Critical Issues for Parents with Mental Illness and their Families

Chapter VIII

Steps for Stakeholders: A Consumer-Researcher's Perspective
Lawrence Stier, Research Assistant

Stakeholders have a unique opportunity to promote positive outcomes for parents with mental illness and their families. It is crucial that people on the receiving end of services and policies - parents and their families, inform this process. Parents can speak best to their needs and the needs of their children. Below are steps that all stakeholders must consider when thinking about the issues of parents with mental illness and their children.

Identify Adults with Mental Illness who are Parents. Are you a parent? This question should be asked of all adults with mental illness. Presently there is no standardized method of state or national data collection on the parenting status of adult clients with a psychiatric diagnosis. In addition, the limited data currently available are usually collected only on female clients. We often fail to recognize that male clients are parents too.

Identifying clients as parents and providing necessary supports can enhance parenting skills, bring a family together, and often assist in a client's recovery. Information should be collected on men and women in the public and private sectors. Questions should be asked that not only identify a client as a parent, but also identify the specific service needs of that parent. This data will show the variety of custodial issues and parenting concerns a parent may be facing.

Recognize the Strengths of Parents. Parents may not be aware of the strengths they bring to the parental role, choosing instead to dwell on the negative. It is important to recognize that all parents struggle with issues relating to raising children. In some cases they may feel they are failing as a parent. The question is how to help parents become aware of their strengths. Recognition of the hard work involved in raising children is important. Emphasizing strengths in parenting skills and acknowledging successes give parents a feeling of pride in their accomplishments. Any parent can identify with the enormous amount of time and energy that is expended raising a family.

Battle the Stigma of Mental Illness. In general, it seems that society feels that a person with mental illness should not be a parent, i.e., that a person with mental illness is incapable of raising and caring for a child. But in many cases, the exact opposite is true. Family unity is a key factor in treatment planning for both parents and children and can often accelerate recovery and improve outcomes for parents and children. Except in cases where a child's safety or welfare may be jeopardized, a person with mental illness should be allowed the opportunity to parent his or her children, and raise a family.

Attend to Custody and Visitation Issues. Parents who will be appearing in court, to retain or obtain custody of their children, should be supported in preparing, and should be encouraged to have a wellness plan in place. How they appear in court, how they take care of themselves, and what they are doing or plan to do to care for their children is their responsibility. If parents temporarily lose custody, they should request a time line for regularly scheduled evaluation or progress reports to determine their capabilities as a custodial parent. Should they lose custody of their children, they should request that this not be permanent. Parents and their advocates should outline a treatment or service plan that includes regaining custody as one of the plan's objectives. This plan should be available to all parties involved so everyone is aware of what actions parents intend to take to regain custody.

Non-custodial parents may have a limited visitation schedule. Parents are often unsure of how to fully utilize visitation time with their children. Parents are concerned about "What is the best activity to fill this visit?" and "How do I entertain my children on a limited income?" Attention must be paid to how parents cope with their feelings about seeing their children on a limited basis when they want to, and may need to, spend more time with their sons and daughters.

How separation affects children must also be considered. Children separated from a parent may feel abandoned, seeing their parent only occasionally or not at all. In some cases there are no provisions for child visitation. When children do visit mental health facilities, there are usually restrictions on where visits can take place and for how long. Cheerful and safe areas should be provided in all mental health facilities for family visitation. For many children this may be the only avenue to seeing and knowing their parents.

Attend to Termination of Parental Rights Issues. A person with mental illness may have his or her parental rights terminated. This can result in parents feeling inadequate, and that they have lost contact with their children forever. Careful consideration needs to be given to whether the termination of parental rights is really in the best interest of a child. If the child is adopted, the prospect of open adoption should be considered. If a parent's rights are terminated, parents will need a forum to deal with feelings and concerns. A peer-to-peer, parent support group, possibly organized by service providers, could provide a low cost forum for custodial and non-custodial parents to talk about their experiences. This would provide a safe environment for parents to ask questions. A parent support group run by parents allows parents the opportunity to share difficulties they may be having, and to see how other parents have handled similar situations.

Attend to the Legal Issues of Parents. Parents need help with legal representation, which should be available on a low cost, or no-cost basis, if necessary. Attorneys sensitive to the issues and rights of persons with mental illness must be available. Emphasis should be placed on the need to keep families together, and the reunification of divided families.

Provide Supports for Children of Parents with Mental Illness. Children of parents with mental illness experience a variety of difficult emotions and life experiences, and may encounter many barriers to "normal" living. Much like adults, children experience feelings of guilt, blame and shame. These feelings may be amplified in children, who are less likely to realize which feelings are based in fact, and which are products of the stigma associated with having a parent with mental illness. A child may feel her actions and conversations could trigger, or even be responsible for her parent's relapse. Children may be hesitant to bring home friends or talk about their parents' illnesses.

Where do children discuss the feelings they have about dealing with a parent with mental illness? How do children understand what their mother or father is going through? Why parents act the way they do? How do children explain their family situation to their peers? Should the process of dealing with these feelings and questions be limited to therapy sessions with a provider whom they may never trust sufficiently? A forum for these children is needed.

A support group similar to Alateen could help children answer these questions. The group's agenda would be specific to children of parents with mental illness. Groups should be age sensitive; older children may understand and cope with feelings differently than younger children. Traditional counseling sessions do not necessarily afford children the opportunity to process their true feelings about parents' mental illnesses.

Educate Professionals to the Needs of Parents. There should be a major effort to educate mental health workers, the court system, and the legal community about the needs of parents with mental illness. Dollars should be allocated to programs instructing parents in parenting skills and providing parent support. Support programs are also needed for non-custodial parents. In most cases, these should be two separate groups since the feelings and problems of a custodial parent and non-custodial parent can differ greatly.

Stakeholders must be educated about conditions that can exist in a parent-child relationship. Clients must be supported when struggling with parental rights issues, and be consoled if there is a loss of these rights. Support must be provided for both custodial and non-custodial parents. Becoming sensitive to the issues of being a parent with mental illness will strengthen the bond between advocate and client.

Peer Supports for Parents. Raising children can be very stressful. A psychiatric diagnosis can make parenting more difficult, and sometimes parents can feel overwhelmed. Parents may be concerned about the emotional or behavioral problems of their children. Parents may have issues regarding child rearing, visitation and custody -- questions that are often difficult to discuss with professionals from the adult mental health or child welfare system. Parents may feel frustrated, and sometimes angry, when they do not understand the important issues raised by child welfare workers related to their children. Parents with mental illness can become discouraged. They are often unable to find a voice regarding their needs as parents. Difficulties in parenting can be addressed by providing support groups and parenting training. These services, provided at a minimal cost, may be all that is required to alleviate most problems. Answers can be suggested and evaluated to aid parents in making difficult decisions.

A national parenting network with an 800 number and web site should be established. This would allow a parent access to parental support and information on a 24-hour-a-day basis. This parenting network could be used by any parent, but would be most useful to the parent with a mental illness. Chat rooms could be set up to discuss concerns. A parent could ask for help and direction during a crisis, such as having an ill child. All parents can appreciate the need for contact with other parents who can identify with a difficult situation.

Parenting as a Policy Priority. Federal and state policy makers should place the issues of parents high on their agenda. Legislation should be passed to ensure a parent his or her parental rights, giving parents with mental illness the same rights as any other parent. Currently, several states have policies whereby parental rights termination proceedings can be initiated based simply on a parent's psychiatric diagnosis. Policy makers need to realize that having a mental illness does not mean that a person is incapable of being a good parent, or of having a fulfilling and rewarding family life. In many cases, a family environment is better for raising a child then foster care or alternate living arrangements. Family unity can also aid the client's recovery since child-parent separation is often a cause for increased stress, anxiety, fear, and depression.

Coordinate Services for Parents. Agencies and service providers working with parents and their families need to communicate with each other. While privacy and confidentiality regulations must be respected, most parents want the coordination and may be willing to grant release of information if they see a clear benefit for themselves or their children. Coordination across agency boundaries should facilitate the provision of more appropriate services in a more cost-effective fashion. Priority should be placed on keeping families together and reuniting divided families. Family unity should be a priority in making decisions in both the child welfare and adult mental health care arenas.

Parents with mental illness must seek support and legislation to guarantee their parental rights. Service providers should provide supports through parent education and skills training. Parents should insist on the coordination of services between child and adult service agencies, which should prioritize keeping families together while providing a family-friendly and safe environment. A parent must voice his or her needs and concerns in order to be a good parent. If these needs are not met, parents with mental illness can never achieve family unity and the goal of good parenting may be beyond their reach.

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