AICAFMHA:
promoting mental health for young Australians
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022

Children of Parents Affected By a Mental Illness Scoping Project March 2001

Issues & Recommendations

Forward/Contents/Etc
Executive Summary  (includes brief recommendations)
Report in Full
Issues & Recommendations
Appendices 1-3
Appendices 4-5

7. ISSUES

The data-gathering and consultation processes indicated that a number of recurring themes were important and these included:

• It is not clear whose clients these children are.
• It is not clear how a multisystemic approach and a network of support can be provided.
• It is not clear how needs can be met effectively, that is, to provide intervention and support that is flexible and not time limited.
• Very few programs exist nationwide that are specifically designed to meet the needs of children with parents affected by mental illness.
• The states are at different developmental levels with regard to their awareness of the needs of children with parents affected by mental illness and program responses to these children. No states are adequately meeting the needs.
• The needs of children in cultural circumstances differing from the mainstream of Australian society — for example, those in Indigenous, migrant and rural or remote families — are not being met.
• Less than half of those programs that do exist are addressing the support needs identified as highly important by parents who have a mental illness.
• Programs must be reoriented from cure to prevention, so that they encompass a full range of interventions and strategies to effectively promote the mental health of children with parents affected by mental illness.
• It isn’t clear what obstacles must be dealt with in moving from an adult, individual-centred service delivery to a holistic service that recognises the children of adult clients and the wider roles, for example, that of being a parent, that the adult plays in their community, and their importance to all family members’ mental health.
• It also isn’t clear how prevention and promotion work can occur when funding is based on numbers of clients seen, not even on the number of times they receive a service. Adequate resourcing must be secured for promotion and prevention work.
• Funding is stretched to meet current demands. These children are low on the priority list, for example, potential suicides are often first. Reliable funding is needed because short-term funding does not allow sustainable projects to be developed, and more funding must be directed to promotion and prevention activities.
• The evidence base underpinning the work of these programs is sparse, and this information should be identified and circulated to agencies, along with information about current best practices.

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Background

Some recommendations can be made on the basis of information gathered so far by this scoping project. The following recommendations were developed with the assistance of the reference group for the project and further refined after consultation with the PWPP and the Commonwealth Department of Health and Aged Care. Recommendations are grouped under three headings: Mental health services, Intersectoral collaboration and Research and education.

Recommendations

Some recommendations can be made on the basis of information gathered so far by this scoping project. The following recommendations were developed with the assistance of the reference group for the project and further refined after consultation with the PPWP and the federal Department of Health and Aged Care. Recommendations are grouped under three headings: mental health services, intersectoral collaboration and research and education.

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Recommendation 1.1: An expert multidisciplinary group should be convened to develop and disseminate clinical practice guidelines for child and adult mental health services on appropriate responses to children with parents affected by mental illness and the parents themselves. The Commonwealth should then publish these standards and encourage their adoption by mental health services.

There is room for improvement among mental health agencies in identifying and responding to the needs of children and parents in families where a parent has a mental illness. An expert multidisciplinary reference group of key professional disciplines in mental health service delivery could be convened to develop these guidelines. An organisation that has a multidisciplinary focus across sectors, such as AICAFMHA, could be contracted to coordinate this consultation and disseminate the guidelines once they are developed.

Endorsement of these guidelines by the National Mental Health Working Group would facilitate their use as part of routine clinical practice for all mental health professionals. These clinical practice guidelines will develop the knowledge base of practitioners and incorporate good practice principles for working with this population, including:

• identifying these children, and all family members (this requirement should be considered in the context of the conclusions and recommendations in the document Toward a national approach to information sharing in mental health crisis situations [2000]);
• assessing, and determining the appropriate response to, and the needs of, these children, including offering or facilitating access to a broad range of support and intervention options in both the mental health and other service sectors, such as family support, peer-support programs, education and so on;
• determining parents’ needs and assisting parents in accessing resources to support them in their parenting role, such as peer support, and respite and in-home support;
• clearly identifying and allocating case-management responsibilities for families with a mentally ill parent, particularly where a number of agencies are involved;
• supporting generic agencies in providing service responses tailored to the special needs of these families (possible strategies are described under recommendations on intersectoral collaboration below); and
• ensuring that the rights and confidentiality of all family members are addressed and protected.

To ensure rapid uptake of protocols and clinical guidelines, an active dissemination and communication strategy must be implemented under the auspices of the PPWP. This should be a multilevel strategy and include booklets on the guidelines, dissemination via electronic media and presentations at conferences. Appropriate networks could be contracted to develop and implement these dissemination strategies, for example, AICAFMHA, the Mental Health Council, and THEMHS.

The scoping study indicates that there are currently few programs across Australia that directly address the needs of children with parents affected by mental illness, and indirectly support the children by assisting their parents in their parenting role. A focus on developing such programs would be complementary to the implementation of the guidelines and strategies developed under Recommendation 1.1, and meet a current need in the community.

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Recommendation 2: Intersectoral collaboration

The scoping study highlighted the fact that children with parents affected by mental illness have different needs and issues, and may never present to a mental health agency. They may instead come into contact with other agencies, where opportunities to respond appropriately to their needs — either within that agency or through referral to more specific services — may not be recognised, and the children continue to be ‘hidden’. The following recommendations address this issue.

Recommendation 2.1: Mental health services should take a leadership role in developing protocols, linkages and coordination across all sectors involved with children. This collaboration would aim to help other agencies identify and respond appropriately to children who would benefit from support as a result of a parent’s mental illness.

Children may present with issues related to their family circumstances to general health services, general practitioners, and welfare, family court and education sectors. Collaboration across these sectors by mental health services would be facilitated by the development of the guidelines suggested in Recommendation 1.1 and through the endorsement of the PPWP. Commitment to and implementation of this collaborative approach should be facilitated and required at all levels of management and service delivery (federal, state, organisational and individual) and be directed to all levels of intervention (child, parent and family, and organisational service and policy).

Both federal and state and territory mental health agencies are in a position to raise awareness and educate the agencies that are likely to come into contact with the children and their parents regarding identification and appropriate responses. Dissemination of information on their needs to mental health agencies, and agencies with which mental health agencies will be developing linkages, will assist in uncovering these ‘hidden’ children and families. Dissemination strategies could include presentations at conferences, state-based consultations and education activities, professional and continuing education courses, and web-based strategies. Appropriate networks could be contracted to develop and implement these dissemination strategies.

Recommendation 2.3: State and territory mental health agencies should investigate strategies for educating and supporting all agencies or organisations who are likely to come into contact with parents who have a mental illness and their children about the special needs of these clients.

These activities should involve establishing collaborative strategies to assist agencies to meet these families’ needs. Strategies could include presentations at conferences and meetings of peak bodies, and targeted mail-outs of information.

Recommendation 2.4: Barriers to appropriate and collaborative service delivery for children with parents affected by mental illness should be clearly identified, along with practical strategies for overcoming these.

A number of barriers to collaboration between mental health services and other sectors have already been identified by this report, and more may exist (O’Donovan, 1994; Cuff & Pietsch, 1997a; Einfeld & McLaughlin, 1998; McEnroe, 1998; Cowling, 1999; Farrell et al, 1999; and Kalucy & Thomas, 1998). Any development of guidelines or strategies arising from Recommendation 1.1 should address these barriers. Strategies for identifying the barriers and possible solutions could include a face-to-face consultation with key sectors at a state and federal level on this issue, or further indirect consultations utilising the scoping study methodology. In addition, professional development within mental health services could focus on skills needed to achieve successful interagency collaboration and solve problems.

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Recommendation 3.1: The nature of mental health practice should be examined by a multidisciplinary reference group of key mental health professionals with a view to reorienting it to support the clinical practice guidelines identified by Recommendation 1.1.

Current practice and funding models within most adult mental health services are characterised by an individualistic and ‘medical’ model. This approach does not help practitioners provide a holistic family-friendly approach that better supports the children, spouses, other family members and parents with mental illnesses themselves. A reorientation of the services could be considered as part of the National Mental Health Information Strategy. It should ensure that data collection identifies children of adult clients (including direct carers) of adult mental health services, and acknowledges service activities related to providing support to, and involving the children and their parents in, mental health promotion and prevention activities.

A number of Australian reports by federal and state funding bodies regarding support for children with parents affected by mental illness already exist and include recommendations that, given their recent nature, are likely to be relevant. These recommendations should be collated and examined to clarify why they have not been implemented.

Time constraints incumbent on mental health workers make it difficult for them to access and analyse current research evidence related to the needs of children with parents affected by mental illness and their families. If they do have time to carry out this work, it may represent a duplication of effort as few reviews appear to be published. An organisation such as the federal Department of Health and Aged Care could contract AICAFMHA to develop such a resource, and make it available nationally.

Most of the programs to support children with parents affected by mental illness indicated that they were engaged in evaluation activities, but that these activities are not research based and will not contribute to the evidence base for this area of practice. States and territories could consider strategies such as collaboration with universities or government health research units to maximise opportunities to further develop the sparse research evidence available on successful interventions for these children and their families.

Experience in Victoria has indicated that the strategy of promoting and sharing knowledge of ‘good practice’ programs has assisted in further development of programs and strategies for children with parents affected by mental illness in that state and around Australia. First, the information regarding programs and practices gathered by this scoping study should be disseminated. It is recommended that this type of information be shared across Australia through as many avenues as possible, for example, in conference presentations, and by placing information on the AICAFMHA website. A mechanism for continued peer review and updating of these programs on the AICAFMHA website would greatly facilitate networking and development of support.

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Last Modified: 11-12-2002 16:37:47