Parental mental health: A ‘double-storied’ approach

Almost half (45%) of all Australian adults experience mental illness in their lifetime and 23% of Australian children have at least one parent with a mental illness (Patrick, Reupert, & McLean, 2019). While it is important to recognise that not all mental health issues are associated with disadvantage, a lack of resources, connection and opportunity can commonly be passed down through two or more generations, negatively affecting wellbeing and mental health (Chicote, 2018).  

Intergenerational mental illness can be exacerbated by adverse childhood experiences (ACES), such as family and domestic violence, poverty, housing insecurity and substance use. These adversities can get in the way of safe and consistent parenting (Laslett, et al., 2015; Humphreys & Campo, 2017; Maybery & Reupert, 2018).   

Without support, mental illness can dominate adult self-identity, causing a strong sense of hopelessness and shame about perceived parenting failures. This sense of failure can continue a dominant negative narrative that most often begins in childhood, particularly in parents affected by intergenerational disadvantage and mental illness (Salveron, 2019).  

The ability to enquire about aspects of the parent’s knowledge, skills or values as an alternative to this dominant failure story is often a necessary entry point for successful engagement. This may involve an examination of the socio-political contexts of their adversity and the obstacles they have had to face. If a practitioner uses an intergenerational lens, they may become immediately interested in looking back to the parent’s own childhood experiences.  

Unpacking a parent’s childhood experiences of adversity and resilience can help you to understand the parent’s story and contribute to effective family-focused recovery (Price-Robertson, Olsen, Francis, Obradovic & Morgan, 2016). This does not involve ignoring the current problems that affect their children’s mental health and wellbeing. Rather, a double-storied approach helps you to focus on the stories of both adversity and resilience that all parents bring with them to professional services. 

Who is this resource for?

This resource is for any practitioner who works with parents affected by mental illness. It identifies ways to support parents to examine ‘double stories’, which include their histories of adversity and challenges as well as their resilience, hopes and know-how (Dulwich Centre, 2008).  

These ‘double stories’ can help parents to reflect on their own experiences of being parented, bringing to the fore considerations of their own ethics as they relate to raising children. In turn, these considerations can support adults to make plans for how they want to parent in the future, and how they can provide their children with consistent experiences of safety, nurturing and care.

Every parent derives a strong sense of identity from their relationship with their children. This can provide a significant sense of pride and joy to parents, or give rise to feelings of shame and regret (White, 2005).  

Shame can make parents less likely to share their concerns about their children, due to a fear of being judged. Adult-focused practitioners can move beyond a parent’s initial hesitancy, by using an intergenerational lens to explore every aspect of the adult’s parenting story: how they were parented as a child; how they currently parent their own children; and how they prefer to parent in the future.  

A parent’s description of their own parenting story is an opportunity for them to consider their current approaches to parenting, what they would like to provide for their children, and what happens when adversity gets in the way. The onus becomes less on the practitioner to ‘fix’ poor parenting, and the parent becomes active in finding practical solutions to issues that affect their children. For those parents with mental illness, this is a chance to become active in designing strategies to ensure they can parent in their preferred way, even during tough times. 

Many Emerging Minds child and family partners (parents) with a family history of mental illness describe feeling a strong sense of relief when asked by a practitioner about their relationship with their children. Enquiring about parental stories is an important part of normalising the subject of parenting, and increases the parent’s comfort in sharing information.  

If parents can describe their hopes for their child, or share stories of love and compassion, it becomes easier for them to describe the problems that get in the way of safe and consistent parenting. In this way, parents can share a double-storied account of their relationship with their children, describing both their love and concerns for their child, and the ways that current adversities get in the way of addressing these concerns (Dulwich Centre, 2008).

Many adults who experience mental illness have long histories of dealing with adversity, beginning with their own adverse experiences (ACEs) as children. They may have developed coping strategies that kept them safe or protected a parent or siblings from harm. 

When a parent describes their childhood experiences of adversity, they may take a strong stance towards the actions of an adult during that time. They may even have made a conscious decision that they would parent in a completely different way to their father or mother, or step-parent. These statements become part of their parenting story; a set of preferences for the kind of parent they want to be. If a mother’s own childhood was affected negatively by a mum who was chaotic or irresponsible, she may make certain commitments to provide her child with the safety and consistency that she missed in her own childhood. 

Many people who experience unsafe or inconsistent parenting develop significant resilience and self-reliance in parenthood, and a desire to ‘break the cycle of adversity’ for their own children. Emphasising these aims as a parenting strength can motivate parents to continue to reinforce their own parenting values and preferences (Patrick, Reupert & McLean, 2019).  

Some parents may be parenting in ways that conflict with the commitments they made, particularly when adversity is at its most acute. If parents can notice the contradictions between their parenting commitments and actions, they are demonstrating a perspective that can help them to make change. Even in cases of inconsistent parenting, if small skills or knowledges can be uncovered and replicated, a blueprint for safe and nurturing care can be developed. These stories can contain rich descriptions of how parents have overcome adversity throughout their lives, and they may begin to feel less trapped in their current circumstances (Moss & Dolman, 2018). 

An understanding of the parent’s ecology and their intergenerational context can help to inform which elements they aspire to change (Isobel, Goodyear, Furness & Foster, 2019). Helping to build the parent’s understanding of their own situation can begin to produce small, positive changes for both parent and child. Once parents can clearly see the intergenerational influences at play, it will feel more natural to shift the focus to how the current environment and circumstances are affecting their own children.  

As the parent begins to understand their parenting preferences and the negative effects of adversity, they can start to make plans for a more stable and predictable home environment (Patrick, Reupert & McLean, 2019).

Generalist practitioners are often the first point of contact for parents experiencing long-term mental illness and adversity. These parents may have been avoiding seeking professional support due to a fear of being seen in a negative light; or in more serious cases, the fear that sharing their experiences could jeopardise the custody of their children (Bromfield et al., 2010; Centre for Community Child Health, 2010; McDonald, 2018).   

Practitioners themselves may seek to avoid sensitive topics out of fear of what they may uncover or how the parent might respond, or they may begin to draw assumptions about, or assign labels to the parent, based solely on their stories (Mayers & Agnew, 2019). In addition, practitioners who have not been specifically trained for child-focused conversations may feel uncomfortable, or that they are not able to adequately support parents.  

Secrecy is one of the most significant causes of ongoing social and emotional wellbeing and safety issues for children in Australia. When a generalist practitioner asks an adult about their parenting story, they provide an explicit opportunity to combat this secrecy, and bring the needs of the absent child into the room. This is not an inquisition of the adult’s parenting, but rather a genuine curiosity about their parenting story, and an opportunity for the parent to raise concerns they may not have previously had the opportunity to discuss. 

Emerging Minds’ child and family partners repeatedly describe the importance of being asked about their parenting stories, and the need for practitioners to overcome challenges to ensure these enquiries are a regular part of their practice.

Once parents have described their own stories of being parented, and the hopes and challenges they experience as parents themselves, you are well placed to help them plan the next chapter in their story.  

As you engage with parents, a more vivid account of their own needs, and the support needs of their children, develops. Using tools such as genograms and eco-maps can help you to discuss the important relationships in the child’s life, and how protective factors can be enhanced. Plans can be formed to replicate previously successful factors, and to mitigate risk to a child’s safety and social and emotional wellbeing.  

Helping parents to develop their next chapter may involve practical solutions such as identifying services, booking appointments for programs or events, and reinforcing key support people in the child’s life. Connecting with peers with similar lived experience (through support groups or other services) can improve a parent’s confidence and wellbeing, in turn contributing to a foundation of support and positive mental health for their child (Bromfield et al., 2010; Price-Robertson et al., 2016).

Strategies that explore a parent’s story are a critical element of adult-focused services. Through this process, parents experiencing mental illness may discover important hopes, preferences and values that can help them overcome feelings of stigma or hopelessness. This can be a major motivating factor in creating change in their parenting story and creating plans to parent in their preferred way. The practices described in this paper aim to be both parent and child-focused, moving away from stigmatising and judgmental practice and making room for a double-storied account of the parent’s history.  

This paper aims to equip practitioners of all kinds with the skills and knowledge needed to engage parents in conversations about parenting and childhood experiences of parental mental illness. Children’s mental health is everyone’s business, and these strategies can greatly enhance cross-sector prevention and early intervention practices for at-risk children. However, there is also a role for organisations to play in providing opportunities and resources for practitioners to develop their skills and confidence. Advice for managers, practice leaders and other decision-makers can be found in the practice paper, Supporting staff to work with children and families with complex needs: A checklist for organisations. 

Acknowledgements

Emerging Minds would like to deeply thank Felicity Kime, President and Peer Support Worker at Family Inclusion Strategies Hunter; Jess; and the other child and family partners who graciously shared their lived experience of strength, resilience and adversity to bring this paper to life. We acknowledge the time and emotional strength required to share these moving words and stories, and would like to highlight the importance of including the lived experience voice in informing practice change. We would also like to thank the practitioners whose wisdom and professional experience guided the strategies presented in this paper.

e-Learning courses

Intergenerational mental health

Parental mental illness and child-aware practice

Family Talk

Written resources

Why is it difficult for parents to talk to practitioners about their children’s mental health?

How to help parents find the right support for them

Supporting children in families with complex needs: Nine tips for practitioners who feel out of their depth

Other resources

Videos: Looking back: A co-design project with young people

Podcast: Breaking the cycle of intergenerational disadvantage

Webinar: Engaging with children and parents with complex needs: A systems approach

Webinar: Working with parents and children affected by intergenerational disadvantage

Template: Pathways of care

Various resources: Australian Childhood Foundation

Simple guide to eco-maps

Resources to share with parents

raisingchildren.net.au – Parent helplines

raisingchildren.net.au – Parenting support services

References

Bromfield, L., Lamont, A., Parker, R., & Horsfall, B. (2010). Issues for the safety and wellbeing of children in families with multiple and complex problems: The co-occurrence of domestic violence, parental substance misuse, and mental health problems. National Child Protection Clearinghouse, 33. Available here.

Centre for Community Child Health. (2010). Engaging marginalised and vulnerable families (Policy Brief No. 18). Melbourne: The Royal Children’s Hospital Melbourne. Available here.

Chicote, K. (2018). The Long View: Designing a proactive service system to prevent intergenerational disadvantage. Canberra: Winston Churchill Trust, Department of Communities. Available here.

Dulwich Centre. (2008). Children, parents and mental health. The International Journal of Narrative Therapy, 4. Adelaide: Dulwich Centre. Available here.

Humphreys, C. & Campo, M. (2017). Fathers who use violence: Options for safe practice where there is ongoing contact with children (CFCA Paper No. 43). Melbourne: Child Family Community Australia information exchange, Australian Institute of Family Studies. Available here. 

Isobel, S., Goodyear, M., Furness, T., & Foster, K. (2019). Preventing intergenerational trauma transmission: A critical interpretive synthesis. Journal of Clinical Nursing, 28(7-8), 1100-1113. Available here.

Laslett, A. M., Mugavin, J., Jiang, H., Manton, E., Callinan, S., MacLean, S., & Room, R. (2015). The hidden harm: Alcohol’s impact on children and families. Canberra: Foundation for Alcohol Research and Education. Available here.

Maybery, D., & Reupert, A. E. (2018). The number of parents who are patients attending adult psychiatric services. Current Opinion in Psychiatry, 31, 358–62. Available here.

Mayers, S., & Agnew, E. (2021). Moving beyond diagnosis: Shifting paradigms in psychology. Australian Psychological Society, 41(1). Available here.

McDonald, M. (2018). Why is it difficult for parents to talk to practitioners about their children’s mental health? Adelaide: Emerging Minds. Available here.

Moss, D., & Dolman, C. (2018). Keeping children visible in practice responses to family and domestic violence. Adelaide: Emerging Minds. Available here.

Patrick, P., Reupert, A., & McLean, L. (2019). “We are more than our parents’ mental illness”: Narratives from adult children. International Journal of Environmental Research and Public Health, 16(5), 839. Available here.

Price-Robertson, R., Olsen, G., Francis, H., Obradovic, A., & Morgan, B. (2016). Supporting recovery in families affected by parental mental illness. Melbourne: Child Family Community Australia Information Exchange, Australian Institute of Family Studies. Available here.

Salveron, M., Schuurman, C., Kowalenko, N., & Moss, D. (2019, June). Working with parents who experienced adverse childhood experiences [Webinar]. Emerging Minds and Mental Health Practitioners’ Network. Available here.

White, M. (2005). Workshop notes. Adelaide: Dulwich Centre. Available here.