Supporting families with parental mental health challenges: A guide for social workers

There has been an increased recognition of the high prevalence ofparental mental illness, and it is now seen as a specific public healthissue. Children of parents with mental illness are at an increased risk ofnegative experiences and outcomes and are more likely to experiencemental health issues themselves. Parental mental illness is associated with between 10% and 42% of childprotection cases in Western countries, however, it is important to keepin mind that many parents cope and parent well despite significantmental health problems and without involvement of services. Supportneeds exist on a continuum or spectrum. Families experiencing parental mental illness are more likely thanothers to experience additional social and economic challenges that canaffect quality of life. The relationship between social and economicproblems and parental mental illness is complex; both can exacerbatethe other. There are three categories of stigma around parental mental illness:public stigma (the attitudes and beliefs of others in society), self-stigma(parents’ internalisation of negative stereotypes and beliefs aboutmental illness), and courtesy-stigma (the prejudice and discriminationchildren and family members experience through their ‘association’with the parent); all can result in a range of negative consequences forparents and whole families. Lack of communication around mental illness in families can lead tomisconceptions in children and can increase anxiety or worry that theywill also experience the same illness or blame themselves for theirparent’s illness. Family-focused work can help promote non-judgemental, open communication in families and betterunderstanding of behaviours. It is important that interventions with families experiencing parentalmental illness are voluntary and family-led, however, professionals alsoneed to balance potential safeguarding and child protection concernsthat may arise. Professionals should note that any additional riskfactors such as violence within a household, or alcohol or substancemisuse, that might exist alongside parental mental illness, can increasesrisk of abuse or neglect to children. Recent work exploring the integenerational ‘transmission risk’ of mentalillness has found that focusing on the relational experiences of illnessand recovery (ie ensuring family relationships are considered as centralcomponent) rather than framing these individualistically is beneficial.These approaches emphasise the importance of strengtheningrelationships between family members to help in the recovery process;helping them to identify what recovery means to them and how toachieve it. Family-focused practice focuses on the wider family and caregivingsystem rather than focusing solely on the adult as the mental health‘consumer’. The key features include psychoeducation, assessment offamily, family care planning, joint working between family and services,and instrumental and emotional support. Direct work sessions with families may also include building trust and openness, and anti-stigmamessaging. Services working with families with parental mental illness need to havea holistic system in place, and family-focused practice should be valuedby service managers and available to families across a range of settings 8 Family-focused practice focuses on the wider family and caregivingsystem rather than focusing solely on the adult as the mental health‘consumer’. The key features include psychoeducation, assessment offamily, family care planning, joint working between family and services,and instrumental and emotional support. Direct work sessions with