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Coping with the dual demands of severe mental illness and parenting: The parents' perspective

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Abstract

The experience of parenthood by individuals with severe mental illness has not been well studied. Research on mentally ill parents has focused on their pathology and the potential risk for their children without considering the parents' perspective. This qualitative study used interviews to explore how these parents coped with the dual demands of parenthood and their illness. Participants included individuals whose children are now young adults as well as those with younger children. Themes that emerged were problems with diagnosis and treatment, stigma, chaotic interpersonal relationships, the strain of single parenthood, custody issues, relationship with children, social support, and pride in being a parent. Follow-up interviews focused on the themes of relationship with children, strain of single parenthood, and sources of support. Relationship with children contained three specific topics: discipline, boundary issues, and role reversal. Implications for practice are discussed along with recommendations for future research involving other family members.

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... Given the potential adverse impact of parental mental illness on parenting capacity and, in turn, outcomes for children, engaging this population in parenting training is of importance (Isobel et al., 2016;Phelan, Howe, Cashman, & Batchelor, 2012;Phelan, Lee, Howe, & Walter, 2006). Unfortunately, however, parents with mental illness tend to be reluctant to access generic parenting programs (Ackerson, 2003;Isobel et al., 2016;Phelan et al., 2012). The stigma associated with mental illness, combined with the fear that children may be removed from their care, can prevent parents from accessing such services (Ackerson, 2003;Biebel, Nicholson, & Woolsey, 2014;Reupert & Maybery, 2011). ...
... Unfortunately, however, parents with mental illness tend to be reluctant to access generic parenting programs (Ackerson, 2003;Isobel et al., 2016;Phelan et al., 2012). The stigma associated with mental illness, combined with the fear that children may be removed from their care, can prevent parents from accessing such services (Ackerson, 2003;Biebel, Nicholson, & Woolsey, 2014;Reupert & Maybery, 2011). To enhance engagement and overcome these barriers there is a need to develop specific programs for this population (Isobel et al., 2016;Stewart-Brown & Schrader-McMillan, 2011). ...
... A study by Isobel et al. (2016) found that the group format for parents with a mental illness is particularly suitable as it allows for parents who are initially reluctant to actively engage and observe others sharing openly and share when they are ready, as the group progresses. Furthermore, being in a group with others who have a mental illness is important to engagement as it helps overcome the stigma many parents with mental illness experience accessing generic parenting programs (Ackerson, 2003;Biebel et al., 2014;Reupert & Maybery, 2011).a. ...
Article
The relationship between parental mental illness and poor outcomes in children is well established. While parents with mental illness could benefit from accessing parenting programs, this population tends to be reluctant to do so. To address this need, we developed an adaptation of the Triple P program specific to people with mental illness, and this paper presents the views and experiences of parents who attended this program. The program is a ten week intervention consisting of a six week group parenting program, followed by four weekly home visits.
... A lthough deinstitutionalization has enabled many people with a mental illness to become integrated into their communities, the parenting role of many clients, and in particular fathers, has been overlooked by the mental health system. There have been a number of studies identifying the experience of mothers with a mental illness (Ackerson, 2003a;Bassett, Lampe, & Lloyd, 1999;diaz-Caneja & Johnson, 2004;dipple, Smith, Andrews, & Evans, 2002;mowbray, oyserman, Zemencuk, & Ross, 1995;Nicholson, Sweeney, & Geller, 1998;Sands, 1995); however, the experience of fathers with a mental illness has received little research attention. Accordingly, this article aims to highlight the experiences of fathers with a mental illness and their needs in their parenting role. ...
... on the other hand, interview-based research regarding the experience of motherhood in women with mental illness shows that for many, looking after children is rewarding and central to their lives, even though they reported that the demands of parenting were considerable (diaz-Caneja & Johnson, 2004;mowbray et al., 1995). The stigma associated with mental illness results in many mothers being reluctant to discuss their parenting role, for fear of losing access to their children (Ackerson, 2003a;diaz-Caneja & Johnson, 2004;mowbray et al., 1995). other problems mothers with a mental illness reported included obtaining appropriate and timely diagnosis and treatment, as well as chaotic interpersonal relationships (Ackerson, 2003a;Nicholson et al., 1998). ...
... The stigma associated with mental illness results in many mothers being reluctant to discuss their parenting role, for fear of losing access to their children (Ackerson, 2003a;diaz-Caneja & Johnson, 2004;mowbray et al., 1995). other problems mothers with a mental illness reported included obtaining appropriate and timely diagnosis and treatment, as well as chaotic interpersonal relationships (Ackerson, 2003a;Nicholson et al., 1998). Ackerson (2003a) also found that rather than being too strict, the parents he interviewed saw themselves as too lax and permissive. ...
Article
In comparison to mothers, there is a lack of research on fathers with a mental illness. Consequently, 11 men with a mental illness were interviewed about their parenting experiences and needs. Although none of the participants were living full time with their children, fatherhood was considered an important part of their self-image. However, the stigma associated with mental illness, as well as men's fear of losing access to their children, meant that they "suffered in silence." Many described an overemphasis on their pathology in the community, with some reporting that their mental illness was used as a way of keeping them away from their children. Implications for practice conclude the article.
... Outcomes for children of parents with a mental illness have been studied extensively, although much emphasis has been placed on 'mothers' and their abilities to bond or attach with their children, especially when babies (Mowbray, Oyserman & Ross, 1995). Other studies of the parenting of patients with mental illness have been diagnosis specific and undertaken within institutional settings which may impact on the kind of information that is gathered (Ackerson, 2003). Very few studies have been undertaken to generate understandings of what it is like to be a parent whilst negotiating a personal mental illness. ...
... These heartfelt narratives concur with Sands et al, (2004) who also found that parents with mental illness derive great meaning and pride from parenthood but this is often overlooked because of the narrow focus on their mental illness. Ackerson (2003) also found that parents with mental illness were more highly motivated to get well as opposed to people without these interdependent relationships. ...
... There could be various explanations for this marginalized position, however, it does appear that the experience of mental illness (and its associated illness identity and stigma) silence the parenting role and that label of mental illness either takes away or delimits the role of parenting (Goffman, 1968). This was even true for parents with good social capital which is known to enhance connectedness and found by Ackerson (2003) to be a mechanism for coping and reduced the likelihood of custody loss of children. ...
... The corrosive effects of stigma were cited in over threequarters of the studies, exacerbating women's problems by preventing them from discussing them openly (Diaz- Caneja and Johnson 2004); discouraging them from going out and making social contacts (Alakus et al. 2007) and making them more reluctant to seek help (Ackerson 2003). Wilson and Crowe (2009) found that the stigma associated with a psychiatric diagnosis was reinforced by also being a parent. ...
... Fear of custody loss was related to severe chronic illnesses , with most studies reporting it as a concern. In Ackerson's (2003) study, for example, 11 of the 12 participants were worried about losing custody; this was not without reason as seven had lost custody of a child at some point. Bassett said this fear " permeated all they had to say " (Bassett et al. 1999). ...
... & Environmental — for example, that a mother's periodic inability to care properly for her child might cause significant developmental damage (Mowbray et al. 1995 ). Many were worried about the generally detrimental effect of their illness on their children (Ackerson 2003; Robertson and Lyons 2003; Ueno and Kamibeppu 2008). Some women were worried about the psychological impact of their child witnessing frightening behaviour (Caneja and Johnson 2004), others by the lack of a " normal " childhood (Ackerson 2003) and the burden placed upon the child to care for their mother: " it's almost like sometimes I am the child, and he's the parent " (Khalifeh et al. 2009, p. 636). ...
Data
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The majority of women with a severe mental illness (SMI) become pregnant and have children. The aim of this systematic review and meta-synthesis was to examine the qualitative research on the experiences of motherhood in women with SMI from preconception decision making to being a mother. The experiences of the health professionals treating women with SMI were also reviewed. Eleven data-bases were searched for papers published up to April 25, 2012, using keywords and mesh headings. A total of 23 studies were identified that met the inclusion criteria on the views of women with SMI, eight reported the views of health professionals including one which reported both. The meta-synthesis of the 23 studies on women's views produced two overarching themes Experiences of Motherhood and Experiences of Services. Sub-themes in-cluded the following: Guilt, Coping with Dual Identities, Stigma, and Centrality of Motherhood. Four themes emerged from the synthesis of the eight papers reporting the views of health professionals: Discomfort, Stigma, Need for education, and Integration of services. An understanding of the experiences of pregnancy and motherhood for women with SMI can inform service development and provision to ensure the needs of women and their families are met.
... (Gopfert, Webster, Pollard, & Nelki, 1996) and many consider parenting to be just as important as employment () and a valued role in their lives (Nicholson et al., 1998a). Although the cyclical nature of mental illness might mean a temporary inability to care for their children, parenting behaviors need not necessarily be the focus of intervention.Ackerson (2003a;2003b)observed that the literature on mentally ill parents focuses on a parent's pathology and not on the strengths parents bring to manage their illness and to care for their children, nor their potential parenting capability if their mental illness was properly managed. A serious mental illness can adversely affect an individual's abil ...
... Such support was especially critical when alternative care was needed, such as when the parent was hospitalized or very unwell (Ackerson, 2003a). In comparison, parents who did not have such support were more likely to have lost custody of their children (Ackerson, 2003a). However, as parents with a mental illness are more likely to be living without partners (White et al., 1995) and marital discord is more common among families in which a parent has a mental illness (Downey & Coyne, 1990), the need for parents to find support from his or her extended family and the wider community is further emphasized. ...
... In this way, rather than only focus on the problems within families affected by parental mental illness, we need to also address the failure of governments and society to enable the mentally ill to have independence, freedom from discrimination, and full family functioning. The stigma associated with mental illness is a problem, as many mothers report being reluctant to discuss their parenting role, for fear of losing access to their children (Ackerson, 2003a;Mowbray, Oyserman, Zemencuk, & Ross, 1995). The stigma associated with mental illness is entrenched; North Americans rated leprosy and mental illness as two of the worst things that can happen to anyone (National Institute of MentalHealth, 1986). ...
Article
Full-text available
A multiperspective account of the issues and subsequent interventions for families affected by parental mental illness is reviewed in this article, including those involving the children, the parent with mental illness, other family members, agencies, and society in general. An overview of various issues and interventions for families affected by parental mental illness is seen as potentially useful for practitioners and program developers as well as providing a resource bank for systematic evaluation, research, and policy.
... Unpredictable mood changes of the mentally ill parent, lacking information and knowledge about the illness, an unstable and disruptive family life, and the necessity to support the parent emotionally and/or in daily routines leave children overburdened, and often they are left alone with their feelings of guilt, fear, or anger (Gatsou, Yates, Goodrich, & Pearson, 2017;Gladstone, Boydell, Seeman, & McKeever, 2011;Grant, Repper, & Nolan, 2008;Riebschleger, 2004). Parents with mental health problems, especially mothers, place great importance on their parenthood and report positive consequences of this role, for example, on their self-esteem (Ackerson, 2003;Diaz-Caneja & Johnson, 2004;Fox, 2009;Mowbray, Oyserman, Bybee, MacFarlane, & Rueda-Riedle, 2001). On the other hand, they frequently feel helpless and unable to overcome the difficulties they face, and many report a profound feeling of insufficiency with regard to their parenting (Ackerson, 2003;Tjoflåt & Ramvi, 2013). ...
... Parents with mental health problems, especially mothers, place great importance on their parenthood and report positive consequences of this role, for example, on their self-esteem (Ackerson, 2003;Diaz-Caneja & Johnson, 2004;Fox, 2009;Mowbray, Oyserman, Bybee, MacFarlane, & Rueda-Riedle, 2001). On the other hand, they frequently feel helpless and unable to overcome the difficulties they face, and many report a profound feeling of insufficiency with regard to their parenting (Ackerson, 2003;Tjoflåt & Ramvi, 2013). However, a considerable number of these parents are reluctant to seek professional help, suspecting that professional helpers might criticize their parenting competencies, or that children might be taken into custodial care (Awram, Hancock, & Honey, 2017;Blegen, Hummelvoll, & Severinsson, 2010;Charles, Reupert, & Maybery, 2016;Ritsher, Coursey, & Farrell, 1997). ...
Article
Children with parents with mental health problems have an increased risk of adverse developmental outcomes. Nonetheless, services for these children are still scarce in Switzerland. Therefore, an innovative program was developed, implemented, and evaluated in close practitioner-researcher cooperation. The program aims to support these children by providing lay supporters as so-called “godparents” to them. The program evaluation shows that the continuity of contacts between children and godparents builds the ground for a relationship that fosters the children’s development and relieves their parents. A carefully undertaken process of matching families with godparents appears to be crucial for a lasting godparenthood. However, a main challenge is the acquisition of godparents, who engage on a voluntary basis in the program.
... HFP aims to improve i) child mental health and behavioural problems, ii) parent-child relationships, iii) parental emotion regulation and coping and iv) families' social resources. HFP incorporates validated therapeutic content focussed on parenting, emotional regulation and interpersonal functioning [9,[18][19][20] with a relational, goal-orientated model of collaborative, therapeutic engagement that reduces parental alienation and stigma [16,21]. The intervention delivered individually, offers parenting and self-care strategies and aims to develop a shared understanding between parent and clinician about how parents' emotional and interpersonal difficulties impact on their parenting and the child's functioning. ...
... These findings are consistent with studies reporting stigma felt by parents with significant mental health difficulties [18]. While parenting difficulties may indeed be related to the symptomatic difficulties of the parent [5], in developing useful clinical formulations, other factors known to contribute to parenting difficulties need to be taken into account such as the child's temperament and their own mental health difficulties [10,27], lone parenthood [13] and social isolation [1,27]. ...
Article
Full-text available
Background Evidence-based parenting programmes are recommended for the treatment of child mental health difficulties. Families with complex psychosocial needs show poorer retention and outcomes when participating in standard parenting programmes. The Helping Families Programme (HFP) is a 16-week community-based parenting intervention designed to meet the needs of these families, including families with parental personality disorder. This study aimed to explore the help seeking and participatory experiences of parents with a diagnosis of personality disorder. It further aimed to examine the acceptability of referral and intervention processes for the HFP from the perspectives of (i) clinicians referring into the programme; and (ii) referred parents. Method Semi-structured interviews were conducted with parents recruited to receive HFP (n = 5) as part of a research case series and the referring NHS child and adolescent mental health service (CAMHS) clinicians (n = 5). Transcripts were analysed using Interpretive Phenomenological Analysis. Results Four themes were identified for parents: (i) the experience of parenthood, (ii) being a parent affected by personality disorder, (iii) experience of the intervention, and (iv) qualities of helping. Three themes emerged for clinicians: (i) challenges of addressing parental need, (ii) experience of engaging parents with personality disorders and (iii) limited involvement during HFP. Comparison of parent and clinician themes led to the identification of two key interlinked themes: (i) concerns prior to receiving the intervention, and (ii) the challenges of working together without a mutual understanding. Conclusions This pilot study identifies potentially significant challenges of working with parents affected by personality disorder and engaging them in HFP and other similar interventions. Results have important wider clinical implications by highlighting potential barriers to engagement and participation and providing insights on how these barriers might be overcome. Findings have been used to inform the referral and intervention processes of a pilot RCT and further intervention development.
... Few studies have considered parenting with a mental illness and many mental health providers fail to address parenting at all. Most research into parenting has focused on risks to children rather than the perspectives and experiences of parents, and on pathologies rather than strengths [174,175]. Often parents, particularly those from culturally and linguistically diverse backgrounds and single mothers, will not seek out mental health services with this prevailing focus [28]. A parent-peer specialist approach may be a useful strategy for these clients who frequently have limited social support [171]. ...
... With self-determination as the overarching goal, the Wellness Recovery Action Plan (WRAP) was developed as evidence-based practice [180,181] and contrasts with more common recovery approaches which focus on recovering from an illness [174,175]. Recovering from an illness versus recovery of wellness shifts the focus away from the whole person and their strengths to a focus on the deficits of an illness [34,179]. ...
Technical Report
Full-text available
This report presents an evaluation of the Nepean Blue Mountains Partners in Recovery program funded by the Nepean Blue Mountains Medicare Local and carried out by researchers from the Department of General Practice at the University of Western Sydney.
... The parenting role potentially offers further scope for social connection within one's local community with other parents through children's education settings and friendship networks; however, overcoming stigma is a prerequisite (Dolman et al. 2013). Women with mental illness describe a sense of connection emanating from their mothering relationship with their children (Ackerson 2003;Montgomery et al. 2006), intimate partner relationships (Heron et al. 2012;Nicholson et al. 1998), and from friendships and extended family relationships which could be consolidated through participation in events, such as children's birthdays or junior sporting pursuits (Maybery et al. 2015). Connectedness might strengthen over time from being known within communities, especially if those communities are intimate, such as in rural locations, or within cultural groups. ...
... Previous studies have identified that mothers express regret and guilt associated with the impact of their mental illness on their connection to their children (e.g. Ackerson 2003;Blegen et al. 2012). Although particular parenting challenges were mentioned, the data from the current study did not reveal this as a strong finding, and in fact, relationships with children were described in overwhelmingly positive terms that conveyed mothers' experience of these relationships as robust and reciprocal connections. ...
Article
Full-text available
Social connection is a fundamental human need, but challenging for individuals with characteristics that are socially stigmatized. Parenting with mental illness presents obstacles, as well as opportunities, for connection. In the present study, we examined connectedness within a personal recovery paradigm for rural mothers with a mental illness. In-depth interviews with 17 mothers with a mental illness, utilizing constructivist grounded theory, resulted in six categories of meaning, including 'yearning for connection', 'connecting intensely', 'encountering rejection and exclusion', 'choosing isolation', 'being known', and 'finding peers/helping others'. Women expressed a strong desire for connection, but for many, prior experiences of trauma and rejection created barriers to the development of trust, preventing some women from seeking opportunities for connection. Connectedness to self and significant others, and a broader life meaning and purpose can support and expedite personal recovery from mental illness for rural women. However the factors that contribute to the mental illness might also inhibit the development of trust needed to attain social connection. Increasing connectedness in mothers with mental illness is a complex endeavour requiring concerted focus as distinct from other service-delivery goals. The perinatal period could be a key time for intervention.
... Approximately 4.5 million U.S. caregivers reported poor mental health, with reported poor mental health associated with parenting stresses, poor coping and support, problematic socioemotional functioning and developmental concerns about the child. A greater proportion of those with lower educational attainment and household income, those who are unemployed, Black and single mothers to have poor mental health (Artazcoz, Benach, Borrell, & Cortès, 2011; WHO Secretariat, 2012; Williams, Yu, Jackson, & Anderson, 1997), and U.S. caregivers with poor mental health from our study were more likely to experience parenting stress, a lack of emotional support, and poor coping (Ackerson, 2003aAckerson, , 2003b). As with mothers, fathers with poor mental health may struggle with parenting, relative to fathers without mental health problems (Spector, 2006). ...
... Second, caregivers with poor mental health may have deficits in caretaking and other parenting practices, which consequently lead to children's problematic behavior (Beeghly & Tronick, 2011; Goodman & Gotlib, 2002; Smith, 2004 ). Third, caregivers with mental health problems may be more likely to perceive their children's behavior as problematic (Cornish et al., 2006; Maughan, Cicchetti, Toth, & Rogosch, 2007); in recognition that their children could be at greater risk for developmental issues because of family mental health problems (Ackerson, 2003a). While the large majority of caregivers do not report poor mental health, their children may still exhibit problematic outcomes; children with caregivers who have poor mental health do not necessarily exhibit problematic outcomes. ...
Article
The 2007 National Survey of Children's Health was used to determine the prevalence of poor mental health among U.S. mothers, fathers, and guardians, specific parenting experiences and children's functioning. More guardians (13.7%) reported poor mental health compared to mothers (7.7%) and fathers (5.3%), generalizing to 4.6 million U.S. caregivers with poor mental health. Caregivers with poor mental health were at least 3 times more likely to report children's problematic functioning after accounting for sociodemographic factors and parenting stress and experiences. Research and clinical activities should recognize poor caregiver mental health as a condition that affects parenting and children's functioning.
... Consistent with previous research (Ackerson, 2003; Boursnell, 2007), participants in this study reiterated that parenting is highly valued and provides great joy, pride and satisfaction ; the presence of mental health concerns, however, could make parenting challenging . Parent perceptions of the impact of mental health for other family members reflected a sense of concern, and interpretation of possible harm or burden. ...
... Consistent with previous research ( Ackerson, 2003;Boursnell, 2007), participants in this study reiterated that parenting is highly valued and provides great joy, pride and satisfaction; the presence of mental health concerns, however, could make parenting challenging. Parent perceptions of the impact of mental health for other family members reflected a sense of concern, and interpretation of possible harm or burden. ...
Article
This qualitative study ascertained how parents with an affective disorder perceived their family to function during times with and without symptoms of their mental health concern. Fourteen parents with depression and/or anxiety responded to theoretically derived questions about family functioning when mentally well and ill. The data were subject to thematic content analysis, in conjunction with being coded using seven a priori codes originating from the domains within a family functioning model. Four identified themes pertained to enjoyment of parenting, mental health concerns as a barrier to parenting and family interaction, psychological outcomes of parenting with mental health concerns and incentives to focus on parenting and family functioning. At least 12 parents reported three domains of family functioning (communication, role performance, affective involvement) changed between times of mental illness and wellness. Some parents perceived changes to family values and norms, and approximately half reported that affective expression, control of family members and overall task achievement was affected. This study may deepen understanding of family experiences and parent interpretations of their experience, and inform the design of interventions.
... There is limited literature exploring experiences of stigma and discrimination in women and men considering having children or in pregnancy, although there is some evidence of the desire to be a parent being undermined by societal attitudes for individuals with mental illness [15]. Existing research has also demonstrated that the stigma of parental mental illness can affect children [21]. These studies are informative about the parents' experiences of the broader concept of stigma. ...
... Like other research [30], we found that access and custody were major issues for fathers with mental illness, but also discovered eight other areas where men reported parenthood-related experienced discrimination. Our research supports Ackerson's [21] in finding reports of the stigma of parental mental illness extending to affect children . Also, parents in this study reported being avoided by their own children, a scenario which might have been prevented through better support for the needs of children in this situation [31] . ...
Article
Full-text available
Background Experienced discrimination refers to an individual’s perception that they have been treated unfairly due to an attribute and is an important recent focus within stigma research. A significant proportion of mental health service users report experiencing mental illness-based discrimination in relation to parenthood. Existing studies in this area have not gone beyond prevalence, therefore little is known about the nature of experienced discrimination in relation to parenthood, and how is it constituted. This study aims to generate a typology of community psychiatric service users’ reports of mental illness-based discrimination in relation to becoming or being a parent. A secondary aim is to assess the prevalence of these types of experienced discrimination. Methods In a telephone survey 2026 community psychiatric service users in ten UK Mental Health service provider organisations (Trusts) were asked about discrimination experienced in the previous 12 months using the Discrimination and Stigma Scale (DISC). The sample were asked if, due to their mental health problem, they had been treated unfairly in starting a family, or in their role as a parent, and gave examples of this. Prevalence is reported and the examples of experienced discrimination in relation to parenthood were analysed using the framework method of qualitative analysis. Results Three hundred and four participants (73% female) reported experienced discrimination, with prevalences of 22.5% and 28.3% for starting a family and for the parenting role respectively. Participants gave 89 examples of discrimination about starting a family and 228 about parenting, and these occurred in social and professional contexts. Ten themes were identified. These related to being seen as an unfit parent; people not being understanding; being stopped from having children; not being allowed to see their children; not getting the support needed; children being affected; children avoiding their parents; children’s difficulties being blamed on the parent’s mental health problem; not being listened to; and being undermined as a parent. Conclusions This research highlights the need for: greater support for parents with mental illness, those wishing to have children, and those who lose access or custody; services to better meet the needs of children with a mentally ill parent; training about discrimination for professionals; and parenting issues to be included in anti-stigma programmes.
... Sousa argues that, while these supporters can enhance success, it is necessary to understand the way consumers "relate to and are inter-dependent with significant people" (Sousa, 2005, p. 163). Ackerson (2003) studied relationships with extended family among parents with mental illness and found that, while parents had social support, they also reported problems with conflict in their relationships with others who could provide assistance, like childcare, during times of psychiatric crisis. ...
... Arditti's study of divorced parents suggested a model of family functioning that included closeness, boundaries, and role flexibility as family strengths (Arditti, 1999). Ackerson (2003) identified the consistency of boundaries as a challenge to the extent that custodial parents with mental illness may appear closer to their children. In addition, findings suggest that parents reported role reversal in that they identified a child as their caretaker. ...
Article
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Social work principles of strengths, empowerment, and consumer-centered care for persons with mental illness are currently being adapted to broader contexts. This article presents study findings on practice wisdom about custodial parents with mental illness, a potentially increasing group of consumers in light of mental health reform. The research team organized thirty-six professionals with practice experience into five focus groups. Findings reflect strengths perspective categories of resilience, social support, family functioning, self-care, and parents' positive experience of their symptoms. Implications discuss how providers who work with custodial parents and their children can apply these findings in assessments and interventions.
... They also Parenting 9 speak to the many obstacles that stand in the way of the goal: stigma of mental illness, poverty, lack of support, lack of resources, role strain, cognitive problems, ill health, side effects of medication, shame and guilt at decisions impulsively taken. [34, 35] Chernomas et al. [36] report that many women suffering from psychotic illness face contradictory choices. They feel their isolation but do not initiate friendships for fear of rejection. ...
... that emerged in many of the interviews were problems blamed on physicians (for changing diagnoses and treatments), problems blamed on society (because of stigma and custody issues), on economics (the strain of single parenthood), on spouse and family of origin (for lack of support), and on themselves (for inadequacy in disciplining their children). [35] Despite the problems, these women see themselves overall as good mothers. They describe themselves as emotionally available, sensitive to their children's needs, and accepting of their children's idiosyncrasies. Mothers with schizophrenia invariably describe their children as central to their lives despite the difficulties of coping wit ...
Article
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Background: Schizophrenia has been seen as a severe and persistent illness that disqualifies mothers from adequately parenting their children. Aim: To understand the scope of the issue, to learn about the subjective experiences of mothers and children, to appreciate the impact of psychotic illness on children at various ages, and to review the necessary components of intervention programs. Results: Approximately half of all women with a diagnosis of schizophrenia are mothers. The rate of custody loss in this group is high. Most women with schizophrenia value their roles as mothers, and their adult children remain attached to them. There can be serious harms, however, associated with being the child of a mother with psychotic illness. Most of these appear to be mediated not by the illness itself but by associated risks: poverty, substance abuse, domestic violence, social isolation, and/or substandard housing. Intervention programs have begun to cut across agency divisions to provide wraparound care in multiple domains for families in distress. Conclusion: Schizophrenia in mothers poses problems for offspring but does not preclude effective parenting.
... This understanding is particularly important in the context of documenting support needs, as parents are often the best reporters on their needs and gaps in existing services (Biebel, Nicholson, & Wolf, 2015). Peer supports, for example, have been identified by parents with psychiatric disabilities in several studies as crucial (Ackerson, 2003;Coates, Phelan, Heap, & Howe, 2017;Isobel, Meehan, & Pretty, 2016;Nicholson & Valentine, 2018, 2019. Although parents with psychiatric disabilities have reported informal supports as being important to assisting in their caregiving role, interviews have also revealed isolation and strained familial relationships as barriers for some (Awram et al., 2017;Carpenter-Song et al., 2014;Perera, Short, & Fernbacher, 2014;Savvidou, Bozikas, Hatzigeleki, & Karavatos, 2003). ...
Article
Substantial numbers of US parents with psychiatric disabilities are highly vulnerable to loss of child custody or visitation, through child welfare system involvement or divorce proceedings. This study describes the community-based needs of parents with psychiatric disabilities who experienced legal challenges to their parenting rights. This exploratory study involved semi-structured telephone interviews with twelve former clients of a legal services program that provides representation to low-income parents with psychiatric disabilities facing challenges to child custody or visitation. Interviews were audio-recorded, professionally-transcribed, and analyzed using a qualitative, content analysis approach. Three broad themes emerged regarding the types of supports parents reported as useful for their well-being: (1) informal support networks; (2) responsive mental health care for the whole family; and (3) meaningful legal representation. Within these three areas, unmet needs were frequent and problematic. A fourth theme emerged: chronic economic hardships and material deprivation, which point to unmet financial needs. The needs and supports described in this study should be addressed through the development of comprehensive services and supports that meet the psychosocial, legal, and socioeconomic needs of parents with psychiatric disabilities and their children. Future research is also warranted.
... Researchers have highlighted that parenting stress can compromise mental health (28)(29)(30), and discovered that mothering confidence and competence can be undermined by the scrutiny and prejudice imposed by over-zealous service providers (26,31) and family members (32), who are often operating within a risk aversion framework. ...
Article
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Developing a “positive identity” is considered a core component of personal recovery, and mothering offers meaning in life and a valued identity. Few studies have highlighted the factors influencing identity within a personal recovery paradigm for mothers with mental illness. This study explores how mothers describe their identity in relation to recovery, including the factors that influence identity. Using constructivist grounded theory methodology, in-depth interviews were conducted with 17 women who were mothers and experienced mental illness. Women defined their self-concept broadly, accentuating motherhood, but also including vocational, community and social roles. Analysis revealed six categories: defining self, becoming a mother, being a “good” mum, feeling different, doing it my way and speaking out. Valuing identity in parenting was found to be linked to recovery. Services may facilitate personal recovery by supporting mothers to enhance a self-concept associated with mothering, as well as other diverse attributes and roles.
... Specifically and alarmingly, the results show that parents with the highest needs reported the lowest levels of psychosocial support. Indeed, parents with better psychosocial networks, including marital and social relationships, are more likely to have good parenting outcomes (Abel et al., 2005) and have been found to function better in times of crisis compared to socially isolated parents and to be less likely to lose custody of their children (Ackerson, 2003). Conversely, parenting stress is reportedly higher for mothers when they experience less psychosocial support and more social contextual risk factors such as frequent daily hassles (Kahng et al., 2008). ...
Article
Objective: Parenthood is central to the personal and social identity of many people. For individuals with psychotic disorders, parenthood is often associated with formidable challenges. We aimed to identify predictors of adequate parenting among parents with psychotic disorders. Methods: Data pertaining to 234 parents with psychotic disorders living with dependent children were extracted from a population-based prevalence study, the 2010 second Australian national survey of psychosis, and analysed using confirmatory factor analysis. Parenting outcome was defined as quality of care of children, based on participant report and interviewer enquiry/exploration, and included level of participation, interest and competence in childcare during the last 12 months. Results: Five hypothesis-driven latent variables were constructed and labelled psychosocial support, illness severity, substance abuse/dependence, adaptive functioning and parenting role. Importantly, 75% of participants were not identified to have any dysfunction in the quality of care provided to their child(ren). Severity of illness and adaptive functioning were reliably associated with quality of childcare. Psychosocial support, substance abuse/dependence and parenting role had an indirect relationship to the outcome variable via their association with either severity of illness and/or adaptive functioning. Conclusion: The majority of parents in the current sample provided adequate parenting. However, greater symptom severity and poorer adaptive functioning ultimately leave parents with significant difficulties and in need of assistance to manage their parenting obligations. As symptoms and functioning can change episodically for people with psychotic illness, provision of targeted and flexible support that can deliver temporary assistance during times of need is necessary. This would maximise the quality of care provided to vulnerable children, with potential long-term benefits.
... A family- focused approach by nurses can be used to prevent prob- lems for children and their families, and identify their strengths as well as vulnerabilities, address the challenges and to build resilience. Mental health nurses can learn from this exploratory study that if patients have children, they will probably be the most important part of their social network (Ackerson 2003). For many people parent- ing can be an important context for recovery and conveys a positively validated identity. ...
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Unlabelled: WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience. Introduction: Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new. Question: What are the strategies of parents with a mental illness to be successful? Method: Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods. Results: Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children. Discussion: Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals.
... Föräldrar med psykisk ohälsa och deras upplevelser av sitt föräldraskap är inte lika väl belyst i forskningen. I två studier (Ackerson, 2003, Diaz-Caneja & Johnson, 2004 har dock framkommit att ansvaret för barnen var en viktig anledning för föräldrarna att delta i rehabilitering och behandling för att återfå och upprätthålla sin psykiska hälsa. Svårigheter de upplevde i föräldraskapet var att fokusera på att ge barnen omsorg samtidigt som mycket energi måste läggas på behandling av den egna psykiska hälsan. ...
... This is often the case in frontline counselling and welfare services where families affected by parental mental illness may present to services with a range of issues including family conflict, substance abuse problems, family violence, experiences of trauma among family members, child behavioural problems or couple relationship issues (Golding, 1999;Hegarty, 2011;Weaver et al., 2003). Even in the context of other issues, however, parental mental illness is likely to be a factor influencing family well-being, given the pervasive impact of mental illness on couple and family relationships (Ackerson, 2003;Foster et al., 2011). ...
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There is strong evidence supporting the benefits of family work, for both parents and children, in the treatment of parental mental illness. However, there has been only limited research on the implementation of family work in settings outside the mental health sector, such as family therapy or family counselling services, where mental illness may not be the primary presenting issue for a family. This article reports on a qualitative study that explored the experiences of family therapists working with families affected by parental mental illness. The article focuses on dilemmas clinicians faced integrating discussions about parental mental illness into family sessions. The findings support the need for clinicians to have appropriate training in family work related to mental health issues and also to develop the skill set needed to actively introduce, negotiate and explore the topic of mental illness with families.Practitioners pointsDeveloping knowledge, language and confidence in talking about mental illness may assist clinicians to raise discussions about parental mental illness in family sessions.Training in evidence-based interventions for working with children of parents with a mental illness may provide a tool for clinicians in family sessions.Clinicians must be attuned to the ‘emotional readiness’ of parents and children to discuss parental mental illness. Developing readiness may take time.
... Social interactions are among the factors found associated with child custody loss among women with serious mental illness (other factors include psychiatric diagnosis, substance abuse, marital status, distress, parenting knowledge and skill, age at first birth, number of live births, work history, poverty, and homelessness). Having less social support or fewer supportive services has been found to contribute to the increased risk of loss or relinquishment (Ackerson, 2003; Brunette and Dean, 2002; White et al., 1995). ...
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In a given year, approximately 26 percent of persons in the United States 18 years and older suffer from a diagnosable mental disorder. About six percent are diagnosed with a serious mental illness and 65 percent of these are mothers. Mothers with serious mental illness are at increased risk of losing custody of their children. This report represents findings from a qualitative study of the relationship between positive and negative social interactions as three such women went through the process of experiencing threats to their children’s safety, relinquishing custody, and working to regain it (or to adjust to a permanent placement). Data collection involved semi-structured interviews. A thematic analysis of data was conducted. Among three conceptual models of social interactions – additive, moderating, and domain specific, the domain-specific model was prominent. Findings are discussed as preliminary to future similar studies involving larger samples. Tentative implications for policy, practice, and research are discussed.
... In Australia sole parent families are also on the rise (Australian Bureau of Statistics (ABS), 2004) and studies reveal that sole mothers in particular face a number of problems, including prejudice, discrimination and stigma (Holdsworth, 2001; Swinbourne, Esson, Cox and Scouler, 2000), as well as unemployment and poverty (de Vaus, 2004). The literature also reveals that parenting can often present major difficulties for people suffering from mental health problems, especially schizophrenia, with grandparents the most frequent carers if a parent is hospitalised (Ackerson, 2003; Bassett, Lampe and Lloyd, 1999; Cowling, 1999). In Australia there are no exact numbers of children and young people who have parents affected by mental health problems. ...
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During the last quarter of a century there has been a worldwide dramatic increase in the number of grandparents who are raising their grandchildren because of their own adult children’s inability to take on the parenting role. A wide range of social changes has contributed to this growing social phenomenon. These include an escalation of drug and alcohol abuse, a rise in the number of sole parent families, an increase in mental health problems, high rates of incarceration (especially of women), increases in child abuse and neglect, the introduction of HIV/AIDS into our community, death (often due to drug overdose), as well as the world-wide trend towards welfare agencies placing children at risk into ’kinship care’ rather than foster care. Research has shown that apart from the joy it brings into their life, becoming a custodial grandparent can have many negative personal, interpersonal and economic consequences. To date, very little research has been conducted into grandparents who are raising their grandchildren in Australia. This paper arises from a qualitative study which explores the impact of social change on 30 grandparent-headed families who are raising their grandchildren in New South Wales. Data from the study reveals that grandparents who are raising their grandchildren derive many benefits from taking on the caregiving role of their grandchildren, however they also face numerous challenges. Preliminary conclusions indicate the need for a large range of interventions to address the many emotional, social and economic concerns affecting grandparents-as-parents.
... Role modelling, emotional support, and practical assistance are benefits that can be derived from the presence of social supports (Reupert & Maybery 2007). Mothers in crisis are more likely to lose custody of their children if they have poor support networks (Ackerson 2003; Howard et al. 2003; Reupert & Maybery 2007). Conversely however, mothers with psychiatric illness can experience additional stress when the social supports that are available to them are intrusive and/or controlling (Nicholson et al. 1998). ...
Article
Motherhood is a challenging role and a life-changing experience. For women living with psychiatric illness, the challenge of motherhood is amplified. Psychiatric illness (including schizophrenia, affective and personality disorders) is associated with multiple adversities that can impair the capacity to parent. Social adversity, fluctuating symptoms, and medications and their related side-effects, can create difficulties for the new mother as she adjusts to her role. The risk for relapse among women who are unwell is heightened during the post-partum period. For many other women, the post-partum period is when psychiatric symptoms emerge for the first time. Equally important are the continuing concerns pertaining to infant well-being where maternal psychiatric illness is present. For mothers who exhibit symptoms at this time, a very real threat of protective removal exists. In the mother-infant setting, child protection legislation is biased towards the rights of the child. While there are cases for which this bias is clearly appropriate, there are less clear situations from which the infant is removed with little regard for the mother. Often mothers with psychiatric illness struggle to meet the cognitive, emotional, and financial demands of drawn-out custody proceedings. For these mothers, there is a paucity of appropriate support available, as will be evidenced throughout the present paper. There is an urgent need for professional advocacy to support women who are unwell in their transition to motherhood. The mental health nurse is able to fill a key advocating role in the perinatal psychiatric setting. Nurses in this role hold a unique position whereby social and community supports can be activated, while guidance is imparted from a ground-level standpoint. The nurse in this role has the capacity to liaise with authorities, negotiate service provision, and ensure that key parenting skills are acquired by the mother as she works to secure her role. Through the provision of proactive advocacy during this time, the nurse has the potential to ameliorate the outcomes of mothers who are unable to cope alone and the well-being of their infants.
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Objectives Research into military-related posttraumatic stress disorder (PTSD) and the impact to families is growing. However, qualitative studies exploring the family life or parenting experiences of military/veteran families living with PTSD appears limited. The current paper aimed to systematically review research that explored different family members’ experiences of living in families where a parent had a military related PTSD. Methods Adhering to the PRISMA guidelines for systematic reviews, six online databases were comprehensively searched, along with manual searches of relevant journals, reviews and reference lists. Interrater reliability for identifying papers was established through blind co-screening of 20% of search results, with minimal initial discrepancy. Eleven studies were identified. Each study was critically appraised for quality using the RATS (relevancy, appropriateness, transparency, soundness) qualitative research review guidelines. Results Thematic analysis identified six primary themes including: the absent parent; walking on eggshells; still part of the family; children and partners as care givers; making sense and understanding; and long-term impacts upon the family. Quality of the identified research was mixed. Conclusions The existing literature is extended by presenting a systematic review of published qualitative research on the subjective experiences of the parent with military-related PTSD, their partner and children. Themes across veteran, partner and child focused papers illustrated interconnected elements of the family experience of PTSD. Future studies might integrate the views of family members. Clinicians need to be mindful of the relational context in which PTSD exists.
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Mensen met psychische aandoeningen zijn vaak niet alleen patiënt/cliënt, maar ook ouder van kinderen. Het zou voor hulpverleners een tweede natuur moeten zijn om niet alleen naar de psychische klachten te vragen maar ook naar de rol als ouder. Dit kan zowel het welzijn van de kinderen als het herstel van de ouder ten goede komen. Als mensen ondersteuning krijgen om hun ouderrol (weer) op te pakken, geeft dit vaak structuur, invulling van het dagelijks leven en bevordert dit het contact met de buitenwereld. De interventie Begeleid Ouderschap biedt hulpverleners handvatten de ouder te helpen om zijn of haar ouderrol te versterken. Eventuele partners kunnen hier essentieel aan bijdragen.
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This article is devoted to the psychological characterization of mothers with eating disorders. Unfortunately, there is a limited number of studies focusing on the psychological experience of maternity by these mothers. The analysis of the result of qualitative and quantitative studies shows that a mother’s eating disorder has a very strong impact not only on her relationship with children, including parenting styles, but also her perception of children, family, and illness. Reports reveal the dramatic struggle of mothers with eating disorders with the challenge of caring for and raising children optimally, however, it could be noted that, first of all, these mothers have to confront their illness, which is usually chronic, and even once it has been treated the threat of relapse hangs over them. In the summary, once the conclusions were drawn, a series of requests for psychological aid for mothers with eating disorders has been presented. Niniejszy artykuł został poświęcony psychologicznej charakterystyce matek z zaburzeniami odżywiania. Niestety, istnieje niewielka liczba badań, które koncentrują się na psychologicznym doświadczaniu macierzyństwa przez te matki. Analiza wyników badań jakościowych oraz ilościowych, pokazuje, że zaburzenie odżywiania matki wpływa bardzo silnie nie tylko na jej relację z dziećmi, w tym na style wychowawcze, ale także na jej postrzeganie dzieci, rodziny oraz choroby. Doniesienia ujawniają dramatyczne zmaganie się matek z zaburzeniami odżywiania z wyzwaniem, jakim jest opieka na dziećmi i ich optymalne wychowanie, chociaż można zaobserwować, że przede wszystkim matki te muszą stawić czoła swojej chorobie, która zazwyczaj ma charakter chroniczny i nawet, gdy została wyleczona, wciąż mają przed sobą perspektywę nawrotu. Po sformułowaniu wniosków, przedstawiono szereg postulatów w zakresie pomocy psychologicznej matkom z zaburzeniami odżywiania.
Article
Objective: The aim of this study was to understand the strategies women living with mental illness use to balance the demands of mothering with mental health recovery. Method: Semi-structured interviews were conducted with 10 Australian women who self-identified as managing to balance mothering with mental health recovery. The data were analysed using constant comparative analysis, and other techniques informed from grounded theory. Results: Mothers used four interconnected balancing strategies: prioritising in the present; looking after myself; buffering children; and using supports. Awareness of the crucial interconnectedness of mothering and recovery was the foundation for these balancing strategies. Developing this awareness was essential in order to value, develop and therefore implement these strategies. Supports and resources played a critical role in helping mothers to develop awareness of, as well as use, strategies to balance motherhood and mental health recovery. Discussion: Mental health services can support mothers to develop an understanding of the inextricable connection between their own recovery needs and the needs of their child. Mothers can also be supported to successfully identify and employ their own strategies within each of the four categories developed in this study.
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This study compares the levels and predictors of paternal warmth and involvement of 69 fathers with serious mental illness (SMI) and 69 matched non-clinical (NC) fathers in Israel. Findings show that the NC fathers were more involved with their children, whereas the SMI fathers reported more warmth and perceived their children as less difficult. The interactions that were found in the regression analyses highlight the differences between the two groups. Among the SMI fathers, but not the NC fathers, higher paternal self-efficacy was associated with increased father involvement, and lower family support was associated with decreased warmth.
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Limited knowledge exists about the experience of mothers with serious mental illness in developing their maternal identity and the challenges they face in this process. This subject was examined in Israel in a qualitative research with 12 mothers. The results indicated the contribution of the motherhood experience to the development of positive identity and to the management of mental illness. The mothers described tensions between their efforts to maintain their maternal identity during periods of deterioration in their mental health situation, as well as lack of sufficient attention by their formal and informal support systems to these tensions. Mental health professionals need to provide legitimacy to the positive contribution that the motherhood experience may have on the women’s identity, as well as to provide them support with the effects that changes in their mental health situation may have on their sense of maternal identity.
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There are well-established risks for parents with severe mental illness (i.e. psychotic and bipolar disorders), both for their children and themselves. Interventions to help parents fulfil their role should therefore be a public health objective, but their implementation needs to be underpinned by research evidence. This systematic review determines what is known about the nature and effectiveness of interventions for parents with severe mental illness. We conducted a narrative synthesis of controlled and uncontrolled studies reporting interventions for this patient group after the post-natal period (i.e. after the child has turned 1 year old). Eighteen publications reported data from 15 studies. All but two studies were rated as low quality studies. Interventions included home visiting programmes, complex community programmes, residential treatments, and online interventions. Interventions targeted diverse areas, with parenting skills and understanding the impact of mental illness on parenting most frequently addressed. Both parent and child-related outcomes improved, but children were only assessed via observers and follow-up times were short. Interventions were diverse with respect to their nature and effectiveness. Future interventions should combine different intervention strategies to target multiple areas in a flexible manner. The addition of positively focussed and resource-oriented components should be investigated. Trials should include direct assessments of both parents and children, outcomes that are relevant from a public health perspective, and establish the long-term effects ideally until children have reached 18 years of age.
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This article aims at achieving insight into acquiring an understanding of parenting while dealing with one's own bipolar disorder. It is based on results from in-depth interviews of six parents with bipolar disorder, and analyzed using guidelines from interpretative phenomenological analysis (IPA). The results from the study suggest the parents experienced diverse, complex, compound, and demanding challenges. However, the results also highlighted the fact that parents went through a “change and growth” process, in which they developed an experience-based competence perceived as being useful due to their living situation, including the strengthening of their parenting function and their personal recovery process. Aspects about how the time dimension in recovery, as well as how parents' dependence on their children can play both a central and paradoxical role in their lives, are discussed, which is then followed by implications for the support system.
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This study examined whether having a parent with a mental illness or a parent who abuses substances predicts treatment outcomes for children receiving community-based services for exposure to violence. From 2001 to 2011, data were collected from 492 children from one-and-a-half to seven years old and their primary caregivers enrolled in Safe From the Start services. Results indicated significant improvements pre-intervention to post-intervention in child emotional and behavioural problems, as measured by the Child Behavior Checklist (CBCL). One-way bivariate analyses indicated that children of mothers or fathers with a mental illness and children of mothers who abused substances had higher CBCL scores at intake. Repeated-measures analyses of variance revealed a main effect such that maternal and paternal mental illness and maternal substance abuse were associated with poorer CBCL scores. The only parental risk factor to moderate the association between treatment and CBCL scores was paternal mental illness. Treatment was associated with greater improvement in CBCL scores for children of fathers with, relative to those without, mental illness, and the effect was due to higher CBCL scores at intake for children of fathers with mental illness rather than lower outcome scores. Results suggest that Safe From the Start services which provide early intervention can be effective in improving children's emotional and behavioural functioning. Additionally, the effectiveness of services appears to be robust to parental risk factors such as mental illness and substance abuse.
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Integrative Family and Systems Treatment (I-FAST) is a systems-based, home-based, and strengths-oriented treatment model that has been developed and implemented within the community mental health system. Using a single case example, this paper discusses the application of I-FAST to a Chinese family in Hong Kong in which the mother was diagnosed with depression. The paper critically examines the deficit-based approach, widely used in the mental health field, which stigmatizes people with psychiatric disabilities. Treatment implications of families with parental mental illness in a Chinese context are discussed.
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Children and families impacted by severe mental illness (SMI) have multiple strains that effect family functioning, child safety, and parental rights. Traditional services for children and families struggling with severe mental illness have not achieved success in improving family functioning and keeping families intact. Wraparound is a philosophy and a system of care with a promising evidence base that could enhance collaboration of child welfare, mental health, and community services to work more effectively with families impacted by SMI.
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The majority of women with a severe mental illness (SMI) become pregnant and have children. The aim of this systematic review and meta-synthesis was to examine the qualitative research on the experiences of motherhood in women with SMI from preconception decision making to being a mother. The experiences of the health professionals treating women with SMI were also reviewed. Eleven databases were searched for papers published up to April 25, 2012, using keywords and mesh headings. A total of 23 studies were identified that met the inclusion criteria on the views of women with SMI, eight reported the views of health professionals including one which reported both. The meta-synthesis of the 23 studies on women's views produced two overarching themes Experiences of Motherhood and Experiences of Services. Sub-themes included the following: Guilt, Coping with Dual Identities, Stigma, and Centrality of Motherhood. Four themes emerged from the synthesis of the eight papers reporting the views of health professionals: Discomfort, Stigma, Need for education, and Integration of services. An understanding of the experiences of pregnancy and motherhood for women with SMI can inform service development and provision to ensure the needs of women and their families are met.
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This paper explores the lived experiences of parents with mental illness in Australia. It draws on in-depth interviews with parents (n=10) who have mental illness and provides an analysis of national mental health policies. The analysis of the parents' narratives is essential in building a picture for those involved in the issues associated with directing and developing services to support parents with mental illness. This paper also provides information for workers who are often faced with a lack of good practice programmes to address the complexities that parents with mental health issues often present. Little is known in this field about the complex needs of families who live with mental illness or recognition of the complex needs of this vulnerable group of families. In fact, there is only recently emerging evidence to indicate an awareness of children in the lives of parents with mental illness. This paper focuses upon lived experience, social process, and social policy across the troubled terrain of mental illness.
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Four children from three families in which the mother had a bipolar disorder were interviewed to understand their perspectives on their mothers' parenting. Children identified strengths in their mother's parenting, such as helping them with homework and moods and providing for their wants. They also identified challenges, such as mothers sleeping well into the day and displaying anger. Two children were worried over the possibility of having a bipolar disorder themselves. Implications of these findings for social work practice include acknowledging and supporting mothers' strengths in parenting, providing appropriate services to manage mothers' sleep and anger, and psychoeducation for children.
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Bipolar disorder is a severe form of mental illness with a primary disruption in mood. With fluctuating phases of mania and depression, bipolar disorder can have a serious impact on all activities of daily living, including parenting. Ten mothers with bipolar disorder were interviewed to understand their strengths, challenges, and service needs in parenting. Results describe their love for their children, problems in disciplining, and need for more support groups, among other findings. Interestingly, manic and hypomanic phases are reported to provide more energy to parent. Implications of the study for social work practice and research are discussed.
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Background: Fathers with psychosis have often been ignored by the research community. Aims: This project was designed to explore some of the potential issues concerning this group. Method: This study involves a qualitative investigation into the experiences of 10 white fathers who have a diagnosis of psychosis (schizophrenia, schizoaffective or other psychotic-type disorder). The collected data was analysed by means of Interpretative Phenomenological Analysis. Results: This study found that psychosis may directly and indirectly undermine the father-child relationship and the work of parenting. The fear of one's children inheriting psychosis is a concern amongst this group. In the process of fulfilling the role of fatherhood, men with psychosis benefit from a sense of pride in the father role, a sense of purpose to one's life, a feeling of pleasure in the creation and development of life, and motivation to change for the better. Conclusions: Treatment and care programmes need to be sensitive to the effects of fatherhood on psychosis and the effects of a father's psychosis on the mental health of his family. Extra support during the first months of fatherhood, parenting programmes and systemic approaches might help fathers with psychosis and their families.
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Although it is known that many antipsychotic drugs, at the doses prescribed for schizophrenia, are sedative and cause daytime drowsiness, the effect of potentially diminished vigilance on parenting parameters has not been studied. The aim of this paper is to advise clinicians about sedative load in mothers who are prescribed antipsychotic medication. A Medline search was conducted into the sedative effects of antipsychotics, with the following search terms: sleep; sedation; somnolence; wakefulness; antipsychotics; schizophrenia, parenting, maternal behavior, and custody. The results showed that antipsychotic drugs differ in their propensity to induce sedation and do so via their effects on a variety of neurotransmitter systems. It is important to note that mothers with schizophrenia risk losing custody of their infants if they are perceived as potentially neglectful because of excessive daytime sleepiness. Clinicians must choose antipsychotic medications carefully and monitor for sedative effects whenever the patient has important responsibilities that require the maintenance of vigilance.
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This study compared parental psychiatric symptom severity, and the absence or presence of severe substance abuse, as predictors of contact with minor children for a representative sample of adults with diagnoses of serious mental illness (N = 45). Child contact and psychiatric symptom severity were measured during regularly scheduled 6-month research interviews over a total 30-month period following each participant's entry into the project. Severe substance abuse was documented as present or absent for the 6-month interval preceding each interview. Results revealed that incidence of severe substance abuse was repeatedly associated with less frequent parent-child contact, even after controlling for psychiatric symptoms, diagnosis, gender, age, ethnicity, and socioeconomic status. Neither psychiatric diagnosis nor symptom severity predicted frequency of child contact when substance abuse was taken into account. Mental health agencies offering parenting classes for adults with serious mental illness should incorporate substance use interventions to reduce loss of child custody and strengthen parent-child relationships.
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Parental and child psychiatric disorders have been found to be associated, and this association can be mediated by other psychosocial variables, including parenting attitudes and strategies. As most previous studies included clinical samples, the purpose of this study was to establish the relationship between parental psychopathology and parenting strategies with child psychiatric disorders in a national survey population. The sample included 10,438 children of 5-15 years and their parents, from representative UK households. Families were assessed on child psychiatric diagnosis, parental psychopathology, family functioning, and socioeconomic status. Parenting strategies included using rewards, physical and non-physical punishments towards their child. Parental psychopathology scores (OR 3.99, 95% CI 3.13-5.09) and non-physical punishment (OR 1.50, 95% CI 1.27-1.76) were associated with child psychiatric disorders. This association was particularly prominent among children with conduct disorders: parental psychopathology scores (OR 3.13, 95% CI 2.28-4.30) and non-physical punishment (OR 3.19, 95% CI 2.55-3.97). Absence of child psychopathology was associated with a combination of rewarding and non-punitive parenting strategies. Although parents in the general population may be using less physical strategies than in the past, non-physical punishment is strongly related to mental health problems in children. Enhancement of positive parenting through universal and targeted interventions is an important preventive strategy.
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To understand and promote recovery from serious mental illnesses, it is important to study the perspectives of individuals who are coping with mental health problems. The aim of the present study was to examine identity-related themes in published self-narratives of family members and individuals with serious mental illness. It adds to the body of research addressing how identity affects the process of recovery and identifies potential opportunities for using published narratives to support individuals as they move toward positive identities that facilitate recovery. Forty-five personal accounts from individuals with severe mental illness, which were published in two prominent research journals between 1998 and 2003, were qualitatively analysed. Individuals with mental illness and their family members described a loss of self and identity that had to be overcome, or at least managed, for recovery to become possible. Writers described (i) a loss of self, (ii) the duality of (ill/well) selves, (iii) perceptions of normality, (iv) specific concerns about parenting and identity, and (v) hope and reconciliation. Individuals' stories of their experiences of severe mental illness describe severe challenges managing identity. Efforts to publish personal accounts that focus on strengths-based patient-centred stories, rather than on deficits, could be helpful to provide hope for patients. These published narratives highlight the importance of moving recovery and hope to the forefront among patient, family, and clinician groups. Increasing such information and role models can provide important resources to individuals working to redefine themselves and create a sense of self-worth and stable identity that will support productive, happy lives.
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Increased time in the community has made developmental life tasks of adulthood more relevant to individuals with severe mental illness (SMI). Parenting and motherhood are thus important areas of study, since it has been established that women with SMI are likely to have children. Previous research has concentrated primarily on the deleterious effects on the child of having a mentally ill parent. Mothers' capabilities or problems in parenting and the meaning of motherhood from the women's perspective have received limited attention. In the present interview study of 24 mothers with mental illness, satisfaction and self-reported competency in parenting were found to be high, although significant economic and some support problems were reported. Women described the meaning of children and the significance of the parenting role, yet realistically portrayed their concerns over discipline and the effects their problems have. Implications for mental health services are discussed.
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This article presents the findings and recommendations of a statewide interagency task force on parents with mental illness who have young children. Based on testimony from consumers, providers, and advocates, the task force concluded that this is a substantial and neglected public policy issue requiring an intergovernmental, services integration approach. Recommendations were made in the areas of services, policies and procedures, and service coordination.
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Schizophrenic ( n = 53), depressed ( n = 25), and well women ( n = 23) were studied to determine the quality of their parenting and its affect on their 3-month to 5-year-old child's social and intellectual development. Most of the women were single parents; all were poor and Black. Parenting behavior was studied with observations in the lab and the Home Observation for Measurement of the Environment inventory. Children's behavior was measured with an IQ test and social competence observation. Quality of parenting was lowest in schizophrenic women, and more variable in depressed women. Certain parenting practices significantly predicted children's IQ scores and social behavior. The mother's parenting practices, and not her diagnostic status per se, accounted for much of children's intellectual and social competence, supporting an interactional model for transmission of psychopathology from mother to child. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This article highlights issues involved in carrying out evaluations for termination of parental rights cases and suggests caution for mental health professionals doing such evaluations. It argues that current models of parenting that come from the child development and child maltreatment fields are too narrow in their focus to act as a foundation for such evaluations and are often based on research with select groups in our society making them open to bias. Similarly, it is argued that traditional assessment measures are limited in their utility for responding to the kinds of relational and basic care questions asked in such evaluations. A functional-contextual model is offered as an alternative with examples of potentially useful measurement strategies. With such a frame as a starting point, the field might progress to providing more useful information to courts. Future research directions to improve this practice arena are discussed.