Families with parental mental illness : supporting children in psychiatric and social services

Sammanfattning: Children living with a parent with a mental illness can face difficulties. Parental mental illness may influence the parents’ ability to cope with family life, where the parents’ awareness of their illness plays an important role. Family interventions provided by psychiatric and children’s social care services can be a way to support these children, making them feel less burdened, and improving the relationships within the family. The aim of this thesis was to illuminate how children in families with a parent with a mental illness are supported in psychiatric and social services, especially by means of family interventions, and how families experience the support. Study I explored how professionals in adult psychiatric outpatient services deal with children and families when a parent has a mental illness. The findings showed that professionals balanced between establishing, and maintaining, a relationship with the patient and fulfilling the legal obligations towards the patient’s children. Asking the patient about their children could be experienced as intrusive, and involving the patient’s family in the treatment could be seen as a dilemma, in relation to the patient. Efforts were made to enhance the family perspective, and when the patient’s family and children joined the treatment this required flexibility from the professional. Study II examined how professionals in children’s social care services experience working with children and families when a parent has a mental illness. The social workers’ objective was to identify the needs of the children. No specific attention was paid to families with parental mental illness; they were supported in the same way as other families. When the parental mental illness became difficult to handle both for the parent and the social worker, the latter had to set the child’s needs aside in order to support the parent. Interagency collaboration seemed like a successful way to support these families, but difficult to achieve. Study III investigated if patients in psychiatric services that are also parents of underage children, are provided with child-focused interventions or involved in interagency collaboration between psychiatric and social services and child and adolescent psychiatry. The findings showed that only 12.9% of the patients registered as parents in Psykiatri Skåne had registered children under the age of 18 years. One fourth of these patients had been provided with child-focused interventions in psychiatric service, and 13% of them were involved in interagency collaboration. If a patient received child-focused interventions from the psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention. Study IV explored how parents and their underage children who were supported with family interventions experienced these interventions. The results showed that parents experiencing mental illness were eager to find support in explaining to and talking with their children about their mental illness, although the support from the psychiatric service varied. Both children and other family members appreciated being invited to family interventions. After such an intervention, they experienced the atmosphere in the family as less strained and found it easier to communicate with each other about difficulties. Unfortunately, the participating partners felt that they were left without support specifically targeted at them. The thesis showed that there is a gap between how professionals deal with questions concerning these families and their support, and the parents’ and the families’ needs to receive support in handling the parental mental illness in the family. The psychiatric and social services need to expand their approach and work with the whole family, in order to meet the needs of the child and other family members involved.