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Children of Parents With Mental Illnesses: When to Intervene

Michael T. Compton, MD, MPH Posted: 08/22/2011

Author's Note: The commentary below is the first in a 3-part series highlighting and providing perspective on select topics from the 32nd International Congress on Law and Mental Health, held under the auspices of the International Academy of Law and Mental Health at Humboldt University in Berlin, Germany, from July 17-23, 2011. Specifically, part 1 will cover experiences of children of individuals with mental illnesses, part 2 will look at therapeutic jurisprudence and mental health courts, and part 3 will address behavioral genetics and the antisocial personality spectrum, though the Congress covered a much broader array of topics than just these few. Children of Parents With Mental Illnesses: Introduction Presenters from New Zealand, Canada, and the United Kingdom discussed "Moving the Agenda Forward on Services for Parents With Mental Illness and Their Children."[1] Grant Duncan (Massey University, New Zealand) discussed his qualitative research with adults who had been raised by a parent with a serious mental illness like schizophrenia. Although a substantial amount of research on such children's risk of developing mental illnesses has accumulated, he feels that more important questions pertain to how such children cope, their resilience strengths, and what we can learn from their experiences. At least 5 themes were apparent in his presentation. First, a parent having schizophrenia is not a necessary or sufficient reason for separating a parent and child. However, he noted that secure attachment may be disrupted as some affected parents may not respond well emotionally to their children (though separation would obviously be even more detrimental to attachment). Whereas abuse or neglect may justify separation, a mental illness diagnosis alone does not, though it should warrant an increase in supports available to the family. "Separation should be a last resort," Duncan noted. Third, disruption to the family resulting from the mental illness may be much more damaging than the mental illness itself. Sole custody by the parent with a mental illness, without the stability and support of the other parent, may convey a higher risk for problems among children. It should also be recognized that signs/symptoms witnessed by children are highly variable (eg, ranging from being intrusive to being very distant). Fourth, children feel a heightened sense of responsibility, though they usually receive very little age-appropriate information from clinicians, which may be growing even more problematic in light of privacy laws and misunderstandings about such laws by clinicians. Fifth, Duncan's research participants nearly never mentioned stigma per se, though they did speak about feelings of embarrassment. How Do Children Perceive Stigma? Regarding the latter concern, Elaine Mordoch, from the University of Manitoba, presented a study of how children of parents with various mental illnesses (eg, depression, posttraumatic stress disorders, attentiondeficit/hyperactivity disorder, borderline personality disorder) perceive stigma, in particular, stigma by association, or "courtesy" stigma (ie, stigma acquired as a result of being related to a person with a stigmatized condition).[1] She noted that according to recent epidemiologic statistics, 17% of Canadian children are parented by a person with a mental illness, which may be an underestimate. Thus, the magnitude of this issue is considerable. In interviewing youths 6-18 years of age, she found that children (6-11 years old) spoke most commonly about concerns related to observable differences that could cause them to be treated differently. On the other hand, older youths seemed to be more aware of possible stigma tied to the mental illness and became aware that the illness could affect family income, job security, and, thus, going to college in the future.
Children as Caregivers?

From Loughborough University in the United Kingdom, Jo Aldridge presented on a study involving children who