Acting early to break the cycle of family mental illness

Both the 2021 Victorian Royal Commission into Victoria’s Mental Health System and the 2020 federal Productivity Commission Inquiry Report highlight the impact of a parent’s mental illness on their children, and the need to break the cycle of mental illness in families.

Monash University’s leadership role in addressing the issue over the past 10 years resulted in the establishment of a research group comprising more than 50 researchers from 12 countries, the Prato International Research Collaborative for Change in Parent and Child Mental Health.

Their work was recently highlighted in the Journal of Child Psychology and Psychiatry, outlining the key principles and recommendations for working with families living with parental mental illness.

Group member Professor Torleif Ruud, from Norway, has previously published research that shows 36% of clients attending adult services have children under 18. These prevalence rates are consistent across many Western countries.

“Mental health services are typically reactive, where their focus is either on managing crises or treating an individual’s mental health challenges,” says Monash Faculty of Education’s Professor Andrea Reupert, the report’s lead author. “While both are obviously important, if this is their only focus, critical opportunities for prevention and early intervention are missed.”

Services missing an opportunity

Monash Rural Health’s Professor Darryl Maybery, a co-author, says mental health services that treat the parent miss a critical opportunity to stop the cycle of mental illness in the community.

“In later life, children whose parents have a mental illness are up to three times more likely to develop their own illness, but nothing is done until they present with their own social or mental health problems.”

Read more: With youth anxiety and depression at record levels, mental health hubs could be the answer

The group’s research has resulted in recommendations for practice, organisational, and systems change.

They found that while genetics play an important role in the transmission of mental illness from parents to children, environmental and socioeconomic factors – including parenting competence, the level of parents’ illness disability, and other family and social supports and stressors – will also influence whether, and how, a parent’s illness impacts their children.

A “family” lens can be provided by incorporating parenting into mental illness treatment plans, and identifying parenting status for those entering mental health services.

Mental health and wellbeing facilities need to be family-friendly, and time, training and resources should be provided to clinicians when working with families. All services – across health, education and welfare – play a part in addressing the needs of these families.

Family members need to be engaged

Other core recommendations include that family members, especially children, are engaged in ongoing conversations and decision-making opportunities when the parent is being treated for an illness; their own needs should be identified and addressed.

There’s an ongoing need to develop legislation, collaborative models of practice, training in family models of care, and the need to benchmark and audit services to ensure children and parents are provided with appropriate care, the researchers say.

“Current practice relies on models that only see individuals, particularly in mental health services,” says Professor Maybery. “This must change. Along with treating a parent’s mental health, professionals must be proactive and provide targeted prevention and early intervention initiatives to children and parents living with parental mental illness.”