It is widely agreed that parental mental illness should be discussed with children, despite various obstacles to discussion.
Talking to children stems unnecessary confusion and fear, and helps contribute to a child’s resilience.
Learning about parental mental illness by seeing a parent hospitalised or being exposed to symptoms is often a confusing and negative experience.
Families are encouraged to discuss parental mental illness more than once and tailor information to the child’s level of understanding as they grow.
Practitioners should be aware of the programs now available to assist families to discuss parental mental illness.
Why should we speak to children about parental mental illness?
There is widespread agreement that children whose parents have a mental illness should be told about the illness. Lack of information can contribute to unnecessary confusion for a child about the illness, including fear of developing the illness themselves, worry that a parent may not recover and believing that they are responsible for causing the illness.1,2
Retrospective research of adults’ experience of growing up with a parent with mental illness indicates that mental illness was rarely explained to children,a finding which is confirmed by young people even today.6,7,8,10 In these cases where children are not specifically told about a parent’s illness they are still often aware of aspects of the illness and their imagination may fill the gaps in their knowledge. Talking to children about their parent’s mental illness alleviates unnecessary fears, reduces confusion and contributes to developing resilience in young people.3-5
Parents have difficulty discussing mental illness with their children. Although parents have stated that they would like their children to be better informed about parental mental illness they have reported a number of obstacles to disclosing the facts to their children. Parents may have difficulty understanding their own illness.2 They may also sense their child’s reluctance to discuss what can be a difficult topic.11,12,13 They may be unsure who should provide their children with information, how a child should be told and how to provide the information in an age appropriate way.9 Parents are not alone in this uncertainty, as mental health workers have reported similar difficulties when talking to client’s children.14 Parents have stated that they would appreciate help with this discussion but many are unsure about how to access such assistance.9,13
Recent research demonstrated that when parents themselves are not responsible for initiating discussion about parental mental illness, young people are often provided with information through other avenues.13 Parents reported that their children found out about parental mental illness from other people, by being exposed to the symptoms of the parent’s mental illness or by the parent being hospitalised.13 This was frequently said to be a negative experience for children as they were provided with incorrect information or witnessed intense and confusing symptoms of their parent’s illness.13
Children’s experiences of talking about their parent’s mental illness
Young people have reported great difficulty understanding their parent’s mental illness and have indicated that they would prefer to learn about it from one of their parents directly.2,15 Research suggests that children are aware of a reluctance on the part of significant others to talk about their parent’s illness, although there are some children who themselves are reluctant to talk about it and who would prefer not to receive such information.2,13
Some young people are aware that their parents have concealed information about their illness.16 In addition, some may only be told about a parent’s illness once, as a single event, rather than a process over time.13 This may mean that the information that a child receives is limited to his or her level of understanding at the time, and they may feel unable to ask parents questions about the illness at a later period.
Very little research exists which examines the disclosure process for parents with mental illness. Likewise, there is a paucity of research presenting young people’s experiences and attitudes regarding how a parent’s mental illness might be explained to them. Parental mental illness involves all members of the family and it is important that further research examines the disclosure experience of each family member and how this might be optimally managed.
Although it is clear that talking to children about parental mental illness contributes to better outcomes for children, there are a number of obstacles which make talking within families difficult. Practitioners should be mindful of the possible reticence from both parents and their children about discussing the topic of parental mental illness.
There are programs available to assist practitioners to empower families to talk about parental mental illness. Beardslee and colleagues have developed the ’Family Talk’ course (www.fampod.org) which focuses on supporting families where a parent has depression. At present an Australian resource is also being developed, based on the Beardslee course. The Australian ‘Family Focus’ intervention has been developed to support families experiencing parental anxiety and depression.
Meadus RJ, Johnson B. The experience of being an adolescent child of a parent who has a mood disorder. Journal of Psychiatr Ment Health Nurs 2000; 7(5): 383-90.
Handley C, Farrell GA, Josephs A, Hankes A, Hazelton M. The Tasmanian children’s project: The needs of children with a parent with a mental illness. Aust N Z J Ment Health Nurs 2001; 10(4): 221-28.
Garley D, Gallop R, Johnston N, Pipitone J. Children of the mentally ill: A qualitative focus group approach. Journal of Psychaitr Ment Health Nurs 1997; 4(2): 97-103.
Beardslee WR, Podorefsky D. Resilient adolescents whose parents have serious affective and other psychiatric disorders: Importance of self-understanding and relationships. Am J Psychiatry 1988; 145(1): 63-69.
Cogan N, Riddell S, Mayes G. Children living with an affectively ill parent: How do they cope? Educational and Child Psychology 2005; 22(4): 16-28.
Knutsson-Medin L, Edlund B, Ramklint M. Experiences in a group of grown-up children of mentally ill parents. J Psychiatr Ment Health Nurs 2007; 14(8): 744-52.
Pölkki P, Ervast S, Huupponen M. Coping and resilience of children of a mentally ill parent. Soc Work Health Care 2005; 39(1): 151-63.
Riebschleger J. Good days and bad days: The experiences of children of a parent with a psychiatric disability. Psychiatr Rehabil J 2004; 28(1): 25-31.
Wang AR, Goldschmidt VV. Interviews with psychiatric inpatients about professional intervention in regard to their children. Acta Psychiatrica Scandinavia 1996; 90(6): 459-65.
Thomas L, Kalucy R. Parents with mental illness: lacking motivation to parent. Int J of Mental Health Nurs 2003; 12(2): 153-57.
Maybery D, Ling L, Szakacs E, Reupert A. Children of a parent with a mental illness: Perspectives on need. Australian e-Journal for the Advancement of Mental Health.2005; 4(2): 1-11.
Stallard P, Norman P, Huline-Dickens S, Salter E, Cribb J. The effects of parental mental illness upon children: A descriptive study of the views of parents and children. Clin Child Psychol and Psychiatry 2004; 9(1): 39-52.
Ferguson B. Children of parents with mental illness: Parental disclosure, children’s illness beliefs and the development of a shared understanding of mental illness in the family [PhD thesis]. Adelaide, SA: University of Adelaide; 2011.
Maybery D, Reupert A. Workforce capacity to respond to children whose parents have a mental illness. Aust N Z J Psychiatry 2006; 40(8): 657-64.
Fudge E, Mason P. Consulting with young people about service guidelines relating to parental mental illness. Australian e-Journal for the Advancement of Mental Health 2004; 3(2): 1-9.