationship, ve
  sibling rel., music, support from other adults,
  ve role model)

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Being a young person in a family with PMI -
experiences

• Disrupted life family, emotional disturbances,
  sense of uncertainty, feeling unloved (Shih,
  1995)
• PMI -gt ve effect on academic performance,
  concern re genetic risk, craving information
  (Garley et al., 1997)
• Ripple effect of PMI on family, stigma
  isolation, need for support services (Farrell et
  al., 1999)
• Sense of responsibility, struggling to cope
  (Meadus Johnson, 2000)
• Good days bad days (Riebschleger, 2004)

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The experiences of adult children of parents with
serious mental illness -overview of the study

• Qualitative inquiry using multiple methods
• (thematic analysis and narrative analysis
  autoethnography)
• Purposive sample - 10 participants (incl.
  researcher)
• 25 - 57 yrs (8 female, 2 male)
• Unstructured interactive interviews member
  checks

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Themes of experience
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Being uncertain youd think this roller
coaster was never going to stop
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Uncertainties

• Mum was all wrapped up with nuclear warfare
  and she really believed the world was going to
  endI grew up being told that I wasnt going to
  live a very long life. The world was going to
  end, mum knew that quite clearlyI mean I knew
  that that wasnt realI had enough sort of
  connection, Im thinking of my high school years
  nowbut it meant that you couldnt talk about the
  positives in life, you couldnt. S
  ue (as a teenager)

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• you grew up with, you knew when she was going
  off, shed get these wild eyes and shed look
  like a caged animal, and that was really scary,
  you knew she was going off. And dad would ring
  the doctor and mum would go off again.
• Marnie (as a teenager)

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• I still couldnt find a niche for myselfI was
  still so hopelessly muddled up in my thinking. I
  sort of now wonder how I even worked at all,
  because I couldnt concentrate on anything,
  especially my work, and I was always sort of
  drifting off into, you knowthis endless task of
  trying to make sense of my worldand doubting my
  own essencemy own place in the world, even my
  identity, like, who the hell am I really?, you
  know?
• Eccles (at 18)

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Struggling to connect we were super close and
now were not
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Struggling to connect

• I really dont know what a relationship is really
  between a mother and a daughter, a normal one,
  because its always been in the reversethe
  disadvantages of having a parent with serious
  mental illnessthe biggest one would be my
  relationship with my mother, that I lost that,
  that it was never, it was always in the reverse,
  so I havent got that closeness.
• Marnie

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Being responsible I think I grew up in a hurry
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Being responsible

• I think I grew up in a hurry, took on
  responsibilities very early in lifewhich no-one
  asked me to take on, but which I probably took on
  as a method of survival really. There didnt seem
  to be any other way or anybody else to take on
  those responsibilities probably much of what I
  did was driven by a fear that the family unit
  would be even further disintegrated that it
  already was.
• Sue

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Seeking balance I had to be in control of the
situation
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Seeking balance

• I was always an actor, and interestingly, when I
  think about it, thats why Im a good actor.
  Because the things that I will not allow myself
  to express, my self and myself, its great.
• On stage you know how its going to turn out. You
  can be mad, you can cry, you can laugh, because
  you know where its going. Its safe. And you can
  express your emotions safelybecause the storys
  written. You know how its going to come out and
  so you can be somebody else, you can have all
  these feelings that you would never allow
  yourself to be seen having, you know, a loss of
  control.
• Naomi

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Messages from COPMI for practice

• Please notice us. Please listen.
• Ask us what we know, think, want
• Dont ignore us. Tell us whats going on, now
  for the future ( sort out confidentiality
  please)
• Look at how weve coped. Dont pathologise us. We
  hate it. Were not our parents
• Give us people to talk to who understand dont
  judge us
• Give us a break from being carers
• Help keep our family together if you can
• (Foster, 2006 Bilsborough, 2004).

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Looking forward Strengthening resilience for
children families

• Facilitating emotional intelligence in children
• Understanding contradictions, uncertainty
  ambivalence as not needing to be fought/escaped
  from, but as usual or normal (change as a
  constant?)
• Emphasising notions of choice
  self-determination
• Encouraging social emotional connections
  providing supports
• Appreciating resilience as a dynamic spiral

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Working with families

• Assessment of parental role and dependent
  children on intake to service
• Greater focus attention to needs of children
  and families with PMI from marginalised/diverse
  backgrounds
• Understanding families as unique whole
• Viewing families as resilient (Walsh, 2006), as
  well as individual members as resilient
• Understanding that families with problems can
  still be successful
• Focusing on strengths, abilities successes, as
  well as problems

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Future directions

• Using a family-focused service approach
• Using therapeutic pluralism (complementary
  approaches)
• Exploring the inter-generational impact of PMI
  (including the notion of narrative inheritance)
• Working with the dynamic ebb flow of resilience
• www.copmi.org.au

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References

• Bennett, C., Fossey, E. (2001).
  Characterisation, Recognition, and Outcome of
  Schizophrenia and Related Disorders. In G.
  Meadows B. Singh (Eds.), Mental Health in
  Australia Collaborative Community Practice (pp.
  269-282). South Melbourne Oxford University
  Press.
• Billings, A., Moos, R. (1983). Comparisons of
  children of depressed and non-depressed parents
  A social-environmental perspective. Journal of
  Abnormal Child Psychology, 11(4), 463-486.
• Bilsborough, S. (2004). What we want from adult
  psychiatrists and their colleagues Telling it
  like it is. In M. Gopfert J. Webster (Eds.).
  Parental Psychiatric Disorder Distressed Parents
  and their Families. Cambridge UK.
• Farrell, G. A., Handley, C., Hanke, A., Hazelton,
  M., Josephs, A. (1999). The Tasmanian
  children's project report The needs of children
  and adolescents with a parent/carer with a mental
  illness. Tasmanian School of Nursing and the
  Department of Health and Human Services.
• Foster, K. (2006). A narrative inquiry into the
  experiences of adult children of parents with
  serious mental illness. Doctoral thesis, Griffith
  University.

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• Garley, D., Gallop, R., Johnston, N., Pipitone,
  J. (1997). Children of the mentally ill a
  qualitative focus group approach. Journal of
  Psychiatric Mental Health Nursing, 4(2),
  97-103.
• Hearle, J., Plant, K., Jenner, L., Barkla, J.,
  McGrath, J. (1999). A Survey of contact with
  offspring assistance with childcare among
  parents with psychotic disorders. Psychiatric
  Services, 50(10), 1354-1356.
• Jablensky, A., McGrath, J., Herrman, H., Castle,
  D., Gureje, O., Morgan, V., Korten, A. (1999).
  People living with psychotic illness An
  Australian study 1997-98. An overview.
  Commonwealth of Australia.
• Maybery, D., Reupert, A., Patrick, K., Goodyear,
  M., Crase, L. (2005b). VicHealth Research
  Report on Children at risk in families affected
  by parental mental illness. Melbourne Victorian
  Health Promotion Foundation.
• Meadus, R. J., Johnson, B. (2000). The
  experience of being an adolescent child of a
  parent who has a mood disorder. Journal of
  Psychiatric Mental Health Nursing, 7(5),
  383-390.
• Mowbray, C. T., Bybee, D., Oyserman, D.,
  Allen-Meares, P., MacFarlane, P., Hart-Johnson,
  T. (2004). Diversity of Outcomes Among Adolescent
  Children of Mothers With Mental Illness. Journal
  of Emotional and Behavioral Disorders, 12(4),
  206-221.

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• Riebschleger, J. (2004). Good days and bad days
  the experiences of children of a parent with a
  psychiatric disability. Psychiatric
  Rehabilitation Journal, 28(1), 25-31.
• Rutter, M., Quinton, D. (1984). Parental
  psychiatric disorder Effects on children.
  Psychological Medicine, 14(4), 853-880.
• Shih, H-H. (1995). Growing up with a mentally ill
  parent A phenomenological study of chinese
  children in Taiwan. Unpublished doctoral
  dissertation. University of Texas, Austin.
• Walsh, F. (2006). Strengthening family
  resilience. (2nd ed). New York Guilford Press.
• Werner, E. E. (1995). Resilience in development.
  Current Directions in Psychological Science,
  4(3), 81-85.
• Worland, J., Weeks, D. G., Janes, C. L. (1987).
  Predicting mental health in children at risk. In
  E. J. Anthony B. J. Cohler (Eds.), The
  invulnerable child. (pp. 185-210). New York
  Guilford Press.