Child & Youth Services

ISSN: 0145-935X (Print) 1545-2298 (Online) Journal homepage: http://www.tandfonline.com/loi/wcys20

What do we know about families where parents

have a mental illness? : A systematic review

Andrea Reupert & Darry Maybery

To cite this article: Andrea Reupert & Darry Maybery (2015): What do we know about families
where parents have a mental illness? : A systematic review, Child & Youth Services, DOI:
10.1080/0145935X.2016.1104037

To link to this article: http://dx.doi.org/10.1080/0145935X.2016.1104037

Accepted author version posted online: 16

Nov 2015.

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What do we know about families where parents have a mental illness? : A systematic review

Associate Professor Andrea Reupert: corresponding author

Krongold Centre

Faculty of Education

Monash University, Clayton

3800 Victoria

Australia

andrea.reupert@monash.edu.au

Associate Professor Maybery,

Child & Youth Services

Monash University,

Department of Rural and Indigenous Health

PO Box 973

Moe Victoria 3825

AUSTRALIA

darryl.maybery@monash.edu.au

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Abstract:

This paper provides an overview of what we know about families where a parent has a mental

illness, in order to situate the following papers for the special edition. An extensive search

during November, 2014 in the Ovid MEDLINE and PsycINFO databases identified relevant

papers that were then synthesized and presented in terms of (i) prevalence of parents and

children living with parental mental illness (ii) mechanisms of risk for children (iii) needs of

children (iv) needs of parents and (v) intervention types and outcomes. A significant paradigm

shift across all levels of policy and service development is required to adequately meet the needs

of parents and children living with parental mental illness.

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Highlights:

 Many of those with a mental illness are also parents

 Protective and risk factors emulate from the child, parent, family and community

 Children want to be with their family

 Parents need to manage their mental illness and assume a parenting role

 A paradigm shift is needed in mental health services to better meet family needs

Key words: parental mental illness, review, prevalence, risk mechanisms

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This opening paper establishes the context for the special edition, by synthesizing research

regarding the prevalence of these families, the mechanisms of risk for children, the needs of

family members, and the types of interventions currently available to children, parents and

families living with parental mental illness. Recommendations for policy and practice conclude

this paper and provide a springboard to the subsequent papers which explore these issues in

further depth.

The adverse outcomes of children of parents with a mental illness are well established. We

know that compared to other children, children living in these families are at risk of poorer

psychological health (Reupert & Maybery, 2007), dropping out of school (Farahati, Marcotte &

Wilcox-Gők, 2003), increased behavioral and developmental difficulties (Leischied, Chiodo,

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Whitehead & Hurley, 2005), lower rates of perceived competence (Maughan, Cicchetti, Toth &

Rogosch, 2007) and as adults have higher substance abuse rates (Mowbray & Oyserman, 2003).

At the same time, not all children will be adversely affected nor will all children in the same

family be affected in the same way (Reupert, Maybery & Kowalenko, 2012). Recent research

efforts have moved beyond considering whether children are at risk, and instead have begun to

identify the mechanisms by which risk is transmitted to children. Perhaps even more important

is the emerging evidence for the different types of interventions for children and parents living

with parental mental illness, which provides a critical evidence base to support practice change.

The research questions framing this review are: what do we know about families where a parent

has a mental illness in terms of (i) prevalence (ii) mechanisms of risk for children (iii) needs of

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children, (iv) needs of parents and (v) intervention types and outcomes. Framed within these

questions, a systematic literature review was conducted.

Methodology

Relevant literature was drawn from the Ovid MEDLINE and PsycINFO data bases and searched

during November, 2014 for peer reviewed, English language papers. Search terms included

variations of parent (e.g. mother or father) and child (e.g. child or offspring) as well as specific

parental disorders (such as depress* or affect* and so on) (specific search terms available from

the authors). There was a preference for more recent studies (post 2000) though some seminal

studies were included. There were no geographical limitations for the papers selected in this
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review. We included only those papers that considered children under the age of 18 years which

meant excluding retrospective studies. We included review papers (meta-analytic, systematic

and narrative) and research papers with primary data; we excluded opinion pieces and editorials.

Papers were identified on the basis of their relevance to the review questions.

A total of 1863 papers across the three data bases were found using the search terms, though only

297 of these were considered relevant to the questions framing this paper. Not all papers are

cited in this review; instead we attempted to provide a range of timely studies across various

countries to highlight the type and quality of research in this area.

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Results and discussion

i. Prevalence

There are generally two types of studies in this area; those that estimate the number of parents

with a mental illness who have children or those that estimate the number of children living with

a parent with a mental illness. An early study in the former group comes from the US, where

Nicholson, Biebel, Katz-Leavy and Williams (2004) estimated the prevalence of parenthood

among adults meeting psychiatric diagnostic criteria for mental illnesses using data from the U.S.

National Comorbidity Survey (NCS) obtained in the early 1990‟s. They found that women (68%)

and men (54%) meeting criteria for mental illnesses were slightly more likely to be parents than
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those reporting no psychiatric or substance use disorder (62.4% and 52.9% respectively). Over

the course of their lifetime, the majority of women and men falling into the representative

diagnostic categories were parents: affective disorders (66.8% of the women; 58% of the men),

anxiety disorders (68.2% women and 56.4% men) and posttraumatic stress disorder (72.8%

women; 67.9% men) and non-affective psychosis (61.8% women and 55.2% men). Among

participants who were parents, almost half of the mothers and almost a third of the fathers had a

lifetime prevalence of mental illness. More recently, Luciano, Nicholson and Meara (2014)

estimated the prevalence of motherhood as 42% among women with no mental illness to 38%

among women with serious mental illness by using data from the 2009 and 2010 U.S. National

Survey on Drug Use and Health. Rates of fatherhood ranged from 35% among men with no

mental illness to 23% among men with serious mental illness. Again using a population approach,

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Campbell et al., (2012) used data from the second Australian survey of psychosis (n=1825) and

found that more than half the women and about one quarter of men were parents.

Other studies examine the numbers of clients in psychiatric settings who are parents. In a cross-

sectional survey of psychiatric in- and out-patients in Sweden, 36% (n=137) of adult clients had

children under 18 years of age (Östman & Eidevall, 2005). In the USA, Craig and Bromet

(2004) found that 130 (29% ) of 453 clients at a community based mental health service were

parents, with women twice as likely as men to be parents in all diagnostic groups. Patients with

mood disorder and/or psychosis were twice as likely to be parents as those with

Schizophrenia/Schizoaffective Disorder. Substance Use Disorder was a common comorbidity

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among fathers and to a somewhat lesser extent among mothers. However, as parenting status is

not routinely collected in mental health services, these results may be an underestimation of the

number of parents with a mental illness.

The second group of studies estimates the number of children living with parental mental illness.

Some studies screen for psychopathology in parents when children present with their own mental

health difficulties. For example, in the USA, Vidair et al., (2011) found that of the 801 mothers

and 182 fathers seeking mental health treatment for their children, 18.8% of mothers and 18.4%

of fathers reported elevated internalizing symptoms. However, such studies are problematic as

they focus on children who are registered in a mental health service. As not all children living in

these families present with mental health difficulties or are not receiving treatment, an

underestimation may occur.

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Maybery, Reupert, Patrick, Goodyear and Crase (2009) examined both the number of parents

and children by examining three data sets. First, they combined two population studies from the

public domain; the Mental Health and Wellbeing: Profile of Adults, Australia 1997 and family

characteristic data from the Australian Bureau of Statistics. Second, they examined 38,455 client

attendee records at all state run psychiatric units in one Australian state over during the 2003-

2004 financial year to examine parenting status. Third, a survey of 701 community participants

with children 8-12 years was conducted in 2006, where parents self-identified their own and/or

their spouse‟s mental illness status. On this basis, they concluded that 23.3% of all Australian

children have a parent with a non-substance mental illness, 20.4% of mental health service users

have dependent children and 14.4% of the community sample have at least one parent with a
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mental illness.

The discrepancy across studies may be explained by methodological differences; how

participants were recruited (adult psychiatry or child mental health services), which family

members are included (parents, children or both), from where (community or clinical settings)

and how the parent‟s mental illness was diagnosed. Whether and how parenting status was

defined also varies. Moreover, rarely do these studies consider the heterogeneous nature of

families, such as the severity/chronicity /diagnosis of the parent‟s disorder and different family

circumstances (e.g. whether children are in care, the presence of stepchildren).

ii. Mechanisms of risk for children

A recent review of theoretical frameworks explored how children are impacted (or not) by their

parent‟s mental illness (Reupert, Maybery & Nicholson, in press). Across these frameworks, the

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risk exposure for children varies, depending upon multiple and interacting genetic, child, parent,

family and community factors.

Recent research suggests that while children of mothers with schizophrenia are at an elevated

risk of schizophrenia, they are also at risk of acquiring other psychotic, affective and personality

disorders (Dean, Stevens, Mortensen, Murray, Walsch & Pedersen, 2010). The authors suggest

that this broad-spectrum effect may be attributable to interactions between genetic factors,

neurobiological processes and environmental conditions.

Child characteristics that may predispose them to be more or less affected include a difficult

temperament, behavioural inhibition, negative emotionality, stress reactivity and poor cognitive
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and social skills (Hosman, van Doesum & van Santvoort, 2009). These child related variables

may result from exposure to the parent‟s mental illness, or be present in the child independent of

the parental disorder and subsequently function as a moderator of the impact of the parent‟s

illness on the child. Nonetheless, child variables have the potential to influence a child‟s

relationship with his or her parent, as well as other significant adults in a child‟s life.

Many of those with a mental illness can parent well while others need support (Foster, O‟Brien

& Korhonen, 2012). Moreover, parents that require support may not need this all the time;

symptomology fluctuates and/or parents may find some phases of child development more

challenging than others (e.g. infancy or adolescence). Parenting capacity does not appear to be

related to diagnosis but instead to severity (e.g. suicidality or psychotic behaviour) and the

frequency and duration of the illness (brief, reactive or endogenous) (Reupert, Maybery &

Kowalenko, 2012). However, having a mental illness may disrupt parenting behaviour and the

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child-parent relationship. For instance, parental pre-occupation, resulting from obsessions,

rumination or delusions, can impair a parent‟s responsiveness to children (Brockington, et al.,

2011). Similarly, because of their mental illness a parent may be emotionally unavailable to

children (Brockington, et al., 2011).

Another moderating pathway involved in the transmission of mental illness from parents to

children is social learning, for example children may observe their parent using alcohol as a

means of regulating mood and subsequently copy this behavior (Kroll, 2004). The illness itself

may also impact parent-child relationships, for example, compared to other parents, those with

an anxiety disorder are less likely to grant their children autonomy, to be more catastrophizing
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during child interactions and more likely to demonstrate an overprotective style (Gerull & Rapee,

2002). Finally, the symptomatology of some disorders (for example, personality disorders or

substance abuse disorders) may be associated with impaired self-awareness, which may mean

that the parent is not able to perceive the impact of his or her illness on children and not seek

assistance for the family (Reupert, Maybery, Nicholson, Göpfert & Seeman, in press).

Family discord, trauma and domestic violence may be both the consequences of and/or risk

related factors for parental mental illness (Hosman, van Doesum & van Santvoort, 2009). The

presence of another parent will also influence the level of risk that children are exposed to; if the

partner also has a mental illness or is abusive this will further exacerbate risk to the child, though

if supportive may successfully buffer the negative impact of a parent‟s illness (Hosman, van

Doesum & van Santvoort, 2009). Other research has found low cohesion and poor

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communication among families with a serious mental illness (Warner, Musfon & Weissman,

1995).

Similar to the other domains, the community in which a child lives may be both a protective and

a risk factor for children. Social networks, including neighbors, teachers, grandparents, may

offer support, diversion and respite to families (Hosman, van Doesum & van Santvoort, 2009).

The support the parent receives from mental health agencies is another factor that might

influences family outcomes in some countries. For example, in Australia parents with a mental

illness do not typically receive support for their parenting role when being treated for their illness,

and similarly, mental health clinicians rarely ask about their client‟s children (Maybery &
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Reupert, 2009). The needs of families are often not incorporated into mental health policy and

organizational procedures (including collecting parental status); this is also associated with

deficits with practitioner skill and knowledge for working with parents and children (Maybery &

Reupert, 2009). More broadly, the stigma related to mental illness means that parents with a

mental illness may be seen as incompetent or violent and children as contaminated or pitiful,

which in turn may lead to discrimination regarding child custody arrangements, housing or

employment opportunities (Larson & Corrigan, 2008). Rutter (1987) argues that the direct

effects of parental mental illness are less detrimental than the social adversities typically

associated with mental illness, such as poverty and isolation.

In sum, there is no single risk, protective factor or developmental course that dictates children‟s

outcomes. As can be seen here, while a parent‟s mental illness represents a significant risk factor

to the wellbeing of children, it is by no means the sole contributor for how children fare.

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Additionally, we need to acknowledge the bi-directional influences between parents and children,

where not only does a parent‟s illness impact children, but a child‟s behavior and/or emotional

state impacts the mental health of the parent (Falkov, 2012).

iii. Needs of children

All children need love and nurturing from a significant adult, and an environment in which to

strive. Children whose parents have a mental illness have additional needs, though the child‟s

developmental stage will influence their understanding of the family circumstances and their

coping ability; for example, the needs of an infant and those of an adolescent will differ. Other

factors that influence children‟s needs include the relationship of the child to the parent, for
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example, whether the parent who has the mental illness is the primary caregiver. The severity

and chronicity of the illness are other factors that influence children‟s needs, e.g. a prolonged

illness may tax a child‟s coping resources, while a parent who is suddenly ill may engender

shock or disbelief.

Notwithstanding these variations, a number of generic needs may be ascertained. The primacy of

family was highlighted by the studies reviewed by Gladstone, Boydell, Seeman and McKeever

(2011), as children worried about being separated from their parents (through hospitalisation or

intervention from child protective services), and wanted to keep their family together and

emotionally connected. Similarly, in an Australian, interview based study with 12 young people

whose parent had both a mental illness and a substance abuse disorder, Reupert, Maybery and

Goodyear (2012) found that children valued “good times” with their family and wanted more

opportunities to positively connect with family members.

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Some children assume caring responsibilities for their parent and/or siblings. While part of a

healthy upbringing involves some degree of caring, respite may be required if caring becomes

onerous and limits a young people‟s educational and social opportunities (Charles, Stainton &

Marshall, 2008; 2012). A recent meta-synthesis on the qualitative findings of 11 studies of the

experiences of young carers (including but not limited to caring for parents with a mental illness)

found that some young people felt that they had no choice when it came to adopting their caring

role (Rose & Cohen, 2010). While many described the difficult aspects of the role, including

uncertainty and isolation, they sought to derive a sense of pride and self-esteem from being a

„carer‟. Specific to young people caring for a parent with mental health issues were issues of

„invisibility‟, shame and stigma (Rose & Cohen, 2010). Banks et al., (2002) argues that while
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some level of caring is always like to occur in some families, those youth who wish to provide

care need support to enable them to do so, and respite as required. Additionally, young people

who care for their parent and/or siblings need to have this role acknowledged and supported by

family members, school personnel and health professionals.

Children also express a need for knowledge and information about mental illness generally and

their parent‟s illness in particular (Grove, Reupert & Maybery, 2013). A seminal study

undertaken in the USA by Beardslee and Podorefsky (1988) with 15 resilient young people

found that they were able to distinguish between themselves and their parent‟s illness and

appreciated that they were not the cause of their parents‟ illness. Focht and Beardslee (1996)

found that enhancing children‟s understanding helps them to develop a sense of coherence

regarding what they are seeing, experiencing and feeling which “helps them to trust their own

experience” (p. 9). While there is some contention as how much to tell children about their

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parent‟s illness, Murdoch (2010) concluded that children “needed enough information about

mental illness to help them live with their circumstances, avoid unnecessary emotional duress

and give them hope for the future” (p. 21).

Closely related to knowledge, is the need for open and honest family communication about the

parent‟s illness. While many people (such as the family doctor or teacher) may talk to the child

about their parent‟s illness, many young people want to discuss the illness with their affected

parent (Fudge & Mason, 2004). Opening up family conversations gives young people the

opportunity to discuss what is happening for them and ask specific questions that they may have.

Family conversations provide an opportunity for parents to hear from children what they are

experiencing. As Solantaus, Reupert and Maybery (in press) summarise, “The aim of these
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conversations is for children to understand their parent‟s behaviour and for the parent to

understand their children‟s experiences in order for parents and children to find mutual

understanding and ways of coping” (emphasis included in the original).

Opportunities for emotional expression are another developmental need for children. The review

by Gladstone et al., (2011) indicted that some children have no safe outlet for difficult feelings

related to their parent‟s illness including worry, fear, sadness, shame, guilt and blame. Children

considered peer relationships to be an important source of support though were wary of

potentially negative reactions when talking about their shameful „family secret‟ (Gladstone, et al.,

2011, p. 283). The company of similar peers, whose parents also have a mental illness, helped

them realise that they were not alone (Gladstone, et al., 2011). Similarly, connectedness with the

others if the parent is not available, such as from the other well parent, peers, extended family

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members, teachers and so forth is regarded as an important source of social and emotional

support (Reupert & Maybery, 2007).

Crises such as when a parent is hospitalised or very unwell are particularly at risk times for

children. Crisis plans may be useful here; these involve the family working out together (when

the parent is well) what needs to happen if or when a crisis should occur, such as where the child

may need to stay (Reupert, Green & Maybery, 2008). In these times, practical support is

essential, and may include allowing the child to visit his/her parent in hospital, and having a

trusted adult live in the family home.

iv. Needs of parents

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A parent with a mental illness faces the same challenges that all parents face but simultaneously

needs to cope with the sometimes debilitating symptoms of their mental illness. Hence, their

needs relate to managing their mental illness as well as assuming parenting responsibilities.

With appropriate support, treatment and/or medication, most people with a serious mental illness

can become competent parents (Risley-Curtiss, Stomwall, Trueet Hunt & Teska, 2004).

There is some disagreement as to whether mental health services should focus on improving a

parent‟s illness, without incorporating parenting responsibilities into treatment plans. For

example, an Australian medical practitioner interviewed by Reupert, Maybery and Morgan (2015)

argued she needed to focus on “getting the parent well [because] then parenting looks after

itself”. There is some research to support this stance. Swartz et al., (2008) found evidence of

associations between successful treatment of parents‟ depression and improvement in children‟s

symptoms and functioning. Conversely, Forman and colleagues (2007) found that the treatment

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of a parent‟s depression, even successfully, was insufficient to change the mother-infant

relationship. Likewise, Kelley and Fals-Stewart (2002) found that couple-based therapy recorded

greater benefits for children than individual based therapy, for families where a parent had a

substance misuse disorder, perhaps because improvements in the couple‟s relationships

positively impacted on family dynamics. We would suggest that the above research highlights

the need for both; timely and effective treatment for the parent and the need to include parenting

and family relationships into standard treatment protocols.

Just like other parents in the community, some parents with a mental illness may require support

and guidance in their parenting interactions. However, generic parenting programs generally do
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not address the specific concerns of a parent who has a mental illness (Thomas & Kalucy, 2002).

Instead parenting programs for those with a mental illness need to be flexible in program content

and time to allow for parents to drop in and out as required, and provide opportunities to learn

from and with other parents in similar circumstances (Reupert & Maybery, 2011). In terms of

specific skills, Solantaus, Reupert and Maybery (in press) suggest that some parents may not

have the language or confidence to talk to their children about their illness and may require

guidance to do this safely.

Others have also highlighted the nature of support required by some parents, for role modelling,

emotional support, companionship, and practical assistance in caring for children and running a

household (Reupert & Maybery, 2007). At the same time, support needs for parents will vary

over time and fluctuate depending on symptomology. Nicholson et al., (1998) found that while

a partner or extended family member may help the parent with the mental illness by assisting in

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child care, they may take over the running of the household and negatively impact family

dynamics.

v. Interventions: types and outcomes

There have been several reviews conducted on the type and/or efficacy of interventions currently

available for children, parents and/or families (see Bee, et al., 2014; Brockington et al., 2011;

Hosman, van Doesum & van Santvoort, 2009; Reupert, Cuff, Drost, Foster, van Doesum & van

Santvoort, 2012; Reupert, Maybery & Kowalenko, 2012). The following is not a definitive list

of all available interventions. Instead we present a selected group to demonstrate the scope of

intervention types for different stakeholders, and the range of ways they are evaluated.
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Peer support programs may be offered to children whose parents have a mental illness, where

groups of children living in similar families learn more about mental illness, adaptive coping

strategies, develop peer relationships and are provided with respite from caring. In the

Netherlands, van Santvoort, Hosman, van Doesum and Janssens (2014) assessed the

effectiveness of one such program, using a randomized controlled trial (RCT) of children from

254 families. Children in the intervention group experienced a greater decrease in negative

cognitions and sought more social support, immediately after participation and three months later,

as compared to control group children. Peer support programs commonly adopt a group,

strength based, preventative approach that aim to prevent mental health issues from occurring;

this may mean that children with current mental health difficulties are excluded and instead

directed to active, individual treatment (Reupert, Cuff, Drost, Foster, van Doesum & van

Santvoort, 2012). Other less commonly documented child approaches include online

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interventions (Drost, Cuijpers & Schippers, 2011) and bibliotherapy, where children are

presented with literature with characters who are in similar positions to themselves (Tussing &

Valentine, 2001). Young people who care for their siblings and/or parent may also be supported

financially, e.g., Carers Australia provides bursaries to allow young carers to continue or return

to study. It is still early days for these latter approaches in building an efficacy base.

Other interventions focus on parents as the catalyst of change back in their family. For example,

Let‟s Talk about Children, is a manualised, 2-3 session intervention that provides parents with

the skills to discuss depression with their children and support their family within the context of

the disorder. A RCT conducted with 109 Finnish families reported increased parent
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understanding, reduced guilt and shame and children reported significant reductions in emotional

symptoms and improved pro-social behaviour (Punamäki, Paavonen, Toikka & Solantaus, 2013).

In the USA, the Families Facing the Future intervention (Haggerty, Skinner, Fleming, Gainey &

Catalano, 2008) targets parents in methadone treatment and is designed to reduce their risk of

relapse and their children‟s risk of substance abuse. The intervention includes a parent training

curriculum where parents are taught positive family management practices, how to communicate

more effectively with children and how to teach children problem-solving and drug-refusal skills.

While there was evidence of a significant difference in intervention by gender (with a reduced

risk of developing a substance disorder for boys compared to girls), there was no difference for

girls in either the control or intervention groups.

Family interventions target the whole family though there are different ways these are conducted.

For example, the US based Keeping Families Strong is designed for depressed mothers and their

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children aged 9-16 (Valdez, Mills, Barrueco, Leis & Riley, 2011). This cognitive behavioral

approach involves ten sessions including parent and child multifamily groups and individual

family meetings. A non-experimental design found mother-reported decreases in child behavior

and emotional problems, improvements in the quality of family interactions and routines and

improvements in their own well-being and support from others (Valdez, Mills, Barrueco, Leis &

Riley, 2011). Children reported decreased internalizing symptoms, improved coping, increased

maternal warmth and acceptance and decreased stressful family events.

Family Options is a very different family focused intervention conducted through a clubhouse

agency in the USA (Nicholson, Albert, Gershenson, Williams & Biebel, 2009). Designed for
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parents with a serious mental illness and their children aged 1.5 through to 16, the goal of Family

Options is to build essential skills in both parents and children and promote access to formal and

informal supports systems. Families meet with a Family Coach, and together they work on a

family care plan, where family goals are identified in domains such as family relationships, child

behavior management, work and school. Support is then provided to the family in achieving

these goals, within a 12-18 month time frame. While child outcomes have yet to be reported,

mothers report high satisfaction with the intervention provided.

Recently, Bee et al., (2014) reviewed 29 intervention studies, of which 26 targeted parents and/or

children where the parent had depression, highlighting a need for interventions for parents with

other disorders. While they found evidence for effect in 18 programs for severely depressed

mothers they concluded that most trials were of poor or unclear quality and few collected

longitudinal data. As Reupert and Maybery (2015) summarise, we still do not know enough

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about intervention targets (child, parent, family), content (e.g. therapy or psycho-education) and

whether intensity (measured by program duration) relates to effectiveness.

Some comments regarding available research

Some tentative conclusions might be drawn about the research conducted in this field. Most

research focuses on families where a parent has an affective disorder, in a Western context

(North America, Europe and Australia); more research is needed on different family types

(including same sex parents), parental diagnoses other than an affective disorder, and various

cultural groups including those from the developing world, migrant and refugee families. On the

whole, studies in this area fail to consider the economic implications of parental mental illness or
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the cost effectiveness of interventions (Bee et al., 2014) and these areas need to be a priority for

future work.

Recommendations for policy, research, service delivery and practice

A fundamental paradigm shift is required at all levels of service development, delivery and

policy to better meet the needs of families. Parenting status needs to be a standard intake

question and assessment should consider the needs of a client‟s children and identify the supports

required by the client in assuming his or her parenting role. Family focused practices and

interventions should be delivered with each member of the family in mind. For example, family-

friendly spaces should be provided in psychiatric wards, so that children may safely visit their

parents when hospitalised. Family sensitive policies and guidelines need to be considered when

determining work allocation, interagency collaborations and service evaluation methods. In

addition, training in family focused practices needs to be offered during graduate years and

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ongoing professional development programs (see for example, Reupert, Foster, Maybery, Eddy

& Fudge, 2011) including supervision. More research is required to determine what works, for

whom, and when, in regard to prevention and early intervention for these families. Similarly,

there is a need for culturally sensitive and/or targeted interventions necessary for increasingly

multicultural and blended societies.

We know that children and parents living in families affected by parental mental illness are at

greater risk of various adverse outcomes but at the same time, the research clearly demonstrates

that these consequences do not have to be inevitable. Given that we know that these children are

a particular at risk group, it is a moral imperative to ensure that these families are identified, and
Child & Youth Services

structures are in place to adequately address their needs at prevention and early intervention

stages. While an evidence base is still emerging in terms of formal child, parent and family

interventions, there is still much to be done to ensure that community, mental health and other

services have the capacity to work with clients with mental health issues and their children, in an

inclusive, family centred manner.

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