Parenting with mental health: An ESRC Better Lives Essay

Psychologist Abby Dunn is a doctoral researcher at the University of Sussex whose work has focused on parenting, and in particular parenting for those with complex needs. In this shortlisted essay from the ESRC Better Lives Writing Competition, in which PhD students who have received money from the ESRC write short essays about how their research leads too better lives, she examines how mental health practitioners interact with patients who are also parents.

My son rolled around on the floor kicking the door with all his might – considerable for a person less than a metre in height. At two years old he was hell-bent on ruling the family. As he exerted his will with fierce determination (to eat lollies for breakfast, to not wear shoes, to get on a train RIGHT NOW) I found myself becoming less and less measured in my responses. But I am lucky. I have a supportive partner and relatively robust mental health. What’s more, I have a good understanding of why a two-year-old might work himself up into a frenzy, and I have learned approaches to deal with it from friends, from books, from professionals. Being a parent can be wonderful, but it is also challenging. While children offer an opportunity to love, to nurture and to have fun, this can be accompanied by powerful feelings of worry, frustration and guilt. Alongside this emotional rollercoaster there may be relationship pressures and financial strains, not to mention sleeplessness. How parents navigate this is informed by their own personality, their experiences and the support they have. For parents with mental health difficulties these challenges can be even harder to manage.

“I knew I wasn’t like the other mums so I avoided them, I just ran straight home and shut the door.” (Mother, mental health services user)

Over half of mental health service users are parents. Many of these individuals will do a great job of responding to and caring for their children. For others, mental health difficulties can compromise their ability to provide responsive and nurturing care. For example, parents who struggle to manage their own anxieties may find themselves being overprotective and preventing their child from fully engaging with and exploring the world. The stigma around mental health and the fear of disclosing it can also make many parents isolated and frightened to ask for help. This places the children of parents with mental health difficulties at risk of poorer psychological and physical health, and they are more likely to develop their own mental health difficulties.

My research is focused on exploring how mental health practitioners are engaging with and supporting their patients in being parents, and what is getting in the way of them doing that. This is important because many parents with mental health difficulties live in a world where doors feel closed to them, and these services may be the only place they access support.

“I don’t want to open up a can of worms.” (Clinical psychologist)

Mental health practitioners strongly believe that adult mental health relates to child wellbeing, according to a questionnaire I sent out to mental health practitioners working at 14 mental health trusts across England. However, this is not reflected in practice. Although the majority of practitioners routinely ask if a patient has children, less than half ask the patient how they find parenting or about their relationship with the child.

Even fewer practitioners routinely ask whether the child has emotional or behavioural difficulties, or assess the child’s needs. Despite the relationship between the challenges of parenting and dealing with mental health difficulties, only half of practitioners routinely consider the patient’s role and responsibilities as a parent when planning their care.

If mental health practitioners acknowledge the importance of the relationship between adult mental health and child outcomes, what is stopping them from engaging with parenting? It is not simply a lack of motivation, as practitioners state they want to work more with patients as parents. Lack of organizational policy has been identified as a structural barrier, but practitioners also identify workload and time pressures as playing a central role.

For many, lack of knowledge and confidence in how to engage with parents prevents them from doing so. “Opening a can of worms” is how more than one practitioner described having a conversation about parenting. They were expressing their worry that talking about a patient’s family role may lead to the identification of a need for support which they do not have the skills or resources to provide. But perhaps we should see opening a can of worms as an opportunity.

My research may appear at first sight to have uncovered a failure to support parents, with little in the way of solutions. But just as we can only understand the support a parent needs by asking them, so we can only understand how to improve the support we offer to parents in mental health services by exploring what is – and isn’t – happening, and what needs to change. If the starting point to helping parents with mental health difficulties is having a conversation, then understanding and supporting clinicians to open that door is central to helping both parent and child experience better lives.

Shortlisted and winning essays in the series:

• Playtime in the camps | Bobby Beaumont, University of Birmingham
• This land is my land | Holly Chalcraft, Durham University
• Building a better life with dementia | Elyse Couch, King’s College London
• Working relationships | Rosa Daiger von Gleichen, University of Oxford
• Parenting with mental health | Abby Dunn, University of Sussex
• Reliving trauma, relieving pain | Alessandro Massazza, University College London
• The psychology of flooding | Niall McLoughlin, University of Bath
• Becoming a diagnosis | Lauren O’Connell, University of Essex
• The illusion of eternal independence | Chloë Place, University of Sussex
• Tilting at windmills in a climate-changed world | Celia Robbins, University of Exeter

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WINNING ESSAYS

• Notes on a G-string | Rosie Cowan, Queen’s University Belfast
• Better lives with better toilets | Ian Ross, London School of Hygiene and Tropical Medicine