WITH a little help: Supporting children whose parents have mental illness

WITH (Well-being In The Home) is an information resource, accessible at exa.mn/WithProject for the up to 20% of children/young people whose parents struggle with their mental health either occasionally or daily. The plight of these young people is often not spoken about – they can in fact be ‘forgotten children’.

The WITH video clips currently online deal with illnesses including depression, anxiety and alcohol/substance misuse and, within the next few weeks, further clips will be added – on psychosis, personality disorders and bipolar affective disorder.

Dr Sharyn Byrne, a senior clinical psychologist on the South Mayo CAMHS team is WITH project lead. She explains that the psycho-educative tool prioritises the young person’s self-care, so that they mind themselves in what can be an extremely distressing life situation.

“The theme throughout is: ‘you are not responsible for your parent’s depression, anxiety or mental illness. It is your parent’s responsibility to seek support and help. It’s not your responsibility to make mum or dad well’.”

Byrne says research proves that information is protective for young people experiencing parental mental illness.

She points to the words of Alan Cooklin, the British-based psychiatrist and campaigner for children whose parents have mental illness: ‘Equipping [children] with greater knowledge and understanding of their parent’s illness is a significant factor in promoting their resilience.’

Byrne says information helps young people understand what it is they’re experiencing and that they’re not the cause of their parent’s problem. It increases the young person’s resilience, it prevents them from internalising the distress and it reduces vulnerability to developing emotional/mental health distress themselves.

With the Covid-19 storm raging on, Byrne says everybody’s survival limbic system is activated now.

“Our brains are naturally a bit more chemically frightened than they’d normally be. There’s nobody in Ireland whose limbic system isn’t activated. But imagine if you add onto that parental mental health distress? For some young people at the moment, Covid-19 is increasing their exposure to that distress,” says Byrne, adding that children’s – and parents’ – usual protective factors are gone.

“Access to a social life, to extra-curricular activity, to exercise and educational advancement are practically eliminated. These are all protective, resilience-promoting factors. And for parents who struggle with mental health, their access to services is curtailed.”

All of these outlets, as well as opportunities for mindful reflection (whether it’s time out in a café or 20 minutes in the gym), she says, would have had a chemical effect on keeping the brain calm.

And Covid-19 is likely to be making the mental health struggles themselves worse.

“If you have a parent who experiences OCD for example, where there’s fear of contamination, can you imagine the level of distress at the moment?

We all share each other’s energy space and, if the energy space is distressed and very frightened, the child is more in it now than in the non-Covid-19 situation. Our children look to us to gauge their safety and if we don’t feel safe, our children can’t – it’s not neurologically possible.

Pointing out that there’s nobody with a mental health disorder, who doesn’t have some sort of trauma in their lives, she says Covid-19 is causing international trauma – with increased helplessness, uncertainty and fear – which is affecting how all of our brains are currently functioning.

“Having these experiences can reactivate previous experiences of trauma, which may be particularly pertinent to people with mental health difficulties. So at all levels, this group is terribly vulnerable right now.

"All the more reason why the WITH online resource is vital right now, helping children/young people put meaning on their parents’ mental health distress – so that a child knows, for example, that ‘mum’s irritated because she’s depressed. She’s not cross with me. I haven’t done anything wrong. I’m still good. Mum’s struggling because of how she feels’.

"That’s the health-promoting gap – between Mum’s own illness/her responsibility and the child who didn’t cause mum’s suffering – that the kind of information on WITH can create."

Through her work, Byrne has heard children and young people talk about how parental mental ill-health impacts on them.

"Children whose parents have depression confide: ‘Half the time, he doesn’t even realise I’m here’ or ‘She gets so angry, so cross, so quickly’. With personality disorder, they describe their parent as ‘all over the shop’ – one minute they seem fine, the next they’re shouting.

“One nine-year-old with a parent with extreme paranoia would see their dad each night setting up a metal sheet under the handles of the front and back doors and putting a line of coins on the handles, so he’d know if anyone tried to break in,” recalls Byrne.

This level of unsafety, felt by the parent, can have profound effects on the child.

“To safely attach to the world, we need to be able to safely attach to our parent first – from there we’re willing to explore the world. When the child experiences a high level of un-safety, there’s reduced intention to explore the world.”

For children whose parents have bipolar affective disorder, the goalposts regularly change.

“There’s no consistent message of who Dad is, who Mum is. It changes so rapidly. So there can be no safety, because one of the major components of safety is consistency.”

Byrne says some of the inspiration for WITH came out of an inter-agency project led by adult mental health social worker Vincent McHugh, which was completed in 2016 and with which she was involved.

It involved a series of focus groups with parents, at that time attending mental health services.

“Parents told us they found it really difficult to talk to children about their own mental health without causing fear. Only one parent out of six was aware of a resource to help her talk to her children about her depression.

“Parents have shown – even in the worst of mental health situations – that they’ve done their utmost to provide for their children in as much as their health allowed them. And when parents regain wellness, there are massive opportunities for repair and safety-forming attachments and attunement.”

The WITH project is a South Mayo CAMHS initiative in collaboration with Mindspace Mayo and members of youth groups, and is funded by Department of Children and Youth Affairs. It has been shortlisted for the HSE 2020 Excellence Awards and won the Community Safety category of Mayo Garda Youth Awards 2019.

Parental mental illness and its effect on children is like the elephant in the room.

“It’s taking chunks out of everybody but nobody’s talking about it. It’s stampeding people emotionally, but they don’t know what the elephant is,” says Byrne.

WITH, she says, is about naming the elephant in the room.

• International figures suggest 68% of women and 57% of men with mental health difficulties are parents.
• Up to 20% of children/young people have parents who struggle with their mental health.
• It’s often not spoken about and these children can be ‘forgotten children’.
• Research shows information can be protective, increase the young person’s resilience and reduce vulnerability to developing emotional and mental health distress themselves.

WITH can be accessed on Youtube here

Information about mental health is also available here at www2.hse.ie/mental-health