Parental influence on the mental health-related behaviour of young people with mental illness: Young people’s perceptions
Abstract and Figures
Parents of young people with mental illness use a variety of strategies to try to positively influence young people’s mental health-related behaviours. Evidence suggests that these parents can influence young people’s well-being and mental health trajectories. However little is known about how young people perceive and are affected by the strategies parents use. In-depth qualitative interviews focussing on parental involvement in mental health were conducted with 26 young people with mental illness. The data were analysed using constant comparative analysis. Young people described parents as directly influencing their mental health-related behaviour through facilitative, persuasive and controlling practices. Young people’s behavioural and emotional responses to these practices were influenced by when the incident occurred; what they believed about the attitudes and motives behind their parents’ actions; whether they agreed in principle with the practices; the degree to which they accepted their parents’ authority and anticipated their own increasing autonomy; and whether other support was provided alongside the behavioural practices. Understanding how young people view their parents’ influence on their mental health-related behaviour under different circumstances is a vital step towards promoting the best possible parental support for these young people.
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... Noticing how my parents and I each understood mental illness, and how those understandings changed with age, made me want to further investigate the links between young adulthood as a life stage, parent-child relationships, and mental illness. Approaches to the study of mental illness have focused on coping and support strategies between young people and their parents with most of the focus directed towards adolescence (Armitage et al, 2020;Draucker, 2005;Griffiths et al., 2011;Heerde et al., 2014;Honey et al., 2013;Moses, 2010). Family studies have considered the interactions of parents and children, but generally overlook the role of mental illness within that relationship. ...
... Each of these stages requires active participation from both sides, and I am curious about how interactions at each stage construct "the problem." Honey et al. (2013) address interaction again, this time interviewing mentally ill youth on their perceptions of how parents influence their behaviour. The youths in this study identified their parents as either facilitating behaviours (making desired behaviours easier), persuading to behave certain ways (encouragement), or controlling (forcing), and that they responded differently depending on how they viewed their parent's motives, their own autonomy, and their acceptance of parental authority (Honey et al. 2013). ...
... Honey et al. (2013) address interaction again, this time interviewing mentally ill youth on their perceptions of how parents influence their behaviour. The youths in this study identified their parents as either facilitating behaviours (making desired behaviours easier), persuading to behave certain ways (encouragement), or controlling (forcing), and that they responded differently depending on how they viewed their parent's motives, their own autonomy, and their acceptance of parental authority (Honey et al. 2013). This is of relevance to my study because how the teens respond depends on their perception of adult motives, demonstrating that youths might construct their mental illness differently whether they feel that they are being excessively controlled or being cared for. ...
While public awareness about young people’s mental health has been on the rise, the context in which it is studied has many gaps. Adolescent mental health is often studied within the context of family relationships but the same is not true for young adults over 18 years old. Drawing on interviews with young adults who have mental illness and their parents, I found that the parent-child relationship is a relevant context in which ideas about what mental illness is are constructed. Through the conscious presentation of self within the unique expectations of this relationship and the feedback from parents or children, young adults construct definitions of mental illness which guide their ideas of self and actions in the relationship. By considering this specific relationship and life stage, I hope to contribute to a more specific understanding of the social construction of mental illness and to highlight its practical implications in the lives and relationships of young adults.
... Finally, young people themselves have reported that parents' responses to their mental health issues affected their behaviour, feelings, and well-being (Honey, Fraser, Llewellyn, Hazell, & Clarke, 2013). Considered together, this evidence strongly suggests that parents' behaviours can influence young people's outcomes. ...
... This controlling strategy is extreme and likely to be used only as a last resort, in the context of mental health crisis. Even if responded to negatively at the time of implementation, young people have reported that in some cases, even controlling parental strategies are retrospectively perceived as having been necessary (Honey et al., 2013). Considerable individual variation in reported helpfulness was apparent for most strategies, and strategies that are less helpful for many parents may well be extremely helpful for some. ...
... Positive parent-young person relationships appeared to enhance the helpfulness of some strategies, including some aimed at changing young people's behaviour. This is supported by reports from young people, who indicated that they were better able to tolerate parents trying to influence their behaviour if parents also provided emotional and practical support (Honey et al., 2013). Therefore, it may well be important for parents to use emotionally supportive strategies in conjunction with behaviour-changing strategies where these are used. ...
Parents are a critical resource in supporting young people who live with mental health problems. Qualitative research has identified that parents use a wide range of strategies to provide support. However, parents report being unsure which strategies are likely to be helpful, so often struggle in this role. Presently, little empirical evidence exists to assist parents to decide which strategies are likely to be most helpful. This study aimed to explore the parent‐perceived helpfulness of parental strategies to support young people living with mental health problems. Data were collected from February to July of 2018, using a cross‐sectional, online, anonymous, self‐report survey of participants who identified as parenting a young person (15–24 years) diagnosed with a mental health problem (n = 70). Overall, the strategies perceived as most helpful were practical assistance and personal interactions aimed at promoting positive thoughts and feelings and obtaining appropriate treatment. Least helpful strategies tended to be control‐type strategies, aimed at behaviour change. Overall, there was good alignment between strategies’ helpfulness and frequency of use, however, there were exceptions. These exceptions are likely reflections of the specific context of particular situations as well as parental uncertainty regarding alternative strategies. Generally, perceptions of strategies’ helpfulness were unrelated to parent or child characteristics. However, helpfulness of strategies was associated with parents’ satisfaction with their relationship with the young person. Parents’ collective experience‐based perceptions about the helpfulness of strategies used to support young people experiencing mental health problems can be harnessed to inform mental health practitioners’ advice to parents and contribute to better mental health outcomes for young people.
... Agency was described here as central to a recovery-oriented approach in healthcare, which was also highlighted by Kaplan and Racussen (2012). Sometimes, however, the agency was perceived as something not entirely unproblematic, for example, addressed in the article by Honey, Fraser, Llewellyn, Hazell, and Clarke (2013). They highlighted the tension that often arises in youth psychiatry when staff are expected to involve young people and encourage agency in a context where parents are sometimes described as overprotective. ...
... When referring to the mental health needs of children and adolescents, emotional, academic, behavioral, and psychological needs are included and when young people need more intensive outpatient contacts or inpatient care, the demands on youth-adapted care are at the forefront. The importance of flexibility (Ward, 2014), therapeutic alliance (Gueguen et al., 2017;Kaplan & Racussen, 2012;Law et al., 2020;Ramjan, 2003), trust (Kelada, Hasking, Melvin, Whitlock, et al., 2018;Wallstr€ om et al., 2021), and an approach that promotes personal recovery (Honey et al., 2013;Schneidtinger & Haslinger-Baumann, 2019) are described consistently in a number of articles. The perspectives and reflections of young people themselves may be considered important for how feedback is given to mental health services (Rosado, 2019;Salamone-Violi et al., 2015;Schneidtinger & Haslinger-Baumann, 2019;Wallstr€ om et al., 2021). ...
Background
Recovery from mental illness and mental health problems is relatively well‐researched among adults, but evidence that focuses on the recovery experiences of young people and what characterizes it is scarce. With this in mind, this article aims to map out the existing research in order to identify prevailing knowledge about the recovery of young people between the ages of 12 and 25.
Method
Drawing on scoping review methodology, this article is based on an analysis of 33 articles conducted in the USA, Australia, and Europe.
Results
Our findings reveal that young people express both similar and divergent lines of reasoning about recovery compared with adults. Our findings also indicate that young people often fluctuate in the way they view recovery, and that they thus tend to be ambivalent about what recovery means. Parents usually highlight the importance of professionals facilitating recovery, while care staff problematize the organizational frameworks available as aggravating circumstances for implementing personal recovery. Young people, parents, and care staff consistently describe recovery as a way to, despite lingering problems, enable a satisfying life.
Conclusions
Through this review, we outline the need for a more distinct focus on agency and participation in young people's recovery processes, at the same time as family involvement needs to be further investigated and operationalized.
... This theory hypothesises that mental health is influenced by all people in the family and should be treated in a systemic manner. Extensive research has directly underlined the role of parents in supporting youth mental health recovery (Delaney & Engels-Scianna, 1996;Dooley & Fitzgerald, 2012;Honey, Alchin, & Hancock, 2014;Honey, Fraser, Llewellyn, Hazell, & Clarke, 2013;Honey et al., 2015;Resendez, Quist, & Matshazi, 2000). The salience of the parental role is felt to be due to the young person's developmental stage and the need for parents to facilitate the acquisition of understanding, support engagement with services and help with developing effective coping skills. ...
... As this research is taking the first steps in theory generation, it was deemed unethical to interview young people directly as questions related to their mental health symptoms and recovery may be distressing (Department of Health and Children, 2013). Considering the young person's developmental stage, parents are viewed as key collaborators and service users and therefore are perfectly positioned to facilitate the development of a youth mental health recovery theory (Delaney & Engels-Scianna, 1996;Dooley & Fitzgerald, 2012;Honey et al., 2013Honey et al., , 2014. ...
Background
Mental health disorders have a negative impact on the individual, society and global economy. The prevalence of mental disorders is increasing in young people, if unaddressed, they may develop into severe and chronic illnesses. Despite this, research into youth mental health recovery is limited. The current study aims to develop a theoretical framework of recovery in youth mental health and identify what facilitates this process.
Methods
Fourteen parents of children engaged with the Child and Adolescent Mental Health Service were interviewed in relation to their understanding of youth mental health recovery. The transcripts of these interviews were analysed using the constructivist grounded theory approach.
Results
A theoretical model of youth mental health was developed. The model provides an understanding of (a) the characteristics of youth mental health recovery, (b) the facilitators of recovery and (c) the barriers to recovery. The theory suggests that due to developmental factors youth mental health recovery occurs within the ecological context of complex social systems.
Conclusions
The theory reflects elements of existing developmental and recovery research and provides a novel understanding of youth mental health recovery. This model may inform social, government and service attitudes and policy, and highlights areas for future research.
... For example, parents: ■ Provide practical support, such as finding and organizing treatment ■ Interact in particular ways, for example, withholding negative emotions ■ Facilitate positive environments, for example, by encouraging others to treat the young person in a supportive way ■ Sometimes control young people's behaviour, for example, by using their parental authority. Young people have reported that their parents' actions have an impact, for better or worse, on their behaviour, activities, thoughts, feelings and treatment (Honey et al, 2013). Given that mental illness accounts for 61% of the non-fatal burden of disease in young people (Australian Institute of Health and Welfare, 2007), optimising parent support for young people experiencing mental illness should be a high community priority. ...
... First, young people's ideas about optimal parent involvement may not always align with parent or professional opinions and may also change over time. Some young people have reported resisting parents' attempts to help them, but later seeing the same actions as helpful in retrospect (Draucker, 2005;Honey et al, 2013). Second, parents are likely to differ in terms of their willingness and capacity to provide support (Honey et al, 2015). ...
Background/Aims
Parents can be an important source of support for young people living with mental illness. Young people have the potential to shape this support to best suit their needs, however little is known about this issue. This paper explores, from the perspectives of young people, how they manage parental support and involvement.
Methods
Interviews were conducted with 26 young people (15–24 years old) who were living with mental illness and in frequent contact with at least one parent. These were analysed using constant comparative analysis.
Findings
Young people reported shaping parental involvement using a combination of facilitation, compliance and resistance. Their actions were determined by a complex alignment of their wish for parent involvement, perceived potential to influence their parents, and ability to communicate their needs.
Conclusions
By understanding these dynamics, therapists working with young people and their parents can help address barriers to achieving optimal parent support for young people experiencing mental illness.
... Self-management is an empowering process that allows adolescents to take responsibility and to make decisions about their own mental health, while being supported by family, friends and, in some instances, professionals (Collins & Laursen, 2004;Honey et al., 2013;MHCC-Au, 2014). These results show that youth can identify strategies that allow them to feel better on a daily basis, reinforcing the relevance of including youth in decisions that concern their mental health, as they know best what is good for them. ...
Anxiety and depressive disorders are the most prevalent mental health problems in adolescents, however, little is known about the strategies they use to deal with their difficulties and regain power over their symptoms. This exploratory study documented the self-management strategies used by adolescents to recover from difficulties related to anxiety and/or depression. Individual interviews were conducted in Montreal, Canada with 49 participants aged 11 to 18 years (28 girls, 20 boys, and 1 non-binary person from various cultural origins) after approval by the Institutional Review Board. Young people were questioned about the self-management strategies they put in place when they felt stressed, sad, or anxious. The data were coded according to the thematic analysis method using an inductive approach. Participants reported 73 self-management strategies, regrouped in four broad themes: (a) I think through; (b) I surround myself with people/animals; (c) I feel and manage my emotions; (d) I continue my daily activities. Their strategies emphasize the role played by their social network and the place of social media as a support in their recovery. Self-management is an empowering process that allows adolescents to take responsibility and to make decisions that foster their recovery.
... Second, through engaging with participants in multiple interviews it provided the opportunity to recall and relay events and meaning over time and thereby to uncover the intersectionality of personal, social and locational dimensions within and across interpersonal discriminatory acts. Third, our multiple interview method had proved highly feasible in our earlier studies with young people with disabilities (Honey et al. 2013;Foley et al. 2012 The focus on the contextual particularities of individual biographies has been found to be especially important when studying groups who are marginalised, both as a tool for empowerment and as a way of revealing contradictions and exceptions unexpected by the research agenda (Plummer 2001). Lived experience narratives are widely documented in disability research and studies, see for example Bogdan and Taylor (1994) in the United States, a lifetime of work from Thomas (1999) and Oliver (1990) and in Australia (Clifton, Llewellyn and Shakespeare 2018a; Clifton, Llewellyn and Shakespeare 2018b). ...
This article examines findings from a qualitative study exploring the experiences of young adults with disabilities regarding their perceptions of interpersonal discrimination on public transport in two Australian states. Interpersonal discrimination by members of the public included contests for accessible seating, receiving unwanted physical assistance, bullying and intimidation. Participants reported that transport staff engaged in verbal abuse and hostile interactions including questioning the young person’s disability. These experiences appeared to be influenced by narrow perceptions of disability, visibility or otherwise of the young person’s impairment, limited understanding of the needs of young people with disabilities, and the age and gender of the person behaving in a discriminatory way. The discriminatory experiences were reported to have had a negative impact on the social and economic participation of these young adults in their communities.
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The participants of the study disclosed diverse experiences of interpersonal discrimination by the travelling public and transport officials.
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Interpersonal discrimination impacted on some of the young adults’ capacity to move about freely, as they sought to avoid exposure to prejudicial attitudes and verbal abuse.
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Heightened concerns about getting to and from activities safely affected the young adults’ willingness to use public transport for their daily activities.
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Eliminating day-to-day interpersonal discrimination that young adults with disabilities experience on public transport requires legislative, policy and societal change.
... Nordby et al. (2010) showed that professionals should consider relatives as experts on their young adult and allow them to be heard and supported in sharing their knowledge and experiences with the professionals. Relatives play an important role in the young adults' recovery and transition to adulthood (Honey, Fraser, Llewellyn, Hazell, & Clarke, 2013;Lindgren et al., 2015), but being in-between demanding needs is a balancing act, especially if the relative is a parent. Relatives who do not manage their own lives are at risk of not being able to support the person with ill health (Rusner et al., 2013). ...
Parents of young adults with mental illness may face a continued demand for support, even though their children have reached the age of majority. The aim of this study was to explore relatives’ experiences of parenting a young adult with mental illness in transition to adulthood. Individual interviews were conducted and analysed according to Grounded Theory. The results showed that relatives experienced powerlessness and a sense of inescapable duty with limited possibilities to be relieved. With a family nursing approach, relatives can be supported and, when the young adults’ needs of care are met, they can be relieved from their burden of responsibility.
This study explores staff balancing parental involvement when performing recovery-oriented work via Patient-Initiated Brief Admission (PIBA) for adolescents. Data from focus group interviews with employees in Swedish Child and Adolescent Psychiatry (CAP) is discussed and analyzed using ecological systems theory. Findings suggest dualistic views on participation and parental involvement, where safety and security have to be considered supporting adolescents’ participation in psychiatric inpatient care. Staff has the potential to involve parents during PIBA without automatically diminishing adolescents’ participation, and this has to be legitimized if PIBA is to become an integrated tool to promote recovery-oriented care in CAP.
Objective:
To efficiently target capacity-building efforts for child mental health services in low- and middle-income countries (LMICs), it is critical to define how care is structured across sectors and individual-level factors.
Methods:
In a community-based sample of 1,408 children and adolescents (ages 6-15 years) from Itaboraí, Brazil, the authors assessed need and service use across four care systems (mental health specialty, health, welfare, and informal). Individual-level factors included child gender and age, maternal perception of child mental health need, paternal absence, maternal education, and maternal anxiety and depression.
Results:
The mental health treatment gap was 88%, with only 12% of children with psychiatric problems using mental health services. Children with mental health problems were more likely than those without these problems to use health and other sectors of care and to use services in more than one sector of care. Overall, 46% of the children with any clinical mental health problems and 31% of those with only internalizing problems were identified by their mothers as having a mental health need. Among those with clinical mental health problems, factors associated with mental health service use were being a boy and paternal absence but not mental health problem type or maternal awareness.
Conclusions:
Closing the child mental health treatment gap in urban settings in LMICs where resources are scarce will likely require system-level changes, such as engagement of diverse service sectors of care. Interventions need to target increased maternal awareness about mental health problems and encourage provision of mental health services to girls.
The conceptualization and measurement of parental support is predominately the work of adult researchers from the West. This mixed-method study reports the parental behaviors that adolescents themselves perceive as supportive. Data come from the Cross-National Adolescent Project, a survey of adolescents in 12 nations or ethnic groups in Africa, Asia, Australia, the Americas, the Balkans, Europe, and the Middle East. The authors find that adolescents in all 12 settings validated the substantive content of existing survey measures of parental supportive behaviors. Adolescents in all settings also expanded the list of supportive behaviors. When parents provide a rare and valued commodity, it is perceived as love. The specific commodities, which include quality time, basic necessities, and support for education, vary across culture. In the discussion the authors describe how parenting strategies that have been interpreted previously as reinforcing distinct cultural purposes may, in fact, serve the same purpose.
Adolescent depression is a serious disorder marked by a prevalence rate of approximately 5% along with significant rates of relapse and mortality (Brent & Birmaher, 2002). This qualitative study involved semistructured interviews of nine young adults who were diagnosed with and treated for major depressive disorder between the ages of 15 and 18. Five themes emerged from the interviews: (a) talking to a counselor about their depression was helpful; (b) participants obtained relief in their counseling and expressed respect for their professional helpers; (c) parental (and adult) partnerships are important; (d) friends of the adolescent clients were usually helpful to them; and (e) the adolescents possessed a realistic optimism concerning a possible subsequent depressive episode. Implications for mental health counselors are also discussed.
Parenting is a critical and complex occupational role, requiring different occupations and abilities depending on the developmental stage and specific characteristics of each child. When a young adult child develops a mental illness, assisting and supporting them to overcome or adapt to the mental illness becomes a crucial aspect of this occupational role to which many parents devote a great deal of time and energy. The way parents respond to mental illness can have an important impact on young people. However, to date, research on these parents has focussed almost exclusively on their characteristics and personal coping rather than what they do to try to assist and support young people. The aims of this study were to identify the occupations parents currently engage in to promote mental health and wellbeing for a young person with a mental illness and to explore the perceived helpfulness of these occupations.
Interviews with 26 young people (15-24 years old) and 32 parents were analysed using constant comparative analysis.
Participants reported 78 conceptually distinct mental illness related occupations aimed at promoting: appropriate treatment; positive activities and actions; positive thoughts and feelings; and an ordinary life. Importantly, few participants could evaluate with confidence the helpfulness of individual mental illness related occupations.
This research demonstrates the breadth of the mental illness related occupations parents employ and provides a framework for understanding their complexities. It highlights the need to establish an evidence base for various mental illness related occupations so that parents can have more knowledge and thus confidence in these critical occupations.
An overview of the Family Socialization and Developmental Competence longitudinal program of research (FSP) is followed by a presentation of the hypotheses and findings pertaining to family patterns as determinants of adolescent competence, and of types of adolescent substance users. Data include clusters derived from comprehensive ratings of parents and their children completed independently within- and across-time periods at ages 4, 9, and 15 years. At Time 3 (T3), the sample included 139 adolescents and their parents from a predominantly affluent, well-educated, Caucasian population. Parenting types were identified that differ on the bases of commitment and balance of demandingness and responsiveness. Authoritative parents who are highly demanding and highly responsive were remarkably successful in protecting their adolescents from problem drug use, and in generating competence. Authoritative upbringing, although sufficient, is not a necessary condition to produce competent children. Casual recreational drug use was not associated with pathological attributes, either precursive or concurrent, although nonusers showed an increment in competence from Time 2 (T2) to Time 3 (T3).
Background: Although social relationships have been studied regarding psychotic illness and developmental stages, little is known about the social experiences of adolescents and young adults with recent-onset psychosis. Aims: The purpose of this phenomenological study was to explore young people's experiences of social relationships during the recovery phase of first-episode psychosis in order to facilitate their social relations. Method: Six young people recovering from a first episode of psychosis and attending a Recovery Group Program in an early psychosis treatment facility were interviewed regarding their subjective experiences of social relationships. Results: Five themes highlighted participants' experiences of losing contact with friends they had prior to their illness, valuing being with people who are understanding, and receiving support from family members and other young people who had also experienced psychosis. The participants also described feeling and being perceived as different, yet building new relationships in the recovery phase of their illness. Conclusion: The findings suggest the need for psychosocial programs that provide young people with environments that support them to cope with the direct implications of psychosis and to engage in behaviors and activities typical of young adults, thereby supporting the integrative processes following the onset of psychosis. Declaration of Interest: None.