Parents with Mental Illness : Family Relationships

by SAMHSA

(Page 6 of 20)

Parents Worry About Their Children.

Many children of parents with mental illness do not have abnormal difficulties (Beardslee & Poderofsky, 1988). However, parents worry about the impact of their mental illness on their children, and may view children's "normal" behavior through the lens of their illness (Nicholson et al., 1998a). They may be concerned that any signs of misbehavior or distress on their children's parts are signs of developing emotional disturbance in the younger generation. If parents had impoverished or abusive childhoods themselves, they may not have realistic expectations regarding children's development or behavior, or may not have ideas about how to stimulate their children's development through play. Parents, therefore, may not only need psychoeducation regarding their own mental illness, but information about normal child development, and feedback that their children's behavior is age-appropriate and to be expected (Nicholson et al., 1998a).

Parents with acknowledged psychiatric disabilities report almost 50% of their children have disabilities as well (Barker & Maralani, 1997). These children may have emotional or behavioral issues requiring appointments with treatment providers or medication. Parents, therefore, may have to manage their children's treatment regimes as well as their own. They may prioritize their children's special needs, making sure their children participate in counseling appointments, but neglect their own service needs if time, energy or money are in short supply (Nicholson et al., 1998a). Parents with mental illness often feel they have to prove themselves, and feel blamed or responsible for their children's difficulties, whether they fall within the range of "normal," or are extreme enough to require special attention.

Family Relationships and Social Networks.

There are positive as well as negative aspects to family relationships for parents with mental illness. Family members may be a primary source of social support, and a buffer against stress. Fifty-five percent of the women in Ritsher et al.'s study (1997) indicated they have at least one family member who is supportive, and 61% feel fully accepted as a member of the family. Mothers, however, describe feeling disempowered when grandparents or other relatives make decisions about children's schooling or medical care without consulting them (Nicholson et al., 1998b).

While parents with mental illness are more likely to have ever been married than adults with mental illness who are not parents, they are also more likely to be living without partners (Mowbray et al., 2000; White et al., 1995). Women with schizophrenia are less likely to be married or living with a partner when their children are born (Miller, 1997; Miller & Finnerty, 1996). Mothers explain husbands or partners, in fact, may be resources or stressors, e.g., assisting with childcare and household tasks or undermining women's efforts to parent and/or recover from illness (Nicholson et al., 1998b). In Mowbray and colleagues' study, children's fathers were one of the hassles rated highest by mothers (Mowbray et al.). While single parents may be isolated and without supports, the addition of a partner may not always be a positive factor.

Many mothers with mental illness rely on relatives or friends for child care assistance (Hearle, Plant, Jenner, Barkla & McGrath, 1999, Nicholson et al., 1998b). Patterns of caregiving and social support vary among ethnic and racial groups, with mothers of color with mental illness more likely to be primary caretakers than Caucasian mothers (White et al., 1995). Mothers caring for children have been found to have better immediate and extended social networks (White et al.). As these data are cross-sectional, it is not clear whether mothers with better social networks are more likely to retain custody of their children, or whether caring for children provides increased opportunity to develop social networks.

SUMMARY: Much of what the public knows about parents with mental illness is not empirically-based. Most research on the experiences of parents with mental illness has focused on small samples of mothers, recruited in public sector treatment settings, who are diagnosed with serious mental illness (primarily psychotic disorders), are African-American, parenting without partners, and poor. While findings from these studies may not be generalizable to the larger population of parents with mental illness, they certainly tell us a great deal about the families most likely to be at greatest risk, and in greatest need of services, particularly public sector mental health services.

While the experiences of parents with mental illness are similar to those of all parents in many ways, the literature has emphasized their unique circumstances and, most commonly, their deficits and failures. Parents with mental illness face particular challenges in pregnancy, and suffer higher rates of reproductive crisis. They are vulnerable to losing custody of their children, and often must cope with the pain of separation and loss. They are likely to be survivors of violence and victimization, with consequences for their functioning as adults and as parents. They worry about their children, and often feel responsible or blamed for their problems. Patterns of support and care giving most likely vary among ethnic and racial groups; family members may be viewed as a resource or a source of stress.

RECOMMENDATIONS: More research is needed on the broad spectrum of parents with mental illness-mothers and fathers--from all walks of life, i.e., varying racial and ethnic groups, socioeconomic classes, diagnostic categories, marital statuses, receiving public or private sector services, etc., across the life span. There has been only one published study of fathers with mental illness-clearly an overlooked population. Longitudinal studies could focus on the impact of parenting on mental illness, as well as the impact of mental illness on parenting.

The existing research on the common issues and themes identified by parents with mental illness suggests many opportunities for ameliorative and preventive intervention for both parents and families. Potential intervention targets include reproductive decision-making and perinatal health care; dealing with custody loss, visitations and placements; mitigating the impact of past and present violence on current functioning and relationships; understanding normal child development and how to stimulate and play with children; building a repertoire of child behavior management skills; and developing supportive family support and social networks. These targets are not necessarily specific to parents with mental illness. Successful intervention strategies build on strengths, rather than focus on deficits.

About the Author

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