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Monday, July 25, 2011

Mental Health and Child Protection

A new report from Australia helps to highlight the connection between mental health issues and child protection. This is an important topic, as anyone working directly with cases will know how frequently the connection exists. The report is titled, "Keeping the child in mind: Child protection practice and parental mental health" makes an important point - It is not the presence of the mental illness that matters but the impact that it has on parenting. Practitioners will know that there are many cases where parents with mental illness still manage to provide at least good enough parenting. The same can be said with those suffering chronic physical illnesses.

As well, practitioners must also pay attention to what supports exist that can remediate the impact of the illness.

The authors sum up the parenting point quite well stating, "Parental diagnosis of mental illness alone is not sufficient to cause problems for the child and family. Rather, it is how the illness affects the parent’s behaviour and familial relationships that may cause risk to a child. The age of onset, severity and duration of the parents’ mental illness, the degree of stress in the family resulting from the parents’ illness, and most importantly, the extent to which the parents’ symptoms interfere with positive parenting, such as their ability to show interest in their children, all influence the level of risk." (p.10).

A fundamental question is what is the impact on the child in areas such as attachment, development and their own mental health. Will they be required to assume responsibilities beyond their capacity which may also include looking after the ill parent?

Mental health may also be episodic meaning that children can have experiences that vacillate between rather good parenting to neglectful or abusive. Their world may be quite unpredictable. This illustrates the need for good assessment and attempts to ensure parents are connected to ongoing services. Their insight might be impaired by the mental health issues resulting in challenges with cooperation between the parent and child protection.

The implications for parenting capacity assessments are noted on p. 12, "In their view, parenting capacity assessments need to be comprehensive and based on:
• an acknowledgement of the family’s strengths
• child-parent observations in natural settings over a period of time, recognising the often episodic nature of mental illness
• linkage of specific qualities and functional aspects of parental behaviour with protective or risk factors for the child
• a multi-method, multi-source approach that includes, where possible, information from mental health professionals who are familiar with the parent’s mental health status."

A good assessment matters as mental health issues, which include substance abuse, require treatment that is a good match with the parent and the issues. Resource availability can, of course, limit the best choices but understanding what they should be helps to develop the best plan. These can be challenging cases to work when the mental illness is at its height as resistance and poor insight are common. This is partially why so many of these cases result in some period of time in foster care for the children. Good resources and supports that reduce the frequency and intensity of the symptoms will reduce entry into foster care - a benefit for the children! Of course, that requires parental willingness which may be its own challenge.

This research highlights the specific challenges of Borderline Personality Disorder as one illness that presents often in child protection populations. "Recent research has emphasised the relationship between borderline personality disorder and early childhood trauma and adversity and suggests that the core features associated with this disorder will have an immediate impact on parenting, compromising the promotion of attachment security and healthy child development. Parents with borderline personality are ‘high risk’ parents, who, as this study has demonstrated, are likely to be over-represented in child protection services. Children of mothers with borderline personality disorder present with various clinical syndromes and types of emotional disturbance (Newman and Stevenson 2005:386). There are significant community and public health implications if the needs of these parents remain unaddressed – borderline personality disorder can impact on parenting and on the child over time and across generations.'(p.44). Treatment can often be long and resources limited for BPD patients.

The report also highlights the need for inter agency cooperation - a theme that we have seen often in child death inquiries, for example.

Reference:

Jeffrey, H., Rogers, N. & Hirte, C. (2011). Keeping the child in mind: child protection practice and parental mental health. South Australia: Department of Families and Communities. Downloaded 2011/06/25 from http://www.dfc.sa.gov.au/pub/LinkClick.aspx?fileticket=ec1nlu8xxAo%3d&tabid=607

2 comments:

  1. As an adult child of a bipolar mother I can agree that the implications of a mentally ill parent on the emotional development of a child is far reaching into adulthood. I often find myself struggling with many issues which I am certain stem from my relationship with my mother. I see traits in my personality which mirror the experiences I had as a young child - taking care of myself and often my mother, being preoccupied by the emotional needs of my mother, being preoccupied at school and worrying about the situation at home... these translate into hypercontrolling behavior and a mild obsession with searching for stability in my life (which manifests itself in anxiety surrounding finances, housing and material goods). I have strong concerns that I will face serious mental health challenges as I get over, but as I am becoming a more independent adult I am seeing these anxious tendencies to become less pressing when I am away from my mother and more forward when I have stressful situations with her. I would love to have a conversation with someone who understands this link to help me better understand my own situation.

    - A former student of Dr. Choate

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