Coming to terms with the impact of mental illness on a family member can be difficult and often takes a long time to understand. All families have to deal with stressful situation at times, and it is easy for a parent of carer to overlook the needs of children and young people. This is particularly so in times of crisis. Sometimes can be so upset themselves that they may not realise how much more difficult can be for children who do not have the same level of understanding that we do.
Children can feel confused, upset, guilty, frustrated and angry, just as adults can, but they may not be able to talk about their feelings and may show feelings in other ways. Being alert to signs that children are not coping, and spending some time with them to address their concerns can help them, and you, feel a lot better about the situation.
If you are caring for a child, your own or someone else's, who has a close family member affected by mental illness, it is important to give them your love and support. Listening to children and doing something with them to help them cope with the changes in their life can help you, as well as them, to gain a better sense of control and understanding.
Finding time to talk to them during difficult times and letting children know that you care and will support them is very important.
The way children, young people and families experience the impact of mental illness on their family and their lives is very different, and for children, may be influenced by their age, developmental stage and by the information and support that has been available to them.
For some children and young people the experience will have been quite positive and may not have disrupted their life or prevented them from having their needs met. For others, the experience may have been very stressful, involving separation and/or exposure to traumatic or confusing situations. It is important to listen to children and young people and to try and understand what they have experienced and what the has meant for them and whether there is anything they need from you.
Children and young people know when something is not quite right. There may have been changes to their home life, to their daily routine, maybe someone has gone away for a while, or perhaps they may be staying with someone else. Perhaps they have witnessed some unpleasant scenes.
It is important to tell children and young people something about what is happening. If they are not told anything at all they will create their own version of what is happening and may imagine all sorts of wrong and frightening things.
Give children and young people enough information so that they can understand what the problem is, but don't give unnescessary detail. If you tell them nothing, they will probably imagine the worst. Tell the what they need to know – they may surprise you with how much they understand. Ask them to tell you what they understand and what else they want to know.
Older children are capable of understanding more and may appreciate some simple written information. Try to be as honest as possible, if you don't know something, then tell them you don't know.
Talk with other people involved to try and reach and agreement about what the children should be told. If you have permission and/or feel it is appropriate to talk about illness, let them know that their family members' behavior is part of an illness that can affect the way people, think, act and feel. Let them know that the illness is not about them, they didn't cause it, they cant fix it and that they are still loved.
The important thing is to realise that children and young people may express their feelings and fears in a range of ways – often they do not have the words or understanding to be able to express themselves in ways that adults expect or understand.
Children and young people may express themselves (acting out, acting younger, anxiety, attention seeking etc), physical signs, and thinking (poor memory, confusion, distracted and pre-occupied).
It is difficult to pinpoint any specific behavior that might be a sign that a child or young person is not coping as all children experience a range of these behaviours, physical signs and thoughts.
However, it is important to be alert to a sudden or gradual change in a child or young person that might indicate difficulties in coping.
The following are some signs of mental health problems in children, adolescents and young people. If you are concerned for their safety and well-being or symptoms appear to be lasting more than a few weeks, seek professional help.
Security is extremely important for babies and infants. Young children feel safest when they are with a person who is familiar and protective. They become anxious and distressed if closeness to a carer or parent is threatened, even for short periods.
It is important to provide them with consistent, nurturing care by a familiar and trustworthy adult. They will feel safest when they are with a person they know cares about them. If possible, don't spread young children's care around too much. They will feel more secure with fewer carers rather than more. Having too many carers can be confusing and disruptive.
Try to provide simple truthful explanations about what is happening; especially explain any separations from a parent and when they are likely to be reunited.
All children capable of talking should be given a simple and truthful explanation of what is happening. This can serve as a foundation for developing future understanding. Even very young children can be told that 'mummy is sick in her feelings' or 'your big brother is going to hospital to help him feel better'.
If possible establish regular visits during and separations. Regular visits and photographs will help maintain children's memories so that reunions are easier. It is valuable to structure contact through play or enjoyable food so that the child has positive contact with their relative.
'protest' behavior is a normal reaction to being separated from parents. Common signs of stress in young children are:
• Becoming clingy, tearful or uncooperative • Showing sudden changes in their eating and sleeping patterns • Tantrums or become frustrated without apparent reason • Initial rejection of contact with parent who they have been separated from
Such behaviours should be regarded as signs of distress not naughtiness or abnormality. Reassurance and the maintenance of routines are likely to help children settle. Children are very resilient and periods of separation from parents are not harmful, provided the child is adequately cared for.
As children become older (5-12 years) they need to understand and make sense of their world.
They need clear and accurate statements about what is happening and why. Explanations should be given in a sensitive but truthful manner, it helps them if they understand that some behaviours and feelings are symptoms of illness or stress.
Children can have their trust in relationships undermined if they feel misled. Withholding facts can also lead them to become worried and preoccupied trying to fill in the gaps. However, children should not be flooded with the feelings and worries of the adults. Simple explanations are best, such as 'your father has an illness called schizophrenia. It affects the way he thinks about things and sometimes he cannot tell what is real and what is a dream. He is going to hospital for a while so he can be give a medicine which helps'.
Some children prefer to be open with peers and some will prefer privacy. It is useful to review what to say to other people, and to have clear reasons why someone should or should not be told. Children often do not know what to say even if they would like to. Adults can help to find the right words for them to enlist support from friends.
It can be helpful to rehearse in advance some difficult or awkward situations a child may have to face so that they are less anxiety producing. Give the child some suggestions as to how to behave and what might be the best way to react. Rehearsal could cover events such as visiting a disturbed sibling who says strange things, what to do if you are teased and what to do if a parents starts to cry or becomes upset or angry.
Rehearsal helps to build children's resilience by helping them to discover and develop their own problem solving strategies. Children can be very creative in dealing with challenging life events.
Some children will attempt to respond to a crisis by becoming a caregiver themselves. They may need guidelines as to which are appropriate responsibilities and roles for them to assume.
Allow regular contact with the ill parent or sibling unless they are so disturbed they are frightening, intimidating or have delusional beliefs about the child. If these kinds of disturbances exist, discuss with staff how to minimize confusion and anxiety brought about by contact.
If hospitilisation occurs, visits should be regular enough to bother reassure the child that the patient is O.K. and to the maintain the relationship. They should not be so frequent that they disrupt the child's ongoing life.
Remember that even in crisis situations children still need to carry on playing, spending time with friends and asking questions to help them learn about their world.
Continue familiar routines and relationships with peers and other significant adults as far as possible.
Explain any intense feelings or unusual behavior of the ill family member. It is common for children to experience anger, resentment, and sometimes shame in relation to the ill person, while at the same time wanting to care for them and protect them.
Show the child appropriate ways to express how they feel. Upset children should be comforted. Angry or frustrated children may need to be encouraged to kick a ball, run, or go for a swim. Play is a very important distraction at times of stress for children.
Children sense the stigma that can be attached to mental illness. They may fear being teased or ridiculed. They may also become worried about themselves. Offer the child explanations so that they understand that the illness is not because the person is bad, naughty, dirty, sinful or being punished.
Identify people who are willing to her 'news' about important family members. This helps the child process new information and gain perspective on events. For example, a child whose mother has expressed a lot of angry feelings could be asked, 'when mum gets angry what do you think is the best way to act?'.
Adolescence is a time of preparation for adult life. Teenagers are practicing skills developing their own identity and are in the process of separating from the family. Friends, instead of family, become the dominant role model for behaviour and expectations.
Adolescents need support and encouragement in gradually separating from their family to assume adult roles. Severe illness in the family can disrupt this process and become a source of conflicting feelings. It helps adolescents if reassurance is given that adequate care is being taken of the ill person. Adolescents can then continue the delicate work of becoming more independent from intense family ties.
Adolescents need concise and factual information about the illness and recovery process. They will also be alert to any implication of a severe illness in the family for their own development. This includes worrying about the possibility that they could develop or show signs of an illness themselves.
Ensure a trustworthy adult is available with whom the adolescent can discuss important practical and emotional decisions, such as relationship issues and school or career choices. Adolescents may respond positively to a brief but meaningful exchange when they are feeling relaxed and rapport is good rather than being sat down for a lengthy 'talking to' or 'lecture'.
Adolescence is also a time when young people experiment with different styles of behaviour as they look for ways to express themselves. Under stress this experimentation may be more extreme. It is common for adolescents to experience doubt and uncertainties. A member of the family becoming ill may heighten these doubts.
Adolescents may react to stressful situations in many different ways. They may become out of control, withdrawn, moody, confrontational or develop 'hang-ups' or start to use drugs and alcohol at risky levels.
Adolescents are keen observers, give them opportunities to express their observations of the ill family member and the impact of the illness on the family. Try to ensure that there are people both within and outside the family that they can talk to about their observations and the impact the illness is having on them personally.
The case worker, psychiatrist or other staff members can help work through any family issues that arise out of the illness of a family member. During periods of emotional turmoil, individuals can behave very differently from how they or other normally expect this can lead to breakdowns in trust can communication amongst family members. It can be helpful to discuss such issues as a family, as well as personally.