Parents may not always view their mental health as a problem or understand how their behaviour affects their child or poses a risk to safety. They can also be worried they will be labelled by mental illness or a diagnosis.
A parent can feel shame, stigma and fear about their mental health issues and this can be a powerful barrier to them accessing treatment and support.
They may be upset, angered or feel judged if conversations and case plans are centred on a diagnosis.
Focus on helping parents understand their mental health condition
To overcome this challenge, focus on how to help the parent notice and manage the symptoms of their illness. It helps to know about possible symptoms of common mental health issues in order to support parents through their experience. Part of casework might be in supporting parents to understand how their mental health issues are impacting on their life, parenting and child.
Advocacy group SANE Australia says the more a person understands symptoms, triggers and early warning signs of when they are becoming unwell, the more prepared they will be to manage them.
Think about the following:
- conversations with Child Safety may be the first time anyone has spoken to the parent about their mental health issues
- they may have never been treated for their mental health issues
- they may have never thought about how their issues impact upon their child
- hey may have asked for help before but did not find it helpful or faced discrimination and judgement
- they might be confused about their symptoms or find them hard to describe
- they might be afraid that if they talk to you about their mental health issues they will be seen as an unsafe parent.
Learn more about how mental health issues may affect a person’s parenting in part 2 Working with children who have a parent with a mental illness within this kit.
Start talking to parents about change
- What are you worried about?
- I’d like to share with you what I’m worried about ...
- Are our worries similar? In what ways? What’s different?
- What do you need?
- What do you need from Child Safety or from others?
- Tell me about your day-to-day life as a parent?
- What is a typical day when you’re feeling well? Who cooks? How do you get the kids to school?
- What’s a typical day when you’re not feeling great or beginning to get unwell?
- How do you manage?
- What gets in the way of you being the kind of parent you want to be?
The The Family Roadmap tool is very useful to help parents understand the worries and the barriers they face in parenting their child safely. This tool also helps to identify what life would look like at its best and provide hope and goals for the parent. Helping families to understand things they have done well and the strengths and resources they possess can be very motivating and again provide hope.
Note
This information has been adapted from SANE Australia who support Australians living with mental health issues.
For practical advice and resources to use with parents and families see these SANE articles: The first steps and The roads to wellness.
Think about what else is happening
Mental health issues may be a response to other experiences such as childhood abuse or family violence. Some people also experience mental health issues when there has been no significant trauma.
Take the time to explore a parent’s past, present and future. This exploration helps to learn more about how to best help the family. It will also help clarify which issues are not causing risk to the child.
For example, consider the following scenario:
‘Leo’s mum Jenny has had depression but she is taking medication and her mental health is stable. You are still worried about this because there has been a pattern of stability followed by instability over a significant period of time. You would like Jenny to agree to a mental health assessment as a way of viewing her mental health contextually as part of the case plan.’
Think about:
- Why are there ongoing concerns about Jenny’s mental health?
- What specific worries are there about Jenny’s depression? What does this mean for Leo?
- What really needs to change for Leo to be safe? Can the evidence be described for this? Can this be articulated clearly for Jenny?
- What does not need to change — what is already working?
- How can the intervention be tailored to support the progress Jenny is making with her mental health, rather than creating more stress for her and possibly increasing risk for Leo?
- What sits behind the concerns about Jenny’s mental health?
- Is the focus on problems that are more comfortable to work with?
- What biases, assumptions and values about depression or mental health influences the work?
- What support is most useful to Jenny and Leo?
- Can any other current mental health assessments help make decisions?
Assess a parent's readiness for change
A parent’s poor mental health may affect their understanding, readiness and motivation to change. This is particularly true if they are very unwell.
If there are any concerns about a parent’s ability or capacity to take part in case planning, get advice from the CSSC manager and a mental health professional. There may be times, particularly if court matters are in progress, that a case plan will need to be developed without the parent’s input. It will be important at these times that the safety and support network and any professionals involved in the parents care participate in case planning. It needs to be clearly documented why the parent was unable to participate and be included in any decision making affecting their child’s life.
The parent might be powerless to change some parts of their mental health. They may feel change is impossible. A good relationship with the family can help restore their confidence. Bring hope, motivation and optimism to conversations to help this.
Note
‘Resistance to change is not something inherent in the person with the problem, but in the relationship where the intervention is not tailored to their readiness.’
(Newbigin and Leggett, 2009, pp. 13.)
Practice prompt
Be careful not to misinterpret a parent’s angry or hostile response to Child Safety involvement as another symptom of their mental health. Step into the parent’s shoes and consider how these feelings can be common responses from parents who feel afraid, fearful, disempowered, ashamed or upset.
Stages of change
To assess a parent’s readiness, think about the different stages of change. The stages of change model describes readiness to change as a dynamic process. Parents might feel stuck with conflicting feelings: on one hand they want to change but on the other they are worried, scared or ambivalent.
Tip
Remember: We are not asking parents to make their mental illness go away. Sometimes mental illness can be a lifelong condition. We are asking them to make some changes to the way they parent and manage their children.
If goals are set that do not match where the parent is at, it is unlikely they will engage meaningfully in interventions or maintain lasting change. Start by identifying where the parent is sitting on the stages of change below.
| Stage of change | In practice |
|---|---|
|
Precontemplation (not ready) |
Parents may: Seem resistant, fearful or reluctant to change. Miss scheduled meetings with Child Safety or other professionals. Deny or minimise their behaviours and the risks to their children. Parents may say: I don’t see that I have a problem. Why do I need to change? Everyone has times that they feel flat and depressed. What to do: Focus on building the relationship and increasing the parent’s awareness of the problem rather than trying to persuade them to change. Ask them what is important to them. Be genuinely interested in the parent. Draw out their motives. Help the parent understand how their child experiences their behaviour and mental health issues. Use statements like: What do you think it may be like for your kids when you’re feeling really flat and can’t get out of bed? |
|
Contemplation (thinking about change) |
Parents may: Feel confused about change. They may say they want to change in one meeting and in the next say they are not ready. Attend some meetings but miss others, and make excuses or doubt their ability to change. Parents may say: I know when I’m feeling down I can’t get out of bed and the kids get worried about me but I’ve tried to get help before and it doesn’t work. I know it’s not good for the kids when I can’t get them to school but I suppose at least they can walk there on their own now. What to do: Be curious. Talk about the differences between their hopes for their kids and their current behaviour. Weigh up the pros and cons of change with the parent. Help them identify reasons for change and the risks if they cannot do this. Increase the parent’s confidence in their ability to change. Use statements like: Let’s draw up a table and list all the pros and cons of change so we can see where you are at. This will help to know more about how to help you. From what you’ve said there are things you’d like change and with support you may be able to do that. I hear on the one hand you want to be there for your kids and take them to school but on the other you’re saying that they can get there on their own and I hear some ambivalence about whether that’s okay for you as a parent. Let’s talk about that some more. |
|
Preparation (getting ready) |
Parents may: Make small steps towards change and starting to commit to change. Talk about making change and how to do this. Have more understanding of their behaviour and the impacts on their kids. Accept support. Parents may say: I know I’ve got to do something to help me feel better cause I do want to be a better mum, my kids are growing up so fast and I want be there for them. I’ve got to try to make some changes. What to do: Keep encouraging them. Have hope they can change. Be optimistic. Ask the parent what they feel will be most helpful to support change. Start to develop clear goals with the parent. Use statements like: It sounds like you’re keen to do something different. What do you think will help you to do that? How can I help? |
|
Action (ready, doing) |
Parents may: Develop new skills and are open to receiving help. Attend meetings and talk about how they’re going and the strategies they are learning. Children are telling you that things are changing. Parents may say: I’ve been feeling heaps better since I saw my GP and had a talk about why I was feeling flat. And I’ve been able to walk the kids to school for the past few days. What to do: Set clear goals with the parent to help them move forward, help them make contact with services and identify supports. Do not simply give a parent details for a service and ask them to call – support them through each step. Check how they are going. Talk about their strengths and what is going well. Keep being clear about what the shared goals are and have open conversations about next steps. |
|
Maintenance (sticking to it) |
Parents may: Actively work on sustaining changes that they have made for the child. They are using the skills that they have learnt. Look physically better, engage more with their kids and the community, continue to engage in the case plan. Talk about the positives of change, what is different than before. Be clear about how they are going to keep up with the changes and use the skills they have learnt. Parents may say: It’s like coming out of a fog — I can see now why my kids were worried when I couldn’t get out of bed. When I have days now that I feel like I might be getting flat I know what to do and I call a friend, support person, or go see my GP or take the kids to the park — it’s really working. What to do: Help the parent to develop and use strategies to prevent relapse. Talk to them about the possibility of setbacks and talk through strategies, actions or places they can go to for support if this happens or if things are not going well. Use statements like: It’s really common to hit a few hurdles along the way. Let’s plan for that and talk about a few things you feel know will be helpful to do if you start to get worried that things aren’t going as well. I understand this can happen and we know it’s better that we work together. |
|
Relapse (learning) |
Parents may: Deteriorate in their physical presentation. Avoid Child Safety and other professionals. Present with similar issues and behaviours as when work initially started. Not be focused on the child, who might talk about what is happening for them. What you might hear: I can’t meet with you today as I’m not feeling well and I can’t do it. It’s all getting too hard. What to do: Remember that relapse happens – many mental illnesses have a fluctuating course – they remit and relapse. Do not overreact or withdraw support – remind the parent that relapse is common but that they have more knowledge and supports this time. Talk through how this might affect the child. Encourage the parent to be open about any negative feelings they are having about their relapse. Help the parent renew the process of contemplation and action without becoming stuck or disheartened. Be non-judgemental and curious about what triggered their relapse. Help them identify and reaffirm their motivation for change. Talk about coping strategies and why they didn't work. Brainstorm new strategies and set new goals. Use statements like: I wonder what was happening for you when you felt you couldn’t get up to take the kids to school? Did you notice any different feelings in the time leading up to this? Does this time remind you of other difficult times you have had? |
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