Parenting

Be the Best Parent You Can Be

Mental health conditions can affect any person regardless of gender, age, health status and income, and that includes people who have or want to have children of their own. Parenting is both greatly rewarding and a daunting task for anyone, but it poses some particular challenges for people with a mental health condition. Here, you will find information about parenting and mental illness, where to go to get help for you and your family, and how to support yourself and your children.

Everyone can improve on their parenting skills. Consider taking a parenting class to learn the basics and lessen the anxiety of being a parent. Parentingwell.org is a web site especially for parents with mental illness. It includes an online community, tips and tools and other resources. For perspective on all of the roles being a parent entails, visit the Parenting section of the Temple University Collaborative on Community Inclusion website.

My Mental Illness and My Child

My Child's Mental Health

Talking to My Child

Caring for Children

Could I Lose My Child?

Legal Issues

Keeping Families Intact

What impact does a parent's mental illness have on children?

The effect of a parent's mental illness on children is varied and unpredictable.[1] Although parental mental illness poses biological, psychosocial and environmental risks for children, not all children will be negatively affected, or affected in the same way. The fact that a parent has mental illness alone is not sufficient to cause problems for the child and family. Rather, it is how the mental health condition affects the parent's behavior as well as familial relationships that may cause risk to a child. The age of onset, severity and duration of the parent's mental illness, the degree of stress in the family resulting from the illness, and most importantly, the extent to which parents' symptoms interfere with positive parenting, such as their ability to show interest in their children, will determine the level of risk to a child. The child's age and stage of development is also important.

Will my child have a mental health condition as well?

Mental health conditions are not contagious, but research shows that some mental health conditions may have a genetic link. Bipolar disorder, for example, has long been shown to run in families. Other people may pass on hereditary traits that make a mental health disorder more likely without passing on a specific disorder.

Because you have a mental health condition does not mean that your child will have a mental health condition. But because of your own experiences, it may help you be better attuned to the psychological challenges that parenting can bring.

Risk Factors

Children whose parents have a mental illness are at risk for developing social, emotional and/or behavioral problems. An inconsistent and unpredictable family environment, often found in families in which a parent has mental illness, contributes to a child's risk. Other factors that place all children at risk, but particularly increase the vulnerability of children whose parents have a mental illness, include:

• Poverty
• Occupational or marital difficulties
• Poor parent-child communication
• Parent's co-occurring substance abuse disorder
• Openly aggressive or hostile behavior by a parent
• Single-parent families

Families at greatest risk are those in which mental illness, a child with their own difficulties, and chronically stressful family environments are all present. Many of these factors, however, can be reduced through preventive interventions. For example, poor parent-child communication can be improved through skills training, and marital conflict can be reduced through couple's therapy.

The Prevention Perspective

Whether or not children of parents with mental illness will develop social, emotional, or behavioral problems depends on a number of factors. These include the child's genetic vulnerability, the parent's behavior, the child's understanding of the parent's illness, and the degree of family stability (for example, the number of parent-child separations). Preventive interventions aimed at addressing risk factors and increasing children's protective factors increase the likelihood that they will be resilient, and grow and develop in positive ways. Effective prevention strategies help increase family stability, strengthen parents' ability to meet their children's needs, and minimize children's exposure to negative manifestations of their parent's illness.[2]

Protective Factors

Increasing a child's protective factors helps develop his or her resiliency.  Resilient children understand that they are not responsible for their parent's difficulties, and are able to move forward in the face of life's challenges. It is always important to consider the age and stage of development when supporting children. Protective factors for children include:

• A parent's warm and supportive relationship with his or her children
• Help and support from immediate and extended family members
• A sense of being loved by their parent
• Positive self-esteem
• Good coping skills
• Positive peer relationships
• Interest in and success at school
• Healthy engagement with adults outside the home
• An ability to articulate their feelings
• Parents who are functioning well at home, at work, and in their social relationships
• Parental employment

References:

1. Joanne Nicholson, Elaine Sweeny, and Jeffrey Geller. Mothers With Mental Illness: I. The Competing Demands of Parenting and Living With Mental Illness. Psychiatric Services. May 1998. Vol. 49. No. 5.

2. Ibid.

How do I talk to my child about my mental health condition?

How you talk to your child about your mental health condition will depend on the age and maturity of your child and your willingness to open up to him or her.

In general, children, especially as they grow older, are very astute and knowledgeable about their surroundings. They can sense emotional changes and can often tell if something is hidden from them without their knowledge. Some children may be able to fully understand what it means to have a mental health condition. In talking with children you can help them to know how to cope when you are not feeling well. And, a child may be able to support you in your recovery by reminding you when to take your medications or help you stay on track.

Your decision to talk to your child about your condition should also take into account your readiness. Parents often want to appear invincible and strong to their children, as they think it is the parents' role to care for a sick child and not the other way around. The decisions you make should be made with both parent and child in mind.

Before proceeding, you should always talk to your doctor or therapist about the best ways to bring this information up. You may want to consider the possibility of inviting a child to a session to explore this information.

What can I expect from my child?

Your child might experience some of these feelings:

• Anger - Your child may be angry at you for having a mental health condition. The child may think that it was your fault that you had a mental health condition and that it is your fault that they will experience a harder life. Your child might also be angry at external forces, such as a higher power or the world, for unfairly hurting you or your family. Your child may also be angry at him or herself. If you notice anger problems in your child, you should talk to your therapist or doctor about arranging for your child to join in sessions.
• Fear - Your child might be scared about what the future will bring. Your child might be afraid about how your mental health condition will change your relationship. They might be afraid about your ability to take care of them. Your child may also be scared about what others will think if they found out that you have a mental health condition. Sit down and talk to your child about these issues, reassure them you still love them.
• Guilt - Your child may blame himself or herself for your mental health condition, especially in cases or anxiety or depression. Your child may express guilt by taking over an inordinate amount of household duties. Your child may try and hide his or her own problems so as not to make your life any worse.
• Shame - Despite efforts to educate the public about mental illness, mental illness is still often a stigmatized and misunderstood condition. Your child might be embarrassed. He or she might think that your condition will have negative impacts on his or her social life and might be worried.
• Sadness - Children can become very sad when they learn that a loved one, especially a parent, is hurt or sick. You should talk to your doctor about ways to cope with sadness and ways to know when sadness becomes depression.
• Anxiety - Your child may become overanxious or worried about you if he or she learns that you have a mental health condition. These children tend to be overly helpful and may miss out on their own lives.
• Relief - For some children, learning that you have a mental health condition might be a relief. It might help explain behaviors or incidents that they experienced that they previously could not understand.
• Supportiveness - Your child may be very supportive of your mental health, regardless of his or her previous attitudes toward mental illness. Often, having mental illness in a family can change someone's orientation toward mental illness.

How can I care for a child while caring for myself?

In addition to being a parent, you are also a person of your own. Your recovery plans and activities should always include time for yourself that is relaxing and beneficial. 

If you have a crisis action plan or a psychiatric advance directive, you should designate someone to help with your parenting duties.  If your child is old enough, you should discuss your plan with your child and identify resources and options together for handling things when you are not well.

Could I lose my child because I have a mental health condition?

A higher proportion of parents with serious mental illness lose custody of their children than parents without mental illness.  There are many reasons why parents with a mental illness risk losing custody, including the stresses their families undergo, the impact on their ability to parent, economic hardship, and the attitudes of mental health providers, social workers and the child protective system. Supporting a family where mental illness is present takes extra resources that may not be available or may not be offered. Also, a few state laws cite mental illness as a condition that can lead to loss of custody or parental rights. One unfortunate result is that parents with mental illness might avoid seeking mental health services for fear of losing custody of their children. Studies that have investigated this issue report that:

• Only one-third of children with a parent who has a serious mental illness are being raised by that parent.
• In New York, 16 percent of the families involved in the foster care system and 21 percent of those receiving family preservation services include a parent with a mental illness.
• Grandparents and other relatives are the most frequent caregivers if a parent is psychiatrically hospitalized, however other possible placements include voluntary or involuntary placement in foster care.[1]

The major reason states take away custody from parents with mental illness is the severity of the illness, and the absence of other competent adults in the home.[2] Although mental disability alone is insufficient to establish parental unfitness, some symptoms of mental illness, such as disorientation and adverse side effects from psychiatric medications, may demonstrate parental unfitness. A research study found that nearly 25 percent of caseworkers had filed reports of suspected child abuse or neglect concerning their clients.[3]

The loss of custody can be traumatic for a parent and can exacerbate their illness, making it more difficult for them to regain custody. If mental illness prevents a parent from protecting their child from harmful situations, the likelihood of losing custody is drastically increased.

Legal Issues

All people have the right to bear and raise children without government interference. However, this is not a guaranteed right. Governments may intervene in family life in order to protect children from abuse or neglect, imminent danger or perceived imminent danger. When parents are not able, either alone or with support, to provide the necessary care and protection for their child, the state may remove the child from the home and provide substitute care.

Adoption and Safe Families Act

The Federal Adoption and Safe Families Act, Public Law 105-89 (ASFA) was signed into law November 19, 1997. This legislation is the first substantive change in federal child welfare law since the Adoption Assistance and Child Welfare Act of 1980, Public Law 96-272.4 It is intended to achieve a balance of safety, well-being and permanency for children in foster care. It requires that state child welfare agencies make "reasonable efforts" to prevent the unnecessary placement of children in foster care and to provide services necessary to reunify children in foster care with their families. ASFA establishes expedited timelines for determining whether children who enter foster care can be moved into permanent homes promptly-their own familial home, a relative's home, adoptive home, or other planned permanent living arrangement.

While ASFA is designed to protect children, it also includes provisions pertaining to parental rights. For example, under ASFA, parents have the right to receive supports and services to help them retain custody and keep their families intact. The child welfare system must provide these services according to an individualized plan that has been developed and agreed upon by all parties to ensure parents with mental illnesses are not discriminated against due to their illness. A plan with parental input also helps ensure that, when appropriate, efforts are made by state welfare agencies to promote family permanency, including establishing whether children in foster care can be moved into a permanent living situation.

Helping Families Stay Intact

Parental mental illness alone can cause strain on a family; parental mental illness combined with parental custody fears can cause even greater strain. Such strain, as well as the lack of specialized services for families in the child welfare system and the overall stigma associated with mental illness, makes it difficult for families to get the help they need. With the right services and supports though, many families can stay together and thrive. The following efforts by advocates can help families living with mental illness maintain custody and stay intact:

• Help parents become educated about their rights and obtain legal assistance and information.
• Advocate for parents as services plans are developed, and assist adult consumers to develop their own self-care plans and advance directives to strengthen their parenting skills and manage their own illness.
• Enable parent-child visitation during psychiatric hospitalization to maintain the bond between parent and child.
• Train child protective services workers to better understand parental mental illness.
• Educate the legal system about advances in the treatment of serious mental illness.
• Advocate for increased specialized services for parents with serious mental illnesses available through the court system.

References:

1. Network practical tools for changing environment. Making the Invisible Visible: Parents with Psychiatric Disabilities. National Technical Assistance Center for State Mental Health Planning. Special Issue Parents with Psychiatric Disabilities. Spring, 2000.

2. Roberta Sands. "The Parenting Experience of Low-Income Single Women with Serious Mental Disorders. Families in Society." The Journal of Contemporary Human Services. 76 (2), 86-89. 1995.

3. Joanne Nicholson, Elaine Sweeny, and Jeffrey Geller. Mothers With Mental Illness: II. Family Relationships and the Context of Parenting. May 1998. Vol. 49. No. 5.

4. Ibid.