Coping and resilience of children of a mentally ill parent

This paper examines the needs and stress reactions of children of mentally ill parents, as well as coping and resilience. The study is based on the interviews of six 9-11 years old children and narratives of seventeen female grown up children of mentally ill parents. The younger and older children of the mentally ill parents had not been informed about their parent's illness. The illness of the parent aroused a variety of emotions in them. The children used both practical problem solving and emotional coping mechanisms. Informal social support was available to them but seldom from the public services. It is recommended that professionals in mental health and child welfare services clarify their roles when working with mentally ill parents. The best interest of the child and the parenting they need should be carefully assessed. Open care measures should be offered to families early enough to prevent serious child welfare and mental problems.     

Parents of mentally ill adult children living at home: rewards of caregiving

In the context of parents caring at home for an adult child with mental illness, this study explored the positive aspects and rewards of caregiving. Specifically, it measured the extent to which parents perceive their ill child as providing assistance and support--practical and emotional--and perceive their own caregiving as emotionally and mentally rewarding. One parent from each of 93 households completed a self-administered questionnaire. All the parents reported receiving help and support from their child, but perceived the satisfaction gained from fulfilling their parental duties and from learning about themselves as far more important. Their assessment of this satisfaction was entirely unaffected by the subjective and objective burdens on them and the severity of the child's illness.     

Utilizing role theory to help employed parents cope with children's chronic illness

Role theory is utilized to detail a six-step process for developing balanced coping through role negotiation. As applied in this paper, the role theory framework provides health educators with a useful tool for helping employed parents cope with a child's chronic illness. The emphasis is on partnering with parents or primary caregivers to identify, understand and manage the multiple role demands of working parents with chronically ill children. Role theory suggests ways health educators can support balanced coping by educating families about the demands of a child's illness, and helping to reduce those demands, helping to increase family resources, supporting parents and facilitating role negotiation. The ultimate goal is the development of balanced coping strategies that (1) meet the medical and emotional needs of the ill child, (2) allow parents to maintain their physical and mental health, and (3) enable parents to meet the demands of their other roles (e.g. paid employment).     

Parenting and the significance of children for women with a serious mental illness

Increased time in the community has made developmental life tasks of adulthood more relevant to individuals with severe mental illness (SMI). Parenting and motherhood are thus important areas of study, since it has been established that women with SMI are likely to have children. Previous research has concentrated primarily on the deleterious effects on the child of having a mentally ill parent. Mothers' capabilities or problems in parenting and the meaning of motherhood from the women's perspective have received limited attention. In the present interview study of 24 mothers with mental illness, satisfaction and self-reported competency in parenting were found to be high, although significant economic and some support problems were reported. Women described the meaning of children and the significance of the parenting role, yet realistically portrayed their concerns over discipline and the effects their problems have. Implications for mental health services are discussed.     

Foster and Adoptive Parent Perspectives on Needs and Services: a Mixed Methods Study

Caring for children with complex needs severely stresses foster and adoptive parents, but few studies have examined their perspectives on needs and services. To examine parental views, the authors analyzed four focus groups (n = 27 participants) and one state-wide survey (n = 512 respondents, 42% of 1206 contacted) of foster and adoptive parents in one state. Results highlighted inadequate communication between providers and families, cultural and legal barriers, needs for parent training and preparation, the importance of several types of parent supports, and needs for specialized mental health treatment for the children. Surveyed parents identified children’s behavior problems as their top challenge, and over half rated the availability of mental health providers who treat attachment and family as insufficient. The findings suggest specific areas in which state leaders could enhance training and supports for child welfare staff and foster and adoptive parents and improve mental health services for children in foster and adoptive care.     

Meeting Children's Mental and Physical Health Needs in Child Welfare: The Importance of Caregivers

Caregivers in the child welfare system are an important element in ensuring that mental and pediatric health services for their children are utilized appropriately. The high prevalence of mental and physical health problems of children in the child welfare system along with the inadequate utilization of health services make the role of caregivers essential for improving health outcomes. This article explores the barriers to meeting the health needs of this vulnerable population of children and how different types of caregivers (unrelated foster, kinship foster, and birth parents) utilize mental and pediatric health services. Child welfare caseworkers need to increase their communication with caregivers, assess adherence to health care recommendations, and help alleviate barriers to care.     

白血病患儿及家长的心理状况及干预

目的调查白血病患儿及家长心理健康状况和疾病应对方式,为心理干预提供依据。方法采用焦虑性情绪障碍筛查表、抑郁障碍自评量表、患病行为问卷、SCL-90症状自评量表、医学应对方式和应对方式问卷,对60例白血病患儿（初治和强化组各30例）、39例非恶性血液病患儿（对照组）及52例健康组儿童和家长,进行心理卫生和应对方式调查。结果与健康组相比,白血病组患儿及家长存在较多负性情绪,初治组更明显;白血病组较对照组更多采用回避和放弃方式来应对疾病,其家长的自责、求助和幻想的分数高于对照组。结论白血病儿童及家长存在较多的心理问题及消极应对方式。有效的心理干预有助于提高患儿的生活质量和改善家长的身心健康。     

Chronic Sorrow in Parents of Premature Children

The relationship between premature children experiencing a stressor event and parents experiencing chronic sorrow was studied Data indicated that the subjects experienced feelings of loss/grief and fear when their premature child experienced the stressor events of illness, surgery, medical and behavioral problems, chronic illness, and day care, as well as when another child surpassed their child developmentally The subjects offered in-depth feedback directed to professionals to assist them in coping These data may help professionals to become aware of the emotional responses of parents of premature children and to assist them in copmg with their needs/concerns, preventing major adjustment and psychosocial problems for both the child and parents.     

Anxiety and/or Depression in 10–15-Year-Olds Investigated by Child Welfare in Canada

PurposeTo examine five types of child maltreatment and other risk correlates to establish associations with anxiety and/or depression confirmed or suspected in children investigated by child welfare services.MethodsThe present study used the data of a subsample of 10–15-year-olds (n = 4,381) investigated by child welfare services across Canada obtained from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003. The analysis took into account the nested structure of the data by considering the variability existing among families and the clustering of siblings within them. Several models were analyzed for the construction of the presented hierarchical model. Striving for parsimony, we included only statistically significant variables in the final model.ResultsThe strongest associations were found with child substance abuse, substantiated emotional maltreatment, primary caregiver's mental health problems, and substantiated sexual abuse. Among the child maltreatment variables, substantiated physical abuse and substantiated exposure to domestic violence did not show any statistically significant associations with anxiety and/or depression in the model.ConclusionThis analysis helped us in understanding child maltreatment and other adverse experiences in childhood that were related to anxiety and/or depression, which can further aid in the development of mental health and child welfare policies and programs.     

Recasting research into children's experiences of parental mental illness: beyond risk and resilience

Children who live with a mentally ill parent are viewed primarily as being 'at risk' of developing a mental illness themselves and those who remain well are considered extraordinarily resilient. This particular risk/resilience discourse is embedded within larger contemporary discourses about risk and childhood. Childhood is seen as a critical period of development during which children need protection due to their physical and psychological vulnerabilities. In this paper, the implications of this dominant casting of children are explored and it is argued that the conceptual repertoire about those living with a mentally ill parent should be expanded. A critique of the literature that established the risk/resilience discourse is followed by a discussion of research about parenting with a mental illness within which children are surprisingly absent. Recent thinking about children arising out of the 'new' social studies of childhood is summarized to illustrate its resistance to the hegemonic image of children as passive, developing, 'unfinished' persons. A recasting of children as complex young persons who have competencies as well as vulnerabilities linked to their developmental stages, would lead to different lines of inquiry about children's experiences of mental illness in a parent.     

Prevalence of serious mental illness among parents in the United States: results from the National Survey of Drug Use and Health, 2008–2014

PurposeThis brief research report presents findings from a US national household survey on the number and percentage of parents with mental illness.MethodsUsing combined annual data from the 2008–2014 National Survey on Drug Use and Health, parents were defined as having children in the household from birth to 18 years. Prediction models developed in an earlier clinical study using a National Survey on Drug Use and Health subsample were used to estimate serious mental illness (SMI).ResultsA total of 2.7 million parents (3.8%) had a SMI in the past year and 12.8 million parents (18.2%) had any mental illness in the past year. Mental illness was more common among mothers than fathers and least common among Asians compared with other races. SMI was less prevalent in parents who were aged 50 years and older compared with younger age groups.ConclusionsThe burden of mental illness in parents is high in the United States, especially among mothers. Physicians who treat parents should routinely screen for mental illness and discuss its implications for parenting.     

Living with a mentally ill parent: exploring adolescents' experiences and perspectives

Although a considerable body of research has described the implications of parental mental illness, the perspectives of children and adolescents have rarely been addressed. In this article, I explore adolescents' experiences in everyday life, based on an action-oriented study of a Norwegian online self-help group for adolescents (aged 15 to 18) with mentally ill parents. The analysis was conducted through participant observation of the group for 2 years. The adolescents experienced a variety of difficult challenges related to their parent's mental illness: lack of information and openness; unpredictability and instability; fear; loneliness; and loss and sorrow. However, they also discussed strategies for active management of the challenges arising from the family situation. I argue that these adolescents can be understood as vulnerable as well as active participants in managing their everyday lives. I emphasize the importance of including perspectives of children and adolescents in further research so as to improve health care for families with parental mental illness.     

Mental health outcomes among parents of a child who has a developmental disability: Comparing different types of developmental disability

BackgroundThere is very little information on the effects of different types of developmental disability on the mental health of parents of children who have a DD.ObjectiveThis paper compared the mental health of parents of children with Autism Spectrum Disorder (ASD), Down syndrome, Fetal Alcohol Syndrome (FAS) and other types of DD.MethodsA cross-sectional design was used to examine population-level administrative health data for mental health outcomes in cohorts of fathers and mothers of children with four different types of a DD. As well as type of DD, additional variables were examined, these included: sex of the parent, age of the parent at birth of the child with the DD, income, sex of the child with the DD, number of children in the family and place of residence.ResultsFor both fathers and mothers odds of a diagnosis of depression or another mental health problem were associated with type of DD. Parents of children with FAS experienced the greatest odds of a depression or other mental health diagnosis. Odds of a diagnosis for fathers were associated with low income. Odds of a diagnosis for mothers were associated with the sex of the child with the DD.ConclusionsThese findings are important for understanding families which include a child with a DD, as a guide for future research, and for developing effective programs and services for these parents.     

A Preliminary Analysis of the Receipt of Mental Health Services Consistent With National Standards Among Children in the Child Welfare System

Objectives. We sought to examine the extent to which children in the child welfare system receive mental health care consistent with national standards.Methods. We used data from 4 waves (3 years of follow-up) of the National Survey of Child and Adolescent Well-Being, the nation''s first longitudinal study of children in the child welfare system, and the Area Resource File to examine rates of screening, assessment, and referral to mental health services among 3802 youths presenting to child welfare agencies. Weighted population-averaged logistic regression models were used to identify variables associated with standards-consistent care.Results. Only half of all children in the sample received care consistent with any 1 national standard, and less than one tenth received care consistent with all of them. Older children, those exhibiting externalizing behaviors, and those placed in foster care had, on average, higher odds of receiving care consistent with national standards.Conclusions. Adverse consequences of childhood disadvantage cannot be reduced unless greater collaboration occurs between child welfare and mental health agencies. Current changes to Medicaid regulations that weaken entitlements to screening and assessment may also worsen mental health disparities among these vulnerable children.Ensuring that children in the child welfare system receive high-quality mental health services has been a policy priority for the past 2 decades, and professional organizations have proposed standards of care specifically tailored for this population. However, there is no information on the extent to which children in the child welfare system actually receive care that is consistent with these national standards.Attention to standards-consistent mental health care is important because children in the child welfare system have very high needs for mental health services. Nearly half of all children coming into contact with child welfare agencies nationally have clinically significant emotional or behavioral problems,¹ and 40% to 60% of children in the child welfare system may have a psychiatric diagnosis.² Local and regional studies have also documented high rates of problems across several domains among these children.^3–5 Children in foster care have between 10 and 20 times the rate of utilization of mental health services when compared with children maintained within their homes,^6–8 and national estimates suggest that the point prevalence of psychotropic medication use is 13.5%⁹—far above the 4% seen among privately insured children¹⁰ and the 5% to 6% seen among Medicaid-enrolled children.^11,12Given this magnitude of service use and the unique vulnerabilities of children in child welfare, the Child Welfare League of America proposed standards for the provision of health and mental health services for children in foster care in 1988.¹³ The American Academy of Pediatrics proposed similar standards in 1994 and in 2002,^14,15 as did the American Academy of Child and Adolescent Psychiatry in 2001.^16,17 These recommendations are highly convergent with regard to mental health care and suggest that all children should receive a mental health screening when placed into foster care, a subsequent comprehensive mental health assessment by a mental health professional within a month of being placed into foster care, and a systematic, coordinated approach to the delivery of services to meet children''s ongoing mental health needs.These standards since have been operationalized for use by child welfare agencies and extended to children who are not placed in foster care. For example, the Council on Accreditation, presumably informed by the literature documenting significant mental health needs among non–foster-care child welfare populations,¹ evaluates child protective services agencies on their case-management abilities, including needs assessment and the provision of counseling and intensive mental health services.¹⁸ These standards govern processes of care—not quality of clinical care—and are primarily designed to assist child welfare agencies in implementing organizational structures and processes that can improve child well-being. Passage of the 1997 Adoption and Safe Families Act^19–21 provided additional federal impetus to standards development, and states are currently evaluated on the extent to which children “receive adequate services to meet their … mental health needs.”²²Despite professional consensus and federal legislation and regulation, there is little information on whether children in the child welfare system actually receive care that is consistent with these standards. In 2002, Halfon et al. reported on the overall inadequacy of services available to children in foster care²³; a key informant survey of state and county mental health agencies found that only one third of all mental health agency respondents reported being aware of these standards²⁴; and another study found that fewer than half of all counties had policies regarding mental health assessments for children in child welfare.²⁵ However, there was no information obtained at the child level to determine whether this lack of knowledge and policymaking adversely affects the care received by individual children.In an attempt to quantify the extent to which children in the child welfare system receive mental health services consistent with national standards, we analyzed data from the first national study of children coming into contact with child welfare agencies—the National Survey of Child and Adolescent Well-Being (NSCAW). We conducted longitudinal data analyses to estimate the prevalence of standards-consistent care among this national sample and identify child-, caregiver-, and caseworker-level characteristics that place children at most risk for receiving care inconsistent with these national standards. Through these analyses we attempt to provide policy guidance for child welfare and child mental health policymakers to better construct systems of care for these highly vulnerable children.     

Design of an internet-based health economic evaluation of a preventive group-intervention for children of parents with mental illness or substance use disorders

Background  

Preventive interventions are developed for children of parents with mental and substance use disorders (COPMI), because these children have a higher risk of developing a psychological or behavioral disorder in the future. Mental health and substance use disorders contribute significantly to the global burden of disease. Although the exact number of parents with a mental illness is unclear, the subject of mentally ill parents is gaining attention. Moreover there is a lack of interventions for COPMI-children, as well of (cost-) effectiveness studies evaluating COPMI interventions. Innovative interventions such as e-health provide a new field for exploration. There is no knowledge about the opportunities for using the internet to prevent problems in children at risk. In the current study we will focus on the (cost-) effectiveness of an online health prevention program for COPMI-children.     

Living with the mentally ill: Effects on the health and functioning of other household members

Based on data from the National Health Interview Survey Mental Health Supplement, 1989 (NCHS, 1991), this article compares health outcomes for respondents living with someone who is mentally ill (N = 776) with a randomly selected subsample of respondents not living with someone identified as mentally ill (N = 716). When other predictors of health are controlled, sharing a household with a mentally ill person is associated with poorer self-reported physical health, increased risk of reporting some activity limitation, and increased service utilization—both greater risk of hospitalization or visiting a physician, and a greater number of days hospitalized and number of physician visits among those utilizing these services. The severity and duration of mental illness have little effect across health outcome measures. Impaired health and increased utilization of medical care among persons living with someone who is mentally ill suggest hidden costs to individuals, to families of the mentally ill, and to the service system.     

'There but for the grace of God': moral responsibility and mental illness

Abstract Setting the terms of praise‐ and blameworthiness has long dominated philosophers’ discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise ‘the mentally ill’? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to appraise a person as (morally) praise‐ or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold ‘the mentally ill’ responsible for their actions? If not, can it in any way be reasonable to expect them to ‘take responsibility’ for their actions and/or characters? The expectation that ‘the mentally ill’ will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of ‘the mentally ill’. It would seem that such treatment approaches are coherent only to the degree ‘the mentally ill’ can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of ‘mental illness’ and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame.