Adult children of parents with mental illness: Dehumanization of a parent – ‘She wasn't the wreck in those years that she was to become later’

Children who have lived with parental mental illness experience long‐standing reduced health and social outcomes, alongside ongoing personal distress. While there has been some dialogue regarding interventions to support children who are living with parental mental illness, there remains a paucity of knowledge regarding adult children's experiences and potential needs. Given this, the aim of the present study was to establish parenting narratives of adult children who had experienced childhood parental mental illness. This included their experiences of being parented alongside their own subsequent parenting roles. Three men and 10 women, ranging from 30 to 78 years old, met individually with a researcher to tell their stories. Narratives were thematically analysed to establish themes. The findings of the study demonstrated that individuals who have lived with childhood parental mental illness dehumanized their parent with mental illness. The authors argue that all mental health services should be underpinned with a whole of family assessment and care philosophy. There is also a need for all mental health services to consider how policies and procedures might inadvertently dehumanize clients who are parents, which could contribute to familial dehumanization. This could prevent the dehumanization of parents who experience mental illness to preserve parental and child relationships.     

Addressing the support needs of families during the acute hospitalization of a parent with mental illness: A narrative literature review

Hospitalisation of a parent with acute mental health problems impacts the consumer, their extended family/carers and children. Mental health nurses are at the forefront of promoting recovery for consumers in an acute inpatient setting. Recovery‐oriented care can include provision of family‐focused care which supports recovery of the parent‐consumer and their family members and contributes to prevention of intergenerational mental illness. The aim of this narrative literature review was to explore existing knowledge regarding the experiences, care and support needs of parent‐consumers, their family members/carers and children during the parent's acute mental health hospitalisation. It also aims to explore existing knowledge about the practices of mental health nurses providing care to this consumer group, to inform future healthcare practice and strengthen parent, child and family outcomes. Nineteen published studies addressed the review questions. In the context of hospitalisation, the majority of research regarding parenting with a mental illness is focused on mothers. Parents reported experiencing stigma during their hospitalisation. Separation from children was a concern for parents and their extended family, but admission provided an opportunity for the parent to receive treatment and for the family to receive support. Mental health nurses did not always identify parental status on admission. When parental status was identified, nurses reported issues regarding logistics and practicalities of using family rooms, children visiting the unit, and their own professional knowledge and organisational support regarding familyfocused care. Implications for practice are identified, highlighting how mental health nurses can develop their practice to support the recovery of parent‐consumers.     

Impact of parental mental illness on children's HoNOSCA results in a regional child and adolescent mental health service

Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6‐month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6 months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education‐related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted.     

Adult Children of Parents with Mental Illness: Losing Oneself. Who am I?

There is a limited body of research that focuses on experiences of families of people with mental illness. While the body of knowledge concerning children of parents with mental illness is increasing, there remains limited discourse surrounding the experiences of adults who have lived with childhood parental mental illness. This paper examined one major theme of a study focusing on parenting narratives of adults who had experienced childhood parental mental illness. The narrative study from a metropolitan area of Australia reflects adult children's experiences of being overwhelmed with parental mental illness. They felt unsure of their own emotions and felt they had lost a sense of who they were as individual people. Adult children felt confused about their sense of reality, particularly for those whose parent had a diagnosis of schizophrenia or psychosis. Their experiences of loss were closely associated with changing self identity. Furthermore, many of the narratives demonstrated experiences of grief for adult children. Greater understanding of adult children's perceptions of being parented by a person with mental illness, alongside their experiences of loss, has the potential to help health and social care professionals to facilitate greater resilience for families who are living with parental mental illness.     

Experiences of primary care among young adults with mental illness – A systematic literature review

Background

Mental illness, such as depression, anxiety disorders, attention deficit hyperactivity disorder and different addictive diseases, has increased among young adults over the last decade. Mental illness is associated with distress and problems functioning in social activities. Healthcare centres, that is, primary care, serve as the first point of contact with healthcare professionals for those young adults and provide outpatient medical and nursing care covering both physical and mental illness.

Objective

To explore experiences of primary care among young adults with mental illness.

Methods

A systematic literature review was conducted that followed the method of Bettany–Saltikov and McSherry. A keyword search was performed in various databases, and after a quality assessment 23 articles were included in the review.

Results

Young adults' experiences from primary care are described in four categories – Facing difficulties to accept help, relational preconditions, structural and organisational hindrances and satisfaction with youth-focused mental health interventions. Young adults with mental illness experience many difficulties in accessing and receiving proper help from primary care. Further, they did not believe in recovery from mental illness, and they also expressed a lack of mental health literacy.

Conclusion

While being the first contact with healthcare professionals, primary care needs to adjust its services to address the growing group of young adults suffering from mental illness. It is necessary to provide tailored guidelines and interventions in primary care for young adults with mental illness, and the Tidal Model may improve the contacts with young adults in primary care.     

Stigma in relation to families living with parental mental illness: An integrative review

Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma‐related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta‐Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty‐eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children’s experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent’s mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.     

Childhood Parental Mental Illness: Living with Fear and Mistrust

This paper presents one major theme of findings from a doctorate study. The study used a narrative enquiry approach, to gather parenting narratives of adult children of parents with mental illness. A Partnership Model for a Reflexive Narrative for Participant and Researcher (Partnership Model) was used to invite participants into the study, while encouraging a space for reflection for both the adult children and researcher. In total, 13 adult children participants constructed their narratives of living with childhood parental mental illness, alongside their current parenting role. Their stories reflected childhood experiences of fear and emergence of mistrust of others, particularly their parent with mental illness. For some participants, fear and mistrust continued into adulthood. Many adult children reported their childhood experiences of feeling lonely and isolated. They felt unable to disclose their experiences of parental mental illness to others. In addition, participants were unable to access information about their parent's condition, leaving them feeling unprepared and unskilled, despite their childhood desire to help their parent. This furthermore, compounded their sense of fear and isolation. Early identification of children and families experiencing mental illness is important to facilitate dialogue, psychoeducation and support. Social and health professionals have an important opportunity to enhance the social integration and support for families experiencing parental mental illness, to reduce long-standing fear, isolation and mistrust.     

Nurses’ views and practices on parental mental illness: An integrative review

When a parent has a mental health problem, family members can be affected by it. Nursing professionals can provide care for the whole family, including children. Nurses can support the parental role of parents with mental illness. This integrative review aimed at the following: To identify and to synthesize the views and practices of nurses on parental mental illness (PMI). An integrative review methodology was employed, following PRISMA guidelines. Theoretical and empirical literature was included. Twenty-three articles were obtained to be analysed, using the Whittemore and Knafl approach. A lack of knowledge about nurses' views and practices on PMI was found. Especially, in some demographic areas such as Mediterranean countries and Central and South America. Different issues which influence how nurses perceive PMI were identified: subjective meaning of family concept, personal experience of being parent, and perceptions of mental illness, among others. The main findings on nurses’ practices were as follows: guidelines to implement family-focused practices, knowledge, and skills; therapeutic relationship; and teamwork and interagency communication; among others. These issues are intimately related. They could act as enablers or barriers to support parental role of parents with mental illness. Adequate guidelines and policies are necessary to support parents with mental illness and their families. There is a need to include knowledge about PMI and family-focused approach in nursing education curricula. Training could include reflection on nurses’ experiences and personal values to become aware of how these can affect their interventions and practices.     

The Tasmanian children’s project: The needs of children with a parent/carer with a mental illness

This paper presents some of the key findings and recommendations of the report The Tasmanian Children’s Project (TCP): The Needs of Children with a Parent/Carer with a Mental Illness, October, 1999. The TCP, a collaborative venture between the University of Tasmania’s School of Nursing and the Mental Health Services – South, Tasmania (Department of Health and Human Services), is the first study in Tasmania to formally examine the needs of children where the parent/carer has a mental illness. The study is a modified replication and extension of the 1993/94 Victorian Children’s Project. Extension aspects of the TCP included interviews with children (in addition to parents and service providers), the inclusion of data on both maternal and paternal mental illness and a broad definition of mental illness (beyond psychotic illness and major affective disorder). The report highlights the need to provide a range of programs that encourage the development of personal competency among children, parents, and other family members and those that emphasize interagency collaboration. Implications of this research for mental health nursing education and practice are also addressed.     

Development and psychometric validation of the Task-Specific Self-Efficacy Scale for Chinese people with mental illness

The aim of this study was to validate a Task-Specific Self-Efficacy Scale for Chinese people with mental illness. The study included 79 men and 77 women with chronic mental illness. The Task-Specific Self-Efficacy Scale for People with Mental Illness (TSSES-PMI) and Change Assessment Questionnaire for People with Severe and Persistent Mental Illness were used as measures for the study. Factor analysis of the TSSES-PMI resulted in four subscales: Symptom Management Skills, Work-Related Skills, Help-Seeking Skills, and Self-Emotional-Regulation Skills. These community living skills were found to be related to the level of readiness for psychiatric rehabilitation among Chinese people with mental illness. In conclusion the results support the construct validity of the TSSES-PMI for the Chinese population and the TSSES-PMI can be a useful instrument for working with Chinese people with mental illnesses.     

Self‐expressed strengths and resources of children of parents with a mental illness: A systematic review

The aim of the present study was to explore the strengths children reported to have acquired while coping with their parents illness, and the external factors these children indicated had facilitated their coping process. A systematic literature search was conducted of peer‐reviewed papers that focused on self‐reported experiences of children with parents who had mental illness, and revealed their strengths and resources. The search included the following databases: MEDLINE, PsycINFO, and CINAHL. Results were filtered according to whether search terms appeared in the title or abstract. Fifty‐seven full‐text papers were reviewed; 26 of them met the inclusion criteria and were included in the review. The statements were analysed using content analysis. The search identified 160 relevant statements, 38 (24%) of which could be described as self‐reported strengths, and 122 (76%) as self‐reported resources. According to these statements, the children described themselves as more mature, independent, and empathic than their peers who did not have a parent with a mental illness, and as having acquired several abilities. The statements about resources indicated that the children regarded social support, information, and particularly the support of mental health‐care professionals as helpful when living with a parent with a mental illness. Recommendations for nursing actions to support children's ability to cope with their parents' illness are outlined.     

Effects of Parental Presence during Children's Venipuncture

Objective: To determine whether parental presence during venipuncture (VP) altered self-reported distress of the child, the parent, or the health professional (HP) performing VP.
Methods: During nine consecutive months, 130 nonconsecutive 8–18-year-old children having VP in an urban pediatric ED were prospectively randomized into two groups of 65 patients each. Before VP, every child, parent, and HP completed a questionnaire developed to measure epidemiologic variables believed to influence distress during VP. The patients were randomized to have either a parent present or both parents absent during VP. The patients, the parents, and the HPs privately self-reported their distress during VP on a visual analog scale (VAS). Statistical significance was determined by the Mann-Whitney U (rank-sum) test.
Results: In the parent-present group, distress scores were lower for the parent (p < 0.01) and for the child (p < 0.04) than they were in the parents-absent group. The HP performing VP had no difference in distress scores with and without parental presence (p < 0.55).
Conclusions: Parents and children having VP have less distress with parental presence. Health professional distress is not affected by parental presence.     

Should the mentally ill adopt children? How physicians can influence the decision

No established criteria exist for determining whether a person with a mental illness should or should not be allowed to adopt children. The basis for opinion in such cases can be derived from previous custody cases described in the literature. The interest of the potential parent, as well as the child, must be a primary consideration. Physicians are often called on to make recommendations regarding the parental fitness of a mentally ill person. An intensive assessment of the potential adoptive parent, including a thorough history and investigation of the person's resources and support systems, is necessary before a recommendation can be made.     

Factors Associated With Parental Distress

PROBLEM:  Associations of perceptions of social support, personal control, and child behavioral problems to distress in parents of children with mental health problems were examined.
METHODS:  One hundred and fifty-five parents of children 2–19 years old receiving community mental health services participated.
FINDINGS:  Stepwise regression analysis identified internalizing and externalizing child behaviors, perceived personal control, and tangible social support as independent predictors of parental distress. Independent predictors of objective distress included internalizing child behaviors, perceived personal control, and intangible social support.
CONCLUSIONS:  Internalizing and externalizing child behaviors were significantly associated with parental distress. Perceived personal control moderated the relationship between internalizing child behaviors and parental subjective distress.     

Stress and Parents of Children with Autism: A Review of Literature

The purpose of this review is twofold. The first is to synthesize factors that impact parents’ experiences of caring for a child with autism spectrum disorder (ASD); the second is to identify factors that impact parental stress and parental decision-making to use autism services or not. Parents of children with ASD score higher on levels of stress than other groups of parents. The daily challenges of caring for the child are endless and effect all aspects of the child's care as well as the parent's mental health and ability to manage the needs of the child and family. Understanding more about the challenges parents face will provide direction for research, intervention development, and practice. Accordingly, a search was conducted using CINAHL and Medline. Inclusion criteria included articles available in full text, published in English, and focused on children with ASD distinct from other diagnoses, as well as parental experiences of caring for a child with ASD. Articles (N = 132) that met the inclusion criteria were summarized. Challenging aspects of the child's diagnosis and care are discussed, as well as the factors that impact parental stress and decision-making to use autism services. Recommendations for research and practice include interventional development related to early diagnosis, disparity, access to care, parental decision-making to use autism services, and parental stress management.     

Great expectations: a position description for parents as caregivers: Part I

Parents caring for a child with a chronic condition must attend to a myriad of day-to-day management responsibilities and activities. This two-part series examines parental roles and responsibilities in detail. Part I will review both the adult and pediatric family caregiving literature. It will also describe four major caregiving responsibilities with associated tasks in both direct and indirect illness-related care, which parents are expected to perform when caring for a child with a chronic condition. These are: (a) managing the illness; (b) identifying, accessing, and coordinating resources; (c) maintaining the family unit; and (d) maintaining self. Part II (to be published in the next issue of Pediatric Nursing) will present a multifaceted list of parent caregiving management responsibilities and associated activities drawn from the literature. Clinical nursing implications associated with caregiver responsibilities and tasks will also be addressed.     

Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic

Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.     

Children of parents with mental illness. I: An overview from a nursing perspective

This paper explores the psychosocial consequences of parental mental illness for child mental health and the implications for mental health nursing. The literature on risk and vulnerability to psychosocial disorder, resilience, child protection, disorder prevention and epidemiological data are reviewed. Based upon a health promotion approach, a model for mental health nursing advocacy for families of adult consumers is proposed as an effective means of preventing disorder in subsequent generations.