Parents with Mental Illness : The Needs of Parents

by SAMHSA

(Page 7 of 20)

Parents with mental illness have needs common to all parents, as well as needs specific to their illnesses. The stigma of mental illness and the pervasive assumption that parents with mental illness will fail keep many parents from seeking help. Parents may appear to be non-compliant with service plans that are deficit-based or do not consider their unique needs as parents. Existing services may be irrelevant to the specific needs of these families, or fragmented due to organizational issues and funding streams.

Parents with mental illness and their service providers identify a set of needs and challenges generic to all parents. These include: access to safe, affordable housing; transportation; employment, or educational or vocational training opportunities; access to benefits and entitlements when work is not possible; low-cost or free recreational activities for families; safe, dependable child care; adequate health care; support for learning parenting skills; trusted respite care for children, when parents need to be hospitalized or take a break from parenting responsibilities; and support for advocating for themselves and their children's needs, particularly with the school system.

While these challenges may be similar to those of other parents in nature, they may differ in degree. Mowbray and colleagues, in their study of mothers with mental illness in Detroit, indicate that neighborhood safety is a worry for many; unemployment rates are extremely high; physical health is rated poorly; and mothers report a high frequency of stressful life events and hassles, such as psychiatric and financial crises, death of a close friend or relative, and separation from children. While these are common problems among poor families, the unemployment rate of these Detroit mothers with mental illness is four times that of women in the same census tracts, suggesting that living with mental illness plays a role above and beyond that of poverty alone.

Parents also face challenges specific to their illnesses, which alter their experiences as parents and influence their relationships with their children. Managing symptoms and taking steps essential to recovery may drain individual and interpersonal resources. For example, obtaining services, implementing treatment regimes, and maintaining relationships with helpers require time and energy. Parents with mental illness often must advocate for themselves and their children to obtain necessary services and supports, and deal with the access challenges inherent in the "managed care" era. Parents with mental illness face the additional, illness-related challenges of understanding the impact of their illness on their children, and communicating with their children about their illness and recovery.

Some of these needs may be met in the mental health service system. In the above mentioned study of mothers in Detroit, the vast majority were receiving mental health services, which they found "somewhat helpful". While about 44% listed their mental health provider as a source of support, only 20% of the mothers listed their mental health provider as someone who could be supportive about being a mother. In the past, research has shown that parenting services are more often provided through the child welfare system. However, mothers may view child welfare case workers quite negatively. In Mowbray's study, nearly 40% of the mothers gave child welfare case workers one of the highest hassle ratings, which the researchers attribute to mothers' long-standing concerns about losing custody of their children and more recent fears about being taken off welfare.

Mothers with mental illness in focus groups also talk about what their children need: nurturance, discipline, encouragement to develop their talents and interests, positive role models and friends, a dependable home environment, safe places to go away from home, to feel "regular" or "normal" like other families, open communication with their parents, and to understand that they are not responsible for their parents' illnesses, nor are they responsible for "fixing" them.

Barriers to Service Utilization

Mothers have identified problems with, and barriers to programs and services. The single most pervasive factor affecting parents' access to and participation in services is the stigma accompanying mental illness. Mothers are affected by their anticipation of, or actual experiences of, the negative attitudes of providers and family members. Women may hide their pregnancies from providers, fearing negative comments and the potential loss of custody. Obviously, prenatal care is jeopardized. Pregnant women with schizophrenia are not likely to receive obstetric consultation until their third trimester of pregnancy, nor to keep follow-up obstetric appointments after discharge from inpatient psychiatric care.

Stigma and assumptions about individuals with mental illness may lead providers to the conclusion that adults with mental illness are not parents or cannot parent successfully. Therefore, adults' goals regarding parenting and caring for their own families may not be identified or addressed by providers. The primary concern of adult providers is who will care for the patient, not whether the patient will be caring for someone else. Lack of attention to adults' goals as parents decreases the likelihood of their involvement in programs or compliance with treatment recommendations.

The stigma of mental illness ultimately translates for parents into the fear of custody loss particularly because of the assumptions made by society at large about individuals with mental illness, i.e., that they are incompetent, violent or potentially dangerous. Fear of losing custody can keep parents from acknowledging problems and requesting services. Worry about losing custody or contact with children can contribute to parents' stress. The removal of a child from a parent's care may undermine a parent's motivation to recover, and may contribute to decompensation. A focus on deficits and the assumed or real inadequacies of parents with mental illness, rather than their strengths, contributes to a cycle of hopelessness and a view of the "helping" relationship as adversarial.

About the Author

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SAMHSA works to improve the quality and availability of substance abuse prevention, alcohol and drug addiction treatment, and mental health services. Includes links to support groups, information resources, events and articles.