How many parents of children attending child and adolescent mental health services experience mental illness themselves?

Children’s mental health is related to the mental health of their parents

Parental mental illness is associated with a greater risk of psychological and developmental problems in children (Reupert et al., 2012). Research has found that around 14% of children in Australia (Lawrence et al., 2016) and 10–20% of children globally experience mental illness (Kato et al., 2015). For children whose parents have a mental illness, the likelihood of developing mental health problems increases to 41–77% (Hosman et al., 2009).

Studies have also shown as many as 45% of adult mental health service consumers are parents (Maybery & Reupert, 2018), and 1 in 5 children will grow up with a parent who has a mental health concern (Maybery, et al., 2009). This means that in many Australian families, both parent and child experience mental illness.

Previous research has suggested that parental mental health is an important determinant of how children engage with, and respond to, treatment in child and adolescent mental health services (CAMHS). Children attending CAMHS who have a parent who also experiences mental illness typically:

• present with more severe mental health symptoms (Naughton et al., 2019)
• make less progress over the course of treatment (Rishel et al, 2006); and
• drop out of treatment more frequently (Kazdin & Wassell, 2000).

This suggests that supporting the mental health of parents may benefit children attending CAMHS.

The current study

To investigate how many parents of children attending CAMHS experience mental illness, the researchers completed a systematic review of studies published worldwide, in English language, between 2010 and 2018. The review sought to:

• summarise the prevalence of mental illness among parents of children in CAMHS
• evaluate the research methods that have been used to assess the prevalence of parental mental illness in CAMHS
• identify additional adversities experienced by families where both parent and child experience mental illness; and
• make practice recommendations for CAMHS based on these findings.

The main findings

The review identified 18 studies that had measured the prevalence of mental illness among parents of children attending CAMHS. All continents except South America were represented, though studies were predominantly conducted in CAMHS operating in developed nations, including two studies from Australia (Naughton et al., 2018; Reay et al., 2015). Collectively, the studies indicated that:

• the prevalence of parental mental illness in CAMHS ranged from 16% up to 79%, with five studies reporting prevalence rates that exceeded 50%. The most rigorous study (Wesseldijk et al., 2018) reported prevalence rates of 36% for mothers and 33% for fathers

• families where both the parent and child experienced mental illness were particularly vulnerable to experiencing additional difficulties, including:
  • minimal social supports
  • unemployment and financial hardship
  • a parent having a substance-use problem
  • a member of the family having experienced a serious illness or injury
  • family conflict and breakdown.

  These adversities were also identified as barriers to parents and children remaining engaged with services.

Researchers have used diverse approaches to investigate mental health among parents in CAMHS, which is believed to contribute to the wide range in prevalence rates reported across studies. Determining the prevalence of parental mental illness in CAMHS was not a primary focus in the majority of studies reviewed and, accordingly, the research methods used were not always the best for examining mental illness among parents. These limitations highlight the need for further well-designed studies in this field.

Implications for practitioners and CAMHS

This research demonstrates that many children attending CAMHS have parents who also experience mental illness. Accordingly, children who present to CAMHS might also benefit from intervention that includes supporting the mental health of their parents or caregivers.

Based on these findings, CAMHS and child and adolescent mental health practitioners can support children, parents, and families in these circumstances by:

• integrating screening for parental mental illness,¹ family support needs, and family strengths into assessment procedures
• purposefully engaging with, and sensitively supporting, parents’ mental health as part of the treatment of children’s mental health problems. Suggested practices include making recommendations for family members’ self-care and implementing whole-of-family interventions where appropriate. Emerging Minds also offers various resources designed to help practitioners build their skills in supporting parental mental health, including practice papers and e-learning courses. One example is Let’s talk about children, an online training course that aims to build expertise in having conversations about parenting and mental illness, including how a parent’s mental health might impact on their children
• working together with adult mental health services to provide coordinated mental health care for children, parents, and the family as a whole.

Conclusions

The high rates of mental illness among parents of children attending CAMHS further demonstrates the interdependent nature of parent and child mental health. Mental health practitioners who work with children and adolescents could incorporate this understanding into assessment and treatment planning to support children and families who live in these circumstances. Adopting practices that attend to the family context can enhance the mental health care of children, particularly for those who live with adversity.

Further reading

Falkov, A. (2012). The family model handbook: An integrated approach to supporting mentally ill parents and their children. East Sussex: Pavilion Publishing & Media.

Naughton, M. F. A., Maybery, D. J., & Goodyear, M. (2018). A parent’s perspective of the bidirectional impact of mental illness in families. Clinical Nursing Studies, 7, 8-18. Available here.

Naughton, M. F. A., Maybery, D. J., & Goodyear, M. (2019).  A child’s perspective of bidirectional impacts of mental illness in families: “It’s like a cold it goes from one of us to the next”. Clinical Nursing Studies, 7(2), 46-55. Available here.

Reupert, A., Maybery, D., Nicholson, J., Gopfert, M., & Seeman, M. (2015, Eds.). Parental psychiatric disorder: Distressed parents and their families. Cambridge: Cambridge University Press.

Social Care Institute for Excellence. (2011). Think child, think parent, think family: A guide to parental mental health and child welfare. Available here.

¹ A variety of tools exist for screening for mental illness in adults. One example is the Achenbach System of Empirically Based Assessment (ASEBA), which includes an adult questionnaire (i.e. Adult Self-Report). The ASEBA collection also includes screening questionnaires for assessing social, emotional and behavioural functioning in pre-school, primary school, and adolescent children (Child Behaviour Checklists; Youth Self-Report). The various ASEBA questionnaires have a similar structure and domains, and thus can be useful for screening all family members in an integrative or comparable way.

References

Hosman, C. M., van Doesum, K. T., & van Santvoort, F. (2009). Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands: I. The scientific basis to a comprehensive approach. Australian e-Journal for the Advancement of Mental Health, 8(3), 250-263. Available here.

Kato, N., Yanagawa, T., Fujiwara, T., & Morawska, A. (2015). Prevalence of children’s mental health problems and the effectiveness of population-level family interventions. Journal of Epidemiology, 25(8), 507-516. Available here.

Kazdin, A. E., & Wassell, G. (2000). Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health  Services Research, 2, 27-40. Available here.

Maybery, D. J., & Reupert, A. E. (2018). The number of parents who are patients attending adult psychiatric services. Current Opinion in Psychiatry, 31(4), 358-362. Available here.

Maybery, D. J., Reupert, A. E., Patrick, K., Goodyear, M., & Crase, L. (2009). Prevalence of  parental mental illness in Australian families. Psychiatric Bulletin, 33, 22-26. Available here.

Naughton, M. F., Maybery, D. J., & Goodyear, M. (2018). Prevalence of mental illness  within families in a regional child‐focussed mental health service. International   Journal of Mental Health Nursing, 27(2), 901-910. Available here.

Naughton, M. F. A., Maybery, D. J., Sutton, K., & Goodyear, M. (2019).  Impact of parental mental illness on children’s HoNOSCA results in a regional child and adolescent mental health service. International Journal of Mental Health Nursing, 28(5), 1053-1064. Available here.

Reay, R. E., Raphael, B., Aplin, V., McAndrew, V., Cubis, J. C., Riordan, D. M., … Preston, W. (2015). Trauma and adversity in the lives of children and adolescents attending a mental health service. Children Australia, 40(3), 167-179. Available here.

Reupert, A. E., Maybery, D. J., & Kowalenko, N. M. (2012). Children whose parents have a mental illness: prevalence, need and treatment. The Medical Journal of Australia, 199(3), 7-9. Available here.

Rishel, C. W., Greeno, C. G., Marcus, S. C., & Anderson, C. (2006). Effect of maternal mental health problems on child treatment response in community-based services. Psychiatric Services, 57(5), 716-719. Available here.

Wesseldijk, L. W., Dieleman, G. C., van Steensel, F. J. A., Bartels, M., Hudziak, J. J., Lindauer, R. J. L., … Middeldorp, C. M. (2018). Risk factors for parental psychopathology: A study in families with children or adolescents with psychopathology. European Child & Adolescent Psychiatry, 27, 1575-1584. Available here.