Working with parents and carers with mental health difficulties

According to the Royal College of Psychiatrists, 68% of women and 57% of men with a mental disorder are parents.

Whilst most of these parents will usually have a mild or short-lived illness which can be easily treated, some are living with a severe or long-term mental illness such as schizophrenia or bipolar disorder.

Most parents and carers living with a mental health illness will not abuse or neglect their children, however since it can affect a person’s ability to cope with family life, mental health problems are often present in cases of child abuse or neglect.

In an analysis of 175 serious case reviews, 53% of cases featured parents with mental health problems.

Most parents and carers living with a mental health illness will not abuse or neglect their children

Signs of mental health difficulties in a parent or carer

• Intense anger or difficulties controlling anger around their children.
• Withdrawn, apathetic or emotionally unavailable to their children.
• Children are seen as a source of comfort and solace.
• Distorted views of their children. For example, they may believe a child is to blame for their problems.
• Trouble with keeping to routines such as mealtimes, bedtimes and taking children to school.
• Own and children’s basic physical needs are neglected.
• Struggle to set boundaries, discipline and supervise children which could leave them in unsafe situations.
• In rare cases of severe mental illness, parents may have delusions related to their children, for example they may believe they are possessed or have special powers.

Potential impact on child

• Risk of developing own mental health problem.
• Taking on a caring role, providing emotional and social support and more intimate tasks such as nursing or bathing parent or caring for younger siblings.
• Demands of caring for parent may result in fewer opportunities to have fun and build friendships, disrupt education and reduce life chances.
• Constant worry about parent’s health and wellbeing can lead to the child neglecting their own needs and feelings.
• Distress if faced with frightening situations such as parent’s suicide attempt, overdose or volatile behaviour.
• A lower standard of living if parent’s illness makes it difficult for them to work.
• Embarrassment or shame over their parents’ condition, limiting their friendships and social interaction.
• Bullying and isolation due to the social stigma around mental illness.
• Separation from parents or carers by children’s services.
• In the most serious cases, children may suffer abuse or neglect from a parent or carer.

(Aldridge, 2006; Cleaver et al, 2011; Cooklin, 2013; Gajos and Beaver, 2017; Gatsou et al, 2017; Grove et al, 2015; Henninger and Luze, 2012; Stallard et al, 2004; Tunnard, 2004; Wolpert et al, 2015)

Engaging parents

Parental engagement can have a hugely positive effect on a child’s engagement. However, some mental health problems may inhibit a parent’s ability to meet in school (e.g. agoraphobia, social anxiety), they may have had difficult experiences with other services such as the NHS or social services or they might not have time to come in due to other commitments and responsibilities, such as working more than one job.

Meetings and communication

• A variety of methods of communication (both informal and formal) can be helpful for parents and carers. For example, newsletters, face to face, via the school website, by text and social media.
• Ensure that any meetings or initiatives are scheduled at times that parents and carers are likely to be available and to make sure that they are in culturally and linguistically appropriate environments.
• A headteacher or senior leader being visible in the playground at the beginning or end of the day can also be useful in encouraging informal conversation and building relationships.
• An open-door policy which sends a message to parents that they can speak to school staff about any concerns they have also encourages frequent and regular contact if it is needed or wanted.

Giving children accurate, age-appropriate information about mental health problems can address any misperceptions or fears they may have

Key tips for speaking to parents

Speaking to a parent or carer about their mental health and how it is affecting the child may be a difficult conversation. Make sure you set aside adequate time and locate a place where you won’t be disturbed. This meeting may be distressing for the parent so it’s important to be sensitive to their emotional state.

It may be worth suggesting the parent brings a friend, which can allow you to bring a colleague. This can be really helpful if any party is feeling anxious about the meeting.

1) Be clear about the problem

Be specific about your concerns for the parent or child, perhaps using an example of something that has happened in school as it may be difficult for them to know. Explain why you are concerned e.g. “If this continues it will impact on X’s learning and achievement.”

Think about the language you are using, avoiding confusing jargon or terms that will make the parent feel like they are to blame.

2) Position the parent as the expert

Rather than just talking at the parent, invite their opinion and appreciate their ideas. They know their child better than anyone.

Ask them to help you understand what works best for the child. They might have a different perspective of the child, which can help build a picture of their overall needs.

If both sides are listened to, you are much more likely to have a productive conversation.

3) Highlight the child’s strengths

It can be hard for any parent to hear about their child’s ‘problems’. Before saying anything that may be perceived as negative about the child or parent, remember to highlight the child’s strengths.

4) Have a two-way conversation

Make sure you give the parent a chance to voice their worries or concerns and make sure you acknowledge what is said e.g. “From what you’re saying I can see that X is really struggling at the moment.”

Listen to how they are coping and if they have any ideas – this will make it easier for them to take in what you’re saying. Make sure you check back with them to ensure you have understood exactly what they are saying e.g. “Tell me if I’ve got this right but I think what you are concerned about is…”

5) Try to imagine what it might feel like for the parent and child right now

What might they be feeling? Are they upset, anxious, frustrated? Try to acknowledge what it might be like to be in their shoes “I can imagine that you might feel really frustrated about this situation and don’t really want to discuss it."

How can school’s help a child who has a parent or carer with mental health difficulties?

A child who has a parent with a severe mental health problem may feel that they have no one to talk to, therefore it’s important that they have a reliable, consistent and caring adult in school.

Giving children accurate, age-appropriate information about mental health problems can address any misperceptions or fears they may have, whilst also giving them the language to help share their views and experiences.

Through educating children about mental health, schools can also:

• increase the child’s resilience
• challenge the child’s misconceptions about mental health, such as making it clear that it isn’t the child’s fault
• increase the child’s understanding and empathy for their parent or carer
• improve communication between child and parent.

Information about mental health should be produced in a range of different formats such as assemblies, PSHE lessons and workshops. They could also include help seeking strategies and advice on how the child should respond to their parent or carer.

Adapted from the Anna Freud workshop delivered at the Mental Health and Wellbeing conference.