Having been involved with KidsTime Workshops in Hackney for nearly 10 years, I’ve been impressed by parents who have the courage to admit their mental health problems may be affecting their relationship with their children. Being a parent is challenging enough, but if added to that one has to contend with a mental illness this makes the task of parenting even more difficult. This is particularly evident when children start asking questions that are difficult to answer, or when they become worried about their parent’s changeable mood, or availability to meet their needs. I am also aware that the experience for parents is often solitary and guilt-laden, particularly if parents have the single responsibility of childcare, which is often the case.
And yet, when given the opportunity of sharing their concerns with other parents who are in a similar situation, the relief of being able to talk and identify with others is palpable. In KidsTime Workshops, parent groups form part of the programme. Sometimes, for the first time, parents are able to talk about their fears and needs. They can share their worries about losing the ability to parent or losing the care of their children to others, whether temporarily or permanently, as well as their disgruntlement with services if they experience poor understanding and care. I tend to agree that very often services are not trained well enough or equipped to address the problems faced by parents who have a mental illness. This is because either all the attention is paid to managing the illness or because of poor coordination between adult, child and adolescent, and social services.
What is often most distressing for parents is realising that the balance of care sometimes becomes reversed. Children often accurately perceive that the parent is not well, even if this is not discussed openly, and they adopt strategies to compensate for this by becoming little carers themselves, sometimes at the expense of their own needs. They become mini-parents, either of their parents or their younger siblings, in the absence of obvious parental care. They fill the gap, but not always very well, obviously because they have not had the maturation or the experience.
What becomes even more upsetting is when parents who are feeling better attempt to resume their expected role and the child resists this by becoming confrontational or difficult, unprepared to accept parental control or discipline. Talking about this in parent groups in KidsTime Workshops often brings forward practical advice from other parents who have managed to deal with this effectively, and acknowledge the difficulties in resuming parenthood. This often entails the parent accepting gratefully what the child has done, and preparing to be supportive when the child faces difficulties, resuming the parental safety net – something that every child needs reassurance about. If in trouble, can I rely on you?
There is also a tendency to try and gloss over the names given to mental disorders. How does one understand what schizophrenia means, or bipolar disorder, or depression? Unfortunately, many parents have not had full explanations from the clinicians that have given these diagnoses, are in denial about their illness or try to minimise the implications. Parents are also sometimes in the dark about the effects of medications, and whether this can also make them less responsive to their children. So how then can the children make sense of what is going on? I find parents are relieved when there is an opportunity to discuss these diagnostic issues openly, as well as the treatments offered by mental health services. Parents are often anxious about discussing these problems with their children, believing that it can cause them to become more apprehensive. During the workshop they are often astonished to find out how much the children are aware of what is wrong, even if they do not have a solid foundation of understanding. We end up discussing ways in which explanations can be offered to children in a way they are able to understand and help them to see it in a manageable perspective, laying to rest worrying fantasies. The workshops also address these questions with the children themselves, either through play, drama or explanations, which the parents participate in and contribute to.
In one workshop seminar in an exercise to prompt discussion about the impact of mental health on children, we asked parents to think of questions they would like to ask their children about their illness. This proved to be helpful in that it anticipated questions the children would probably have liked answered! They came up with the following questions:
1. Does she feel anxious, upset or frightened when I become unwell?
2. How does she feel when I have to go into hospital?
3. Do you worry about how long will I be unwell?
4. Do you wonder why it happens?
5. Do you think you will get the same problem?
We found that the children were surprisingly open and curious about these matters, and in fact it prompted them to ask for more details to make sense of what had happened to their parent. Their fantasies were then transformed into more grounded facts, making them feel less responsible and more resilient to manage things in the future, especially if they could approach another adult to support them.
NSPCC (2015) Parents with a mental health problem: learning from case reviews
Summary of risk factors and learning for improved practice around parental mental health and child welfare
Royal College of Psychiatrists (2011) Parents as Patients: Supporting the Needs of Patients who are Parents and Their Children (College Report CR164). Royal College of Psychiatrists.