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Helping parents with mental illness

May 1, 2007
by JOANNE NICHOLSON, PHD
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Providers often do not take into account adult consumers' family roles

An estimated 68% of women and 55% of men with mental illnesses in the United States are parents.1 In fact, adults with mental illnesses are as likely to be parents as adults without mental illnesses.2 Like the vast majority of parents, adults with mental illnesses want to do the very best for their children. But some important parenting qualities—energy, foresight, planning, financial skills, patience, and support—can be more difficult for parents with mental illnesses to muster. Subsequently, small obstacles quickly can turn into big problems, and simple situations can spiral out of control.

The parent-child relationship is reciprocal: If parents do better, children do better. Yet despite parenting's key role in most adults' lives, few studies have examined mental illness from the perspective of parenting. In fact, my colleagues and I have found that many mental health providers don't even ask adults they work with if they have children.1

Most providers working with adults focus on them as individuals, without reference to their family roles. The skills and coping mechanisms they teach revolve around “individual” issues such as employment, housing, and education. These efforts are important, but they overlook family issues' critical role in the long-term mental health of adults and children. In contrast, providers treating children increasingly are using a wraparound treatment model that involves providing services to the entire family.

A Different Approach

To help parents with mental illness and their families, the Family Options intervention is being pilot tested at Employment Options, Inc., a psychiatric rehabilitation clubhouse agency in Marlborough, Massachusetts. Family Options is built upon theories, research, and practices from the adult and child mental health fields. The intervention reflects research about the experiences of families living with parents who have mental illnesses (e.g., generic and illness-specific parenting challenges, the pervasive impact of stigma, and the fear of custody loss). In addition, the intervention integrates and utilizes knowledge and practices from empirically supported models for adults with mental illness, family-centered models for children with mental health and other disabilities, and existing programs for parents with mental illnesses and their children.3

Launched in April 2006 with the support of AstraZeneca Pharmaceuticals, Family Options takes a family-centered, strengths-based approach to dealing with mental illnesses, parenting, and family relationships. Recognizing that parenting is one of the most important and fulfilling life roles, Family Options partners with parents in enhancing their family lives and building networks of supports and resources, to strengthen their families as a way of improving the long-term mental health status, functioning, and well-being of all family members.

Family Options' premise is that people dealing with mental illnesses can be successful parents if they have the right supports. The program provides personalized support to each family member. Family members, rather than providers, determine goals. Each family coach has primary responsibility for six to eight families and secondary responsibility for all other program participants.

Despite this personalized approach, common themes lend themselves to application in other settings. The program has a framework of psychiatric rehabilitation with a focus on skills building and recovery. Family coaches help parents build natural support systems that can fill in during crises, and access to primary supports is streamlined. We embrace a broad definition of what is therapeutic to help parents meet basic goals: creating a safe and pleasant environment for their children, planning nutritious meals, getting children to school or involved in positive activities such as sports, and so on. The program works with all family members—children as well as parents—to draw on each family's unique strengths. The result, we hope, is more successful treatment, and more successful families.

Specifically, the program offers:

  • Assessment. Family Options helps families set and evaluate goals.

  • Parenting education. Family Options helps parents identify and improve skills to provide emotional support to their children.

  • Specialized support. Family Options helps parents prepare for difficult periods of the day, such as getting ready for school and work in the morning, and transitioning back from school or work to home later in the day. It focuses on behavior management and the importance of developing regular, dependable routines.

  • Service coordination. Family Options ensures both parents and children receive the services they need and that these services, in turn, meet the family unit's needs.

  • Liaison with mental health, child welfare, primary care, and other support services. Family Options provides families with an advocate to help other service providers understand each family's unique strengths and challenges.

By coordinating care and mobilizing resources with these families, we create a stronger network for support when the inevitable stresses arise. Family Options makes accessing help easier and less confusing.

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