Working with Parents with Mental Illness -...

Resource sharing between the Department of Child Safety, Youth and Women with the Non-Government SectorHello,

I provide you with another resource we would like to share. This word document contains some of the content from our inward facing training resource on the topic of working with parents who have a mental illness. We are sharing this resource with the non-government sector via the various peak bodies.

I note that the content you receive will not be an exact duplication of the versions we provide to our internal staff, for several reasons. The aforementioned resource in their complete and original form contains licensed images, practice instructions, activities, etc., and are hosted on our online learning management system which is only accessible to our departmental staff. Additionally, in their original forms, the training materials are focused on practice and procedural guidelines for frontline staff, and are therefore not in all cases necessarily relevant to practitioners who do not operate within a statutory child protection context.

Consequently, we have extracted what we consider to be relevant content from some of our training modules for your consideration, with the intent that you individually determine the usefulness and relevance of the information provided in the context of meeting development needs of your respective cohorts of staff.

Additionally, we recognise that you have your own resources and training programs which may be entirely sufficient to your organisational needs in their own right. We have therefore elected to provide content from our area in the form of a word document - allowing easy access for review and implementation as you see fit.

We share this material in the spirit of collaboration and collegiality, but request that any content originating from this department is attributed back to the source, along with references to any third-party materials and articles.

Kind Regards,Dr Sonya Ashton, BPsych(Hons), DPsych(Org)A/Director, Capability and LearningCapability and Learning | People and CultureDepartment of Child Safety, Youth and WomenPhone: 3097 5322, 0477 766 904

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Content shared on 27 September 2018.

Notes for use Within the text of this document you will notice a number of section lines, this resource was an

eLearning module when viewed by our child safety staff, and we have maintained some of these section breaks for your ease of reading.

Please amend this content as required to meet the accessibility requirements of your audience (e.g., subtitles for videos, appropriate text to background colour contrast, etc.).

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Working with parents who have a mental illnessTable of Contents Resource sharing between the Department of Child Safety, Youth and Women with the Non-Government Sector.......................................................................................................................................................... 1

Working with parents who have a mental illness.........................................................................................3

Table of Contents........................................................................................................................................ 3

Course outline...................................................................................................................................... 4

Introduction.................................................................................................................................................. 4

Welcome.............................................................................................................................................. 4

Stigma.................................................................................................................................................. 4

Having an open mind............................................................................................................................ 5

Why do this course?............................................................................................................................. 5

Module 1: What is mental illness?...............................................................................................................6

Module Outline..................................................................................................................................... 6

What’s the difference between mental health and mental illness.........................................................6

Mental Illnesses.................................................................................................................................... 7

Dual diagnosis.................................................................................................................................... 11

Things to consider with mental illness................................................................................................11

Module summary................................................................................................................................ 12

Module 2: Possible impacts of mental illness on parenting and children’s wellbeing.................................13

Module Outline................................................................................................................................... 13

Risk factors that influence the impact on children...............................................................................13

Protective factors that influence the impact on children......................................................................14

Depression: Exploring the impacts and risks......................................................................................16

Anxiety: Exploring the impacts and risks............................................................................................16

Bipolar disorder: Exploring the impacts and risks...............................................................................16

Borderline personality disorder: Exploring the impacts and risks........................................................17

Post-traumatic stress disorder: Exploring the impacts and risks.........................................................17

Dual diagnosis: Exploring the impacts and risks.................................................................................18

Module summary................................................................................................................................ 18

Resources:............................................................................................................................................. 19

References......................................................................................................................................... 19

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Course outline

This course consists of the following 2 modules:

Module 1 – What is mental illness? - An overview of some frequently diagnosed mental illnesses.

Module 2 – Possible impacts of mental illness on parenting and risks to children’s well-being.

At the end of this workbook you will find a full resource and reference list.

IntroductionWelcome

Welcome and thank-you for investing your valuable time to the ‘working with parents who have a mental illness’ course. This is a foundational course that invites you to consider how mental illness may impact on a parent’s everyday functioning, parental capacity and subsequently, a child’s wellbeing.

StigmaAs you work with parents who have a mental illness be aware of how you can help reduce the stigma they experience on many levels. A good source of information is the Queensland Government information page on mental health and wellbeing (https://www.qld.gov.au/health/mental-health).There are many families living with a parent who has a diagnosed mental illness where there is little impact upon the child’s wellbeing. It’ important to remember that just because a parent is dealing with mental health issues, this does not necessarily mean they are not able or not willing to care for, protect and keep their child/ren safe.

Further, in line with Queensland Health's strengths based, recovery-oriented mental health framework, be mindful that there is no reason a person with a mental illness can’t recover, or live a full life alongside of their mental illness.

“Recovery acknowledges that having a mental illness does not necessarily mean life-long deterioration. People with a mental illness are recognised as whole, equal and contributing members of our community, with the same needs and aspirations as anyone else. As a result, when working to facilitate recovery, the basic elements of citizenship need to be considered, such as ability to live independently, form social relationships and access employment opportunities. In doing this, it is important that relevant stakeholders adopt and are supportive of recovery-oriented service provision”.

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Having an open mindWhile working through the content of this course, you may find it brings up new thoughts and ideas that you were not previously aware of, in regard to how you think about mental illness.

As “helping” professionals we often think we are not affected by things such as ‘stigma’ or other negative attitudes. However, the reality is that people living with mental illness, especially parents, often experience stigma from those who work with them.

The World Health Organisation defines stigma as:

A major cause of discrimination and exclusion: it affects people‘s self-esteem, helps disrupt their family relationships and limits their ability to socialise and obtain housing and jobs.

Stigma also hampers the promotion of mental wellbeing and the provision of effective treatment and care.

When working with parents who have a mental illness, it can provoke a range of feelings. This is normal but it’s important to be aware of how you are feeling, and maintain sympathy and realistic expectations for the parent.

Why do this course?Mental illness is prevalent in our world

The 2007 National Survey on Mental Health and Wellbeing found that nearly half (45.5%) of the Australian population aged 16-85 years had experienced an anxiety, affective or substance use disorder at some stage in their lifetime.

These figures indicate that you will, at some stage, work with a parent who has a mental illness.

We want to reduce the negative impacts of mental illness on children’s wellbeing

Children whose parents have mental health issues are at a greater risk of adverse consequences other than maltreatment, including:

• developing mental health problems as they get older

• perinatal complications and other health problems in infancy

• social and behavioural problems in childhood and adolescence

• consequences of stress associated with caring for a mentally ill parent.

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Module 1: What is mental illness?Module OutlineIn this module we will look at the following:

The difference between mental health and mental illness.

Some mental illnesses that you may encounter in your role, namely:

◦ depression

◦ anxiety

◦ post-traumatic stress disorder

◦ borderline personality disorder

◦ bipolar disorder

◦ dual diagnosis.

This module will only provide you with an overview of a few of the more frequently diagnosed mental health disorders with the focus on how these disorders may impact upon parental capacity and the safety and wellbeing of children. This is not a comprehensive list of mental health disorders as there are many mental illnesses not discussed here.

What’s the difference between mental health and mental illness

Mental health and mental illness are often used interchangeably as though they refer to the same thing.

Mental HealthOur mental health refers to our state of mind and our ability to cope with the everyday things that are going on around us. Our mental health includes our emotions, thoughts, feelings, our ability to solve problems and overcome difficulties, our social connections, and our understanding of the world around us. Read more on the Reachout website (https://au.reachout.com/articles/what-are-mental-health-issues).

Someone with ‘good’ mental health usually feels capable of dealing with the different everyday situations in which they find themselves. Just like physical health, the more mentally healthy we are, the greater our ability to handle stress and life’s challenges.

Of note: A person with ‘good mental health’ may also have a mental illness and a person with ‘poor mental health’ may not necessarily have a mental illness.

Mental IllnessMental illness refers to a recognised, diagnosed disorder. A mental illness is an illness that affects the way people think, feel, behave and interact with others. There are many different types of mental illness and they have different symptoms that can impact people’s lives in different ways. Mental illness can move on a continuum ranging from well managed to extremely unwell and being disabled by the illness.

Some people may experience mental illness for a short period of time – for example, parents who experience post-natal depression or a person who develops depression in response to a traumatic life

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event. For people who have other illnesses such as bipolar or antisocial disorder, mental illness can be a long term experience. People with long-standing mental illness often live productive and meaningful lives.

Mental Illnesses

We are going to take a closer look at some mental illnesses that are commonly encountered when working with parents who have mental illnesses.

DepressionDepression can affect anyone at any stage of their life however in clinical practice, the term “depression” differs from the everyday description of someone going through a “down” period. For example, major depression will impact on a person in three main ways – they will experience it:

• more intensely• for longer duration (i.e. two weeks or more), and it will• significantly interfere with the person’s ability to function effectively day to day.

Dysthymia is another milder but persistent mood disorder where a parent experiences a number of symptoms of major depression over a period of years. A parent will have low mood or loss of interest but delusions and hallucinations are absent. It is not uncommon for a parent to be referred to as having a “depressive personality style”.

Post-natal depression is also a common form of depression to encounter.

SymptomsCan include a range of feelings and behaviours including:• sadness• frustration• disappointment• lethargy (sometimes)• inability to take action or follow through with activities• disorganisation• forgetfulness• disinterest in activities or personal connections• A person with depression will experience a “depressed mood” relatively consistently day to

day, although the level of elevation in their mood may vary somewhat during a day.

Treatment and recovery:The intensity of this condition and its impact on a person’s daily functioning will dictate the frequency and intensity of any treatment plan. Treatment for depression may include:• therapy • medication, and • lifestyle changes.

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AnxietyAnxiety is more than just feeling stressed or worried. Anxious feelings are a normal reaction to a situation where a person feels under pressure. However for some people these anxious feelings happen for no reason or continue after the stressful event has passed. Anxiety can be a serious condition that makes it hard for a person to cope with daily life.

There are several different types of anxiety disorders: Generalised anxiety disorder Panic disorder Agoraphobia

Generalised anxiety disorderA person will worry excessively and persistently about a number of areas of their lives – such as their family, health, job or finances.

Panic disorderA person will experience recurrent and unexpected panic attacks which are followed by persistent concern about having another panic attack, or concern about the implications of another panic attack.

Agoraphobia (with or without a panic disorder) A person will be anxious about being in a situation from which “escape” may be difficult, embarrassing, or in a panic should a panic attack occur.

The person’s anxiety usually leads to them to avoid ‘potential’ situations (e.g. crowded places, travelling alone, social events).

Treatment and recovery for these disorders:A person’s treatment for anxiety can range from medication to therapy and education on how to manage symptoms.

Unfortunately, there are no ‘quick fixes’ so it is not unusual for a person to have to use a combination of treatments.

Post-traumatic stress disorderPost-traumatic stress disorder (PTSD) is characterised by the development of a long lasting anxiety response following a traumatic or catastrophic event. Typically, a person has experienced or witnessed a traumatic event, such as:

• an actual or threatened (near) death event• serious injury to oneself or another person • a threat to their personal integrity or others.

The person’s response to this involves a sense of, or actual helplessness, intense fear or horror.

SymptomsPTSD usually develops within 3-6 months of the traumatic event, although this timeframe can be longer, resulting in a person experiencing:• images, dreams, flashbacks of the event• avoidance of cues which act as reminders of the traumatic event• amnesia about important aspects of the event• depressed or irritable mood• social withdrawal• concentration and memory difficulties• being easily startled.

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Treatment and recoveryThe intensity of this condition and its impact on a person’s daily functioning will dictate the frequency and intensity of any treatment plan. This disorder often requires a number of interventions such as –• medication • therapy provided by a skilled clinician.

Borderline personality disorder Between two and five percent of the population have borderline personality disorder (BPD), with

the onset of symptoms usually appearing from mid to late teens, or in early adulthood. Women are three times more likely to be diagnosed with this disorder than men. People with BPD have persistent difficulty relating to other people and to the world around them.

This can be very distressing for the person and for those who care about them. Parents with a BPD frequently experience distressing emotional states, difficulty in relating to

other people, and self-harming behaviour. They experience a pervasive pattern of instability in relationships, low self-image and marked impulsivity that can make it difficult to complete schooling, maintain a job, and have long lasting, healthy relationships.

Many people with borderline personality disorder have experienced significant trauma, either in the past or in their daily lives.

SymptomsCan include:

• having an unstable or dysfunctional self-image or a distorted sense of self• feelings of isolation, boredom and emptiness• difficulty feeling empathy for others• a persistent fear of abandonment and rejection – including, extreme emotional reactions

to real or even perceived abandonment• strong feelings of worry, anxiety and depression• impulsivity, risk-taking, self-destructive and dangerous behaviours• hostility.

Treatment and recoveryTreatment for borderline personality disorder can include both therapy and medication. Therapy can assist a person to address their negative and unhelpful thinking styles and may assist in reducing suicidal thoughts and depression.

Bipolar disorderBipolar is a chronic mood disorder that causes changes in mood and energy. One in 50 Australian adults experience bipolar each year.

The most common picture of bipolar disorder involves repeated episodes of mania or depression, usually separated by periods of complete remission. Other patterns may also exist - for example, some people may not experience complete remission between episodes, while others may only ever experience one or more episodes of mania.

SymptomsBipolar disorder is associated with people experiencing depressive episodes followed by high or manic episodes.

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These changes in mood can vary in length and duration. Mixed episodes may be difficult to diagnose, but include the simultaneous and/or rapidly alternating presence of symptoms of depression and mania.

Treatment and recoveryBipolar requires long term management with a range of interventions, including medication and therapy. Bipolar disorder can impact on how people manage their everyday lives.

Schizophrenia spectrumSchizophrenia spectrum includes schizophrenia, other psychotic disorders, and schizotypal (personality) disorder.

They are defined by abnormalities in one or more of the following five domains: • Delusions.• Hallucinations.• Disorganised thinking (speech).• Grossly disorganised or abnormal motor behaviour. • Negative symptoms (e.g. emotionless, flat and apathetic).

Schizophrenia affects the normal functioning of the brain, interfering with a person’s ability to think, feel and act. Some people do recover completely, and, with time, most find that their symptoms improve. However, for many it is a prolonged illness which can involve years of distressing symptoms and disability.

SymptomsIf not receiving treatment, people with schizophrenia experience persistent symptoms of what is called psychosis.

These include:• Confused thinking.

• When acutely ill, people with psychotic symptoms experience disordered thinking. The everyday thoughts that let us live our daily lives become confused and don’t join up properly

• Delusions.• A delusion is a false belief held by a person which is not held by others of the same

cultural background• Hallucinations.

• The person sees, hears, feels, smells or tastes something that is not actually there. The hallucination is often of disembodied voices which no one else can hear.

Other associated symptoms are low motivation and changed feelings.

Treatment and recoveryTreatments include antipsychotic medication, specialist psychological therapies and community support programs to help with social connection, physical health, accommodation and work or school.

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Dual diagnosis

Mental Illness and drug and alcohol useIt’s estimated that anywhere from 40% to 80% of people who experience mental illness also have issues with substance use (legal and illegal) and vice versa. A person can experience challenges related to both issues at the same time. Read more on the Dual Diagnosis website (http://www.dualdiagnosis.org.au/home/).

The term dual diagnosis is most commonly used when a person is experiencing issues with their mental illness and substance use. It’s also referred to as co-morbidity or co-occurring mental illness and substance use. This definition refers to both legal and illegal substances and is also used to describe people who experience intellectual disability and substance abuse issues.

Co-occurring substance use is more likely to occur among people with serious mental illness and disorders as many people use substances to reduce the symptoms of their illness or the unwanted side effects of medication. Factors that contribute to the complexity of a diagnosis and response include:

• the type, intent and frequency of drug use• the nature and severity of the illness• the age of the individual• the physical and social impact of either or both disorders.

Note that the term dual diagnosis whilst commonly referring to mental health issues and drug and alcohol issues can also refer to the co-occurrence of intellectual disability and mental health issues. For the purposes of this presentation, dual diagnosis refers to mental health and substance abuse issues.

Treatment and recoveryThere is no single treatment which works for everyone diagnosed with a dual diagnosis. The range of mental illnesses is broad and the relationship between a mental illness and substance abuse is complicated and individual. Treatment for dual diagnosis is unique in that it treats both the substance and the mental illness. Treatment may involve a period in rehabilitation in addition to therapy and support groups.

Things to consider with mental illness

The effect of a parent’s mental illness on a child is varied and unpredictable. We know that parental mental health issues may pose a biological, psychosocial and environmental risk for children. Despite these findings, not all children in families where parents live with a mental health issue will be negatively affected or can be considered at risk of physical, emotional or psychological harm.

Consider how the mental illness affects the parent’s behaviour, which in turn affects their relationship with their child and how they parent – this is where risk of harm to the child can occur.

If assessing the vulnerability of a child to harm, consider:• consider the age of the child at the onset of the parent’s illness• the severity and duration of the parent’s illness• the impact of the parent’s illness upon their daily functioning and general behaviour• the degree of support (present or required) and the levels of stress experienced by the whole

family due to the person’s illness.

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Module summary

Let’s review what you have learnt so far.You have looked at the difference between mental health and mental illness

You have looked a little deeper into some mental illnesses that you may encounter in your work, namely:

• depression

• anxiety

• post-traumatic stress disorder

• borderline personality disorder

• bipolar disorder

• dual diagnosis.

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Module 2: Possible impacts of mental illness on parenting and children’s wellbeing.Module Outline

In this module we will identify:

• the possible risk and protective factors that influence the impacts of a parent’s mental illness on the wellbeing of children.

Risk factors that influence the impact on children

Children of Parents with Mental Illness (COPMI) (http://www.copmi.net.au/) have undertaken a large amount of research into factors that influence the impact of a parent’s mental illness on a child. COPMI propose that the impact upon children is influenced by the following three (risk) factors:

Duration of symptoms Severity of symptoms Shared risk factors

Duration of symptomsAccording to COPMI the duration of symptoms can actually have a greater effect on children than the severity of the condition.

For example – Daily household routines can more quickly be re-established by a parent following a short acute episode, whereas there is a greater disruptive effect to these routines when the parent has long term depression.

Severity of symptomsIf a parent’s symptoms are significantly impacting their ability to care for a child (and there is no other adult to buffer this), the wellbeing of a child can be adversely affected.

Research has shown that children know earlier and in greater detail about their parents’ problems than their parents’ believed, with the average age of awareness being 4 to 5 years of age (Dawe, et. al., 2007).

Shared risk factorsAre factors that have contributed to the condition that could also be shared with the child, such as poverty, exposure to trauma and homelessness.

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Protective factors that influence the impact on children

Protective factors are those that alleviate the risk of harm to children.

Imagine all of the ways that a family could be supported during times of acute illness or throughout a long term illness. These factors include:

Personal protective factors

Social protective factors

Financial protective factors

Personal protective factors Insight into the mental illness - a parent’s willingness to seek support and capacity to take on

support.

Extended period of wellness.

Good physical health.

Child’s understanding of the parent’s illness - when children understand (at an age appropriate

level) their parent’s illness and they don’t feel “blame” for what is happening.

Another parent - who is in good physical and mental health can “buffer” the effects of the illness

by keeping to routines, if necessary, and by providing consistency as required.

Social protective factors Good treatment options – including, integrated treatment for those with a dual diagnosis.

Safe and affordable housing.

Support of family and friends.

Supportive school.

Financial protective factors Stable employment.

Consistent financial support.

Good budgeting skills.

Systemic protective factors Good policy and frameworks that help de-mystify mental illness and its impacts.

Ongoing public education.

Practitioners who work in a trauma informed framework and understand the stigma associated

with mental illness.

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Risks to children

Children need a source of secure attachment where their physical needs (e.g. food, shelter and clothing) and their emotional needs for love, belonging, acceptance and affection are met reliably and consistently, if they are to develop well.

Depending on a range of factors, parents experiencing mental illness can encounter difficulties in meeting their children’s needs in any or all of these areas.

These factors can be classified as emotional, physical or psychological.

Emotional factors: Parents may find it difficult to attend to their children’s emotional needs which can instil a sense of

isolation and mistrust of those around them. Children may also become “parentified” - assuming the role of carer for their ill parent. This can

cause significant emotional stress and disrupt a child’s overall development.

Physical factors:Children of parents with a mental illness can face a high risk of physical neglect as basic needs may not be met, such as:

regular meals clean clothes safe, stable and hygienic living spaces adequate supervision.

Psychological factors: There are risks of psychological abuse by parents. Children of parents with a mental illness are at an increased risk of developing their own mental health problems (Cowling, 2004).

For example - The postpartum time places great demands on mothers. Emerging research indicates that if the mother is struggling with a mental illness during this time, her ability to develop a secure attachment to her infant may be compromised. The adverse effects of the illness on the quality of the mother-infant relationship may impact on the infants subsequent emotional and cognitive development (Murray, L., Cooper, P., and Hipwell, A, 2003).

Children with the following characteristics were found to be more vulnerable to the effects of parental mental illness:

Low birth weight. Young in age – at onset of the parent’s mental illness. A high temperamental risk – conversely, children with low temperamental risk were less likely to

show disturbance. No supportive relationships – supportive relationships and good parenting predicted resilient

outcomes in children and young people. Poor coping skills

Children who use strategies to accept or adapt to the stress of parental mental illness have fewer adjustment problems than those who were unable to disengage.

Resilient children possessed self-understanding, the ability to view parental illness realistically, and to build the resources necessary to survive despite parental dysfunction. But many children adopted problematic coping styles, withdrawing, avoiding and distancing themselves.

https://www.facs.nsw.gov.au/download?file=321631

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Depression: Exploring the impacts and risks

How can depression impact parenting?Chaffin, Keller and Hollenberg (1996) found that depression was uniquely associated with physical abuse, with one study indicating that 4% of depressed mothers exhibited physical abuse. They found that depressed parents are almost 3.5 times more likely to initiate physical abuse than other parents.

Day-to-day activities: Having depression can make it hard to carry out daily care activities for children. Sticking to a regular routine or getting through the simplest chores, like shopping and cooking, can sometimes seem impossible. It can also be difficult to set limits and boundaries for children’s behaviour which can lead to unpredictable and inconsistent parenting behaviour.

Holding down a job is often difficult. Balancing a job with family life can be a real challenge, especially if a parent gets easily stressed or confused.

Staying connected with your child: Depression can make it hard for parents to tune in to children’s emotional needs, or be emotionally available when children need support or comfort. Older children may assume a parenting role for younger children when everyday activities and routines are being neglected by a parent. This can lead to insecure attachment styles.

Children can blame themselves and think it’s their fault - they might feel frustrated and angry with their parent, which can be difficult for the parent to manage.

Anxiety: Exploring the impacts and risksHow can anxiety impact parenting?You may have heard the phrase, “anxious parents raise anxious kids”. A parent’s anxiety may mean that they limit a child’s natural exploratory behaviour.

Because we learn through verbal and non-verbal communication, when a parent has anxiety their personal internal dialogue of worry, fear and/or doubt often is voiced. When anxious parents project their thoughts onto their children, children may internalise the message that the world is a scary place.

Parental anxiety usually involves excessive worrying about the potential for things to go wrong. Anxious parents, out of genuine love and concern may prevent their children taking risks and exploring the world which can affect the child’s ability to take responsibility for their own mistakes, making it difficult for them to deal with a variety of positive and negative emotions.

Children then learn that exploring and playing is dangerous or scary. This can lead to an anxiety response in the child upon separation from their parent.

Bipolar disorder: Exploring the impacts and risks

How can bipolar disorder impact parenting?A child can find it challenging to live with a parent diagnosed with bipolar disorder. While everyone is affected differently, manic episodes can result in impulsive or erratic behaviour making it difficult for parents to manage boundaries and consistency. There is no logical, reasoned thought that accompanies impulsive behaviour arising from mania.

Sometimes people can become aggressive leading to higher levels of conflict in the parent-child relationship. Often when the manic phase has passed people feel embarrassed by what they said or did

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which can lead to withdrawing from family and friends, leaving children feeling isolated. This unpredictability can make it difficult for children to feel safe and secure in the world, which can negatively affect the parent-child attachment. This may lead to survival or compensatory behaviours by the child that helps them to feel a sense of control over their world.

During the depressed stage parents may find it hard to keep routines going, such as getting children to school and managing other day to day activities as previously discussed.

Borderline personality disorder: Exploring the impacts and risks

How can borderline personality disorder impact parenting?People with personality disorders usually have difficulty in managing relationships. Despite parents and children being biologically wired to love and care for each other, relationships between parents with BPD and their children may instead be challenging and problematic.

The impaired capacity of the parent to hold their child’s mental state in mind impacts their capacity to reflect on their internal mental experience of the self. As such, this impacts the parent’s capacity for:

• empathy

• taking the perspective of the child

• being able to meet the child's needs.

This can lead to blaming and shaming their child.

It may be difficult for you to steer the conversation to discuss parenting as parents with BPD are often focused on other issues or other relationships.

A child’s risk of emotional and physical harm is increased when their parent is unable to focus on the child’s needs and is unable to reflect on their own parenting capacity.

Their world is often examined through the lens of ‘self’ in terms of their own needs and what others are doing to them. Engaging in reflection with a parent with BPD may lead to heightened distress in the parent due to the fear of being viewed as a “bad parent”.

The impaired capacity to take the perspective of the child may make meaningful and lasting change difficult.

Post-traumatic stress disorder: Exploring the impacts and risks

How can PTSD impact parenting?Because PTSD has a range of symptoms, there can be a range of effects on the parent-child relationship and a person’s ability to parent. A common aspect of PTSD is the re-experiencing of trauma through flashback or dreams.

These symptoms can be frightening for the person and also for children witnessing the parent going through intense emotions such as grief, guilt, and anger. Children may not understand what is happening or why and they may worry about their parent and their own safety.

Because the intensity of the feelings can be overwhelming, parents may avoid triggers (this may mean avoiding certain places, thoughts or experiences) that could bring memories flooding back. These avoidance or numbing symptoms can impact children in many ways: e.g.:

• When a parent withdraws from family and friends and has trouble feeling positive emotions, children can interpret this to mean their parent is not interested in them or does not love them.

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Parents with PTSD may also have high levels of arousal which makes sleep and concentration difficult. They tend to be irritable and may experience exaggerated concern for their own safety and that of their children.

Parents with PTSD can be overprotective. Irritability and low tolerance can make a parent seem hostile or distant, thus making a child feel confused about their parent’s love, availability and reliability.

Dual diagnosis: Exploring the impacts and risks

How can dual diagnosis impact parenting?• Substance use disorders include patterns of behaviour that are related to the use of a substance

and thus can impact parenting significantly.

Some impacts can include:

• difficulties in regulating emotions and controlling anger and impulsivity – a parent can create an unpredictable and sometimes unsafe environment for children

• a lack of resources – a parent who spends money on drugs and alcohol rather than essentials, can create an environment of deprivation as children’s physical needs for food etc. are not met

• poor supervision – a parent with reduced functioning arising from drug use can leave a child vulnerable to harm by other adults and from household accidents

• neglect – the daily physical and emotional needs of children can be either secondary considerations, or not even thought of at all by the parent.

Module summary

Let’s review what you have learnt so far.• The effect of a parent’s mental illness on a child can be varied and unpredictable. Although

parents with a mental illness may pose a biological, psychological and environmental risk for children, not all children will be negatively affected.

• Always consider how the mental illness affects the parent’s behaviour, which in turn affects relationships and may cause risk to the child.

• Remember to consider the:

o age of the child at the onset of the illness

o severity and duration of the illness

o degree of support and the levels of stress experienced by the family due to the illness.

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Resources:

For more specific information and support on individual mental illness, please explore the following links:

http:// www.beyondblue.org.au

http://www.blackdoginstitute.org.au

http://www.raisingchildren.net.au

www.sane.org

What are mental health issues? | ReachOut Australia

http://www.community.nsw.gov.au/__ data/assets/pdf_file/0018/321183/ researchnotes_parental_mentalhealth.pdf

References

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Andrews, G., Dean, K., Genderson., Hunt., Mitchell, P., Sachdev, P., and Trollor, J., (2014). Management of Mental Disorders: 5th Edition. Create Space Independent Publishing Platform, US.

Altman, J.C. (2008). Engaging families in child welfare services: Worker versus client perspectives. Child Welfare, Vol. 87, no3, pp 41-62.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association. https ://www.sane.org/mental-health-and-illness/facts-and-guides/schizophrenia

Australian Bureau of Statistics. (2007). National Survey of Mental Health and Well-being: Summary of results. Catalogue No. 4326.0. Canberra, ACT: Australian Bureau of Statistics.

Budd, K., Poindexter, L., Felix, E., Naik-Polin, A. (2001). Clinical Assessment of Parents in Child Protection Cases: An Empirical Analysis. Law and Human Behaviour, Vol. 25, No. 1, 2001, pp93-107.

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https://www.sane.org/mental-health-and-illness/facts-and-guides/schizophrenia

https://www.sane.org/mental-health-and-illness/facts-and-guides/schizophrenia

http://www.community.nsw.gov.au/__data/assets/pdf_file/0018/321183/researchnotes_parental_mentalhealth.pdf



https://au.reachout.com/articles/what-are-mental-health-issues



https://www.sane.org/?gclid=EAIaIQobChMItsjKmuCd3QIVymkqCh1_lA_3EAAYASAAEgIEg_D_BwE

http://www.raisingchildren.net.au/

http://www.blackdoginstitute.org.au/

https://www.beyondblue.org.au/

https://www.beyondblue.org.au/

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