Parental mental illness: the impact on children and adolescents: information for parents, carers and anyone who works with young people

Many children will grow up with a parent who, at some point, will have some degree of mental illness. Most of these parents will have mild or short-lived illnesses, and will usually be treated by their general practitioner.

A few children live with a parent who has a severe mental illness such as schizophrenia or bipolar disorder.  In fact 68% of women and 57% of men with a mental illness are parents. In addition many children live with a parent who has long-term mental health problems, as well as alcohol or drug problems and personality disorders.

Children can often cope well with all sorts of life upsets, especially if:

• the problem is short lived and does not keep repeating.
• they can understand what is happening and as much as possible why.

Parents cannot control the fact that some illness, especially mental illnesses, can last a longer time, and may come back.

However, some parents may try to protect their children from their illness by keeping it a secret or as ‘something’ which cannot be asked about or explained.

Although this is often done for good reasons, it is a mistake and can make it more difficult for the children to cope with or to manage their own feelings.

In these situations many children will worry that:

• They are to blame for their parent’s illness. This may lead to them feeling depressed.
• They may develop the same illness. Although for some conditions, the risk of having similar illness can be higher within families, this can be reduced if the child is helped to see that they are not part of the illness, and they are able to have a good relationship with their parents, peers or any other adults who can be trusted and helps them. Understanding the illness helps the child to achieve this.
• For some children situations where it is more difficult for them to cope are when the children are:
• are separated again and again from a parent who needs to go into hospital for treatment
• are living with a parent who is very unwell and treated at home
• feel unsure of their relationship with the parent with a mental illness
• are not being looked after properly
• are being hit or mistreated (this is more likely if the parent suffers from alcohol or drug problems or has personality difficulties)
• are having to look after an ill parent, or are taking care of brothers and sisters, and missing school
• are being teased or bullied by others
• hear unkind things being said about their ill parent.

Even when children have all the right support and explanation, they may still feel upset, frightened, worried by, or ashamed of their parent's illness or behaviour at times.

Some children withdraw into themselves, become anxious and find it hard to concentrate on their school work. They may find it very difficult to talk about their parent's illness or their problems especially when they have had no explanation of their illness. This may stop them from getting help.

Children are often ashamed of their parent's illness and worry about becoming ill themselves. They can be preoccupied with fears of ‘catching’ the illness and some children can show signs of a similar illness or severe emotional problems.

They can have physical health problems and struggle with school and their education, especially when they live with parents in poverty, poor housing or have an unstable life.

There are some steps that can be taken to try and help avoid these problems and to make the child or young person's life easier. For example:

• having a reliable, consistent and caring parent or other adult they can talk to;
• being given information and explanation about their parent's illness;
• encouraging and supporting the child in their everyday routine, like attending school, playing and doing things like their peers.

If you are a parent with a mental health problem, it is important that you make sure you have the right help. You can discuss your child’s needs for care and support, especially when you are unwell, with your doctor or the professional treating you. All mental health professionals involved in the care of an ill parent should ask about the needs of the children in the household, and whether any further help is required, even if the parent is not being treated in hospital.

A child may really value the chance to talk about their parent's illness, and their fears, with a professional who is familiar with these things.

It is important for parents and teachers to be aware of the possible stresses on the young person with an ill parent, and to recognise that a child's difficult behaviour may be a cry for help:

• the GP or a social worker can help with support and practical help for the family in caring for the child or young person, and give advice and work with other professionals if there are problems that are harming the child's health or development;
• the child could join a local group (sometimes also called ‘young carers’), specifically for the children and young people who care for their parents or siblings.

Some children may be offered therapy or counselling. A lot of children will not be very happy about this as they assume it means that they are either the ‘problem’ or that they will develop the illness. Young carers groups avoid this problem as the children are respected as helping their parent.

If the child or young person has severe emotional or behavioural problems that interfere with their life and that don't seem to be improving, more specialist help may be needed. Their GP will be able to advise about local services and to refer a young person, if necessary, to the local child and adolescent mental health service (CAMHS). This service usually includes child and adolescent psychiatrists, psychologists, psychotherapists, nurses and social workers

Susie is 11 and her school attendance is irregular. When in school, she is often tired and she is often very untidyly dressed and her hair looks dirty. She is quite a “bossy” girl and has difficulty making friends. Some of the younger children feel bullied and intimidated by her, and the school is getting more and more worried about her behaviour.

Mum is a single parent and has twice been invited to come to school to discuss Susie’s behaviour and attendance, but she has not turned up on either occasion. An Educational Welfare Officer (EWO) is allocated to the case and, on making a home visit, discovers that Mum is suffering from bipolar illness. Mum has medication but does not always take it, which results in good and bad days and accounts for Susie’s erratic attendance. The reason for Susie’s bossy behaviour also soon becomes apparent as she needs to “boss” mum to get her to take her medication, and as well as looking after Mum’s well being.She is trying to be a parent to her 9 year old brother Jake.

The Whole Family Plan.

The local Community Mental Heath team (CMHT) review mum's case and assess both the management of her illness and her needs as a parent. CMHT set up monitoring process to ensure medication is taken. Susie’s mum agrees to start attending a voluntary drop in day centre once a week to seek support and advice on self-managing her condition. Both children are assessed under the Common Assessment Framework and support is offered to support them.

The Behaviour support team meets with the school to implement a plan to support Susie to reduce her “ bossy” behaviour and monitor her attendance. She is also given learning support to help to catch up with work that she has missed.

The Educational Welfare Officer also contacts the local young carers project to see if Susie can get support from them. It is decided that the services she needs are befriending and to go to the homework club. The project will also give her information about bipolar illness. Jake is offered a place at the local church Saturday activity club and is also given information about bipolar illness.

Crossroads care for young carers - Information and support about being a young carer including information about local groups.

Bipolar UK - Supports people with a diagnosis of manic depression and their families.

Princess Royal Trust for Carers - Information, advice, discussion and support for carers, and young carers: YoungCarersNet: http://www.youngcarers.net/

Rethink Mental Illness

Offers information and advice to people with severe mental illness and their carers.

Further reading

Minds, Myths and ME booklet, produced by four British young carers, available from the Royal College of Psychiatrists. 

‘When a parent has a mental illness’: film for young carers by Dr Alan Cooklin.

“Being seen and heard”: the needs of children of parents with mental illness: multi-media training pack for use of staff involved with parents and their children.

Gopfert, M., Webster, J. & Seeman, M. 2^nd edition (eds) (2004) 'Parental Psychiatric Disorder' - Distressed Parents and Their Families. Cambridge: Cambridge University Press.

Revised by the Royal College of Psychiatrists’ Child and Family Public Education Editorial Board.

Series Editor: Dr Vasu Balaguru

With grateful thanks to Dr Alan Cooklin.

This leaflet reflects the best possible evidence at the time of writing.

© March 2012. Due for review March 2014. Royal College of Psychiatrists.