An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery
The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.
Parenting responsibilities can be a source of strength and motivation for people in recovery (and alternately, an additional challenge). Because many mental health professionals are not familiar with the relationship between parenting and mental illness, we have devoted the entire issue of RECOVERe-works to this topic. We reached out to Toni Wolf and Joanne Nicholson, PhD, co-authors of Creating Options for Family Recovery: A Provider’s Guide for Promoting Parental Mental Health, for their thoughts. We also asked Pat Feinberg, a peer who has recently become a grandmother, to share her recent experiences.
Few mental health programs focus on parenting issues. Why do you think that is?
TW: Sadly, the majority of people who have serious mental illness do not have custody of their kids. But that doesn’t mean they aren’t still parents. We don’t even ask, “Do you have any kids?” Maybe we are afraid of stirring up unpleasant emotions that might be triggered by these questions. Or maybe it’s because of the stigma.
JN: Adult mental health services are set up for the person with a diagnosis. Eligibility criteria, reimbursement, and services have all been developed for individuals, not families, and not parents together with their children. A simple example of this is program space. Many inpatient psychiatric settings and housing programs won’t even allow children to visit because the space has not been set up for them.
What role can parenting play in a person’s recovery?
TW: One of the most common things I hear from parents is “I am in treatment because of my children.” Having parenting responsibilities is a major motivator for people, even those who do not have custody of their children, who might only see their kids once a month. They say having kids is why they get up in the morning and come to our program. We talk about “purpose” as a focal point for recovery – parenting can be that purpose.
I also think parenting is a bridge to help others connect with people with mental illness. Even if I don’t have a mental illness, if I am a parent, I can understand some of the challenges faced by these moms and dads.
What kinds of supports are helpful to parents with serious mental illness?
TW + JN: First, we need to help parents realize they are in fact parents, especially if they don’t have custody. People who have lost custody may need help starting to grieve.
Parents who do have custody may need all sorts of different supports. For example, they may need help preparing for a meeting with teachers at a child’s school - how to get to the meeting, what to say, or what services to request. Or maybe it’s assistance planning a birthday party, or figuring out what kind of gift is appropriate for a child the parent hasn’t seen in a while.
Parents with mental illness may be scared their illness is hereditary and their children will become sick too. These parents need education about normal child behavior and development. Parents may also need help thinking through emergency care planning – who takes care of the child if the parent needs to be hospitalized? What resources can be tapped and are there natural community supports that are willing to help out?
In helping parents, however, you need to go slowly, respect where they are. Parents know that if they disclose their mental illness, they face stigma, shame, and even a potential loss of custody. So you need to build trust, stay strengths-based, and help parents recognize all they are accomplishing.
If a program wants to begin paying more attention to parenting issues, where should it start?
JN: Agencies can begin by looking at their existing policies, procedures, and space. Is there a place for children to sit in the waiting area? Is there a place to diaper or even to nurse a baby? Do assessment forms ask about children, even those no longer in a parent’s custody? Are there questions about adult children? Are people encouraged to consider parenting goals? Are there groups focused on parenting issues? If there are peers on staff, are any of them parents? Are schedules modified when child care demands conflict with groups or appointments? There are probably small changes that can have a big impact.
TW: Absolutely the first step is to ask the question: “Are you a parent?” Then, “Talk to me about your kids – what are they like? Do you have pictures?” Anything that sends the message that it is okay to talk about your children, including the loss of your children.
There are also services and activities that programs can offer to let clients know they are parenting friendly, such as a peer support group for parents, or holiday parties that start off with activities for parents and children together.
How does the United States’ approach to parenting with serious mental illness compare to practices in other countries?
TW + JN: Here in the United States, we focus on the individual, safety and risk. As a result, in the face of serious mental illness, we often remove children from their parents’ care. In other countries, this is not the case. In fact, there are initiatives in many nations that help children and parents with mental illness stay together successfully. Some of these programs focus on parents, others on children, and others on the parent/child relationship.
Australia has a national initiative focused on kids whose parents have mental illness. Known as COPMI (Children of Parents with Mental Illness), the program provides information and support, and has spawned research, program collaboration, and other efforts. Their website has a wealth of resources for parents, children, other family members, and professionals. The “Young Carers” programs offer similar services in the United Kingdom, with more than 300 support groups for children and teens.
At a recent International Research Symposium, a presenter showed a video of a new mom in Holland hospitalized with postpartum depression. This mother was not separated from her baby. Instead, the baby stayed with the mother, sleeping in a bassinette next to the bed. A parent coach worked with the mom, helping her make regular eye contact with the baby, and teaching her to accurately interpret her baby’s cries, instead of feeling rejected. This allowed attachment between baby and mom to continue despite the hospitalization, and the mother was able to learn important new skills.
We have a long way to go – but the good news is we can learn a lot from what others are doing.
Toni Wolf is the Executive Director of Employment Options, an agency in Massachusetts with special programming for parents. Joanne Nicholson, PhD, is a professor of Psychiatry at Dartmouth Psychiatric Research Center. They are long-time collaborators and co-authors of Creating Options for Family Recovery: A Provider’s Guide for Promoting Parental Mental Health.
I developed mental illness when my kids were little, so I didn’t get to be the parent I wanted to be. That hurt a lot and I have regrets. But a few months ago, my daughter had a baby and now I am a grandmother as well as a mother. There was no way for me to anticipate how wonderful this would feel. I have started to bond with my grandson. And for the first time, my daughter has begun to call regularly for suggestions and support. I know more than I thought. It’s a real validation, and I realize how important I am to her. This year, she sent me the best Mother’s Day card ever. It feels really good.
The opinions expressed in RECOVERe-works do not necessarily reflect the views of the Coalition of Behavioral Health Agencies.
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