2. Parents, mental ill-health and safeguarding

Potential effects of Parents’ Mental Ill-health on children

Introduction

Mental health can be viewed within the mental health continuum model, which is a linear scale ranging from healthy, with normal mood fluctuations through to mental illness. When a person has a mental illness, this means they have a diagnosable clinical disorder that is severe, persistent, and has the potential to impair functioning. For the purposes of this toolkit, we will consider how living with a parent or primary carer who is living with a diagnosed mental illness can impact the child. Diagnosable illnesses can include conditions such as:

depression
anxiety disorders
schizophrenia
bipolar disorder
personality disorders.

For simplicity we will refer to this range of illnesses as: ‘parental mental health problems’ (NSPCC 2021)

The impact of parental mental health problems on children can be influenced by many factors:

The age and developmental stage of the child
The severity and duration of the illness
Family and community support networks
The child’s resilience levels

For some parents/carers, mental health problems are well-managed and will have a limited impact on children. However, for some individuals, mental health problems will impact their parenting capability. Furthermore, mental health problems can co- exist alongside other problems within families, for example, domestic abuse and/or substance misuse. Research indicates that when these problems co-exist, they work in a cumulative manner and can heighten the risk to children living in these families (Cleaver et al 2011).

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Peri-natal mental health of parents

Recent years have seen a significant increase in interest in the impact of the mother’s pre-natal mental health on their child. The two following articles suggest that pre-natal experiences of the foetus may be at least as important as those occurring after birth:

Satyanarayana VA, Lukose A, Srinivasan K. Maternal mental health in pregnancy and child behavior. Indian J Psychiatry. 2011 Oct;53(4):351-61. doi: 10.4103/0019-5545.91911. PMID: 22303046; PMCID: PMC3267349.

Kinsella MT, Monk C. Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol. 2009 Sep;52(3):425-40. doi: 10.1097/GRF.0b013e3181b52df1. PMID: 19661759; PMCID: PMC3710585.

Research indicates that there is a link between all forms of maternal mental ill-health and an increased risk of neo-natal death.  However, this is thought to reflect indirect causes such as lower attendance at ante-natal support rather than a direct association with mental illness itself. 

See Risk of stillbirth and neonatal death linked with maternal mental illness: a national cohort study, S King-Hele, R T Webb, P B Mortensen, L Appleby, A Pickles, K M Abel, Archives of Disease in Childhood – Fetal and Neonatal Edition 2009;94:F105-F110. 

Post-natal depression affects a significant cohort of mothers, but fathers are also more at risk:

Case-based learning: postnatal depression, Pharmaceutical Journal

Perinatal and Infant Mental Health: What it is and why it matters, IHV website 

Perinatal Mental Health 

Mental health problems in the perinatal period effect 1 in 5 women 

New fathers’ depression rates are double the national average for men in the same age group 

The child’s first months

122,000 babies under the age of one are living with a parent who has a mental illness. The mental health of parents in the perinatal period can have long-term effects on the infant, especially in relation to their later emotional and behavioural development 

Suicide is the leading cause of direct maternal deaths occurring within a year after the end of pregnancy in the UK. 

As more evidence emerges about the effects of perinatal mental illness (PMI) on the mother, father and developing foetus/infant, the term perinatal mental health (PMH) is now commonly used to describe the emotional wellbeing of women, their children, partner and families from conception through pregnancy to 1 year following the child’s birth.

Babies demonstrate proximity seeking behaviour from the moment they are born because they are at a very vulnerable stage of development and their survival, is wholly reliant on their parent/caregiver responding to their needs. When babies receive attuned caregiving that ensures they are fed, nurtured, and kept safe they form a secure attachment to their primary caregiver. If parents/caregivers experience mental health problems during pregnancy or within the first year of the child’s life it can negatively impact their ability to respond to the child and to build a secure relationship or attachment. If the child is unable to enjoy a secure relationship with their primary caregiver it can negatively influence the child’s cognitive, social, emotional, and psychological development (Gajos and Beaver, 2017; Hogg, 2013 in NSPCC 2021).

Dorset Parent Infant Partnership (DorPIP) is an organisation which provides support around infant and parent attachment within the first two years of a child’s life.

Through childhood

Children of any age, living with parents who have mental health problems may not always receive a consistently good-enough standard of care. Children may not benefit from daily routines and age-appropriate boundaries designed to keep them safe. They may miss meals, medical appointments, and school. They may not have clean clothing or live in a clean and tidy home environment. These children may present as unkempt and neglected. Children may not receive reciprocal, encouraging or consistent responses from their parent of caregiver (Kohl et al 2022 cited Cox et al undated).

Sometimes it will be necessary for a child’s primary caregiver to spend time in hospital due to mental illness. In these situations, children may experience separation, instability, and worry. It will be important for them to have access to an alternative carer who can reassure them and keep them safe.

Most often there will be opportunities to support children and their families by ensuring that they have a safety plan in place supported by wider family members or friends when the primary caregiver is unwell. Taking a whole family approach and maximising the use of informal support networks is less stigmatising for children and their families.

Sadly, for some children their parents mental health problems will have serious consequences for their development and in these situations it will be necessary for professionals to complete a child and family assessment to identify what support is required to ensure the child is safeguarded.

Signs that a child might need extra support include: