According to the Australian Institute of Family Studies (AIFS) 2010 report on the co-occurrence of complex issues, the key risk factors for child abuse and neglect are:
- mental health issues
- problematic alcohol and other drug use
- domestic and family violence.
These issues rarely exist in isolation. They are often deeply connected.
‘Individually, parental mental health problems, substance misuse and domestic violence represent significant risk factors for child abuse and neglect, but the reality is that parenting problems rarely occur in isolation. Instead, they tend to be part of a complex and inter-related group of problems.’
Mental health issues and problematic alcohol or other drug use
When a person experiences both mental health issues and alcohol or other drug use, this is referred to as co-occurring conditions (also commonly known as dual diagnosis or co-morbidity).
Co-occurring conditions can further affect a parent’s thoughts, feelings and behaviours. And may put children or young people at greater risk of abuse, neglect or death.
If a parent has a mental health issue and uses substances, think about the different reasons why parents may experience co-occurring conditions. Some reasons include:
- the parent may take alcohol or drugs to cope with the symptoms of their mental health issues — often called ‘self-medicating’
- alcohol or drugs use can trigger symptoms in people who are predisposed to mental health issues
- a person may develop mental health issues or use drugs or alcohol in response to experiences of violence or oppression.
For more practical advice, see NDARC resources on mental health issues and substance use.
Mental health issues and domestic and family violence
Women who experience domestic violence:
- can experience traumatic stress similar to that experienced by torture and trauma survivors
- show higher rates of mental health difficulties than non-victims including post-traumatic stress disorder (PTSD), substance use disorders, anxiety disorders, and depression (Johnson and Zlotnick, 2009.).
And women who experience domestic violence by their partners:
- are more likely to experience mental health issues over the course of their lifetime
- are more likely to develop depression, post-traumatic stress and anxiety disorders and other stress-related syndromes (Braaf and Barrett Meyering, 2013.).
See a mother’s mental health issues (and alcohol and drug use) in the context of her experience of domestic and family violence. Do not lose sight of how this affects the mother and child. Do not assume that the father, who is perpetrating the violence, is safe and supportive because he is easier to talk to and seems to be functioning well. Remember that a man’s use of violence and patterns of coercive control can impact on how his partner is seen in the community and by professionals.
When working with fathers who use violence and coercive control in their relationships, remember that there is no evidence in research that suggests that people living with mental illness are generally more violent than anyone else (SANE Australia, 2016). Violence is not a symptom of psychotic illnesses (SANE Australia, 2016). Be sure fathers are not able to avoid taking responsibility for their violence by blaming their own, or the mother’s, mental health issues. Work holistically with a father who uses violence.
Refer to the Practice Kit Domestic and Family Violence for more advice on working with families where there is domestic and family violence.
When a woman’s mental illness is used as family violence ‘technique’
‘Some perpetrators (most likely intimate partners) use the woman’s mental illness against her as part of perpetrating abuse, making it even harder for women to seek assistance. Techniques can include:
- telling her nobody will believe her because she has a mental illness or ‘because she is mad’
- telling other people that she is ‘crazy’ and makes things up
- threatening to tell others (for example, in her workplace) that she has a mental illness
- withholding medication or controlling when she takes it and how much she takes (e.g. under-dosing, and over-dosing)
- controlling appointments, always accompanying her, and dominating conversations (to prevent disclosure)
- threatening to have her ‘locked up’
- changing things in the house, denying having done so and telling her she it is part of her delusional thinking (also known as ‘gaslighting’)
- threatening to have the children taken away because she is a ‘bad mother’
- turning the children against her by inflating how ‘sick’ she is
- lying to professionals about how unwell she is (for example, making out that she is suicidal, has tried to harm herself or is not taking her medication) when this is not true, or where he has done these things to her.’
(Department of Health and Human Services, 2018, pp.33.)
Risk factors for self-harm and suicide
When a parent is coping with more than one issue at one time, it may be that a parent becomes at higher risk of self-harm or suicide. This will have significant impacts on a child.
As noted by SANE Australia (2018), factors associated with higher risk of suicide include:
- a sense of hopelessness and of being helpless
- social isolation
- recent loss — relationship, death, job
- a previous suicide attempt
- a friend, family member or work colleague who has died by suicide
- a mental illness
- risky behaviours – drugs, alcohol abuse, driving recklessly.
When parents become involved with Child Safety, multiple issues can hit them all at once leaving them overwhelmed and distressed. If their child is still in their care, they may be less able to keep them safe and see to the daily duties of being a parent. If the child has been removed, they may find it very hard to do what needs to be done to reunify with their child. Loss, grief, guilt and shame are common emotions experienced by people in such complex situations — some may cope by self-harming or think of suicide. The self-harm or suicide of a parent can have devastating impacts on a child. Among other risks, it can cause a child to become suicidal themselves.
Learn more about the warning signs of suicide in children and young people from headspace.
There is more information about self-harm and suicide in other parts of this kit:
For further information regarding mental health issues during pregnancy and after birth, also refer to part 3 of this kit Working with parents.
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