Parents with Mental Illness : The Needs of Parents, Part 2

by SAMHSA

(Page 8 of 20)

If treatment plans are made without considering the adult's goals, identity or responsibilities as a parent, the adult may appear to be non-compliant with recommendations. For example, mothers who need to get up early to fix breakfast and send their children off to school may not take medications that make them lethargic in the morning. Mothers who have not identified acceptable respite care for their children may resist hospitalization. A parent's recovery may be jeopardized if she is not allowed contact with or provided information about her children when she is hospitalized, or when her children are in foster care.

Parents with mental illness view typical parenting programs as irrelevant, inappropriate or uncomfortable. While parent skills training interventions, for example, may offer strategies for managing children's behavior, the issues of setting limits and doling out consequences when a parent is feeling distracted, fatigued or worthless because of a mental illness are not addressed. And traditional programs for adults with mental illness do not appear to deal with the issues of parents. For example, ACT or PACT case management services do not routinely encompass the needs of adults as parents, though the model could certainly be adapted. Parenting is not mentioned as an issue in community living, nor are variables related to parenting typically included as ACT outcomes.

Services may not be culturally relevant. Significant differences among racial and ethnic groups in patterns of care giving when mothers have serious mental illness suggest that parents of different racial and ethnic membership have unique strengths and needs, requiring specific interventions and supports. Not only may the acknowledgment, understanding, and impact of mental illness on families vary with race and ethnicity, but race and ethnicity themselves are known to be barriers to service access.

Services for parents and children may be fragmented. Funding streams, and program eligibility requirements may limit participation to eligible adults or children, but not both. Services for adults and children may be provided in different locations. Programs or treatment settings may not allow adults with children to participate, e.g., emergency shelters or residential programs. Prevention services for adults and children in these families are rare. Children whose parents have mental illness, who might benefit from prevention services, may not be eligible for services because they do not have diagnosable conditions, i.e., there is no demonstrable "medical necessity." Parenting services in the public sector may be available only through the child welfare system; a parent may have to be determined abusive or neglectful to be eligible.

Cook and Steigman (2000) summarize a set of principles for working with parents with mental illness and their children. These include:

• Ongoing availability of services;
• Family must be the focus of service delivery;
• A service mix of treatment, rehabilitation, and support;
• Sensitivity to stigma associated with mental illness and prejudices faced by parents with mental illness;
• The importance of custody concerns;
• Parenting serves as the foundation for a parent's recovery; and
• Interagency collaboration.

Comprehensive services for parents with mental illness include an assessment of parenting strengths and needs; case management; peer support, self-help and parent mentoring; medication management; birth control counseling, pregnancy decision-making and support; crisis and respite care; foster care support and linkage; trauma and abuse counseling; substance abuse treatment; marital and family counseling; housing and supports for independent living; child development and parent skills training; assistance with school issues; advance directive planning and support; and benefits and public entitlement counseling.

SUMMARY: Parents with mental illness have needs common to all parents as well as needs specific to their illness. The stigma attached to mental illness is a significant barrier to service utilization for parents with mental illness and their families. Adults with mental illness may not be asked about their goals or role as parents. Services are deficit-based, oftentimes available only when parents or children have diagnosable problems or when abuse or neglect have been documented. Differing patterns of caregiving across racial and ethnic groups strongly underscore the need for culturally relevant services. Services are fragmented, with seemingly arbitrary barriers existing between systems and within systems, e.g., the mental health and child welfare systems, and "adult" and "child" mental health services.

RECOMMENDATIONS: The general public, providers, and families need to be made aware of and educated about the issues and strengths of parents with mental illness. Values and attitudes regarding parents with mental illness need to be clarified in professional training programs. Services must be developed that are relevant to the needs of parents and families, and that are family-centered and strength-based. "Adult" and "child" services must be integrated across and within systems to reduce service fragmentation or duplication, and to ensure that services are as accessible and as effective as possible.

About the Author

www.samhsa.gov
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.