Out of the Mainstream: Helping the children of parents with a mental illness

Rosemary Loshak

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135105570
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Out of the Mainstream identifies those aspects of mental illness which can compromise parenting and affect children's development, as well as the efforts of professionals to intervene effectively. With chapters from professionals working primarily with children or adults, in different agencies and in specialist teams or in the community, the book illustrates the ways in which the needs of mentally ill parents and their children can be understood.

The book outlines different theoretical approaches which may be in use alongside each other, including:

A systems theory approach to work with families and with agencies;

The psychoanalytic understanding of mental illness and its impact on family relationships and organisations;

An educational approach to supporting staff, children and parents;

A psychiatric or bio-medical model of work

Out of the Mainstream considers how the diverse groups of agencies, specialist teams and groups in the community can work together, even when many barriers may hinder the effective co- working between individuals and these various groups. It will be an invaluable resource for psychologists, psychiatrists, social workers, health visitors, mental health nurses, teachers and voluntary sector agency staff.

Part I

Themes, theories and background

This book describes the development of a parental mental health project over a period of ten years. The years during which this happened were a time of rapid change within health and social care sectors, but also an exciting time of growth presenting a real opportunity to make a difference in some children’s lives. The ‘Children and Adult Mental Health Project’ seized the moment and attempted to build a network in one inner city borough with a focus on the children of parents with mental illness, making full use of existing resources.

While the project itself has given rise to the book and is central to it, there are two major themes which underlie it. These are outlined in Chapter 1 and are further developed in the following chapters in Part I. The first theme is that these are a group of highly vulnerable children who nevertheless largely remain hidden from view, whose emotional and ordinary developmental needs may remain entirely hidden from professionals involved with their parents, from teachers and others working with them. The three authors of Chapter 2 pick up on this theme by talking to children and reporting what they have to say about their experiences, so that we hear their voices directly.

Writing from the viewpoint of a systemic family therapist, Lizette Nolte, in Chapter 3, supports children’s views of their experiences with research evidence about the impact of parental mental illness on both the not so ordinary task of parenting, and directly on children. Lizette ends with a plea for more talking to and with children about their parent’s illness. This need not be confined to the clinic setting of Child and Adolescent Mental Health (CAMHS) but may be approached by a number of other professionals, particularly those in adult mental health. It is this change in working practice that the project has sought to bring about.

The second major theme is that of the relevant agencies working together. This has been recognised as a difficulty in most child abuse inquiries of preceding years, a difficulty which is arguably increased when one of the agencies involved is concerned with mental health, an area which many find difficult to understand. The problem is identified in Chapter 1 and illustrated with a case example which had a direct bearing on the start of the project.

In Chapter 4 this difficulty is considered from a psychoanalytically informed approach to the understanding of mental illness, and its impact on the minds and functioning of the adults and the organisations which try to work with it. Anxiety dominates the work of any mental health organisation and this chapter attempts to show how defences, both individual and organisational, are put in place to cope with this, often to the detriment of working together.

The various chapters present different theoretical viewpoints, which will recur throughout the book. This perhaps illustrates a frequently encountered problem in working together: that of managing differences, not only of theory but of professional background, and training.

In the late 1990s, the years leading up to the start of this project, there were major structural reorganisations within health and social services which came about as a response to the 1990 NHS and Community Care legislation, which provided for adult mental health care in the community. These changes affected both adult mental health and child mental health services, resulting in a loss of long-standing and valued team and supervisory relationships. For the editor, this experience of loss served as a catalyst for change, for moving into this new area of work with parental mental health. Loss and change may be thought of as a ‘leitmotif’ carrying through the whole book. Chapter 5 considers its impact directly, describing the context in which the project took place. The context is one of time, and place, of an unremitting experience of loss and change experienced alike by families and those working with them. In devoting space to what is in part a historical overview we are also establishing the importance of our relationship with the past for the present, and showing the impact of disrupted relationships.

1 Hidden children

Rosemary Loshak

This book is concerned with a group of children who, though vulnerable, remain hidden from their teachers, friends and neighbours, and professional networks. Philip Pullman, in his trilogy ‘His Dark Materials’, helps us to understand one of the reasons for this:

Will had first realised that his mother was different from other people and that he had to look after her when he was seven years…. So he kept his mother’s trouble secret…. And he learned how to conceal himself too, how not to attract attention from the neighbours, even when his mother was in such a state of fear and madness that she could barely speak. What Will feared more than anything, was that the authorities would find out about her and take her away and put him in a home among strangers.

(Pullman 1997: 8–11)

Anne Sexton was an American poet who committed suicide in 1974. She had two daughters and had been hospitalised in a psychiatric unit during the early years of her eldest daughter’s life. In a powerful poem she indicates the meaning her first child held for her, as a way of finding herself (Sexton 1981).

In a radio interview in 2010 her daughters describe their experience of feeling that there was ‘not a lot of room for us’ and ‘battered by the illness because we did not understand what was going on. People withdrew from the illness.’ Her youngest daughter spoke of there being ‘always a fear of violence that would erupt and they would start a fight, – it wasn’t a safe house’. They describe feeling angry, guilty, anxious and trying not to think about what was happening (BBC Radio 4 2010).

Children are affected by and cope with parental mental illness in many different ways. Some will remain hidden from view and become young carers, with little independent life of their own, unable to separate from a dependent and needy but loved parent, and socially isolated from their peers as the stigma of mental illness casts a shadow over them also. Some may face real risk of physical injury, or, in rare cases, death, particularly the very young who are most at risk. Not all will suffer actual harm but they will be vulnerable to their emotional, social and physical development being compromised.

This book describes a project extending over ten years which attempts to bring the plight of children of mentally ill parents to the forefront of the minds of the professionals involved with them or their parents. The aim is to intervene early to prevent the crisis which is the realisation of their worst fears, fears of separation, family breakdown and of someone being hurt. In 2002 a coordinator was appointed in the local authority to work across the interface between child and adult services. She was supported by a steering group which at a very early stage had identified the need for experienced children’s social workers to be located in the adult community mental health teams. Such posts were finally created and filled four years later and it is their work that is set out in this book as one possible model of providing services for families affected by mental illness.

A training video made by the Royal College of Psychiatrists allows children and young people whose parents suffer from a mental illness, which has at some point required their admission to hospital, to tell their stories, and lets us glimpse the daily reality of their lives. What is striking about many of these children’s accounts is the absence of other adults who will take responsibility, whether family members or professionals. The young people feel they are left to manage alone, sometimes when there is no food in the house, sometimes with a parent attempting suicide, or family violence (Cooklin 2006).

That these children do so often remain hidden is related to the nature of mental illness and to society’s response to it. A frequent feature of psychotic illness is the denial of the need for help or of difficulties. An Australian study reported that of 124 parents with a psychotic illness, 49 per cent did not want help with their children but preferred to cope on their own, and 30 per cent feared their child being taken away (McLean et al. 2004). The fear of losing one’s child is not without reality. In the 1950s, admissions to asylums were often linked with a shameful pregnancy, whether an illegitimate birth or as a result of rape. In a study of admissions to an Essex asylum, Gittins found that women were ‘certified’ for bearing such children while psychiatrists still admitted teenage mothers of illegitimate babies into the 1950s (Gittins 1998).

The children were often removed from the mother and placed for adoption. The stigma remains, and a vestige of the old attitudes towards the mentally ill having children remains evident in our collective difficulty in recognising the need.

With a variety of more recent developments in service provision these children have slowly been finding their own voice, and it is with this process and these children that this book is primarily concerned. While support for parents and recognition that parenting is a valued social role is an essential aspect of the work described, the focus is on the child in the context of his or her family and wider social network.

Working together to help children and families

This is a second but central theme of this book. The initial appointment was intended not to provide direct services to families, but to address the problems of working together which were recognised by senior management in both health and social care at the time, as obstacles to providing an effective and supportive service to families. There was an expectation that procedures would be established and policy put in place to overcome obstacles and provide effective training programmes for staff.

A personal anecdote is relevant to the problems encountered: prior to taking up this newly created post this author had been, for many years, a social worker in a multidisciplinary child and adolescent mental health service working psychodynamically with parents and children, separately and together as families, and often as co-worker with a colleague of another discipline, usually psychiatrists, psychologists or child psychotherapists. This role provided opportunities for links with adult mental health services, through the hospital social work team which historically covered both adult and child mental health, through a caseload which included several parents who were themselves users of adult mental health services, and through some direct work with adult outpatient psychiatry. It formed the groundwork, the secure base for this venture into community adult mental health in a new role.

The following vignette from her work in that setting illustrates difficulties that can arise among colleagues when working with families where a parent has a mental illness.

I was leading a work discussion group for child protection advisers, who were experienced health visitors. They formed a team within the borough who provided consultation and support to their colleagues about child protection matters. Our discussions were about complex situations which often aroused strong feelings. We shared our anxiety about the matters of life or death where infants and small children were involved. One such discussion concerned a pre-school child and her single mother who was described as acting bizarrely and appearing depressed. The group member expressed a strongly held view that the child was seriously at risk, and urgent action required, possibly to take the child into care.

Taken aback by what seemed a premature rush into action, I was also surprised by my own equally strong reaction, that such a step was drastic and unnecessary, a view that I conveyed. At our next meeting I was asked to support my unusual view with evidence, as the group were agreed that the mental illness of a parent represented a danger to such a young child.

This brief vignette indicates how polarised positions of potential conflict can quickly develop to distort professional thinking and the quality of communication when anxieties are high, and few facts are known. It signals the second theme of this book which is an attempt to understand the impact of severe mental illness on the professionals working closely with it, on their organisations, and on their efforts to work collaboratively.

In the above example neither participant had firsthand knowledge of this mother and child. Responses were determined rather by individuals’ strongly held beliefs and attitudes regarding mental illness, by their different assumptions about the role of the other’s profession, as well as by what may be termed their ‘personal baggage’ (the sum of our own childhood experiences which have been our motivation for entering the caring professions, but which can also operate to blind us to current realities) (Hallett and Stevenson 1980). They were, however, already engaged in a working relationship with me and the group had provided a setting in which self-...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of Contributors
• Foreword
• Acknowledgements
• List of Abbreviations
• Part I Themes, theories and background
• Part II The Children and Adult Mental Health Project (CHAMP) 2002–2012
• Part III The wider context
• Appendix: Origins of Champ
• Index