Mental health

This overview identifies the most relevant research into the numbers and types of parental mental health problems in the UK, how these are identified and by whom, how accessible and acceptable are the services or interventions and what works in terms of outcomes.

What do we know about parents with mental health problems? Parental mental health problems affect the lives of parents, their children, their wider family and ultimately society. There has been much research in recent years about the link between different, often interlinking factors and the impact on outcomes. Factors such as the type of mental health problems, the parents' or children's age, sex, additional health problems, ethnicity, marital status, social exclusion, discrimination, coping and parenting skills have all been identified, but we know much less about how many parents with mental health problems there are, or about how they and their families are identified and supported. This recent overview identifies the most relevant research into the numbers and types of parental mental health problems in the UK, how these are identified and by whom, how accessible and acceptable are the services or interventions and what works in terms of outcomes.

How many parents in the UK have mental health problems? Approximately one in 10 non-elderly women and one in 20 non-elderly men are parents of dependent children and have mental health problems, and at least one in four adults in contact with mental health services is a parent. As many as 25% of children between the ages of five and 16 have a mother who is at risk for a common mental health problem such as depression or anxiety. In an average primary school class this means six or seven children living with a mother with a mental health problem and this will be an even higher proportion where children are living with lone mothers who are more at risk.Most parents have common mental disorders such as depression or anxiety, but a very small proportion (0.5 per cent or fewer) have a psychotic disorder such as schizophrenia. However, of this small number of adults with psychotic conditions over a quarter live with children as couples or lone parents. The evidence also shows that as many as 25% of adults in acute psychiatric hospital settings, and possibly more, are parents.Overall more women than men have mental health problems, more younger women rather than older women and more lone parents than those in couples have mental health problems. Lone parenthood, particularly among women, seems to be a risk factor for mental health problems, but is often associated with socio-economic disadvantage and the interaction of other risk factors.Patterns of mental health problems among black and minority ethnic communities are difficult to pick out and interpret, but it is unlikely that the number of parents from minority communities with mental health problems will be any lower. However there is some suggestion that adults in some BME communities are reluctant to identify themselves as having mental health problems.

How well are parental mental health problems identified and addressed? The conclusion from the research is that professionals who work with adults are probably not very good at identifying parents with mental health problems or their children and this is particularly so among those who work with adults in health care settings. In contrast, those used to working with children, whether in mental health care or in general children and families services, seem to be better at picking up and responding to parental mental health problems. Those who work with parents and families in deprived conditions should be aware that they are likely to be dealing with a higher than average proportion of parents with mental health problems.Several factors influence whether professionals look for and identify parental mental health problems. Firstly, for those who work mainly with children, or outside mental health services, this is about their expertise or lack of it, in adult mental health, whereas for those who work mainly with adults it is about their expertise in relation to children. Secondly, professionals who work with adults with mental health problems often view their role as adult focused only, whether or not he or she is a parent. Thirdly, those working in primary care settings say that lack of time for proper consultation with parents is a barrier to identifying and then working with their mental health problems.At the same time both parents and children worry that if they reveal mental health problems or parenting stresses it could escalate into the child protection arena so that, even when they really need help, they see disclosure as a potentially high risk move.These same concerns can influence whether parents take up the offers of help, needing to feel sure that this is a way of avoiding rather than precipitating child protection proceedings.However where parents or children have an ongoing relationship with someone they trust they are far more willing to admit to problems and to talk about their difficulties without feeling so anxious about being judged or that their children will be removed.

How easy is it for parents to access and engage with services? Once identified it is clear that in many cases parents with mental health problems fall through the net and their needs are not met. Services often fail to work holistically with families; poor collaboration and service coordination, together with confusion over professional roles and responsibilities, make the difficulties worse.The parents' own priorities and what they want to see happen are often ignored and they are not asked for their perceptions about the cause of their mental distress. Where their mental health problem is not too severe or at crisis point, there are often other, more pressing needs which the family wants to deal with. For some parents, offers of support and treatment for mental health problems do not seem be as relevant as alleviating their poor social or financial circumstances. To add to this professionals are not always sensitive to the complicated and chaotic lives some families lead.Multi-disciplinary teams that cut across traditional service or agency boundaries and which allow professionals to understand and draw on each other's expertise, seem to offer a better way of ensuring that both adults and their children have access to acceptable support.

What works? The impact on parental depression or depressive symptoms: Some studies suggest that cognitive-based interventions may reduce depressive symptoms in mothers, but it may simply be the attention that causes the improvement.When cognitive behavioural therapy is compared against other treatment methods or no intervention at all, it appears to have no significant effect on depression in mothers whose children have behavioural problems. A mother and toddler club or a family focused intervention seems to be just as effective in helping depressed mothers.Another trial suggests that delivering psychiatric and psychotherapeutic care for depressed mothers while their children were with them in an in-patient setting, might actually impede their progress towards recovery. The impact on children's mental health: One trial of cognitive behavioural therapy for the children of depressed parents who were themselves at risk for depression showed some improvement to their overall mental health and a reduced risk of depression in the future, but once again it is impossible to know whether this is due to the intervention itself or simply to giving the children some form of attention. Another trial for children already over the clinical threshold for depression, suggested that cognitive behavioural therapy had no effect over and above normal care, which could include other forms of mental health input. The impact on children's behaviour: The trials that measured changes in child behaviour did not show up any difference between children in the treatment groups or in the control groups. Other trials, targeted at depressed mothers of children who had behaviour problems, compared cognitive behavioural therapy alongside other intervention methods and, again, the behaviour of children in the intervention groups improved no more than that of children in the control groups. Nor does cognitive behavioural therapy appear to have had an effect on child behaviour when used with children of depressed parents, who were themselves depressed or 'at risk' for depression. The impact on parenting: There is some suggestion that an intervention for depressive symptoms, together with a parenting programme, may improve aspects of mothers' parenting behaviour, but this is a still a tentative conclusion.Overall there is some evidence of improved outcomes for parents with mental health problems and their children, but little to separate the use of cognitive behaviour therapy with other interventions including family support approaches, and in many cases although the interventions were associated with changes for the better, there is little to indicate that of themselves they caused these changes._______________________________ References: Professor Gillian Parker et al, Research Reviews on prevalence, detection and interventions in parental mental health and child welfare: Summary report 2008 Social Policy Research Unit, York The Family Welfare Association has published a 'before and after' evaluation of its Building Bridges model of support targeted at families affected by parental mental health problems (Morris, 2007).See also: