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These questions and answers are drawn from our research, years of providing services and training workshops, and our own experiences. We are parents with children who range from infants to thirty-something. We have grandchildren. We have lived with mental illness and substance abuse in our own families. We have dealt with divorce and stepfamily issues, chronic and terminal illnesses, hospitalizations, children with special needs, and elderly parents. Everyone's situation is different, so we'd like to hear from you.
Send us your parenting questions or suggest alternative answers. We cannot respond to individual questions, but will review them for themes and post questions and answers of general interest to ParentingWell® web site users. This site does not provide medical advice.

I am a mother with depression. Sometimes I am simply overwhelmed by the stresses of daily life. What can I do? Dealing with parenting and household demands, not to mention work, school, and other demands, is stressful for every parent. Decide what the priorities are for your family, and then decide what you can accomplish and what you can delegate to others. Try to make time in your week for yourself, and seek out support from friends and family whenever you can.

Should I talk with my children about my mental illness? What should I say? Communicating with your children about the experience of mental illness will allow you to have open and honest conversations, while providing opportunities to educate them about the facts and myths. Family members can be involved in formulating a plan of action for support and intervention to help you stay on an even keel, or for additional support should your symptoms worsen. You may be concerned that talking about your illness may be experienced as a "burden" by your children, may trigger their fears of inheriting mental illness, or add to the stigma that may be associated with having a family member with mental illness. However, the truth, presented at a level that fits children's developmental ages and stages, can help alleviate their worries.

When I'm depressed, I'm "down" about everything- the world and everything in it seems gray. How can I stay positive with my children? Focus on your own strengths and on your child or teenager's strengths. This can help you, depressed or otherwise, focus on the positive with your children. One way you can start is by acknowledging and praising the things your children do well. Look for ways to maximize your their opportunities to succeed. Try to have interactions that both your children and you can feel good about.

I worry that my mental illness is part of every interaction I have with my children. How can I focus on the positive with my children when I feel bad so much of the time? Start by focusing on your own positive qualities and your strengths as a parent. This can be hard when you're feeling depressed, for example, but we believe all parents can identify at least 2 or 3 things they do really well. Recognizing your own strengths can help you, depressed or otherwise, be more upbeat with your own children. Acknowledge and praise the things your children do well, too.

Should I worry that my client, who is depressed, will abuse her child? There are no data on the percent of parents with depression who abuse or neglect their children. A diagnosis of mental illness alone does not tell you whether a parent will be abusive or neglectful. Ask your client about her daily activities. Get a clear picture of how well she functions as a parent. Corroborate her report, if possible, by talking with other family members or helping professionals who know her, e.g., a supportive partner, school teacher or pediatrician. Question your assumptions, and form an opinion based on actual knowledge of your client's current functioning and the resources and supports available to her and her family.

My client, a mother with mental illness, is resistant and non-compliant with my treatment recommendations. What should I do? There are many reasons why parents with mental illness may appear resistant or non-compliant. Some are afraid that, if they reveal too much, particularly regarding their concerns about parenting or their children, their children will be taken from them - perhaps by a child welfare worker or an angry ex-partner. Many have had negative experiences with previous providers, who have made the worst assumptions about them as parents with mental illness without asking the right questions. Parents may not follow a treatment regime that conflicts with the demands of parenting. For example, parents may not take medications that make them lethargic in the morning if they have to get up to fix breakfast and send their children off to school. A mother with mental illness may miss an appointment or "resist" a necessary hospitalization if she has no babysitter. You may be able to make accommodations to overcome these obstacles and engage parents in treatment. Your work must be informed by knowledge and understanding of your client's family roles and goals.

How do I go about setting up a support group for parents with depression at my agency? First, it is important that staff and parents work collaboratively, with parents involved in all decision-making about the support group including its procedures, operation and organization. It is a good idea to develop a Parent Support Group Advisory Board to engage community stakeholders, such as case managers, child welfare workers, and representatives from advocacy organizations, as well as parents and family members in the work of the support group. Finally, be mindful of logistical issues that are critical to parents and families by scheduling meetings around "parent hours" and providing child care or transportation when needed.

Parenting can be an emotionally charged subject. How can I make sure that the support group stays grounded and doesn't get too overwhelming for parents? Parents need to know that strong emotional responses are perfectly natural and should be expected, since parenting concerns hit very close to home. Try to focus the support group on parenting issues and solutions, their goals and progress towards those goals. Let parents know they do not have to share their personal experiences if they are not comfortable doing so. They have the right to have their confidentiality respected by the group.

How many people with mental illness are parents? The number of adults with mental illness who are parents is likely to be in the millions. Research indicates that 68% of women and 55% of men who experience a mental illness during their lifetime are parents. Therefore, persons having experienced a mental illness at some point in their lives are more likely than not to be parents.

How do State Mental Health Authorities (SMHAs) respond to parents with mental illness? Less than one-quarter of SMHAs (24%) formally identify adult clients as parents. Just over one-fourth of SMHAs (27%) have services or programs for adult clients who are parents, while only four SMHAs (8%) have written policies or practice guidelines regarding adult SMHA clients who are parents.

What is the impact of federal programs and policies on parents with mental illness? No existing federal programs or policies explicitly consider the circumstances of adults with mental illness as parents. However, many have the potential to affect the lives of adults and children living with parental mental illness. Relevant programs and policies for families living with parental mental illness may include Medicaid, Community Mental Health Services Block Grants, the Adoption and Safe Families Act, the Americans with Disabilities Act, the Personal Responsibility and Work Opportunity Reconciliation Act, and various Children's Health and Early Intervention programs.

What is known about parents with mental illness in the private sector? We know nothing about the prevalence of parents with mental illness receiving services in the private sector, nor about parents who are undiagnosed or not receiving treatment. Research on parental mental illness has been conducted primarily in the public mental health sector, and primarily with mothers.

What about fathers with mental illness? While we can now say, drawing on data from the National Comorbidity Survey, that the majority of men who experience mental illness in their lifetimes are fathers, there have been very few studies of their experiences, or the impact of their illness on their children. Fifty-five percent of men meeting criteria for diagnoses in the nonaffective psychosis category (includes schizophrenia, schizoaffective disorder, and other psychotic disorders) are fathers (Nicholson, Biebel, Katz-Leavy, & Williams, 2004).

How many parents with mental illness lose custody of their children? According to the research literature, which is based on smaller-scale studies conducted in treatment settings, custody loss rates may be as high as 70% to 80% (Joseph et al., 1999; Mowbray et al., 1995). Nuances of custody, living situations, and care giving arrangements make asking the right questions essential. Rather than simply asking whether an adult with mental illness is a parent, or whether he or she has custody of children, ask specific questions about whether an adult has ever given birth to a child; where the child is living; who provides care for the child; and the frequency and nature of the parent's contact with the child. Parents with mental illness may have step-children, or adopted and foster children as well. Our experience is that parents with mental illness are much more likely to define themselves as parents than as patients.

Are adults with mental illness, with extended social networks, more likely to have positive parenting experiences? Not necessarily. There are positive and negative aspects to family relationships. Family members may be a primary source of support, or experienced as undermining and disempowering by parents with mental illness. Be sure to investigate the quality or valence of social networks, as well as their depth and breadth. There are likely ethnic and racial variations in care giving and patterns of social support as well. As most studies have been cross-sectional, it is not clear whether mothers with better social networks are more likely to retain custody of children, or whether caring for children provides increased opportunity for social networks to develop (White et al., 1995; Nicholson et al., 2001).

What does the research tell us about the impact of parental mental illness on children? Two decades of research indicate that children who have a parent with mental illness are at a greater risk for the development of psychosocial problems. (See Nicholson et al., 2008 for additional references.) The research on child outcomes has been limited in several ways. Most studies focus on mothers with a diagnosis of depression. Our understanding of the process of risk and resilience in children is limited with respect to other parental diagnoses. The pathways between parental psychiatric disorder and child outcomes involve multiple mediating and moderating processes. This means there are many ways to intervene and improve outcomes for children.

Where can I find funding for my research? We have been successful in obtaining funding from federal, state, and local sources. Check the web pages of the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration, and the National Institute on Disability and Rehabilitation Research for funding announcements. State mental health and child welfare funds may support the development of interventions for testing in research studies. Local foundations may provide funds to conduct a small pilot study or write an intervention manual.

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