Why is it so difficult to address parental mental illness?

Our upcoming campaign, ‘Being Seen and Heard’ came out of a cry for help from the children of parents with a mental illness. They told us that they were overlooked, talked over and ignored, despite the fact that they lived in the situation and knew most about their parent’s illness.

They spoke of the frustration of having the responsibility of looking after their ill parent but at the same time treated as if they had nothing to say and nothing to contribute to their parent’s well-being. They were often in a situation where they administered the medication but no information was given to them about the medication or it effects on their parents. Sometimes the parent was ‘sectioned’ and the child was a witness but never spoken to, although the experience was evidently traumatic and frightening. In these cases, the child has been sharing the house with a very ill person, watching them becoming more and more ill but unable to intervene because they know they will not be treated with respect or listened to.

The solutions are always in the hands of the professionals who rarely see past their patient to the wider implications of their ‘solution’. This is not meant to be an argument for non-intervention or an argument against medication, as it is often construed. Psychotic episodes are serious medical emergencies but that is not all they are when there are children involved. We must start to make it part of ordinary practice that the family and the children are considered, consulted, listened to and treated with the respect they deserve and want.

Children of parents with a mental illness are often left with the problem and excluded from the solution. These children are ‘nobody’s problem,’ because they fall between services. The adult services only deal with the adult patient and the children and adolescent services will only support their client group once they have become ill and even then, the thresholds for treatment are very high and getting higher.

Here are just some of the barriers to thinking about the children of parents with a mental illness:

  • Resistance to the notion that childhood adversity and trauma has a causal role in mental health problems – this is seen as ‘family blaming’ and avoided
  • Historic opposition to Freud and the psychoanalytic approach as well as to the anti-psychiatric movement of the 1960s, including Laing et al.
  • Focus on bio-genetic basis for mental illness, genes and neurology seen as causal
  • Mental illness is understood as a scientific, pharmacological and medical problem rather than a human, family or social issue
  • Resistance to the notion of historic and cultural violence and their traumatic legacy (for example, slavery, war and colonisation associated with racist ideas)
  • A focus on the social and systemic causes of trauma places professionals in opposition to powerful groups and is consequently avoided (Jackson 2003)
  • Horror as a barrier to encountering and embracing notions of trauma ‘to stand witness to the extent and horror of people’s account of pain and suffering, despair, loss and rage’ (Coles 2014)
  • Change weariness of new ‘fashions’ and new ways of working, concepts of care
  • Role definitions and need to change the boundaries and identities of professionals, for example teachers don’t want to address trauma or adverse childhood experiences because it opens up a ‘can of worms’ that they feel ill-equipped to deal with and they are already overwhelmed with initiatives and responsibilities
  • Austerity and low morale as a result of austerity measures in all areas of public service
  • Complex approaches are difficult to translate into practice as the solutions require a collaborative approach across professional and organisational boundaries
  • Mental health staff have no access to regular supervision in which the burden of dealing with trauma could be processed and contained

The concept of childhood adversity and trauma-informed care has not yet become mainstream and there is little in the way of training to perpetuate and share good practice.

There is a need for a collective shift towards collaborative thinking about the causes of mental distress and how best to heal the past and develop resilience in the face of unsafe and harmful environments, whether in the family, the school, the street or on the internet.

These children must be seen and heard.