Parental mental health problems

Impact of parental mental health problems

Many parents with mental health problems are able to manage their condition and minimise its impact on their children, particularly if they are able to access appropriate support. But sometimes it does affect their ability to cope with family life.

Parental mental health problems may affect children differently according to the severity and type of mental health condition, the child’s age and stage of development, and the child’s personality.

Coping with challenges

Some parents experience mental health problems along with other challenges such as:

• divorce or separation
• unemployment
• financial hardship
• poor housing
• discrimination
• a lack of social support
• domestic abuse
• substance misuse.

If they are facing several challenges at once, it can be very hard for parents to provide their children with safe and loving care, particularly if they are isolated or aren't getting the support they need (Cleaver, Unell and Aldgate, 2011; Gatsou et al, 2017; Grove, Reupert and Maybery, 2015; Hogg, 2013; Wolpert et al, 2015).

Research has found there is a greater risk to children’s safety if parents with mental health problems are also experiencing domestic abuse or substance misuse (Cleaver, Unell and Aldgate, 2011).

Caring for children

Some parents and carers with mental health problems may need support to cope with the routines of daily life, such as housework, mealtimes, bedtimes, taking children to school, and taking children to medical and dental appointments.

They may also find it more difficult to:

• control their mood and emotions around their children
• recognise and respond to children's physical and emotional needs
• engage socially with their children
• set and maintain safe and appropriate boundaries and manage their children's behaviour.

If parents don't get the support they need from family, friends, neighbours and/or professionals, these challenges may escalate. In extreme cases, children may experience abuse and/or neglect.

Babies and younger children

Babies and young children rely on their parents and carers to give them the warm, nurturing care they need to grow.

If parents experience mental health problems in pregnancy or the first year of a baby’s life, this can affect the way they are able to bond with and care for their child. This can have an impact on the child’s intellectual, emotional, social and psychological development (Gajos and Beaver, 2017; Hogg, 2013).

This means it’s important that practitioners are able to recognise if a new parent or carer is struggling with their mental health and help them access appropriate support.

Children’s wellbeing

Many children whose parents have a mental health problem do not experience any negative effects. But if parents are not getting the right support to care for their family, this can have an impact on their children's wellbeing.

Signs that a child might need extra support include:

• being worried about their parent or carer’s condition
• taking on a caring role for parents and other family members
• putting the needs of their family above their own
• having negative feelings about their parent’s condition
• finding it hard to make friends, feeling isolated or being bullied
• not feeling able to talk to their parents or another trusted adult about their worries.

"My parents aren't having a good time. They both have mental health problems and anger issues. They are so aggressive and spark each other off.  I have been scared about something bad happening for a while. My parents don't seem to care about how much seeing them like this upsets me. I don't feel like I can talk to anyone about this. It feels like there is no solution to this situation and I am going to have to just deal with it and carry on hoping things will get better."

Childline counselling session with a girl aged 12

If a parent has severe mental health problems, children may have to cope with frightening and upsetting situations such as:

• being separated from their parents, either because parents need to go into hospital and/or because the child is taken into care
• a parent attempting to take their own life
• a parent displaying extremely volatile behaviour.

If these things happen, it’s important to consider how this has affected the wellbeing of everyone in the family and what support can be put in place.

Stigma and barriers to seeking support

Sometimes families experience stigma related to mental health problems.

Parents, carers and their families may experience discrimination from others, and this may be displayed consciously or unconsciously. For example, children may experience bullying, it may be difficult for parents to get work or families may experience social isolation.

Parents and carers might find it hard to speak out and ask for support, if they:

• are worried that disclosing mental health concerns might make people think that they are incapable of looking after their child
• feel unable to talk about mental health because professionals don’t seem interested or don’t ask them about it
• feel that they should be enjoying pregnancy or being a parent or carer.

New parents and carers may also assume that what they’re feeling is normal when having a new baby. (NHS England, 2023; Centre for Mental Health, 2022).

Professionals have an important role to play in raising awareness about mental health problems, taking action to tackle discrimination, recognising if a parent or carer is struggling with their mental health and making sure families get the support they need.

Risk and vulnerability factors

All families experience challenges from time to time. This doesn’t necessarily mean children are at greater risk of abuse. But when problems mount up, it can be more difficult for parents to cope – particularly if they are isolated or lack support.

The risks to children are greater when parental mental health problems exist alongside domestic abuse and parental substance misuse (Cleaver, Unell and Aldgate, 2011).

Responding

Reporting

If you think a child is in immediate danger, contact the police on 999. If have concerns that a child may not be receiving the care they need but they are not in immediate danger, you should share your concerns.

• Follow your organisational child protection procedures. Organisations that work with children and families must have safeguarding policies and procedures in place.
• Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our child protection specialists will talk through your concerns with you and give you expert advice. 
• Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in. 
• Contact the police.

Services will risk assess the situation and take action to protect the child as appropriate either through statutory involvement or other support. This may include making a referral to the local authority.

> See our information about recognising and responding to abuse

If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.

> Find out about the Whistleblowing Advice Line on the NSPCC website

When you're not sure

The NSPCC Helpline can help when you're not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you’re seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children’s services and the police.

> Find out more about how the NSPCC Helpline can support you

Assessment

The impact of parental mental health problems varies according to the nature of each parent's condition, their child’s health and stage of development, and relationships with other family members.

Practitioners should assess whether a parent or carer’s mental health problems pose a risk to their child’s safety and wellbeing, and whether these risks can be mitigated with appropriate support. You should also consider whether there are any protective factors which will increase the family’s overall resilience, for example if the parent or carer is already receiving effective support from mental health services.

You should carry out a holistic assessment which takes into account:

• the child’s wellbeing and development
• the child's thoughts and feelings
• the impact of every day parenting on the parent or carer’s mental health
• the parent or carer’s ability to meet the child’s needs
• whether the child has taken on a caring role
• the parent or carer’s background, medical history and current circumstances
• the parent’s thoughts and feelings about caring for their child
• the views of colleagues from other agencies who are involved with the family, such as teachers
• whether the parent or carer has support from another parent or relative, or if they are coping with parenting alone.

You should also consider broader factors that might make it harder for the parent or carer to cope. These include:

• substance misuse
• domestic abuse
• financial hardship
• housing problems
• relationship problems
• social isolation.

Always take threats of suicide or threats to kill a partner or child seriously and take immediate action to keep children safe.

Protective factors

Factors which can help reduce the risk to children’s wellbeing include:

• parents and carers who acknowledge their difficulties and are willing to accept support from services
• friends or relatives who are able to care for children and help with household chores when needed
• families receiving support for other challenges, such as income support, benefits and housing advice
• families receiving additional support from other professionals who can also monitor the situation and share concerns if necessary, for example teachers
• children having a trusted adult they are able to ask for help when needed
• wider community support such as young carer’s projects (Cleaver, Unell and Aldgate, 2011).

Supporting children and families

Early help

It’s vital to identify parental mental health problems as soon as they emerge and provide families with appropriate support.

NSPCC services which provide early support include:

Pregnancy in Mind
Supports parents who are at risk of, or are experiencing mild to moderate anxiety and depression during pregnancy and the first year after birth.
> Find out more about Pregnancy in Mind 

Prioritising children’s needs

Anyone working with parents or carers who have mental health problems must maintain a focus on their children’s wellbeing.

Advocacy and mentoring

• Children should be given access to a mentor and/or advocate who they can talk to about their parent or carer’s mental health and who can help make their views heard.
  
  
• Children need someone they can contact for support if they need to, especially if there is an emergency.
  
  
• Be aware that children may be wary about being offered therapy or counselling. Depending on their parents’ experiences, they may have negative associations with this kind of support. They may also have fears about developing mental health problems themselves, and think that being referred to a counsellor is a sign of mental illness (Cooklin, 2013).

Peer support

Children whose parents have mental health problems should have the chance to interact with other children in similar situations. This allows them to both offer and receive support. Successful peer support networks can have a positive impact on children’s wellbeing and resilience by:

• increasing self-esteem
• improving understanding of parental mental health issues
• teaching communication and coping skills (Foster, 2016).

Many children and young people use Childline’s peer support message boards to express their feelings, talk about their experiences and share advice with others.

Empowering children

Children and young people should play a positive role in, and contribute to decisions about, their parent or carer’s care (Royal College of Psychiatrists, 2011).

Children want to be involved in interventions to support their parents, and they want their views to be taken seriously (Cooklin, 2013).

• Giving children and young people accurate, age appropriate information about mental health problems can address any misconceptions or fears they may have and can give them the language to express themselves (Grove, Reupert and Maybery, 2015).
• Allowing children and young people distance from their parent or carer’s emotions and behaviours can enable them to develop their own thinking and emotions (Cooklin, 2013).
• Explaining a parent or carer’s mental health difficulties can be a platform for wider discussions about relationships and emotions in general.

Educating children about parental mental health problems can have a number of benefits including:

• increasing the child’s resilience
• challenging the child’s misconceptions about mental health
• increasing the child’s understanding and empathy for their parent or carer
• improving communications between the parent or carer and child (Grove, Reupert and Maybery, 2015; Wolpert et al, 2015). 

Speaking out

It’s vital to build safe and trusting relationships with children so they can speak out about any problems they are experiencing. This involves teaching children what abuse is and how they can get help.

Our Speak out Stay safe service for schools helps children understand abuse in all its forms and know how to protect themselves.

> Find out more about Speak out Stay safe

Family support

Family members can be reluctant to discuss mental health with each other. Lack of communication can result in misunderstandings and may make children feel worried or alone.

Interventions which encourage families to communicate with each other can help everyone understand the impact of the mental health problems (Grove, Reupert and Maybery, 2015).

Families can benefit from meeting and sharing experiences with other families. This can:

• prevent relapses
• reduce feelings of isolation and stigma
• offer positive ways to interact with each other
• support more open discussion about mental health across the wider family (Wolpert et al, 2015).

Some interventions help family members to design and implement ‘staying well’ plans. This could include:

• sign-posting to other helpful services
• setting goals
• developing problem solving skills
• offering advice on managing stress
• recognising the early signs of a relapse

(Gatsou et al, 2017).

Monitoring progress

Practitioners must maintain a focus on the wellbeing of the child. They should monitor and review children’s progress throughout the period of intervention and respond appropriately.

Legislation, strategy and guidance

Key legislation

In England and Wales, the Mental Health Act 1983 sets out the assessment, treatment and rights of people who have a mental health issue.

The Mental Capacity Act 2005 sets out a framework for acting on behalf of adults who are unable to make decisions about their own wellbeing.

In Northern Ireland, the Mental Health (Northern Ireland) Order 1986 sets out the assessment, care, treatment and rights of people who have mental health issues.

In Scotland, the Mental Health (Care and Treatment) (Scotland) Act 2003 sets out the care, treatment and rights of people who have a ‘mental disorder’.

The Mental Health (Scotland) Act 2015 extends independent advocacy rights, services and accommodation to mothers who have mental health issues.

In Wales, the Mental Health (Wales) Measure 2010 provides for primary and secondary mental health services and independent advocacy across Wales.

Strategy

Public Health England (PHE) developed a Joint Strategic Needs Assessment (JSNA) toolkit to help health and wellbeing boards understand local needs and assess services (PHE, 2019a). Chapter six of the toolkit covers working age adults and asks health boards to consider how parental mental health might affect children (PHE, 2019ba).

In Northern Ireland, the Department of Health has published a mental health action plan (Department of Health, 2021).

In Scotland, the Government has published a Mental health strategy 2017-2027 (Scottish Government, 2017).

In Wales, the Government’s strategy for mental health and wellbeing outlines plans to improve family, parenting and/or caring relationships, which includes parental mental health (Welsh Government, 2012). The mental health delivery plan 2012-2022 sets out how the strategy will be delivered (Welsh Government, 2020).

Guidance

In Northern Ireland, the Department of Health has published guidance on the assessment and management of risk in mental health and learning disability services. It shares principles of best practice for mental health and learning disability care professionals on assessing and managing the risk of service users to themselves or others (Department of Health, 2012).

The Department of Health’s report on preventing harm to children from parents with mental health needs sets out actions for adult mental health services to help keep children safe (Department of Health, 2016).

In Wales, the Government has published guidance for practitioners on engaging with and providing support for parents to enhance their child’s development, care and wellbeing. It includes a section on providing support to parents with mental health needs (Welsh Government, 2019a).

The Welsh Government’s local mental health support services guidance sets out how local health boards can improve access to mental health care and support for individuals, including parents (Welsh Government, 2011).

The Welsh Government’s code of practice on the Mental Health Act 1983 sets out how professionals should treat mental health issues and provide information to patient’s families and carers. It includes best practice guidance on communicating and consulting with a child about their parent’s mental health (Welsh Government, 2016).

Perinatal mental health

There is specific guidance for professionals on supporting parents’ mental health during the perinatal period (during pregnancy and the first year after birth).

In England, chapter four of Public Health England (PHE)’s Joint Strategic Needs Assessment (JSNA) toolkit (PHE, 2019a) covers perinatal mental health (PHE, 2019c). It aims to help health and wellbeing boards understand local needs and assess services.

PHE published guidance for local maternity systems on supporting good parental mental health (PDF) (PHE, 2021a) and guidance for health visitors on supporting maternal and family mental health (PHE, 2021b).

The NHS has also published maternal postnatal consultation best practice guidance for general practitioners including advice on treatment of perinatal mental health (NHS England, 2023).

In Scotland, the Government has published a delivery plan for perinatal and infant mental health 2020-2021. It sets out 10 pledges that have been developed with women who have experienced perinatal mental illness (Scottish Government, 2020).

The Scottish Government has published an action plan for peer support in perinatal mental health services for 2020-2023 (Scottish Government, 2021).

The Scottish Government has also published a strategy to improve perinatal mental health services for women with perinatal mental health issues, their children, partners and families (Scottish Government, 2019).

In Wales, the Government’s maternity services strategy 2019-2024 includes an action to improve parental and infant wellbeing and mental health, and improve perinatal mental health care (Welsh Government, 2019b).

The Welsh Government has also published guidance on the Flying Start health programme. This includes information on assessing a parent’s social, emotional and physical wellbeing and supporting mental health during the perinatal period (Welsh Government, 2017).

References and resources 

Centre for Mental Health (2022) A sound investment: increasing access to treatment for women with common maternal mental health problems (PDF). London: Centre for Mental Health.

Cleaver, H., Unell, I. and Aldgate, J. (2011) Children's needs: parenting capacity: child abuse: parental mental illness, learning disability, substance misuse, and domestic violence (PDF). London: The Stationery Office (TSO).

Cooklin, A. (2013) Promoting children's resilience to parental mental illness: engaging the child's thinking. Advances in psychiatric treatment, 19: 229-240.

Department of Health (2021) Mental health action plan. [Accessed 18/06/2021].

Department of Health (2016) Rapid response report: preventing harm to children from parents with mental health needs. [Accessed 18/06/2021].

Department of Health (2012) Promoting quality care: good practice guidance on the assessment and management of risk in mental health and learning disability. [Accessed 18/06/2021].

Foster, K. et al. (2016) Outcomes of the ON FIRE peer support programme for children and adolescents in families with mental health problems. Child and family social work, 21: 295-306.

Gajos, J.M. and Beaver, K.M. (2017) Maternal depression and risk for antisocial behaviour in children. Child and family social work, 22(1): 349-363.

Gatsou, L. et al. (2017) The challenges presented by parental mental illness and the potential of a whole-family intervention to improve outcomes for families. Child and family social work, 22(1): 388-397.

Grove, C., Reupert, A. and Maybery, D. (2015) Gaining knowledge about parental mental illness: how does it empower children? Child and family social work, 20(4): 377-386.

Hogg, S. (2013) Prevention in mind: All Babies Count: spotlight on perinatal mental health. [London]: NSPCC.

NHS England (2023) GP six to eight week maternal postnatal consultation – what good looks like guidance. [Accessed 05/02/2024].

Public Health England (PHE) (2021a) Maternity high impact area: supporting good parental mental health (PDF). London: Public Health England.

Public Health England (PHE) (2021b) Early years high impact area 2: Supporting maternal and family mental health. [Accessed 18/06/2021].

Public Health England (PHE) (2019a) Mental health and wellbeing: JSNA toolkit. [Accessed 22/06/2021].

Public Health England (PHE) (2019b) 6. Working age adults. [Accessed 18/06/2021].

Public Health England (PHE) (2019c) 4. Perinatal mental health. [Accessed 18/06/2021].

Royal College of Psychiatrists (2011) Parents as patients: supporting the needs of patients who are parents and their children. [Accessed 15/06/2021].

Scottish Government (2021) Perinatal mental health - peer support: action plan – 2020 to 2023. [Accessed 18/06/2021].

Scottish Government (2020) Perinatal and infant mental health programme board 2020-2021: delivery plan. [Accessed 18/06/2021].

Scottish Government (2019) Perinatal mental health services: needs assessment and recommendations. [Accessed 18/06/2021].

Scottish Government (2017) Mental health strategy 2017-2027. [Accessed 18/06/2021].

Welsh Government (2020) Mental health delivery plan 2019 to 2022. [Accessed 18/06/2021].

Welsh Government (2019a) Parenting engagement and support: guidance for providers. [Accessed 18/06/2021].

Welsh Government (2019b) Maternity care in Wales: a five year vision for the future. (2019-2024). [Accessed 18/06/2021].

Welsh Government (2017) Flying Start: health programme guidance. [Accessed 18/06/2021].

Welsh Government (2016) Mental Health Act 1983: code of practice. [Accessed 18/06/2021].

Welsh Government (2012) Together for mental health: a strategy for mental health and wellbeing in Wales. [Accessed 18/06/2021].

Welsh Government (2011) National service model for local primary mental health support services. [Accessed 18/06/2021].

Wolpert, M.et al. (2015) An exploration of the experience of attending the Kidstime programme for children with parents with enduring mental health issues: parents’ and young people’s views. Clinical child psychology and psychiatry, 20(3): 406-418.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about supporting a family member with a mental health issue on the Childline website. You can also download or order Childline posters and wallet cards.

Related resources

Read our briefing on the learning from case reviews about parents with a mental health problem.

> See our research and resources on mental health

Further reading

For further reading about parental mental health, search the NSPCC Library catalogue using the keywords “mental health”; “mental health problems”; “parents with a mental health problem”.

> Find out more about the Library and Information Service