Supporting families of parents with mental illness in general practice

Michaela J Baulderstone, Bradley S Morgan and Elizabeth A Fudge
Med J Aust 2013; 199 (3): S11-S13. || doi: 10.5694/mja11.11146
Published online: 29 October 2013

This is a republished version of an article previously published in MJA Open

Children of parents with mental illness have an elevated risk of psychological problems.1 Associated risk factors include genetic predisposition, the parent’s difficulties in fulfilling a parenting role due to the illness and/or treatments, social isolation, emotional distance or hostility, poverty, conflict between parents, and a chaotic family life.2 Children’s risks can be mitigated by protective factors such as the positive influence of a mentally healthy caregiver and the provision of interventions to reduce the negative factors impacting on the child.1

The number of parents with a mental illness is substantial.3 However, the identification and provision of support to these families is challenging. Identified barriers include low rates of help-seeking for mental illness,4 parents not disclosing their caregiving responsibilities due to the perceived stigma of mental illness,5,6 and lack of insight by parents into the impacts of their illness on their children.7

Many Australians who seek professional support for mental illness approach their general practitioner.4,8 Therefore, GPs are in a prime position to assist patients and their families. Similarly, when parents seek help for their child, the GP can opportunistically discuss parenting challenges and the possibility of associated mental health difficulties.

The parent’s diagnosis and severity of illness are poor predictors of the potential impact on children — more significant is how the illness affects the parent’s behaviour and relationship with his or her child.9 The child’s current age and needs, and his or her age at onset of the parent’s problems play a significant role.2 Parenting responsibilities may also affect the mental health of the parents.10 Therefore, considering the family as a whole can both promote the parent’s recovery and the child’s resilience.1

What can the GP do?

A key theme in these case studies is that of the child “lost” among the stress of parents dealing with their own issues. A useful therapeutic approach to support these families is presented in detail below and summarised in the Box.

Enhance insight without increasing stigma

Better outcomes for the child begin with assisting parents to understand the impact of their mental health on their parenting, and the impact of parenting on their mental health.12 Parents need support to explore these links, and it is important that acceptance of mental health problems by an individual is linked with a positive sense of self or it can result in internalised stigma (“I’m so useless; I’m even ruining my kid’s life!”). The goal is for parents to recognise their illness, and its potential impact on others, without feeling disempowered, blamed or worthless. Encouraging parents to seek support and information for their health (and for their parenting if necessary) not only assists the child but also strengthens the parent’s motivation for recovery.13 A recent study found that as a parent’s understanding of mental illness develops, feelings of guilt and shame decrease and children report less anxiety.14 Therefore, the GP can:

For example, in case study 2, Tom and Diane learnt to recognise the influence of Tom’s depression on Adam’s behaviour and were praised for seeking help. Insight and affirmation were combined with strategies for strengthening Tom’s key role in Adam’s life, and Tom started kicking a footy with Adam in the evenings again. Later, when Tom’s illness prevented him from identifying further small positive steps, the focus shifted to managing Tom’s depression while ensuring that Diane and Adam accessed their own supports during this time.

New parents, new challenges

Exploring mental health issues in the perinatal period, and providing quality advice and care if problems are detected, can reap long-term benefits for children and their families.15 In addition, assessing any potential risk to the child of neglect or abuse, and arranging for supports to be put in place, is a useful prevention strategy. In extreme circumstances (eg, a parent with a long-term psychotic illness, who is not responding well to medication), arrangements may need to be made for the child to be temporarily removed from the immediate care of the parent. In such circumstances, don’t be afraid to ask pregnant mothers what they want for their child when it is born. The parent with insight is often relieved and grateful to know that a safety net can be put in place in the event that they become very unwell.

Stories, play and role models as tools

GPs can encourage parents to talk with their child about parental mental illness and highlight opportunities for communication and reflection that are present in everyday activities, such as storytelling and play. Storybooks, such as the classic Dr Suess’ My many colored days, can assist the parent and child to explore and reflect on emotions together in the comforting and nurturing zone of storytime. When promoting the use of books and play, it is important that the GP highlights that each child is different, so parents can confidently be guided by their knowledge of their own child’s language and favourite ways of interacting. Some examples GPs can share with parents include:

Does the child love to talk things over? Jade and Anne used to have a “special chat” every afternoon before Elise was born. When Anne re-established this activity, Jade’s behaviour improved dramatically. A teenage child might prefer talking to his or her parent in the car or on a walk around the block for “one-on-one” time.

Does the child prefer sitting quietly and drawing? Ask the child to draw a picture of his or her most and least favourite things and reflect on these pictures with their parent. The older child may prefer to write a story about another child in a similar situation or start a diary.

Is the child a little superhero who loves saving the day? Talk about how even superheroes get sick and time helps them recover. For an older active child, drawing on sporting figures the child identifies with can be invaluable.


The general-practice setting provides opportunities to identify and support families when a parent has a mental illness. GPs can support these families by promoting treatment for the parent, providing information on parental mental illness to family members, and encouraging family communication about parental mental illness. Small positive steps, derived from and planned by the family, can be initiated under the guidance of the GP, who can closely monitor and encourage their progress. Gradually, larger and more far-reaching goals can be planned, and the GP can facilitate access to specialist services, preventive interventions and social supports.

Provenance: Commissioned; externally peer reviewed.

  • Michaela J Baulderstone1
  • Bradley S Morgan2
  • Elizabeth A Fudge2

  • 1 Torrens House Parenting Unit, Child and Family Health Service, Women’s and Children’s Health Network, Adelaide, SA.
  • 2 Children of Parents with a Mental Illness national initiative, Adelaide, SA.


Acknowledgement: We thank Michael Farrall for his writing and editorial contribution and Andrew Tobin for his editorial assistance.

Competing interests:

No relevant disclosures.

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