Parental mental health problems

Introduction

The term ‘parental mental health problems’ means that a parent or carer has a diagnosable mental health condition. This can include:

  • depression
  • anxiety disorders
  • schizophrenia
  • bipolar disorder
  • personality disorders.

Living in a household where parents or carers have mental health problems does not mean that a child will experience abuse or even be affected negatively in any way.

The vast majority of parents with a mental health problem are able to give their children safe and loving care.

Sometimes parental mental health problems occur alongside other stressful life experiences, such as:

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

These issues may be a consequence of their illness, or may cause or make their condition worse. Together, these problems can make it very hard for parents to provide their children with the care that they need.

All types of mental health problem can vary in severity and will impact differently on people’s day to day lives.

This is dependent on the individual, their circumstances and the support they receive.

Impact

Impact of parental mental health problems

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

If a parent is experiencing mental health problems along with other challenges, it can be very hard for them to provide their children with safe and loving care (Cleaver, Unell and Aldgate, 2011; Gatsou et al, 2017; Grove, Reupert and Maybery, 2015; Hogg, 2013; Wolpert et al, 2015).

Parents and carers with mental health problems may:

  • have difficulty controlling their emotions, for example showing intense anger around their children
  • have rapid or extreme mood swings which may frighten or confuse their children
  • be withdrawn, apathetic and emotionally unavailable
  • have trouble recognising children’s needs and responding to cues
  • struggle to set and maintain safe and appropriate boundaries
  • view their children as a source of comfort and solace, which can make children feel very responsible for their parent’s wellbeing
  • believe a child is to blame for their problems
  • struggle with keeping to routines such as mealtimes, bedtimes and taking their children to school
  • struggle to meet their own and their children’s physical needs, including hygiene
  • not be able to seek medical care for their children or take them to routine check ups (including dental care)
  • struggle to keep their homes clean, buy food and clothes and pay essential household bills.

If parents are not given the appropriate support, these can all lead to abuse and neglect.

Effects on children

Parents’ and carers’ mental health problems may affect children differently according to their age, development and personality.

But they can have an impact on children’s health and wellbeing. Children may:

  • take on a caring role for parents and other family members, including, providing emotional and social support, carrying out basic household chores and nursing or bathing their parents and siblings
  • put the needs of their family first and deny their own needs and feelings
  • feel constantly worried about their parent or carer’s health and wellbeing
  • have to cope with frightening situations such as a parent attempting to take their own life or displaying extremely volatile behaviour
  • experience social stigma attached to their parent’s condition which limits their friendships and social support network. Sometimes this may lead them to feel embarrassed or ashamed, and/or experience bullying and social isolation.

In some cases, children may also have to be separated from their parents. This may be because parents need to go into hospital and/or because the child is taken into care.

Babies and younger children

Young children rely on their parents and carers to give them the warm, nurturing care they need for healthy development.

Children are particularly vulnerable if their mother’s mental health problems begin in pregnancy or the first year of life, especially if they are long-lasting or severe.

Babies and young children whose parents have mental health problems are at increased risk of:

  • being born prematurely/with a low birth weight
  • developing behaviour problems such as physical aggression by the time they reach school age
  • developing mental health difficulties at an early age.

They may also:

  • have problems sleeping and be irritable
  • have insecure attachment (if post natal depression prevents the parent from bonding with their baby)
  • have delayed intellectual, emotional, social and psychological development (Gajos and Beaver, 2017; Hogg, 2013).

Child mental health

Children whose parents have mental health problems can experience anxiety and frustration. Research shows children experience a number of fears and challenges, including:

  • fear of developing their parent’s condition themselves
  • losing the closeness they may have enjoyed with their parent before their mental health problems began
  • the expectation to act as a 'grown up' and carer at home but being treated like a child at school
  • facing contradictory expectations from their parents or carers
  • fear of being blamed for either making their parent or carer ill or for failing to protect them
  • worrying that the family would be the object of shame or stigma
  • fear of being bullied or singled out by other children and adults
  • worrying that their parent or carer might never recover or that their condition might get worse
  • worrying that the family will be split up and/or that they will be taken into care (Cooklin, 2010).

Our Childline service provides support to children whose parents or carers have mental health problems. One girl told us:

"My mum has depression and sometimes she overreacts and gets angry at little things…she makes me feel bad about myself but I don’t want to tell anybody, I feel like I’m being selfish by thinking of myself because she has her own problems"

Girl, 15 (NSPCC, 2018)

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

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 trained professionals 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

Assessment

The impact of parental mental health problems varies according to each child’s health, stage of development and relationship with family members.

Practitioners should assess whether a parent or carer’s mental health problems pose a risk to the child’s safety and wellbeing, and whether these risks can be mitigated with appropriate support.

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

  • the child’s wellbeing and development
  • 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
  • the parent or carer’s background, medical history and current circumstances
  • whether the parent or carer has support from another parent or relative, or if they are coping with parenting alone.

They should also take into account broader family and environmental factors such as past or current experience of:

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

These difficulties may increase vulnerability and have an impact on a child’s wellbeing.

Thorough assessment should:

  • focus on the child and their needs
  • give children the opportunity to discuss their experience
  • listen to and record the child’s views on the situation
  • identify any children who have adopted a carer’s role
  • treat children, parents and carers as individuals
  • consider the severity of a parent or carer’s symptoms
  • take threats of suicide or threats to kill a partner or child seriously
  • find out whether the parent or carer is accepting support from metal health services and assess whether this is having an impact on the child’s wellbeing
  • seek the views of colleagues from other agencies who are involved with the family, such as teachers
  • assess factors increasing the children’s risk of harm against protective factors which will increase the family’s resilience (Cleaver, Unell and Aldgate, 2011; Gajos and Beaver, 2017; Health Education England and Rance, 2016; Hogg, 2013; NSPCC, 2015; Research in Practice et al, 2016; Webb et al, 2014).

Protective factors

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

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

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 so their children’s wellbeing does not suffer.

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 

Baby Steps
Helps parents learn how to care for their new baby. We’re now supporting other organisations to deliver Baby Steps in local areas.
> Find out more about Baby Steps 

Minding the Baby
Helps first-time mothers develop a positive relationship with their baby.
> Find out more about Minding the Baby

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.

  • 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

It’s important that children whose parents have mental health problems have the chance to interact with others in similar situations. This allows them to both offer and receive support to/from others. 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).

They want to be involved in interventions 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.

References and resources

References and resources 

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. (2010) Living upside down: being a young carer of a parent with mental illness. Advances in psychiatric treatment, 16: 141–6.

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

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.

Health Education England and Rance, S. (2016) Specialist health visitors in perinatal and infant mental health: what they do and why they matter (PDF). London: Health Education England.

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

NSPCC (2015) Parents with a mental health problem: learning from case reviews. London: NSPCC.

NSPCC (2018) Children living in families facing adversity: NSPCC helplines report. London: NSPCC.

Research in Practice et al. (2016) Triennial analysis of serious case reviews (2011-2014): practice briefing for health practitioners. Totnes: Research in Practice.

Royal College of Psychiatrists (2011) Parents as patients: supporting the needs of patients who are parents and their children. [London]: Royal College of Psychiatrists.

Webb, M.A., et al. (2014) Living with adversity: a qualitative study of families with multiple and complex needs. London: NSPCC.

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”.

If you need more specific information, please contact our Information Service.