Resilience in families where a parent has a mental illness

• Author: Dr Melinda Goodyear and Dr Jennifer Power
  
• Series editors: Andrea Reupert and Darryl Maybery (Monash University) on behalf of the COPMI national initiative

Quick facts

• Family resilience, in contrast to individual resilience, refers to the wellbeing of multiple individuals within a family unit, the relationships between them and key family processes.
• Key processes underpinning family resilience are the family’s belief systems, organisational processes, and the clarity of communication and problem-solving ability within the family.
• Many families cope well with the challenges of mental illness and can be quite resourceful in how they manage the impact of mental illness within the family.
• Family resilience provides a useful theoretical framework for a strengthsbased family inclusive approach.
• The framework presumes diversity in family formation, structure and kin networks and presumes there are many different pathways to resilience.
• Mental health clinicians might promote family resilience by providing relevant information about mental illness to the family and facilitating family discussions about the impact of the illness.

Research summary

Parental mental illness can pose particular challenges for families. Family life may be interrupted by the periodic hospitalisation of a parent, and families often need to manage the unpredictability of an episodic and enduring illness. As such, families where a parent has a mental illness can struggle to maintain a consistent and structured approach to family life.^{1, 2} Daily routines such as making meals, getting children to school and maintaining consistent bedtimes can be interrupted. Mental illness also has potential to disrupt trusting family relationships and change the roles that people adopt in their families.^{3, 4}

Families may also be affected by the social and economic burdens often associated with mental illness including poverty, lack of access to education and employment, an increased risk of intimate family violence and a lack of personal and social supports.^{5, 6} Furthermore, the stigma associated with mental illness may impede families seeking assistance, including from health professionals.⁷

Despite this, there is evidence that many families cope well with the challenges that come from parental mental illness and develop a sense of resilience through the challenges.

The concept of family resilience

Resilience is generally defined as a capacity to thrive despite adversity. The concept of resilience is often used in research to outline the ways in which individuals, families or communities recover from trauma, including trauma related to natural disasters or war, or more personal circumstances such as the loss of family members or experiences of violence.^3,8,9

Family resilience is a more complex concept than individual resilience as it refers to the wellbeing of multiple individuals within a family system, the quality of relationships between these individuals and family culture and processes.³ In her work on family resilience, Froma Walsh highlights key family processes that contribute to resilience: the family’s belief and their capacity to make sense of adversity; organisational patterns including the ability to be flexible, a sense of connectedness and mutual support; and the clarity of communication, emotional expression and problem-solving within the family.^1,2,3,10

Family resilience in families where a parent has a mental illness

In a recently published study, Power et. al. used a family resilience framework to understand the experience of families where a parent has a mental illness.³ The findings from this study identified a range of processes that may support families affected by parental mental illness to maintain resilience. The study found the following:

• Communication about mental illness within the family can help people to make sense of the negative impact of parental mental illness, although stigma and shame related to mental illness can inhibit this.
• Rituals and routines, such as regular family dinners or holidays, can help families to maintain a sense of stability and promote family bonding. In two parent families, the parent that does not have a mental illness often plays an important role in maintaining these routines, although they may not always receive support for this role.

Importantly, this study concluded that resilience comes from family members’ capacity to balance negative experiences and feelings with a sense of optimism or hope for their family life.³

Clinical implications

Family resilience can be a complex framework to apply to clinical practice. However, the value of this approach is that it is strengths-based and invites clinicians to focus on the wellbeing of all family members, while looking at the ways in which family culture and the relationships between family members can support wellbeing. Supporting or healing relationships that may have been disrupted by mental illness can be a key element of clinical work to build resilience.⁴ Strategies that a mental health clinician could adopt to promote family resilience include:

• Providing all family members with relevant, age-appropriate information about mental illness and facilitating family discussions about mental illness.
• Working with families to identify and acknowledge the processes and practices that help them enjoy family life.
• Supporting and encouraging family members who work to maintain positive family processes, including acknowledging the importance of maintaining seemingly simple tasks such as making school lunches or organising family dinners.
• Creating the space for families to reflect on the impact of negative experiences while acknowledging the strengths within their family unit and identifying reasons to feel hopeful for the future.

Limitations

The complexity of family resilience as a concept makes it difficult to apply to research or clinical practice as providers may not feel confident or may not have received adequate training. Resilience may also mean different things to different families. Given this, there are no simple scales or tools to measure family resilience. Further qualitative work is needed to refine and clarify the meaning of resilience as it applies to families.

While there are a number of studies that have explored the concept of family resilience in a range of settings, there is very limited research on resilience in families where a parent has a mental illness. Future research and education is needed to integrate the experiences of families and key service providers to devise a pathway to promote the strengths of families as part of core mental health practice. Attempts to integrate family focused care into routine mental health practice are the beginning of this process.^11,12

1. 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. Clinical Child Psychology and Psychiatry. 2004;9(1):39-52.
2. Thomas LJ, Kalucy RS. Parents with mental illness: A qualitative study of the effect on their families. Journal of Family Studies. 2002;8(1):38-52.
3. Power J, Goodyear M, Maybery D, Reupert A, O’Hanlon B, Cuff R, et al. Family resilience in families where a parent has a mental illness. Journal of Social Work. 2015.
4. Wyder M, Bland R. The recovery framework as a way of understanding families’ responses to mental illness: Balancing different needs and recovery journeys. Australian Social Work. 2014;67(2):179-96.
5. Reupert A, Maybery D, Kowalenko N. Children whose parents have a mental illness: Prevalence, need and treatment. Medical Journal of Australia Open. 2012;1(Suppl 1):7-9.
6. Perera DN, Short L, Fernbacher S. It’s not that straightforward: When family support is challenging for mothers living with mental illness. Psychiatric Rehabilitation Journal. 2014.
7. Hinshaw SP. The stigmatization of mental illness in children and parents: Developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry. 2005;46(7):714-34.
8. Black K, Lobo M. A conceptual review of family resilience factors. Journal of Family Nursing. 2008;14(1):33-55.
9. Luthar S, Cicchetti D, Becker B. The construct of resilience: A critical evaluation and guidelines for future work. Child Development. 2000;71(3):543-62.
10. Walsh F. Family resilience: A framework for clinical practice. Family Process. 2003;42(1):1-18.
11. Foster K, O’Brien L, Korhonen T. Developing resilient children and families when parents have mental illness: A family-focused approach. International Journal of Mental Health Nursing. 2012;21(1):3-11.
12. Goodyear M, Hill T-L, Allchin B, McCormick F, Hine R, Cuff R, et al. Standards of practice for the adult mental health workforce: Meeting the needs of families where a parent has a mental illness. International Journal of Mental Health Nursing. 2015.