Key messages from international research evidence. Prof Colette McAuley Chair of Social Work University of Bradford.

1. Professor Colette McAuley
Chair of Social Work University of Bradford
9th BASPCAN Congress 12-15 April 2015 Edinburgh

2.  Parental mental illness-prevalence
 Parental mental illness, parenting capacity and
child abuse/neglect
 Factors associated with better child outcomes
 The impact of parental mental illness on
children’s development
 Listening to children in the general population
about what affects their well-being
 Listening to children in families experiencing
difficulties
 What children and young people want from
services

3. It is estimated that
 between 30-68% adults with a mental illness in the UK have
dependent children
 there are between 50,000 to 200,000 children and young people
in the UK caring for a parent with a severe mental illness (Mental
Health Foundation 2010)
Moreover
 many studies report the rates of mental illness for mothers only
 there is much less evidence regarding fathers and male carers
This means that
 prevalence amongst parents generally is likely to be
underestimated;
 there is little knowledge about the impact of fathers’ mental
health on child development
 the number of children living with both parents with mental
illness is likely to be greater than currently known

4.  Mental health difficulties can impact on a person’s
daily functioning in a number of different ways
 In some cases, it can influence a person’s ability to
parent their child
 Some (but not all) parents may need support to meet
their child’s needs
 In extreme cases, it can contribute to a parent
abusing/neglecting their child or putting their
children in a situation where they are abused by
someone else
 The majority of parents who experience mental
illness do not neglect or harm their children simply as
a consequence of the disorder

5.  Children are more vulnerable to abuse and
neglect when parental mental illness coexists
with other problems such as substance misuse,
domestic violence or childhood abuse
 The impact of parental problems such as mental
illness, substance misuse, domestic violence and
learning disability on children’s welfare has been
repeatedly highlighted in English child protection
research studies (DH 1995) and Serious Case
Reviews (Rose and Barnes 2008; Brandon et al
2009; 2010; 2012)
 This is consistent with findings from Australia,
Ireland and the USA.

6.  The issue of co-occurrence and its association
with child abuse/neglect has been particularly
highlighted in more recent research from both
the UK and Australia
 The impact of such parental problems on
children’s development has become a core
element of SW training in the UK and beyond
 Understanding of child development itself been
been highlighted in Serious Case Reviews as a
key area for improvement in professional
training. This is currently being addressed in SW
training.

7. We have considerable research evidence on the factors
which are associated with better child outcomes:
Parent/family factors
 when the parental mental health difficulty is mild in
nature and short in duration
 parents are more aware of the mental health difficulty
and more willing to seek support/treatment
 there is a secure and reliable family base
 they are living in a two parent family
Worse outcomes are associated with living in one-
parent families or when both parents are dealing with
mental health difficulties

8. Child factors
 children are older at onset
 children have strong coping strategies and
are able to adapt to stress
 children who develop an understanding of
their parent’s mental health difficulties as
something outside their representation of the
parent as an attachment figure

9. Societal factors
 Availability of other support/attachment
figures
 Higher socio-economic status
 Having access to preventative services eg
after school care, child and adolescent
services and preventative programmes

10.  Likely to be multiple risk and protective factors
influencing whether a child is at risk
 An accumulation of risk factors can produce a
negative outcome
 Children are at greater risk if their parent has a
mental health difficulty in conjunction with low
socio-economic status, a substance abuse
problem, domestic violence and/or intellectual
disability
 Whilst not every child living with these family
problems is at risk, practitioners need to be
aware of the different factors and their interplay
and consider carefully when undertaking an
assessment of needs

12.  Recent research has collated what we know
about the child’s needs at different
developmental stages
 Alongside this, they have considered the
impact of parental behaviours such as
parental mental illness on their capacity to
meet the child’s needs at each stage
 Any assessment would also consider the
wider family and environmental context
 Some examples:

13. Parents may be less attentive to the
baby’s health needs and unable to
complete basic care or keep routine
health checks
The baby’s cognitive development may
be affected because interaction between
mother and baby is reduced
A consistent lack of warmth and
negative responses may result in the
infant/child becoming insecurely
attached
The relationship between parents
and babies may be affected if the
parents’ behaviour is inconsistent or
they are emotionally unavailable

14. Children may have an increased risk
of heath problems due to missed
school medicals
Children may not attend school or on
time or schooling may be disrupted
due to unplanned moves
Children may have a more negative
self-image and/or suffer from low
self-esteem
Children may be fearful and anxious
about their parents’ behaviour
and/or display behavioural problems
Inconsistent and unexpected parental
behaviour may cause attachment
problems.
Children may be expected to assume
too much responsibility for
themselves and siblings

15. Adolescents may have to cope with
puberty without support
Parents may be unable to attend
school events or encourage learning
at home
Adolescents may exhibit behaviour
problems and emotional
disturbances
Adolescents may feel responsible for
their parent’s difficulties and suffer
low self-esteem
Young people’s friendships may be
restricted due to their parents’
unreliable behaviour.

16.  A crucial part of any assessment is listening to
the children
 Children’s subjective well-being and the factors
which affect it are the subject of increasing
international interest ( see Child Indicators
Research Special Issue Nov 2012)
 We know from quantitative surveys with children
in the general population that relationships with
family, positive relationships with friends and
experience of being bullied had respectively the
first, second and third highest effect on their
subjective well-being (Goswami 2011)

17.  We know from qualitative interviews with children
in the general population that close family
relationships are very important to children and
that they are characterised by a sense of trust
related to availability and shared activities.
 ‘Best friends’ provided both companionship and
emotional support and the children
demonstrated agency in the choice of friends and
when/what they would do together n their ‘own
time’
 Peer bullying was a predominant issue in the
lives of most children
 Friends were seen as a strong protective factor
(McAuley, McKeown and Merriman 2012)

18. Review of UK studies (1990-2003) where children views of living in families
where there are issues of domestic violence, parental mental health difficulties
or substance misuse Gorin (2004)
 Children were more aware of the problems than parents realise
 Some parental behaviours left them feeling confused and frightened, the
most distressing being violence and conflict
 The unpredictability of parents’ moods and behaviour compounded this
I’m frightened to leave her in case she goes into a fit or something.
When we were little…she got really down and started taking overdoses
and that really scared us…when she’s really down she says I’m going to
take an overdose…I’m frightened to leave her
(Newton and Becker 1996 p 25 cited in Gorin 2004)
It’s not just the caring that affects you…What really gets you is the
worry of it all, having a parent who is ill and seeing them in such a
state…of course it’s upsetting, you think about it a lot. Someone who
is close to you and desperately ill is pretty hard to deal with
(Frank 1995 p42 cited in Gorin 2004)

19.  Feelings of insecurity and living in an unsafe environment can
impact on their school lives-poor concentration, missed days, home
and school moves
 Friendships can be a source of support but making and maintaining
them can be very difficult for children in these circumstances leaving
them isolated
 The stigma and secrecy associated with violent addictive behaviours
and associated chaotic impoverished lifestyles can perpetuate their
sadness and isolation and affect children’s self-esteem
 Likely to be the target of bullying
They (local youths)… used to bully us, well they used to bully
me. And hit and punch me and everything…and they would go
‘At least I haven’t a mental dad or something’
(Aldridge and Becker 2003 p 81 cited in Gorin 2004)

20.  Children’s relations with their families are often
complex. They may have very close relationships
with their parents and a strong sense of love and
loyalty towards them
 Often torn between that and feelings of anger, hurt
, resentment and embarrassment
 They may worry about their parents, both in
relation to their parents’ safety or ability to look
after themselves
 Often they are in a parental role.

21.  Children in the same house may react
differently and can have different experiences
within the same family
 Children who take on the role of carers of
parents with physical and mental health
problems may miss out on opportunities to
mix with peers and may miss out on school
 School staff may not be sufficiently aware of a
particular child’s situation to provide support
or make allowances

22.  Some children will find it very hard to talk to
anyone about their problems
 Reasons-fear of the consequences of telling,
fear of not being believed, not feeling anyone
could help, sense of shame and stigma
 They want someone they can trust, who will
listen, provide reassurance and confidentiality
 They will seek informal support as main
means of accessing help-wider family,
siblings, friends or pets

23.  Children do not always know where to go for
help-advertise where young people gather
 Often favour contacting helplines initially to
obtain control, remain anonymous and are
available outside office hours when crises
may occur-ensure helplines provide
information on wider support available

24. They appreciate professionals who:
 avoid jargon
 listen or talk directly to them
 ask them for their views
 provide age-appropriate information (verbal
and written) which explains what is going on
in their family
Often they want:
 some time from problems in home and
 the chance to get to know other children in
similar situations

25. Aldgate, J. et al (2006) The Developing World of the Child. London:
Jessica Kingsley Publishers.
Brandon et al (2012) New Lessons from Serious Case Reviews: A Two
Year Report for 2009-2011. London: Department for Education.
Bromfield, L., Lamont, A., Parker, R., & Horsfall, B. (2010). Parenting
and child abuse & neglect in families with multiple and complex
problems. Child Abuse Prevention Issues, 33
Cleaver, H. et al (2011) Children’s Needs-Parenting Capacity. Child
Abuse: Parental Mental Illness, Learning Disability, Substance Misuse
and Domestic Violence. Second Edition. London: The Stationery Office
Davies, C. and Ward,H. (2012) Safeguarding Children Across Services:
Messages from Research. London: Jessica Kingsley Publishers.
DH (1995) Child Protection: Messages From Research. London: HMSO.
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26. Department of Health, Department for Education and Employment and
Home Office (2000) Framework for the Assessment of Children in Need and
their Families. London: The Stationery Office.
Gorin, S. Understanding What Children Say: Children’s Experiences of
Domestic Violence, Parental Substance Misuse and Parental Health
Problems. London: National Children’s Bureau.
Goswami (2011) Social Relationships and Childen’s Subjective Well-Being.
Social Indicators Research 3, 575-588.
McAuley, C. et al (2006) Enhancing the Well-Being of Children Through
Effective Interventions: International Evidence for Practice. London: Jessica
Kingsley Publishers.
McAuley, C., McKeown, C. and Merriman, B (2012) Spending Time with
Family and Friends: Children’s Views on Relationships and Shared
activities.’ Child Indicators Research 5 (3) 449-467.
McAuley, C. et al (forthcoming) A Review of International Literature on
Child Protection. Dublin: Irish Research Council/Department of Children
and Youth Affairs
Rose and Barnes (2008) Improving Safeguarding Practice. London: DCSF.