Children of parents with a mental illness are at a greater risk of experiencing a range of behavioural, education, social and developmental challenges, as well as a higher risk of experiencing their own mental health difficulties¹

However, this does not mean that all of these children will experience difficulties as a result of their parent’s health status. Outcomes vary based on a myriad of factors related to the parent, the individual, the family and the community.

Some of these include a child’s personality and self esteem, social connections (e.g. friends at school or outside it), life events they may have experienced, the strength of family relationships and the involvement of other adults in their life.

The good news

Prevention is possible. There are things that professionals, children themselves, their parents, family (and of course the community) can do to enable better outcomes and prevent difficulties from occurring for these children.

Parents and families can be supported to help them cope during tough times and strengthen their resilience. There are actions that families can take themselves, or they can be guided by services and supports where needed.

The critical role of professionals

The interdependence of child, parent and family outcomes means that professionals in a range of settings play a critical role in supporting parents with mental illness, their children and families. Through a family-focused approach, at any point in the developmental pathway of children, there is an opportunity to identify strengths and vulnerabilies and then provide appropriate support for all individuals.

There are now clear guidelines regarding the inclusion of families when supporting a parent who is experiencing a mental illness. See policies and frameworks established for this purpose.

The mental health and wellbeing of children is the responsibility of many sectors. Collaboration between non-government and government services, parents, children, families and the wider community is key if we are to achieve better outcomes for these children.²

For more information

• Advice for professionals in different work settings.
• The Medical Journal of Australia (MJA) Open supplement features research articles and other information about children of parents with a mental illness.
• Evidence-based research summaries, articles and relevant reports can be located in the ‘What works?’ section of Professional pages on this website.

Relevant facts

• There is currently a lack of systematic data regarding the number of adults utilising Australian mental health services who are also parents of dependent children. Many adult mental health services do not (or have only recently begun to) record whether their clients have children.¹  
• Various surveys and audits in the United States of America and in Britain suggest that at least 20% and in some cases up to 50% of adults known to mental health services have children.² 
• Australian surveys have found that between 29% and 35% of mental health services clients are female parents of dependent children under the age of 18.^3-5
• In 1995 Cowling et al. estimated from census data and incidence rates that at least 27,000 Australian children were affected by maternal psychotic illness alone.⁶
• In 2005, Maybery and Reupert estimated that there were between 21% and 23% of children living in Australian households where at least one parent has a mental illness, equating to just over a million children at that time.¹⁷
• Not all children of parents with a mental illness will experience difficulties as a result of their parent’s health status.⁷
• Estimates suggest that between one-third and two-thirds of children of parents known to adult mental health services will experience difficulties, depending on sampling and assessment criteria.²
• A combination of factors including genetic inheritance, psychosocial adversity, the age of child, the nature of the mental illness, family relationships, and the involvement in the child’s life of adults other than the mentally unwell parent impact upon the child’s risk of mental health problems.^8-15
• The stigmatisation of people with mental illnesses and its negative consequences can also affect all family members.¹⁶
• The care burden on children of parents with a mental illness (especially in sole-parent situations) may greatly affect their participation in education and social life.¹⁷

References

1. Reupert, A.E., Maybery D., Kowalenko, N., (2012) Children whose parents have a mental illness: prevalence, need and treatment. MJA Open, 2012 1 Suppl 1: 7-9.
2. Australian Infant, Child, Adolescent and Family Mental Health Association (2004). Principles and actions for services and people working with children of parents with a mental illness. Canberra: Commonwealth of Australia, (accessed Mar 2014).
3. AICAFMHA. Children of parents affected by a mental illness. Scoping Project. Canberra: Australian Infant, Child, Adolescent and Family Mental Health Association, 2001.
4. Falkov A, ed. Crossing bridges: Training resources for working with mentally ill parents and their children. Reader for managers, practitioners and trainers. Brighton, East Sussex: Pavilion Publishing for Department of Health, U.K., 1998.
5. Cowling V, ed. Children of parents with mental illness. Melbourne: The Australian Council for Educational Research, (ACER); 1999.
6. Hearle J, Plant K, Jenner L, Barkla J, McGrath J. A survey of contact with offspring and assistance with child care among parents with psychotic disorder. Psychiatric Services 1999; 50: 1354-1356.
7. Farrell GA, Handley C, Hanke A, Hazelton M, Josephs A. The Tasmanian Children’s Project Report: The needs of children and adolescents with a parent/carer with a mental illness. Hobart: Tasmanian School of Nursing and the Department of Health and Human Services; 1999.
8. Cowling VR, McGorry PD, Hay DA. Children of Parents With Psychotic Disorders. Medical Journal of Australia 1995; 163: 119-120.
9. Anthony EJ, Cohler B. The Invulnerable Child. New York: Guildford Press, 1987.
10. Beardslee WR, Versage EM, Gladstone TR. Children of affectively ill parents: a review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry 1998; 37: 1134-41.
11. Downey G, Coyne JC. Children of depressed parents: An Integrative Review. Psychological Bulletin 1990; 108: 50-76.
12. Quinton D, Rutter M. Family pathology and child psychiatric disorder: A four-year prospective study. In: Nicol AR, ed.  Attudinal studies in child psychology and psychiatry. Chicester: John Wiley & Sons; 1985: 91-134.
13. Beck CT. Maternal depression and child behaviour problems: a meta-analysis. Journal of Advanced Nursing 1999; 29: 623-9.
14. Klimes-Dougan B, Free K, Ronsaville D, Stilwell, J, Welsh, C J, Radke-Yarrow, M. Suicidal ideation and attempts: A longitudinal investigation of children of depressed and well mothers. Journal of the American Academy of Child & Adolescent Psychiatry 1999; 38: 651-659.
15. Dickstein S, Seifer R, Hayden LC, Schiller, M, Sameroff, AJ, Keitner, G, Miller, I, Rasmussen, S, Matzko, M, Magee, K. Levels of family assessment: II. Impact of maternal psychopathology on family functioning. Journal of Family Psychology 1998; 12: 23-40.
16. Wals M, Hillegers MHJ, Reichart CG, Ormel, J, Nolen, WA, Verhulst, FC. Prevalence of psychopathology in children of a bipolar parent. Journal of the American Academy of Child & Adolescent Psychiatry 2001; 40: 1094-1102.
17. Radke-Yarrow M, Klimes-Dougan B. Parental depression and offspring disorders: A developmental perspective. In: Goodman, Sherryl H. (Ed); Gotlib, Ian H. (Ed). (2002). Children of depressed parents: Mechanisms of risk and implications for treatment. Washington, DC, US: American sychological Association, 2002: 155-173.
18. Phelan JC, Bromet EJ, Link BG. Psychiatric Illness and Family Stigma. Schizophrenia Bulletin 1998; 24: 115-126. Carers Australia. Young Carers Research Project – Final Report. Canberra: Commonwealth Department of Family and Community Services, 2001.
19. Maybery, D., A. Reupert, et al. (2005). VicHealth Research Report on Children at Risk in Families affected by Parental Mental Illness. Melbourne, Victorian Health Promotion Foundation. http://www.vichealth.vic.gov.au
20. Maybery, D.J, Reupert, A.E, Patrick, K et al. Prevalence of parental mental illness in Australian families. Psychiatric Bulletin, 2009, 33, 22-26.