Grandparents parenting grandchildren when parents have a mental illness

• Author: Vicki Cowling, Social Worker, Psychologist Child and Adolescent Mental Health, Hunter New England Area Health Service Newcastle, Australia
  Mary V. Seeman, MD Professor Emerita, Department of Psychiatry University of Toronto, Ontario, Canada
  Michael Göpfert, M.D., F.R.C.Psych. Child & Adolescent Psychiatrist, Psychotherapist Alder Hey Children’s NHS Foundation Trust, Liverpool, U.K.
• Series editors: Andrea Reupert and Darryl Maybery (Monash University) on behalf of the Australian COPMI national initiative.

Quick facts

• Grandparents contribute significantly to the community as primary carers for their grandchildren.
• An unquantified number of grandparents are ‘hidden’ due to the stigma of mental illness, and cultural and family values.
• Some grandparents caring for grandchildren rate their health and wellbeing as poor.
• The effect on children of parents with mental illness of grandparent care is not at present known.
• Family counselling can enhance resilience, through shared understanding of the changes for the family, including experiences of loss and grief.

Research summary

Grandparents provide primary care in 22,500 Australian families, for 31,100 children aged between 0 – 17 years; in 2008, 5.7 million US children lived with a grandparent.^1,2 An unquantified number of grandparent carers are ‘hidden’, and do not access financial and other supports. The reasons may relate to stigma (parental mental illness or substance abuse acting as a barrier), or cultural tradition.³

Research to date relating to grandparents as primary carers has not specifically referred to grandparents caring for children of parents with mental illness, consequently this GEMS draws on material concerning grandparents as primary carers more generally, including those caring for grandchildren because of parental drug and alcohol misuse.⁴

An issue closely associated with grandparents becoming primary carers for their grandchildren is the intergenerational transmission of mental illness. Identifying this transmission is an opportunity to identify risk and protective factors that sustain or disrupt patterns of mental illness.⁵ Two publications have studied the intergenerational transmission of depression, including the role of grandparents in moderating the effect of parental psychiatric illness on children, and the possible impact on the parenting of grandchildren by grandparents.^5,6

In the general grandparenting literature, the well being of a child depends on the grandparent’s physical and mental health, as well as on the circumstances that lead to surrogate parenting by grandparents.

Grandmothers raising grandchildren report increased stress and depressive symptoms relative to age peers, but less so if the surrogate parenting role is a cultural norm or freely chosen.^7,8 Several reports suggest negative effects of child-rearing on the health and finances of grandparents, which depend largely on pre-existing grandparental characteristics.^9,10 Other studies found that grandparents experienced benefits such as knowing their grandchildren had stability, and enjoying their achievements.^7,11

Practice implications

Grandparents parenting their grandchildren face a lack of information about programs available for them, general insensitivity to their situation, stereotyping, and a lack of advocacy on their behalf, but practitioners may assist in several ways:¹²

• Counsel grandparents to support them in the transition from the role of grandparent to their parenting role, including managing anxiety about their new responsibilities, and feelings of resentment and guilt they may have about the parent (their own daughter or son) being unable to care for their children.^4,13
• Provide information about child development, particularly children’s emotional needs at different ages, acknowledging also that the child is adjusting to separation from his/her parent.¹²
• Provide psycho-education about mental illness symptoms and treatment and how they may affect the child’s parent, and assist grandparents to understand how the child’s parent is experiencing the loss of their parental role.
• Facilitate family counseling to enhance resilience through shared understanding of the changes for the family, including experiences of loss and grief.
• Link grandparents to social support groups for psychological and moral support, information about legal rights, and processes for negotiating with government departments.
• Link to available neighbourhood groups and online groups.¹⁴ Implement a multimodal intervention program which decreases stress, and improves health, and social support.¹⁵
• Reduce the invisibility of grandparents’ experience by educating service providers such as health and welfare practitioners, professionals, teachers, and government officers, about the role of grandparents as primary carers, and the entitlements of grandparents as carers.¹¹

Limitations

Limitations identified could be addressed through the following research opportunities:¹⁶

• The influence of stigma of mental illness on identifying as a carer and accessing services
• The efficacy of interventions such as psychoeducation for grandparents
• Understanding differences in experiences for grandparents caring for children of parents with mental illness compared with other grandparents
• Outcomes for children of parents with mental illness when cared for by grandparents, including children’s experiences of grandparent care¹⁷
• Relationships between grandparents and parents and children when parents have a mental illness
• Differences in the acceptability of grandparent care across cultural groups, particularly in relation to parental mental illness.

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1. Australian Bureau of Statistics (ABS) (2003). Family characteristics survey. Canberra: Commonwealth of Australia.
2. US Census Bureau. Available at http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb08-ff14.html Accessed 15 February, 2010.
3. Commonwealth of Australia. Who Cares…? Report on the inquiry into better support for carers. 2009. Canberra: Commonwealth of Australia.
4. Baldock, E. Grandparents raising grandchildren because of alcohol and other drug issues. Family Matters, 2007; 76, 70-75.
5. Pettit JW, Olino TM, Roberts RE, Seeley JR, Lewinsohn PM. Intergenerational transmission of internalizing problems: effects of parental and grandparental major depressive disorder on child behavior. J Clin Child Adolesc Psychol, 2008; 37, 640-50.
6. Silverstein M, Ruiz S. Breaking the chain: How grandparents moderate the transmission of maternal depression to their grandchildren. Fam Rel, 2006; 55, 601-12.
7. Dunne EG, Kettler LJ. Grandparents raising grandchildren in Australia: exploring psychological health and grandparents experience of providing kinship care. Int J Soc Welfare, 2008; 17, 333-45.
8. Giarrusso R, Du Feng QW, & Silverstein M. Parenting and co-parenting of grandchildren: effects on grandparents’ well-being and family solidarity. Int J Sociol & Soc Policy, 1996;16 (12) 124-154.
9. Minkler M, Fuller-Thomson DE. Physical and mental health status of American grandparents providing extensive child care to their grandchildren. J Am Med Womens Assoc, 2001; 56,199-205.
10. Hughes ME, Waite LJ, LaPierre TA, Luo Y. All in the family: the impact of caring for grandchildren on grandparents’ health. J Gerontol B Psychol Sci Soc Sci, 2007; 62, S108-19.
11. Backhouse J. Grandparents raising their grandchildren: Impact of the transition from a traditional grandparent role to a grandparent-as-parent role. Thesis completed for Doctor of Philosophy. Southern Cross University, Lismore, New South Wales, Australia. 2008. http://epubs.scu.edu.au/cgi/viewcontent.cgi?article=1081&context=theses
12. Hayslip B, & Kaminski PL. Grandparents raising their grandchildren: A review of the literature and suggestions for practice. Gerontologist, 2005; 45, 262-9.
13. Seeman MV. The changing role of mothers of the mentally ill: From schizophrenogenic mother to multigenerational caregiver. Psychiatry, 2009; 72, 284-94.
14. Gerard JM, Landry-Meyer L, Roe JG. Grandparents raising grandchildren: the role of social support in coping with caregiving challenges. Int J Aging Hum Dev, 2006; 62, 359-83.
15. Kelley SJ, Yorker BC, Whitley DM, Sipe TA. A multimodal intervention for grandparents raising grandchildren: results of an exploratory study. Child Welfare, 2001; 80, 27-50.
16. Grinstead LN, Leder S, Jensen S, Bond L. Review of research on the health of caregiving grandparents. J Adv Nurs, 2003; 44, 318-26.
17. Hislop A, Horner B, Downie J, Hay D. The perceived experiences of children and adolescents living with their Grandparents: “Why living with my Grandparents is so… good”. Curtin University of Technology and Wanslea Family Services, 2004. http://cra.curtin.edu.au/publicationsInformation/printDocs/FinalGCHN_Report_OCT2004.pdf

Resources

• Online information: www.grandparentsasparents.com.au/
• Mental illness fact sheets: https://www.sane.org/mental-health-and-illness/facts-and-guides
• Book: Hayslip, B. & Kaminski, P. (Eds.). Parenting the custodial grandchild: Implications for clinical practice. New York: Springer Publishing Company; 2009. This book has three sections which address: intergenerational relationships, parenting grandchildren, and interventions.