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Parental Psychiatric Disorder
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Book description

'A unique and innovative approach to family issues in psychiatric disorders. The authors tackle a broad range of complex issues that are rarely covered in the depth or with the expertise that this volume brings. This book is a major contribution to the field and provides the kind of international perspective that enhances our understanding of the complex dimensions of psychiatric disorders from a multigenerational and cross-cultural perspective.' From a review of the first edition by Carol Nadelson, Professor of Psychiatry, Harvard Medical School. It is indisputable that mental illness in a parent has serious and often adverse effects on the child, something which is surprisingly unreflected in clinical service provision. In this completely rewritten second edition, an international, multidisciplinary team of professionals review the most up-to-date treatment interventions from a practical, clinical point of view. It is essential reading for all professionals dealing with adult mental illness and child-care.

Reviews

‘A unique and innovative approach to family issues in psychiatric disorders. The authors tackle a broad range of complex issues that are rarely covered in the depth or with the expertise that this volume brings. This book is a major contribution to the field and provides the kind of international perspective that enhances our understanding of the complex dimensions of psychiatric disorders from a multigenerational and cross-cultural perspective.’

Carol Nadelson - Harvard Medical School

‘Over the past two decades, the needs of the informal carers of mentally ill people have been accorded increasing recognition. By contrast, the needs of children of the mentally ill have been sadly neglected. A personal account by such a child, now grown up, expresses this poignantly: ‘Being denied the necessary adult attention left me with the feeling that I did not deserve it, as if I had no right to ask to be cared for.’ This book is a timely and successful attempt to redress this neglect. It is an authoritative compilation which covers a wide range of adult disorders and their impact on children, and is both informative and practical.’

Julian Leff - Institute of Psychiatry, London

‘A welcome pioneer in the area of adult mental illness in the context of parenthood. It brings a wide range of scholarship and perspectives to bear on a hitherto much neglected subject … The scope of the work, covering as it does both general systemic and specific biological developmental and social issues, together with the careful referencing of corroborative studies should make it an important text for students of both child and adult psychiatry as well as community mental health.’

Freda Martin - the Hincks Centre for Children’s Mental Health, Toronto

‘The book is accessible. The chapters are short, and mostly include case studies … I highly recommend this book to CPNs and other professionals looking after the adult mentally ill and their children.’

Source: Mental Health Nursing

‘… it has a great deal to commend it.’

Source: Community Care

‘This book is an excellent example of international teamwork. It brings home the message about how our current approach towards mental illness needs to change … It is very empathetically written … It is a job well-done as it stimulates the reader to think developmentally. It will be the harbinger for future research in this field.’

Source: Doody’s Notes

‘This book is of vital importance to all psychiatrists at different subspecialties and general practitioners that deal with psychiatric patients who are members of a family, and it is of great interest to mental health services planners. I believe this book is a very good buy.’

Source: Saudi Medical Journal

‘This book presents a balanced, expert source of knowledge of prevention and treatment. The impressive list of contributors of different fields of mental health, as well asn the presence of the voice of the users is a powerful model of what could be achieved, without dismissing the work and effort needed to effect such changes. It is a very valuable tool for all those involved in the care of the psychiatric patients and their children.’

Source: Infant and Child Development

‘This is a thoroughly researched textbook but at the same time a carefully and passionately argued call for change.’

Source: Journal of Psychological Medicine

'This book is valuable for all professions that deal with parents who suffer from mental disorders. … this book covers a wide range of relevant topics compiled from a multidisciplinary team of 32 authors and publishers from various countries.'

Source: Journal of Psychosomatic Research

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Contents


Page 1 of 2


  • 1 - What we want from adult psychiatrists and their colleagues: ‘Telling it like it is’
    pp 3-7
  • View abstract

    Summary

    In November 1999 a small group of young people involved with Barnardos Action with Young Carers (AWYC) were invited to take part in a conference launching the report 'Keeping the Family in Mind'. The project provides a service for children and young people who live with someone with a mental health problem, many of whom take on caring roles and responsibilities. All of the young people who participated care for a parent with mental ill health and receive support from staff at the AWYC's project. They have some very important messages for professionals and policy makers. These messages reinforce the view that the direct involvement of service users and their children is essential to improve the quality and range of support to families living with mental ill health. But what they highlight is the need for more fundamental changes of attitude and approach from services.
  • 2 - Parenthood and adult mental health
    pp 8-21
  • View abstract

    Summary

    In many systems of mental health service provision, the identity of the patient as a parent does not receive sufficient recognition. This is true irrespective of the patient's diagnosis or type of service provided and, therefore, clearly reflects deficiencies of service design, training and professional role identity. It is with this consideration in mind that this chapter outlines the role of the psychiatrist and highlights pertinent issues that arise when a patient is a parent. The role of the psychiatrist attending adult patients is, first and foremost, to assess the complaint the patient presents and make a provisional diagnosis. The psychiatrist then rules out other possible diagnoses, considers comorbidities, and initiates a treatment plan. Parenthood, like race or gender, brings with it a whole host of beliefs and activates many of our basic assumptions. The psychiatrist therefore has a particular responsibility to examine those assumptions.
  • 3 - Parental psychiatric disorder and the developing child
    pp 22-49
  • View abstract

    Summary

    This chapter explains how mental illness affects parenting and influences the development of children. It talks about abuse and neglect, the effects of separation and the risk of mental health problems in children. Large numbers of children grow up with a mentally ill parent. A study of parental psychiatric histories of 850 twin pairs in Virginia found that only 26% of families had no lifetime history of psychiatric disorder in either parent. The chapter outlines a developmental framework to help understand the interrelationship of risk variables in the development of the child, the emergence of disturbance and its modification. Clinically, this framework may assist with the developmental assessment of children. The effects of social disadvantage are discussed. The catalogue of risks for children of mentally ill parents described in the chapter emphasizes the need for skilful coordination of professionals involved with both the parents and the children.
  • 4 - Parental psychiatric disorder and the attachment relationship
    pp 50-61
    • By Jonathan Hill, Royal Liverpool Children's Hospital, Liverpool, UK
  • View abstract

    Summary

    Consideration of the attachment of children to parents leads to some indicators of the parental contribution to the attachment relationship, and to ways in which this might be threatened by parental mental illness, and what might be protective processes in the face of such threats. In considering the relationship of psychiatric disturbance, parenting and attachment one needs to take account of the context of the parental disorder. First, the factors that have contributed to the risk of parental psychiatric disorder may also directly impinge on the parent-child relationship, and hence on attachment processes. Second, the parental psychiatric disorder together with associated risks may undermine aspects of parent-child attachment. Third, the disorder itself, independently of other factors, may adversely affect attachment. Finally, the parent's capacity to preserve the sensitive and effective responses may be protective in the face of their psychiatric disorder.
  • 5 - The construction of parenting and its context
    pp 62-84
  • View abstract

    Summary

    This chapter aims to clarify the term 'parenting' as a social role within a culturally determined social construction. It provides tools for the formulation of parenting and for the understanding of the complex interface between psychiatric disorder and parenting in the context of mental health services and of family/community. The chapter uses the role-relationship paradigm as a framework for understanding parenting across the spectrum of care. The role-relationship model facilitates an understanding of both the internal/personal and the social aspects of the parenting role, their interface with one another and with the role of the helping professional. Early role experiences are internalized, and form the backbone of personality development. Other frameworks of psychological understanding provide important contributions to a formulation of the parent-child relationship, and parenting difficulties. The task of assessing parenting capacity requires a holistic view.
  • 6 - ‘The same as they treat everybody else’
    pp 87-92
    • By Vicki Cowling, Maroondah Hospital CAMHS, Victoria, Australia
  • View abstract

    Summary

    Parents want professionals to treat them 'the same as everybody else'. They want professionals to see them as parents before they see them as patients, and for services to acknowledge their family relationships and responsibilities, and credit them with the capacity to act in their children's best interests. The 19 parents who contributed to this chapter come from four parent groups in Australia, Canada and the USA. They were approached through the coordinators of the parent groups, and asked about the need for services to respond to their needs as parent, and the way for the services to respond to the issues that affect their families and children. The chapter coordinates their responses, often reproduced verbatim. Having agreed to participate, each group met for 1.5 hours, and their responses are summarized. They reflect different experiences of interventions such as having their children removed from their care.
  • 7 - Formulation and assessment of parenting
    pp 93-111
  • View abstract

    Summary

    This chapter presents a framework for assessing parents and their families for both forensic and clinical purposes, and helps to ensure that children receive the best care available. It outlines principles that contribute to ethical assessment practice; provides dimensions to consider when making a formulation; and offers ideas about the preparation of court reports. The chapter describes practical ways of conducting collaborative and therapeutic assessments. Depending on resources, philosophy, culture, and service construction, there are wide regional disparities in the conduct of assessments. In most situations, staff from different disciplines contribute to the overall assessment and child-care social workers have the responsibility of coordinating perspectives from different agencies and, ultimately, ensuring the safety of the child. A partnership approach emphasizing the joint responsibility between staff and patients works well in the therapeutic community model of treatment for personality-disordered people.
  • 8 - Mentally ill mothers in the parenting role: clinical management and treatment
    pp 112-122
  • View abstract

    Summary

    Intervening to alleviate parenting problems in mothers with major psychiatric disorders is recognized as a challenge to mental health providers. This chapter provides an overview of clinical services and treatments that address serious parenting problems in mothers with major mental illness. Hospitalization in the postpartum period disrupts the developing mother-infant attachment bond, and may undermine mother's confidence in her ability to care for her infant. Parenting coaching and skills training can be helpful interventions, especially for those mothers who did not experience effective role models in childhood, or those who lack knowledge about specific parenting behaviours. Parenting groups provide a mother with help in learning better parenting skills. The Parent's Clinic at the University of Illinois specializes in mothers with chronic mental illnesses. The parent-infant psychotherapy is based on the notion that parents may re-enact with their young child conflicts with their own attachment figures that remain unresolved.
  • 9 - Perinatal mental illness: nature/nurture
    pp 123-138
    • By Gertrude Seneviratne, Institute of Psychiatry, University of London, London, UK, Sue Conroy, Institute of Psychiatry, University of London, London, UK
  • View abstract

    Summary

    This chapter explores how childbirth can contribute to the onset or exacerbation of psychiatric disorder, and discusses the relative contributions of aetiological factors, including biological, environmental and psychosocial factors. Women with mental health problems, unless supports are in place, will have difficulties in caring for their babies. These difficulties may result directly from the mother's illness, from secondary mother-child separations owing to early and recurrent hospitalizations, or from marital problems. Psychiatric disorders associated with childbirth are traditionally divided into three categories, reflecting severity: maternity blues, postnatal depression (PND) and postpartum psychosis. A survey of services for mentally ill mothers and their infants in the UK concluded that there were 'few comprehensive services with specialist knowledge of the impact of mental illness on the baby and older siblings, as well as on the infant's father'. The chapter presents a case example, which illustrates a number of aspects of a perinatal service.
  • 10 - Assessment and treatment issues when parents have personality disorders
    pp 139-158
    • By Eia Asen, Marlborough Family Service, London, UK, Heiner Schuff, Marlborough Family Service, London, UK
  • View abstract

    Summary

    Many disturbed parents referred for parenting assessments do not present with acute mental illness, but with severe, emotionally unstable, borderline personality disorders. 'Child centred' views of the problem(s) see the child as the 'victim' of adult psychopathology or mental illness. This usually contrasts with the parents' perceptions that it is the child which is the main 'site' requiring treatment. Many parents with psychological disturbance are likely to focus on the child if only to manage their own distress. Furthermore, it is not uncommon that the partner of a disturbed parent colludes by making the child the prime concern and thereby the 'patient' who requires treatment. Assessments which test how the family and its individual members respond to change-inducing interventions permit informed decision making. The assessment of parenting capacity consists of putting together a whole variety of pieces of information gained from different levels of the larger system.
  • 11 - Schizophrenia and motherhood
    pp 161-171
    • By Mary V. Seeman, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
  • View abstract

    Summary

    This chapter addresses the questions: how many women with schizophrenia become parents, and how many actually bring up their children. In other words, what are the dimensions of the potential problems that the conjunction of motherhood and schizophrenia poses. The chapter answers what is the subjective experience of these mothers, how important is the parenting role to them as individuals and how do they perceive the assistance they receive in fulfilling that role. It examines what determines parenting capacity and how and when should assessments be done and what are the mental health outcomes in children of mothers with schizophrenia, whether reared with or reared away from their mothers. The chapter addresses what is the subjective experience of these children, and does schizophrenia impact differently at stages of a child's life and/or at different phases of the mother's illness. It inspects how psychiatric services can best assist mothers with schizophrenia.
  • 12 - When a parent suffers from an affective disorder: effect on the child
    pp 172-184
  • View abstract

    Summary

    Some of the evidence that parental depression has adverse effects on children comes from studies where one or sometimes both parents have bipolar disorders, which is a vastly different picture from a more typical postnatal depression, treated, or as often not treated, in the community. If both partners are depressed they are not available to offer support to each other, and the risk to children increases, with neither parent available to compensate for the difficulties of the other. Poor interaction and maternal depression are not coterminous although they do overlap to a degree. Treatment for postnatal depression is effective, but the needs of the child require special attention and only in rare cases are infant mental health services developed. Effective intervention for parents and children requires the co-ordination of primary and secondary care services across the age range, in combinations that may lie outside the usual multidisciplinary boundaries.
  • 13 - Alcohol and drug problems in parents: an overview of the impact on children and implications for practice
    pp 185-202
    • By Richard Velleman, Mental Health Research and Development Unit, University of Bath, Bath, UK
  • View abstract

    Summary

    The structure and functioning of the family as a system of relationships is affected by alcohol and drug problems. A particularly important area is the impact of drug and alcohol problems on children. The effects on children occur in three stages: during childhood, adolescence and adulthood. There appear to be three linked factors which underlie the process through which parental problem drinking and drug taking affect children. There are large effects on family functioning: serious disruptions in family roles, family rituals, family routines, family communication systems, family social life and family finances. The need for more designated and confidential services aimed at children is self-evident. Agencies dealing with alcohol or drug problems should be given the resources to make their services available to any family members affected by another's alcohol or drug use.
  • 14 - When mothers abuse drugs
    pp 203-216
  • View abstract

    Summary

    Children whose mothers abuse illicit drugs are at risk for developmental problems. During middle childhood and adolescence, they show high levels of delinquency and other conduct problems as well as internalizing problems such as depression and anxiety. A variety of factors may place children of substance abusers at risk. Most public attention has focused on the possible adverse effects of prenatal exposure to drugs on the developing brain. This chapter reviews what is known about the parenting of women who abuse drugs. It examines some of the correlates of parental care by women who abuse drugs. The chapter discusses the clinical implications of findings. If women who abuse illicit drugs are to become effective parents to their children, substance-abuse treatment is essential. That treatment, however, must address the special needs of women, including support for parenting and mental health problems.
  • 15 - Personality disorder in parents: developmental perspectives and intervention
    pp 217-238
  • View abstract

    Summary

    Both personality disorder (PD) and parental inability to meet children's needs have their origins, at least in part, in the quality of early experiences. This chapter uses two theoretical frameworks, attachment theory and role relationships, to examine the concept of PD, and how/why PD interferes with 'good enough' parenting. These frameworks are used to describe implications for assessment and therapeutic interventions. This includes use of alternative care provision for children within the public sector. Within the high-risk environment of the 'PD' family unit lies a substantial proportion of the next generation of parents with PD. There are compelling reasons for better identification, assessment and management of such parents and their children. Improved collaboration between adult and child services could reduce the proportion of children who will go on to develop PD in adulthood and who struggle in the transition to parenthood.
  • 16 - Psychopharmacology and motherhood
    pp 241-248
  • View abstract

    Summary

    One of the most difficult decisions for women suffering from a chronic or recurrent illness is whether or not to continue taking maintenance medications during pregnancy. As with nonpsychiatric disorders, pregnancy may either ameliorate or worsen pre-existing symptoms of illness. For instance, the rate and severity of depression appear to be similar in pregnant and nonpregnant women but panic disorder improves in pregnancy. As the treatment of psychiatric disease improves, more women with psychiatric conditions will become pregnant. The pros and cons of psychotropic drugs in breast-feeding women with mental illness are complicated by the fact that essentially all psychiatric disorders worsen in the postpartum period. Effective treatment at this vulnerable time is essential. Untreated illness in new mothers could lead to hospitalization and mother-child separation, deleterious for both. The pregnant mother needs to be carefully monitored and nonpharmacological treatments are to be preferred whenever possible.
  • 17 - Social work issues
    pp 249-256
    • By David Clodman, Centre for Addiction and Mental Health, Toronto, Canada
  • View abstract

    Summary

    This chapter is written from the perspective of a mental health social worker serving women diagnosed with schizophrenia. Clinic participants come from varying backgrounds and present with a range of needs and experiences. They vary in their awareness of the degree to which mental illness has compromised their ability to perform adequately as parents. The connection between acknowledgement of illness, adherence to a medication regime, participation in a treatment programme and maintenance of child custody is self-evident to some and not at all to others. The author works in collaboration with child welfare agencies but, as the case vignette of Linda presented in the chapter illustrates, the goals of the two systems, child welfare and adult mental health, differ. Social workers are caught between their allegiances to systems. Recommendations for bridging the differences and integrating the systems are provided.
  • 18 - Parental psychiatric disorder and the law: the American case
    pp 257-270
  • View abstract

    Summary

    The legal rights of parents with mental illness in the United States vary from state to state. This chapter examines the current federal and state laws in the United States regarding termination of parental rights, custody and visitation in cases involving a parent with mental illness. It provides recommendations for attorneys and advocates who are working with mentally ill parents. Recent studies have indicated that parents who are diagnosed with a mental illness too often lose custody of their children, either to another party or to the state. One study found that 70-80% of parents with mental illness lost custody of their children. Practitioners must keep in mind that cases involving children are the most emotional cases, and assisting parents with maintaining contact and a continued relationship with their child is a much-needed service.
  • 19 - Parenting and mental illness. Legal frameworks and issues – some international comparisons
    pp 271-284
    • By Amy Weir, Children and Family Services, London Borough of Harrow, London, UK
  • View abstract

    Summary

    This chapter explores the legal frameworks which may apply to families affected by mental illness from a UK and an international perspective. In most countries legal frameworks have been established to regulate the relationship between the individual, the family and the state. In particular, the safeguarding of children's welfare is covered by legal provision to ensure that children's needs are met and that they are safely cared for. In the UK and elsewhere, there is also provision to support families and parents to care for their children, whenever this is possible. As far as mentally ill parents are concerned, there is also separate legal provision to safeguard and support their needs. The evidence from comparing the legal frameworks in several different countries shows how similarities in legal provision mean that families will experience the same level of, or nature of, service to support them.
  • 20 - The child grown up: ‘on being and becoming mindless’: a personal account
    pp 287-291
  • View abstract

    Summary

    In this chapter, the author shares her experience of growing up within a disturbed family. She felt trapped and overwhelmed by the emotional weight of her parents clinging to her, too physically close. Her answer to all of this, as a teenager, was to overdose. The two overdoses that she took were serious, and as she looks at it now, she feels that she was lucky to survive. With the help of long-term psychotherapy she was beginning to find herself and to feel for herself. Being denied the necessary adult attention left her with the feeling that she did not deserve it, as if she had no right to ask to be cared for. She now works with disturbed children and their families, where they still meet children who have been struggling unnoticed with one or both parents suffering from a mental illness.

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