Help seeking for young people with mental health problems in families with a parent who experiences a mental illness
- Author: Dr Coralie Wilson, Academic Leader Personal and Professional Development Graduate School of Medicine, University of Wollongong NSW
- Series editors: Andrea Reupert and Darryl Maybery (Monash University) on behalf of the Australian COPMI national initiative.
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- As many as one in eight young Australians with a mental health issue has a parent who also experiences a mental illness.
- Parents have an important role in maintaining the mental health of their children. This might be challenging when a parent has a mental illness.
- Help-negation may be misunderstood by all parents and might be challenging for parents with a mental illness to address.
- Promotion of appropriate help-seeking must focus on increasing the quality of relationships between a parent with a mental illness and their children.
- Therapeutic intervention must involve the young person as an active collaborator in a recovery plan that empowers them to manage their family context.
Approximately one in four young Australians experience a mental health issue – mostly anxiety disorders (15.4%), substance use disorders (12.7%), and affective disorders (6.3%) – at levels that are moderate to severe. Suicide is also a concern.1, 2 Between 25 – 50% of children with parents who experience mental illness will experience some form of psychological difficulties during childhood or adolescence, and 10 – 14% will be diagnosed with a psychotic illness at some point in their lives.3 Appropriate support and early treatment for these children is vital to reduce the long-term impact of mental health issues and to protect against the development of more severe forms.4
Parents play an important role in maintaining the mental health of their children. Results from the 2007 National Survey of Mental Health and Wellbeing found that half of young people with a 12-month mental health issue had tried to manage their symptoms with strategies that included accessing family for support.5 This means that as many as one in four young people with their own mental health issues turned to a parent also experiencing mental health issues for help.
The role of a parent in managing their children’s mental health is to recognise the presence of a problem, facilitate access to appropriate help, and to model appropriate help-seeking behaviour. ‘Appropriate’ help-seeking refers to a match between the type of problem, its severity and the source of help. For example, low levels of distress following transient stressful experiences may only require support from a friend or another family member, whereas more severe and traumatic experiences might require professional mental health treatment. A parent who demonstrates active and appropriate help-seeking themselves also models appropriate help-seeking for their children. This can have a significant impact on the child’s treatment and recovery.6 Having a mental health issue might compromise a parent’s ability to care for children and adolescents, and may impact a parent’s ability to recognise and respond to their child’s need for help.7
Reluctance to seek help
A prominent barrier to appropriate help-seeking is the process of help withdrawal or avoidance (i.e., the help-negation process) that co-occurs with elevated levels of suicidal ideation, depression, anxiety, and general psychological distress. Consistent with large international studies, Australian studies have repeatedly found that children, adolescents, and young adults with elevated symptom levels are also those most likely to “not seek help from anyone”, and least likely to seek help and support from mental health professionals, including family doctors (General Practitioners), friends, and parents.2
The bidirectional relationship between children and parents with a mental health issue may mean that normal withdrawal by a child who is mentally unwell is misunderstood by a parent with a mental health issue.8 Withdrawal might be misattributed to the child as bad behavior or to the parent as evidence to support a distorted view of themselves or their parenting. Either way, it can be anticipated that the help-negation process will impact the relationship between the child and parent with a mental health issue in ways that may be qualitatively different to how the help-negation process would impact the relationship between child and parent without a mental health issue. Future research needs to examine this possibility.
Strategies for promoting help-seeking among children and parents with a mental disorder2
Strategies for the promotion of help-seeking must focus on increasing the quality of relationships that exist between the child or young person and their parents.6
- Parents with or without a mental health issue need support to understand the behaviours, thoughts and emotions that are normal for young people, as well as the behaviours (including social engagement and withdrawal), thoughts and emotions that might indicate mental health issues are developing.
- Parents, with or without a mental health issue, as well as the young people themselves need to know that for many, a normal reaction to experiencing symptoms of a mental health issue is the desire to withdraw from others.
- Young people and their parents need to know that early signs of help-negation signal an immediate need to seek support and connect with those around them, or with a mental health service depending on the type and intensity of the problem that the young person is experiencing.
- Parents, with or without a mental illness, need to know how to support their children to find services when professional care is warranted. Parents may need additional skills to approach and talk with their children when they suspect mental health issues exist. Parents without a mental health issue, who are in a supporting role, need to know how to offset any negative impact that the help-negation process may have on the relationship between children and their parent with mental health issues.
- Rehearsing help-seeking skills in a safe family context (e.g., family therapy), when the parent with a mental health issue is well or available, might make it easier for the young person to seek help from family or a mental health professional if they experience symptoms of a mental health issue themselves.
Strategies for the therapeutic context2
- Prepare by knowing the developmental stages of children and young people and having skills to develop rapport across developmental stages. This includes skills to communicate effectively and motivate change, knowledge of the major health issues that exist for children and young people and the usual and unusual ways that each issue is expressed.
- Young people must be active collaborators in their consultations and feel heard and understood. Always allow time at the start of a consultation for the young person to safely express how they feel about having a parent with a mental health issue, before addressing the young person’s mental health issue.
- Australian Bureau of Statistics (ABS). Australian social trends (ABS Catalogue No. 4102.0). Canberra, Australia: ABS, 2008.
- Wilson CJ, Bushnell JA, Caputi P. Early access and help seeking: Practice implications and new initiatives. Early Intervention in Psychiatry. 2011; 5 (Suppl. 1): 34-39.
- Worland J, Weeks DJ, Janes CL. (1987). Predicting mental health in children at risk. In E.J. Anthony (Ed.). The invulnerable child (pp. 185- 210). New York: Guilford Press.
- Rickwood DJ, Deane FP, Wilson CJ. When and how do young people seek professional help for mental health problems. Medical J Aust 2007; 187: S35-S39.
- Olesen SC, Butterworth P, Leach L. Prevalence of self-management versus formal service use for common mental disorders in Australia: Findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2010; 44: 823-830.
- Reupert AE, Maybery DJ, Kowalenko NM. Children whose parents have a mental illness: prevalence, need, and treatment. Medical Journal of Australia. 2012; 1 (Suppl 1): 7-9.
- Logan DE, King CA. Parental facilitation of adolescent mental health service utilization: A conceptual and empirical review. Clinical Psychology: Science and Practice. 2001; 8: 319-333.
- Beardslee WR, Solantaus TS, Morgan BS, Gladstone TR, Kowalenko NM. Preventative interventions for children of parents with depression: international perspectives. Medical Journal of Australia. 2012; 1 (Suppl1): 23-27.