MENTAL HEALTH Essay Example

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    Nursing
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    Essay
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    Masters
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Needs of children from parents with mental illness

Introduction

Mental illness can result in mild to serious disturbances in behaviors and thought and can lead to inability to cope with the ordinary routines and demands of life. Consequently, it can significantly affect the stability of a family. Parents having mental illness have lower rates of marriage and divorce compared to the normal population. Some parents suffering from mental ailments may face challenges with parent-child attachment emanating from repeated family instability and separations (Barkla et al, 2000).Therefore, families having a parent with a mental illness require special and unique services that encompass both intervention and prevention services for the children and the parent. The issues and challenges that generally face the affected families include anxiety disorders, depression and schizophrenia, are varied and numerous. Impact of parental mental illness on children The effect of parental mental illness on the well being of children and the family life can not be assumed. Children whose parents have a mental disease are at greater risk of developing emotional, social, and behavioral problems. This is due to the fact that emotional well-being and the development of children are significantly affected by the environment in which they grow. Advocates and service providers working with families where one or both parents have mental illness have been able to identify some of the problems faced by their children. For example, children may be forced to take on inappropriate levels of responsibility characterized by managing the household besides taking care of themselves. Quite often, children blame themselves for the difficulties facing their parents, and in the due course experience anxiety, anger, and guilt (Barkla et al, 2000).Feeling ashamed or embarrassed as a result of the stigma associated with the mental illness of their parents, they may face isolation from their peers and also some community members. Such children may be at risk of poor performance in academics and shaky social relationships. Such children may also be prone to a number of mental health problems such as personality and mood disorders (American Academy of Child and Adolescent Psychiatry, 2000).Despite the numerous challenges, majority of children belonging to parents with mental illness have remarkable resilience and have the ability to soldier on in spite of environmental and genetic vulnerability. Resiliency is therefore directly proportionate to the protective factors and risks that are present within the family, hence the higher the number of protective factors and lower risk factors, the greater the likelihood of resilience in a child. This demonstrates that services for children and families should adequately consider opportunities that can enhance resilience by reducing risk. According to Seneviratne and Conroy (2003), parents suffering from mental diseases may be vulnerable to having no control of their children. It has been reported by some studies that about 70 percent of the affected parents have lost custody of their children. The cardinal reason for custodial hiccup is the stigma that surrounds mental illness. Most of the people believe that individuals suffering from mental ailments are not appropriate to become parents. There is also a widespread misperception that parents with mental diseases are primarily violent and therefore have increased abilities of abusing their children thus most families do find themselves entangled in a cycle of loss. Such parents may avoid seeking help openly as it may give a view of unfitness. Therefore, it is common to find affected parents not seeking the support or services that are appropriate for their conditions, and without assistance then their parenting capacity has to go down. The reduction in the quality of parenting must directly affect children. It has also been noted that some children of parents with a mental ailment, more so those from single parent families usually become the caregiver to the parent. Children as young as three years old are involved in care-giving. Such children have often been referred to as invisible children as mental health professionals do not always have the awareness that their clients are also parents. Psychiatrists have also noted that while experiences of children with caring responsibilities can be both be constructive and destructive, several studies have found child care-givers to be less happy compared to other peers at school. They suffer from depression and lower self-esteem (Barkla et al, 2000). Children who live with a parent suffering from mental illness have been facing isolation. A pilot study conducted on adolescent carers showed that their situation requires urgent assistance. The study noted that children may surrender their childhood needs by taking on the role of a surrogate spouse, which is fundamentally a reverse parenting role. This is seen as children want their parents to recover as fast as possible, to get the necessary attention they require and quite often get frustrated when ignored in their assessments of the needs of their parents. Many of such children tend to hide their distress due to loyalty, shame, fear or stigma. Instead of manifesting their disturbance they may be withdrawn and be regarded as quiet and good. Evidence suggests that children born to parents with mental illness are not in any way exposed to risks of neglect, harm or delay in development just because of the illnesses of their parents. The degree to which such children may be affected is most likely to depend on the frequency of episodes and the severity of illness. In cases where parents may have an insight into their general condition, an integration of welfare agencies in their disease management could gain mileage. However, children also require long-term caring for their psychological and social well-being (Rutter and Quinton, 1984). The first relationship of an infant with the main care-giver, who in most cases is the mother, acts as guidance for further relationships and hugely determines the development of the adaptive capacities and the personality of the child. It has been cited that a father or mother who is emotionally present and available to respond to the needs of the child with warmth and sensitivity will definitely create a good platform for the child’s sense of self-esteem, identity, and emotional regulation hence resulting in formation of insecure attachment. Maternal illness in infancy may be a major cause of formation of insecure attachment that may result in difficulties of establishing future relationships. The exposure of the fetus to unfavourable conditions such as maternal stress and the negative effects of medication are linked to increased dangers of perinatal complications and behavior problems marked by diminished responsiveness and irritability during early infancy as mentioned by Barnes and Stein (2000). There is also strong evidence related to neuro-behavioural disruptions in children born to mothers who, during pregnancy are fond of using antidepressant medication, although no identification of long-term have been conclusively reached. Infants of parents with a mental ailment are at higher risk of medical challenges such as convulsive problems that includes injuries, convulsive disorders as well as increase in frequency of hospitalization (Teti, 1995). Lasting and significant cognitive deficits have been noted in children of parents who had depression in the initial year of life postpartum. Factors such as marital conflict and psychiatric illness may also contribute to the undesirable effects of postnatal depression. It has been suggested that depression may not have a direct impact on cognitive development, but high degree of vulnerability to the bad effects of gender and lower social class. In a study carried out by Hay et al. it came out that depression in mothers when their children are 3 months old continued to impact on the children later in life at about 11 years of age. The study also demonstrated that such children also have attentional problems and lower intelligence quotient. Boys have been found to be more affected compared to girls when it comes to performance IQ (VanDeMark, 2005).

Support strategies for assisting children of parents with mental illness

Addressing the fundamental needs of families in which one of the parents has a mental ailment calls for a change in the way most human and health service systems operate. Provision of care that is family centered is very essential. However, the current emphasis on managed care with limited time of treatment as well as narrow focus on management of symptoms do not augur well with treatment approach that should encompass the entire family. Treatment can only be effective when numerous systems can work together. For instance, institutions of learning should have the ability of providing more consultations on mental health to students, encourage peer counseling and support, and encourage social competencies. The child welfare system could significantly provide cross-training in child issues in relation to children with mental illness parents. Communities should therefore be encouraged to willingly invest in prenatal care as well as expansion of access to quality childcare so as to assist the many vulnerable children (Mullick, Miller and Jacobsen, 2001).

Alleviation of depression

There have been good reports concerning the relationship between mothers to infant psychotherapy in working with children of parents with mental illness. It has been evident that Evidence has emerged that it is important for the health workers such as clinicians to target maternal depressive symptoms in order to protect the child against negative outcomes associated with parental mental illness.

Psychotherapies for mothers and infants

Psychotherapy is principally based on numerous therapeutic approaches and theoretical orientations which encompasses family systems theory and attachment rheory. Several studies have shown positive results from group therapy undertakings involving mothers and their children carried out by a medical professional. According to Craig (2004) there is remarkable improved cognitive and attachment gains in children. They can be achieved when parents have continuous episodes of depression. Mothers have also been found to be less intrusive marked by an increase in maternal sensitivity up on receiving psychotherapy. Infants have also displayed a lot of cooperation.

Interaction guidance

Although the approach is independent of the insights achieved through therapy, it sufficiently make use of video feedback so as to encourage positive aspects between the interaction of the care-giver and the infant thus assist mentally ill parent to gain enjoyment and happiness from their children via experiences of interactive play experience. Interaction guidance as a form of treatment was ideally designed to reach families faced by multiple risks thereby improving maternal sensitivity. For example in the United Kingdom, health professionals have been adequately trained on the usage of ‘Care Index’.

Infant massage

The therapeutic significance of massage has been evaluated and recorded in various studies. It has been shown that it tremendously reduces anxiety and stress. Although there are many types of massage, even the simplest form of it may relay to the recipient an absolute feeling of care. Massage therefore comes in handy for children of parent with mental illness.

Several home or hosptital-based interventions that involve mothers and their children have been designed to thwart the negative effects of maternal depression on children as described by Field (1995). There are reports of positive results, which include the findings related to massage as preventative mechanism of intervention (Field, 1995). Such studies have also evaluated the benefits of massage to the infants, thus can lead to a more positive interaction behaviors, organized infant sleep patterns and more positive interaction behaviors, which are parameters that would in effect have a positive influence on the anxiety and stress levels of a depressed child.

Cognitive behavioral therapy

There have been mixed results in relation to cognitive behavioural therapy (CBT) with mentally ill parents and their children. However, a recent study conducted in Australia has shown high levels of improvement in the relationship indicators between maternal and infant mood at a one year follow-up using a properly instituted CBT program. Positive results from early intervention in the life of affected child may be related to research evidence that attachment is mostly disorganised when one of the parents suffer from depression. In relation to that, Barlow et al (2002) suggested that disorganised attachments are not permanent and therefore may change up on injection of sensitivity-focused interventions Identification of children born of parents with mental illness In order to help children whose parents are suffering from psychiatric problems, the first vital step is to positively identify them. Although it may prove difficult at first, the problem emanates from the medical practitioners as patients are not always asked about anything related to their children. Furthermore there is no recording into medical notes any information related to children. There is also no routine provision of facilities that can enable children to comfortably visit their parents in psychiatric hospitals. It is therefore harder without the help of health professionals to appropriately identify children whose parents are suffering from a disorder. Although there have been existence of good practice in some specific areas, there is still serious deficiencies. The effect of parental mental illness on children is routinely missing in the medical training and education, and even sensitive discussion about issues of parenting never touches on the topic. It has also been argued that parents as well as some medical professionals find it hard to discuss issues related to the mental illness of parents due to the stigma that surrounds it. As discussed by Paz, Jones and Byrne (2005), parents are therefore urged to feel comfortable divulging information about their problems to health officials when deemed appropriate. Overcoming the stigma and other associated challenges is very vital. The significance of appropriately identifying and consequently assisting such children is of greater benefit as opposed to the child alone. For instance, problems of child psychiatry may continue into later years of adulthood in some cases, hence the increase in health expenditure shows that basically the entire community must feel the impact.

Fathers and mothers with mental illness generally experience the same challenges as other adults or parents in their attempt to achieve and balance their noble roles as spouses, parents and bread winners. The repercussions of mental illness, however, may greatly inhibit their ability to perform their roles as well as impairing their parenting capacity. For example, when parents are depressed, they may have less emotional attachment and investment on the daily lives of their children. Consequently, communication between the child and parent may be impaired (Thomas and Kalucy, 2003). The severity of the mental illness of a parent as well as the extent of the symptoms may be a valuable predictor of the need for external assistance as opposed to diagnosis.In order to be effective, children support and intervention programs should be comprehensive, thereby addressing the whole family needs. Services should also be long-term in order to support such children until their primary needs are fully addressed (Howard, 2000).

Quality child care

Studies related to the specific effects of the type of care received by children of parents who suffer from mental health problems have not reached a conclusion. However, families and children languishing in abject poverty are similar in quite a number of ways compared to families having a parent with a mental disorder. What may be noted is that, both parties are parenting in compromised situations that may often include lack of safety and security at home and inadequacy of social networks. Although the rate of prevalence of mental disorder issues among such parents is not well known, it is estimated that over a third of families have cases of a parent with depression. Due to lack of more specific evidence, research carried out in relation to the effects of child care in populations with numerous problems has to be relied on. On the other hand, as a parameter of weighing the relevance of the findings, children receiving quality care displayed a lot of positive results. Royal College of Psychiatrists (2002) reviewed a host of family factors in relation to child care and concluded that evidence strongly lends support to the fact that experiences of quality child care have the potentiality of having stronger effects on children who may be at risk because of bad family environments.

Parenting programs

Barlow et al (2002) in their attempt to identify parenting performance as a main process that concerns the adaptation in relation to children of parents with mental problems suggested that a focus should be laid on improving parenting when intervention programs are being developed for such families. This would then provide space for high priority to the provision of relevant parenting programs for children of parents with mental disturbances. As summed up by many in the community, parenting programs can be of greater importance when considered in terms of the range of results. But the principle that should form the foundation of parenthood is quite the opposite amongst parents with mental illness. Such parents hold a different view of parenting as they view programs of parenting as totally inappropriate and irrelevant.

Conclusion  Maternal mental disorder can have a huge impact on the emotional, social, cognitive and behavioural development of children and to some extent their safety in the surrounding. The mechanisms that characterize mediation of the various effects are in fact complex and interrelated. Evidence have existed to show that such effects are exerted as a result of many factors that includes the genetical make-up, impaired interaction between the parent and the child, temperamental factors, direct effects of behaviour that are linked to maternal illness as well as socio-economic dispositions. Since the effect of maternal mental disorder on children may occur early in life, which can even begin before birth, it is imperative to identify and provide treatment to children at risk in earnest. This would help in ensuring the well-being of the child, mother and other members of the family so as to curb undesirable child outcomes. Despite the obvious challenges, quite a number of children of parents with mental disturbance do make it well in life in spite of environmental and genetic setbacks. Success is therefore directly related to the strengths and challenges that are present in a family thus the greater strengths and the lower the challenges, the greater the possibility of a child having success.

References

American Academy of Child and Adolescent Psychiatry. (May 2000). Children of Parents with Mental Illness. No. 39.

Barkla, J., Byrne, L., Hearle, J., Plant, K., Jenner, L. & McGrath, J. (2000). Pregnancy in women with psychotic disorders. Archives of Women’s Mental Health, 3, 1-4.

Barlow, J., Coren, E. & Stewart-Brown, S. (2002). Meta-analysis of the effectiveness of parenting programmes in improving maternal psychosocial health. British Journal of General Practice, 52, 223-233.

Barnes, J. & Stein, A. (2000). The effects of psychiatric and physical illness on children. In M. G. Gelder, J. J. Lopes-Ibor & N. C. Andreasen (Eds.), The New Oxford Textbook of Psychiatry. Oxford: Oxford University Press.

Craig, E. A., (2004). Parenting programs for women with mental illness who have young children: A review. Australian and New Zealand Journal of Psychiatry, 38, 923-928.

Field, T. (1995), Massage therapy for infants and children. Developmental and Behavioral Psychology. 1995 Apr; 16(2):105-11.

Mullick, M., Miller, L. J. & Jacobsen, T. (2001). Insight into mental illness and child maltreatment risk among mothers with major psychiatric disorders. Psychiatric Disorders, 52, 488-492.

Murray L. Howard
L (2000),Psychotic disorders and parenting-the relevance of patients’ children for general adult psychiatric services. Psychiatr Bull 2000; 24: 3246.

Paz, I., Jones, D. & Byrne, G. (2005). Child maltreatment, child protection and mental health. Current Opinion in Psychiatry, 18, 411-421.

Royal College of Psychiatrists (2002). Patients as parents: addressing the needs, including the safety, of children whose parents have mental illness. Council report CR105.London: RCP, 2002.

Rutter,M. & Quinton, D. (1984). Parental psychiatric disorder: Effects on children. PsychologicalMedicine, 14, 853-880.

Seneviratne, G., & Conroy, S. (2003). Parenting assessment in a psychiatric mother and baby unit. British Journal of Social Work, 33, 535-555.

Teti, D. M., Gelfland, D. M., Messinger, D. & Isabella, R. (1995). Maternal depression and the quality of early attachment: An examination of infants, preschoolers and their mothers. Developmental Psychology, 31, 364-376.

Thomas, L. & Kalucy, R. (2003). Parents with mental illness: Lacking motivation to parent. International. Journal of Mental Health Nursing, 12, 153.

VanDeMark, N. R., Russell, L. A., O’Keefe,M., Finkelstein, N., Chanson, D. N. & Gampel, J. C. (2005). Children of mothers with histories of substance abuse, mental illness, and trauma. Journal of Community Psychology, 33, 445-459.