Valuable resources for inpatient settings

We asked an adult mental health service in Victoria to share how they support children and families when a parent experiences mental illness and is being supported as an inpatient.

We thank Angela Obradovic (Chief Social Worker/Family Work Development Co-ordinator at the Northern Area Mental Health Service in Victoria) for answering the questions below and sharing her organisation's exemplary resources and approach with others.

Resources that support parents, children and families within an inpatient setting

Can you tell us about the ‘Keeping in Touch with Your Children’ Menu and the settings it has been designed for?

The Keeping in Touch with Your Children Menu and associated Practice Guidelines were developed for the adult acute inpatient unit within our service to help promote and support the parenting role of consumers with dependent children during an psychiatric inpatient stay.

The menu is a tool that aims to:

  • reduce the trauma of disruption to the parent-child relationship
    • while we can't easily prevent separation when someone is acutely unwell, we can act to minimise the trauma associated with it. This starts with acknowledging and validating the critical life role of parenting held by many consumers and then creating the conditions to maximise connection between parent and child.
  • reduce the stigma associated with parental mental illness
    • by normalising parenting and children as ‘expected’ topics of conversation and  to encourage conversations between staff and consumers in order to help them stay in touch with their children.
  • help maintain and promote family resilience and well-being
    • by supporting consumers and family members to explore their concerns and move through them together, contributing to strengthening their connectedness. Connectedness is a key factor in providing psychological and social health
  • act as a public statement about our parent/child/family value and recovery-focussed practice position
    • framed A3 sized posters of the menu are permanently displayed in communal areas within the psychiatric inpatient unit and A4 size menus are placed in all the bedrooms. Their visibility is obvious to anyone staying in, working in or visiting the unit. By placing these in public spaces we are creating the conditions to be continually held accountable for the way we provide support – a critical ingredient to true culture change and destigmatisation.

The 9 menu options offer parents the opportunity to:

  • choose to send a message via a staff member, if they feel unable to contact their children 
  • they can be assisted in planning and making phone calls
  • they can send postcards or arrange to have visits by their children, with staff supporting them through the process 
  • the menu also provides options about planning for discharge and returning home, which is frequently an exciting as well as stressful time for the consumer and their loved ones, especially children.

Why is a resource like this needed in this setting?

We know that any inpatient admission is a time of crisis and mixed emotions that can significantly impact on people’s wellbeing. And while adult family members can usually employ strategies to help them survive and make sense of this time (by using information, asking for help or advocacy, participating in decision-making and planning, sharing and gaining support from peers) - it is a different story for others.

For children who are family members, their access to these sorts of strategies is limited by their lack of power. Consumer parents are often overwhelmed by feelings of guilt and fear of judgement in relation to their children. When anxieties like these are left unattended to they can interfere with the recovery of the individual experiencing a mental illness and lead to children either internalising or acting out their distress and confusion.

So ultimately lessening the disconnection, confusion and fear experienced by parent consumers and their dependent children is good preventative mental health treatment and can certainly be done in an acute setting.

How was the menu resource developed?

The resource was designed as our unit was undergoing expansion from 25 to 50 beds and the opportunity to redesign the physical environment lead to the development of the new recovery-focused model of care within the acute setting. We took the opportunity of extending our family-sensitive approach to be more mindful of the relationships that are sometimes less obvious in an adult inpatient unit – that of the consumer who is a parent of dependent children or young carer.

A multidisciplinary working group led by the Senior Social Worker on the ward, Drew Bishop, was established to develop a range of policy guidelines and resources focused on the impact of hospitalisation on the parent-child relationship. This group included inpatient staff, carer and consumer representatives and senior area Family and FaPMI (Families of Parents with Mental Illness) consultants.

While pre-evaluation responses from staff indicated strong awareness of the needs of children and the potential impact of separation, confidence in best-practice approaches to supporting children and parents during an acute phase to minimise trauma and promote resilience was variable. To increase the capacity to have these important conversations we needed a mechanism to promote the discussion.

The menu could not have been realised without the generous collaboration and trust of the National COPMI Initiative. Once the concept and content of the nine menu options was finalised we approached the then director, Elisabeth Fudge, for permission to use the high-quality graphic work that appears in their existing publications and resources. As they are always interested in value-adding products and not reinventing the wheel, they were incredibly supportive collaborators in this venture and with the patient guidance of their design contractors the menu came to fruition.

How have services used this resource in your local area?

Once the KIT menu was developed and produced, staff in-servicing occurred and additional practice tools were developed including Practice Guidelines that provide guidance and suggestions on how to facilitate each of the nine menu items. A staff resource folder is kept updated and includes items such as a tip sheet for writing postcards home to children and recommended children's literature that assist parents in explaining mental illness in an age-appropriate fashion.

Following the introduction of the KIT Menu it became obvious that the absence of clear guidance around safety related to children visiting the unit was a gap. Subsequently our Child Visiting Procedure was developed by the working group aligned to existing clinical risk assessments frameworks and safety initiatives. This procedure is now available on the COPMI website as an example policy/procedure for other services to consider.

What have been the benefit for parents, children and families?

The range of menu options have been constructed to allow for different levels of capacity during an acute phase of illness. It allows for and prompts a graduated decrease in the need for staff support in facilitating communication as a consumer's condition improves. Hence connection is approached as a stepped process within the consumer’s recovery and with everyone's safety and wellbeing in mind.

Our dedicated family rooms are regularly used and provide a child-friendly environment for visits to occur in. One of these rooms is situated immediately outside the ward area off the reception area and is the preferred space for children's visits due to its separation from the ward environment. Family and others who are temporarily caring for children during the parent’s admission have been supported to assist in maintaining the connection and also extending their understanding of the impact of hospitalisation.

The profile of parents, children and families that the KIT Menu promotes has enabled many more conversations about parents’ wishes, concerns and needs for support beyond the acute phase. Conversations started on the ward have encouraged more in-depth follow-up within community teams about ongoing parent-child and family issues.

In her speech at the launch of the menu at the end of 2010, our parent consumer consultant commented that:

“Its real value lies not only in what it will provide and prevent but what it will protect – the bond between a parent and the child…Which is priceless”.

Do you have any advice or suggestions to assist services to apply this resource in their service?

A recovery focus is possible within acute setting and when we tap into the vital area of parenting we are connecting with an important ‘hope-inducing’ life area for consumers and their families. Initial ambivalence and reluctance on the part of staff to enter into the parenting and family realm in our experience is a parallel process to that of consumers and their families, requiring us all to recognise the power of the illness itself to thwart connection. Rather than a focus on limitations, this strength-based, trauma-informed approach has the capacity to liberate us all to engage in more open conversations that lead to better outcomes.

A last word of encouragement:

A powerful anecdote that evidences the menu is indeed doing its job is from a local short-term rehab unit where a staff member had placed it on display, wanting to canvas ideas about a wording change to suit their residential setting: A consumer approached her saying; “I think there is a message for me on the wall.... “. Of course it doesn't take much imagination to consider what anxiety was raised with this specific comment, until he took her over to the poster and said “I think it would be good for my kids to come and visit me here so they know I’m OK – can we do that?”

Is your in-patient mental health service family-friendly?

The COPMI national initiative offers an additional tool for you to check how family-friendly your inpatient or community mental health services are by comparing them with the COPMI Family Friendly Checklists.

This checklist for inpatient settings was developed with information provided by parents with a mental illness, their partners, support people and children as well as service providers.

 

 

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