Promoting children’s resilience when a parent has a mental illness

• Author: Karen Stafford and Gavin Hazel Child, Youth, and Wellbeing Program, Hunter Institute of Mental Health
• Series editors: Andrea Reupert and Darryl Maybery (Monash University) on behalf of the Australian COPMI national initiative.

Quick facts

• Resilience is the capacity to overcome the negative effects of adversity that can be seen when children achieve positive developmental outcomes despite significant challenges.
• Living with mental illness may adversely impact on a parent’s capacity to meet the emotional and physical needs of children, particularly in the acute phases of illness.
• Children of parents with a mental illness sometimes face particular developmental challenges. Generally they are at greater risk of emotional and/or behavioural problems, school difficulties and mental illness.
• Promoting resilience in children who have a parent with a mental illness centres on developing a shared understanding of the parent’s illness within the family, building supportive relationships andenhancing coping skills.
• Family members, teachers, health professionals and community services staff can all play important roles in promoting resilience amongst children who have a parent with a mental illness.

Research summary

Resilience is the capacity of a person or group to minimise or overcome the negative effects of a challenging situation.¹ Resilience is dynamic rather than being a static trait, and is influenced by biological, psychological and social factors that interact in complex ways.² In children and young people, resilience is often seen in terms of adaptation and positive development, despite the presence of risk factors that tend to be associated with poorer outcomes.³

There are some limitations in the research about how best to promote resilience in children who have a parent with a mental illness. For example, few studies have used control groups and some have been limited
by the small sample size used or the lack of follow-up. ⁴ The strategies outlined in this paper are based on the available evidence and the expert opinion from the current literature, however further research is
needed.

The impact of parental mental illness

Up to 23% of Australian children have a parent with a mental illness.⁵ This may affect the parent’s capacity to meet the children’s emotional and physical needs, particularly in the acute phases of illness.⁶ Depending on the type, severity and duration of the illness, a parent may find it hard to maintain positive family relationships or to complete the day-to-day tasks of parenting, working for managing a household.⁶ Some families experience conflict, social isolation and/or economic disadvantage.⁷ The perceived stigma of mental illness can also be a barrier to discussing the situation and seeking help.⁶

Parental illness in the first few years of life may interrupt the development of secure attachment, particularly if the child’s primary caregiver is unwell.¹ When a parent is unwell, children often experience distress and/or worry and sometimes take on a caregiving role for their parent or siblings.^1,4 All of these issues can create significant developmental challenges for children. In general, children of parents with a mental illness are at greater risk than other children of emotional or behavioural problems, school difficulties and mental illness.^7,8

Promoting resilience

Despite these challenges, many children and families demonstrate resilience and cope well when a parent has a mental illness.⁸ Promoting resilience involves identifying and building strengths and opportunities across
three levels: the individual, the family and in the community.^1,3 The best approach for any particular person or group will depend on the children’s developmental stages and their family and community contexts.

Positive relationships with caring adults are central to children’s resilience.² Strategies can be developed to strengthen parentchild relationships and to ensure the childhas a caring relationship with at least one other adult, such as another family member, a teacher or a health professional.¹ For older children, relationships and enjoyable activities with peers are also increasingly important.⁸ These relationships and activities can be supported by offering group programs for children of parents with a mental illness.⁹ Positive experiences at school, both within and beyond the classroom, can also be protective.³

Children and young people need the opportunity to discuss and talk about a parent’s mental illness, in order to address any misunderstandings they may have and to ease the children’s potential worry, guilt or distress.^1,8 Giving young people an opportunity to discuss what is happening also fosters family problem solving as it allows the family to discuss how they can support the child’s particular concerns.

Promoting a shared understanding about mental illness is best approached in partnership with other family members, in particular with the parent with the illness, as part of a broader focus on family support and education.¹

A child’s resilience can be developed, fostered and/or promoted by using active coping strategies that focus on acceptance and adaptation, instead of by dwelling on problems or avoiding the issue.⁸ Individual factors associated with active coping and resilience include a child’s capacity for self-regulation and reflection, their perceived self-efficacy and control, a positive self-concept and well-developed problem-solving ability.^2,3 Children or young people who have a parent with a mental illness may benefit from developmentally-appropriate support that helps them to identify their strengths, develop flexible thinking, manage their emotions and enhance their problem-solving skills.^7,8

Practice implications

Family members, health professionals,  teachers and community services staff can all contribute to promoting resilience in children of parents with a mental illness. ¹

Depending on the person’s role, strategies include the following:

• Strengthening children’s relationships with parents and other family members
• Identifying and strengthening the personal, family and community processes that promote children’s development and wellbeing
• Being aware of and responding to difficulties children may experience
• Inviting children and young people to talk about their needs, wishes and experiences
• Supporting parents and other individuals to communicate appropriately with children about parental mental illness
• Working with children and families in a way that reduces the stigma of mental illness
• Facilitating children’s access to external social supports and peer activities
• Promoting positive experiences and engagement within the school community
• Facilitating access or arranging referral to specialist support where required
• Keeping up to date with emerging information and resources about this issue

1. Pretis M, Dimova A. Vulnerable children of mentally ill parents: towards evidence-based support for improving resilience. Support for Learning. 2008; 23(3): 152-159.
2. Sapienza JK, Masten AS. Understanding and promoting resilience in children and youth. Current Opinion in Psychiatry. 2011; 24: 267-273.
3. Place M, Reynolds J, Cousins A, O’Neill S. Developing a resilience package for vulnerable children. Child and Adolescent Mental Health. 2002; 7(4): 162-167.
4. Fraser E, Pakenham KI. Evaluation of a resilience-based intervention for children of parents with mental illness. Australian and New Zealand Journal of Psychiatry. 2008; 42: 1041-1050.
5. Maybery DJ, Reupert AE, Kent P, Goodyear M, Crase L. Prevalence of parental mental illness in Australian families. Psychiatric Bulletin. 2009; 33(1): 22-26.
6. Reupert AE, Maybery DJ, Kowalenko NM. Children whose parents have a mental illness: Prevalence, need and treatment. Medical Journal of Australia Open. 2012; 1 (Suppl 1): 7–9.
7. Reupert, AE, Maybery DJ. Families affected by parental mental illness: A multiperspective account of issues and interventions. American Journal of Orthopsychiatry. 2007; 77(3): 362–369.
8. Fraser E, Pakenham KI. Resilience in children of parents with mental illness: Relations between mental health literacy, social connectedness and coping, and both adjustment and caregiving. Psychology, Health and Medicine. 2009; 14(5): 573-584.
9. Foster K, Lewis P, McCloughen A. Experiences of peer support for children and adolescents whose parents and siblings have mental illness. Journal of Child and Adolescent Psychiatric Nursing. 2014; 27: 61–67.

Other relevant resources

• Goodyear M, Power J. Resilience in families where a parent has a mental illness. GEMS, Edition 20.
• Center on the Developing Child at Harvard University. (2015). Supportive Relationships and Active Skill-Building – Strengthen the Foundations of Resilience: Working Paper 13.